Weight-Loss Surgery Frequently Asked Questions (FAQ)

The following list of frequently asked questions and answers are designed to assist you if you are considering weight-loss surgery.

1. What is Weight-Loss Surgery?

Weight-loss surgery alters the body's digestive process by limiting the amount of food the stomach can hold and/or by limiting the absorption of nutrients. The most common procedures are restrictive, malabsorptive or a combination of both procedures. Restrictive procedures reduce the amount of food the stomach can hold, but don't interfere with the body's normal digestion of food and nutrients. Malabsorptive procedures bypass most of the small intestine so that fewer calories and nutrients are absorbed. Combined procedures restrict food intake as well as the amount of calories and nutrients the body absorbs.

2. How do I Know if I Am a Candidate for Weight-Loss Surgery?

Candidates are at least 100 pounds overweight. That translates to a body mass index of 40 or over. You should have previously attempted to lose weight through traditional methods, including dieting, nutritional counseling and commercial or hospital-based weight-loss programs. Candidates may have a body mass index of 35 and over if they have medical problems that are associated with obesity, such as hypertension and diabetes.

People with an inflammatory disease, severe heart or lung disease, esophageal, stomach or intestinal problems, cirrhosis or who are pregnant are not candidates.

3. What Are My Options for Weight-Loss Surgery?

The two most common operations are adjustable gastric banding and gastric bypass. With both procedures, the size of the area in stomach where food collects is reduced.

The adjustable gastric band (also known as the LAP-BAND SystemĀ® in the U.S.) is less invasive than gastric bypass and is often done laparoscopically. By placing an adjustable band around the stomach the surgeon creates an upper pouch. As the name suggests, the band can be adjusted in follow-up, outpatient procedures to ensure that the pouch is the right size to control weight loss.

During Roux-en-Y gastric bypass, a surgeon creates a small pouch at the top of the stomach using staples. The small intestine is then rearranged and connected directly to the pouch, creating a bypass of the small intestine.

The band is adjustable; the bypass is not adjustable. The band is reversible; the gastric bypass is irreversible.

4. How Much Weight can I Expect to Lose?

That depends on the procedure and the individual. With the adjustable gastric banding procedure, weight loss progresses steadily over a 2- to 3-year period and then stabilizes. The final result is usually between 50 percent and 60 percent of the excess weight. After four years, studies show the level of weight loss is equal to that achieved by gastric bypass surgery.

After gastric bypass surgery, weight loss usually exceeds 100 pounds or up to 70 percent of the excess body weight, but it generally levels off in one to two years. A regain of up to 10 percent of your excess body weight is common. With adjustable gastric banding, weight gain is minimal.

Ultimately, one's goal weight should be determined by the individual with his surgeon and should be the recommended weight based on the patient's height.

5. What Are the Risks or Complications Associated with Surgery?

The most common complication associated with adjustable gastric banding is the enlargement of the stomach pouch, which can occur if the stomach slips up through the band. However, modifications to the technique have been made to prevent this from occurring. There have also been cases where the band erodes into the stomach.

Research has found that patients who undergo a gastric bypass have longer operative times, more blood loss and longer hospital stays when compared to patients who have adjustable gastric banding.4 Up to 5 percent of patients undergoing gastric bypass may experience leaking, bleeding, wound infection or blockage in an artery in the lungs. In addition, because a portion of the digestive tract is bypassed, the absorption of essential nutrients is reduced and medical complications can result.

6. How Do I Know Which Surgery Is Right for Me?

A patient's medical history and weight are used to determine which surgery is the best option. It is also important to talk with your surgeon to decide which option is right for you.

7. How Much Do the Procedures Cost? Will Insurance Cover It?

Weight-loss procedures cost from 20,000 to 35,000 dollars. Medical insurance coverage varies by state and insurance provider.

In February 2006, Medicare expanded its coverage to include, laparoscopic adjustable gastric banding and open and laparoscopic Roux-en-Y gastric bypass. However, these surgeries are covered by Medicare only if performed in a hospital or by a practice that is judged by the Surgical Review Corporation to be a Center of Excellence, so be sure to verify that your surgeon is affiliated with one of these centers.

8. Will Weight-Loss Surgery Improve My Health?

Weight-loss surgery can eliminate or improve most obesity-related medical complications, including diabetes, hypertension, high cholesterol, sleep apnea, reflux and osteoarthritis, as well as stress incontinence, dermatitis, muscle and joint pain. Improvements in body image and a reduction in the symptoms of depression have also been reported. Weight loss may also be associated with improved fertility and more favorable pregnancy outcomes.

9. What Should I Ask about My Physician's Qualifications?

Find out how many years of experience they have in the field, the number of operations they have performed and how many times they have performed a specific procedure. The surgeon you choose should be experienced with the procedure you are considering. You should also determine if they are board-certified, and if they are members of the American Society for Bariatric Surgery.

Discuss their commitment to follow-up, because weight-loss surgery often involves lifetime follow-up. The doctor should be working with all of the aspects of management and assessment in a clinical, multidisciplinary setting. The affiliate hospital and their office facilities should be able to accommodate large patients and be able to support all of the components of their programs.

10. What is Involved in Preparing for the Surgery?

First, a rigorous medical and psychological screening process, performed by a team of doctors, will determine if you are a candidate. This process helps to identify the aspects of your health that will improve following surgery, as well as the aspects that may increase the risks associated with surgery.

You will also want to come to a complete understanding of the significant, lifelong, lifestyle changes you must commit to, including diet, exercise, limiting alcoholic intake and smoking cessation, if necessary.

11. How Long Will It Take for Me to Recover?

That depends on the procedure. Patients who undergo laparoscopic adjustable gastric banding tend to stay in the hospital for a little more than one day, while the average hospital stays for patients who undergo a laparoscopic gastric bypass is closer to three days. Hospital stays for patients who undergo open gastric bypass surgery can exceed three days.

Recovery times differ too. In one study, patients returned to normal activity in about one week after laparoscopic adjustable gastric banding and over 18 days after laparoscopic gastric bypass.

12. How Will My Diet Change?

Immediately following adjustable gastric banding, only sips of water are allowed. Over the next two weeks, the consumption amount is increased gradually with fluids in the form of water and liquids, such as clear broth, skim milk, low-calorie juice and sugar-free ice pops. You will need to watch how many calories you eat and limit your liquid intake to avoid nausea and vomiting. Low-fat pureed foods, protein-rich chicken and fish, mashed potatoes and peas are started three to four weeks after the operation.

Patients who undergo gastric bypass follow a similar dietary progression for 12 weeks and then they are allowed regular, healthy foods.

Once healed, care must be taken to let your stomach adapt to its new environment. Vitamin supplementation may be necessary, especially in patients who have undergone gastric bypass.

13. How Will My Life Change after Surgery?

Lifetime follow-up is recommended, with at least three follow-up visits during the first year. Adjustable gastric banding requires more frequent visits for band adjustments.

You will need to adopt a healthy lifestyle, including a new nutrition plan and regular exercise, although exercise restrictions may be in place until you are healed.

Because of the decrease in food intake, constipation may occur. A laxative may be recommended.

You may want to consider or may require reconstructive operations after your weight stabilizes.

Medications can be prescribed as needed. However, your doctor may tell you to avoid aspirin and nonsteroidal anti-inflammatory drugs, which can irritate the stomach.

Sources

1. Gastrointestinal surgery for severe obesity. NIDDK Weight-control Information Network. National Institutes of Health. Available at: http://win.niddk.nih.gov/publications/gastric.htm. Accessed July 10, 2006.

2. Buchwald H, for the Consensus Conference Panel. Bariatric surgery for morbid obesity: health implications for patients, health professionals, and third-party payers. J Am Coll Surg. 2005;4:593-604.

3. Gastrointestinal surgery for severe obesity, NIDDK Weight-control Information network. National Institutes of Health, Available at http://win.niddk.nih.gov/publications/gastric.htm. Accessed July 13, 2006

4. Jan JC, Hong D, Patterson E. Laparoscopic adjustable gastric banding versus laparoscopic gastric bypass for morbid obesity: a single-institution comparison study of early results. In: Programs and abstracts of the 45th Annual Meeting of the Society for Surgery of the Alimentary Tract; May 15-19, 2004; New Orleans, Louisiana. Abstract 282.

5. Ponce J, Dixon JB. Laparoscopic adjustable gastric banding. 2004 ASBS Consensus Conference. Surg Obes Related Dis. 2005;1:310-316.

6. Fisher BL. Comparison of recovery time after open and laparoscopic gastric bypass and laparoscopic adjustable banding. Obes Surg. 2004;1:67-72.