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Frequently Asked Questions (FAQ's)
Common Bariatric Surgery Questions
How heavy must I be to be considered for surgery?
In most cases, patients who are accepted for surgery fall within the National Institute of Health guidelines, using a formula that takes into account both a patient’s height and weight. This is called the Body Mass Index (BMI). Patients with a Body Mass Index of more than 35 are considered surgical candidates if they have health problems aggravated by their weight. Patients with BMIs over 40 are considered surgical candidates even if they have no weight-aggravated health problems. (We have limited our care to those patients under 400 pounds because patients over this weight present significant risks and have special needs. We would be happy to refer you to a center able to meet your needs.
How does the Gastric Bypass help a patient lose weight?
The weight loss effect of gastric bypass comes from a combination of (1) much smaller stomach capacity, resulting in feeling full much sooner (2) less hunger sensation for most patients, and (3) slightly quicker passage of food through the small bowel, resulting in less time for absorption.
How does the Gastric Band help a patient lose weight?
Once a band is properly adjusted, a patient will generally have a sense of fullness after only a small amount of food. This sense of fullness helps you stick to a good, low-calorie nutrition program.
How much weight will be lost?
The exact amount of weight which a patient will lose after any type of weight control surgery cannot be exactly predicted. As with any weight control plan, final outcome depends on many factors, such as activity, food choices, motivation, and age. However, the experience with our form of Gastric Bypass in the past several years is that most patients lose well over half of their excess fat in the first 12 to18 months after surgery. Most patients with a gastric band will lose that weight in approximately 2 to 2.5 years. In our experience, highly motivated patients who participate in a good exercise and nutrition program after surgical recovery can often lose 75 percent or more of their extra fat. While there is the potential for minor weight gains, major weight regain is unlikely, provided that the patient does his or her part to follow good eating patterns and remain active.
Other than eating less, what foods will I have to give up?
We have found that all patients are different in food tolerance after surgery, so no exact statements can be made. In general, however, patients should avoid foods high in fat or sweets. High quality protein should be eaten first, and water or thin liquids should be avoided about 30 minutes prior to meals so that the pouch has room to hold the needed nutrition. High calorie thick liquids, such as smoothies or shakes, can get past the new pouch and potentially defeat the surgery. In addition, patients who have Gastric Bypass may develop “dumping syndrome,” which is a sensation of indigestion soon after eating this sort of food, often accompanied by cramping, lightheadedness, heart palpitations, and, sometimes, diarrhea. Whole milk, ice cream, and cream-based soups also often trigger these symptoms and may need to be severely limited or eliminated from the diet by many patients after gastric bypass.
Is pregnancy safe after gastric bypass?
We advise against becoming pregnant in the first two years after gastric bypass since the body is still adjusting to the new digestive arrangement. After the first year, pregnancy probably carries no greater risks to mother or unborn child than for a mother of similar age who has not had gastric bypass. However, there are relatively few studies on this point in the medical literature. Any gastric bypass patient who decides to try to become pregnant, or who finds herself unexpectedly pregnant should promptly register for prenatal care, and should make her obstetrician aware of her gastric bypass surgery. All gastric bypass women in whom future pregnancy is planned or possible should be very faithful to keeping up their vitamin and mineral supplements, including vitamin B12, to minimize the risk of fetal development problems which can sometimes result from inadequate trace elements in the mother.
What about pregnancy after gastric banding?
We prefer women wait at least two years before becoming pregnant. This is to allow for maximal weight loss before pregnancy. The patient should promptly begin prenatal care with an obstetrician. We will coordinate with him/her to potentially loosen the band to allow a more normal food intake. The patient will then need to continue healthy nutrition and activity to avoid excess weight gain during the pregnancy.
I have heard that my hair may become thin after weight-loss surgery?
It is not uncommon for patients to experience a phase of some increased brittleness or thinning of their hair in the early months after bariatric surgery. The causes for this are not fully understood, but may reflect a general response of the body to the many changes in nutritional balance and nutritional stores that occur as the body loses large amounts of weight. Doing resistance training (weight lifting exercise) during the pre-operative phase may help this. Also, during the immediate post-operative phase we will encourage you to pursue moderate cardio exercise, and avoid strenuous resistance training until your rate of ongoing weight loss slows down. In our experience, hair thinning, if it occurs, is usually temporary, happens during the first few months after surgery, and is rarely severe.
Where will the incisions be made? How much of a scar will there be?
The incisions will be made in the upper abdomen, from the umbilicus (navel) upwards, and under both rib cages. All are about one inch in length. It should be noted that occasionally, for safety reasons, the laparoscopic operation must be converted to the traditional, "open" operation. This is unusual and done only out of necessity to ensure the safety of the patient and the technical quality of the operation. It is not considered a complication. The patient would have a larger vertical incision in the abdomen, and need an extra 1 to 2 days in the hospital for pain control.
Will plastic surgery be needed for loose skin after I lose weight?
Some patients develop excessively loose skin on various parts of the body as major weight loss occurs. Many factors determine whether this loose skin can be toned back to satisfactory shape by exercise, or whether plastic surgery may be necessary to help. In general, younger patients, and those with less extreme obesity before surgery are more likely to be able to regain a satisfactory figure without plastic surgery. If plastic surgery is needed, the area which can usually be helped the most is to tighten the skin of the abdominal region by a so-called "tummy tuck". In a few patients, breast lift or breast reduction, skin tightening of the upper arms, and skin tightening of the upper thighs may be considered.
Will bariatric surgery help my medical problems?
A number of serious and life-threatening medical conditions result from excessive weight gain, and can be successfully prevented and/or treated by weight reduction surgery. Adult-onset diabetes, obstructive sleep apnea, acid reflux, high blood pressure, joint disease, and others, can be drastically improved or cured by weight-loss surgery. Gastric bypass is especially effective for diabetes and reflux. Other conditions that this surgery help correct are stress urinary incontinence, infertility, and heart disease.
What general complications can result from gastric bypass?
The risk of short-term complications from this operation is low and includes internal bleeding, infection, wound problems, pneumonia, and hernia formation. Potentially life-threatening complications such as respiratory failure, pulmonary embolus (blood clots in the lung), and leakage from internal intestinal connections are also low. Occasionally open operation or re-operation is needed to address these complications. Long-term complications are rare, but may include stricture (partial blockage) of internal intestinal connections causing vomiting, ulcer formation causing bleeding, internal hernia formation, inadequate weight loss or recurrent weight gain, and malnutrition. It is always possible to develop unforeseeable complications.
What are the general complications of gastric band?
Short-term complications include injury to the stomach, esophagus, and other nearby organs. Longer-term problems are rare but may include band slippage or erosion into the stomach, port complications, such as infection, leak or malposition, and stomal swelling (a stoma is the opening that is made from the pouch, or "new stomach," to the small intestine).
Are there other weight control operations besides gastric bypass or band?
There are different weight-control operations that are done in different centers around the world. Other operations for weight control are "duodenal switch," and "distal bypass." These three operations all involve a greater degree of rearrangement of the small intestine, and create a greater degree of malabsorption of food. Sleeve gastrectomy, and implanted gastric pacemakers are other operations being studied. We continue to stay abreast of scientific advancement by participating in surgical meetings and conferences.