Important Questions You Need to Ask
If you’re considering weight loss surgery, it’s important to know it’s a life-changing decision. Regardless of what type of surgery you and your doctor decide is best, bariatric surgery will limit how much and even what kinds of foods you’ll be able to eat going forward. It’s important to carefully consider how this will affect your life. Existing medical conditions, risks during and after surgery, and cost are also important considerations.
Gastric sleeve surgery (also called sleeve gastrectomy) is the most popular bariatric surgery today, and for good reason. The surgery is minimally invasive, with tiny incisions; recovery time is fast, there is no foreign body (such as a gastric band) to worry about, and sleeve gastrectomy is effective—most patients lose an average of 70% of their excess weight in 6-12 months.
More importantly, many patients experience resolution of obesity-related medical conditions such as diabetes and high blood pressure, greatly improving their quality of life.
Your bariatric physician will help you understand your particular risks and whether surgery is the right option for you. Let’s explore questions to ask yourself and questions to ask your doctor if you’re considering gastric sleeve surgery.
Questions to Ask Yourself
What is my BMI?
If your BMI is 40 or greater, you may be a good candidate for weight loss surgery, unless you have health conditions that would preclude you from undergoing surgery due to high risk (your weight loss doctor will make this determination). If you have a BMI of 35 or greater plus a coexisting related medical condition like type 2 diabetes, sleep apnea…surgery may be an option. Not sure of your BMI? Use this BMI calculator to find out.
Have I tried to lose weight in other ways?
Many (if not most) people have tried at least one diet at some point. If you’ve tried to lose a significant amount of weight on your own without success, the next step is usually a medical weight loss program; this typically involves working with a dietician on a supervised diet plan and taking nutritional supplements, vitamins, probiotics, and (in some cases) protein meal replacements, usually for a minimum of six months. Some insurance companies won’t cover bariatric.
surgery unless you’ve undergone such a program. But many studies now show that this is not needed.
If you have tried losing weight medically without success, including a medical weight loss program, bariatric surgery may be the next step.
Do I have weight-related medical conditions?
Carrying excess weight can bring on and worsen medical conditions like diabetes, sleep apnea, high blood pressure, and heart disease. If you have one or more weight-related medical conditions, significant weight loss after a bariatric procedure, such as gastric bypass or gastric sleeve surgery, can improve the symptoms or even reverse the condition altogether.
Have I researched the different types of bariatric surgery?
There are several bariatric surgery types, and each has its own advantages and disadvantages. Bariatric surgeries work by restricting the amount of food you can eat at any one time (restrictive) or by reducing the calories and nutrients your body can absorb (malabsorptive), or by doing both. The most common bariatric surgeries today include:
- Gastric sleeve surgery: The most popular weight loss surgery today, sleeve gastrectomy involves separating and removing part of the stomach, leaving a smaller stomach pouch that is shaped like a sleeve or banana. The smaller stomach pouch cannot hold as much food, so it restricts the amount of food you can eat at one time.
- Gastric bypass surgery: The second most commonly performed bariatric surgery is gastric bypass (Roux-en-Y). In this procedure the surgeon separates the stomach into two sections, consisting of a small upper pouch and a larger lower section. The smaller, egg-sized pouch is connected to the small intestine. Only the smaller stomach pouch receives food, which greatly restricts how much you can eat or drink; because the food you eat travels through a smaller section of the small intestine, you will also absorb fewer nutrients.
- Gastric banding: This surgery reached its height of popularity 8-10 years ago and involves placing an adjustable band containing an inflatable balloon around the upper part of the stomach. When the band is inflated, it squeezes the stomach into two sections, restricting the amount of food you can eat. In recent years, reports have shown higher than expected failure rates and complications with this procedure; for this reason, Dr. Mirza does not recommend gastric banding.
- Biliopancreatic Diversion with Duodenal Switch: A more dramatic form of gastric bypass, in this procedure the surgeon removes a large part of the stomach and creates a cylindrical pouch that connects the esophagus with the top of the small intestine. Food bypasses much of the small intestine, which limits the number of nutrients your body can absorb. This is a riskier bariatric procedure associated with significantly higher risks of malnutrition, leaks, and complications, but may be appropriate for some patients with super-morbid obesity.
- Gastric Balloons: many Gastric Balloons has been introduced recently to the medical market in the US, essentially, they are water or air-filled balloons that are placed inside the stomach to occupy space and cause satiety with smaller meals, the major disadvantages are; these balloon’s procedures are temporary, and most patients gain weight after their removal (which has to be done in less than 6 months), the modest weight loss relative to other weight loss procedures, the possible complications, and the cost involved.
Am I fully committed to changing my lifestyle?
This is perhaps the most important question because a commitment to making necessary lifestyle changes after weight loss surgery will be vital for long-term success. Weight loss surgeries can fail. You must be willing to modify your diet, eating and activity habits, not just immediately after surgery, but for life.
This can be the most challenging part of the recovery process. Support groups, individual counseling, and working with a dietician and personal (fitness) trainer can all boost your chances of success.
Will insurance cover the surgery, and, if not, can I afford it?
Insurance coverage varies by plan and provider. Many insurance companies will cover bariatric surgery. For patients whose insurance providers will not cover weight loss surgery, there are several factors that will affect the cost of surgery, including the facility, which procedure you choose, and your medical history.
Many facilities, including Bariatric Care Centers, will work with patients to find a manageable payment plan option, including possible financing. Your health and well-being are at stake—bariatric surgery is an investment in yourself.
If you inquired with your insurance company about coverage for weight loss surgery and were denied, try again—especially if you have obesity-related medical conditions like diabetes, high blood pressure, or heart disease. Why? One study found that 25% of patients were denied coverage for weight loss surgery as many as three times before their insurance company finally agreed to pay. 1
Am I willing to undergo subsequent surgeries if necessary?
Although it’s unlikely, if you don’t lose weight as expected or experience other problems, revision surgery may be necessary. If you lose an excessive amount of weight, you may also need additional surgery at some point to remove excess skin, which could involve multiple surgeries performed in different stages. Your doctor can help you understand whether you may need this kind of surgery down the line.
Questions to Ask Your Bariatric Doctor
What is your experience?
Just because a surgeon has performed a lot of surgeries doesn’t necessarily mean he or she is the most skilled surgeon. Yet, experience does matter—surgeons who have performed hundreds or even thousands of surgeries tend to perfect their skills over time, and he or she will likely be better equipped to handle more difficult cases. Look for a surgeon who has completed a bariatric fellowship program in which he or she trained under another surgeon (usually a highly-regarded bariatric surgeon) who specializes in the same surgical specialty.
Which procedures do you perform?
Every surgeon does not necessarily perform all bariatric procedures, and often for good reason. Some surgeons offer gastric bypass surgery, gastric sleeve surgery, and duodenal switch surgery, but not gastric band surgery, or gastric balloons, The surgeon may know through experience that a particular type of surgery has a higher rate of failure or complications.
If a surgeon offers just one surgery type, ask why. He or she may not have been trained in other surgeries. If the particular surgery he or she is trained in is the ideal one for you, going with that surgeon may be fine; but, at a minimum, explore other surgeons who offer more than one option.
What are your complication rates?
Rates of complication vary by bariatric procedure. Serious complications during surgery for gastric bypass were reported at 3.6% as of 2010, according to a study by JAMA. 2 The rates for gastric sleeve surgery were 2.2% and 0.9% for gastric banding surgery. Your bariatric surgeon’s rates should be around the same as or below the national average.
What resources do you offer before and after surgery?
Bariatric surgery is only part of your weight loss journey. Having access to a caring, competent dietician and support groups is vital to your success. Make sure the facility you choose offers pre- and post-operative support groups, and meet with the dietician before your surgery to make sure you are comfortable with him or her. In short, make sure the doctor you choose explains your future care in detail.
Start Your Weight Loss Journey Today at Bariatric Care Centers
The caring staff at Bariatric Care Centers, led by Dr. Brian Mirza, MD, FACS, FASMBS, will work with you and provide the care you need every step of the way through your weight loss journey.
Dr. Mirza is Chief and Medical Director at First Street Hospital, First Choice Weight Loss Program, and Bariatric Care Centers. As one of the most experienced, fellowship-trained bariatric surgeons in the Houston, Texas area, Dr. Mirza has performed thousands of surgeries with a 0% rate of postoperative leaks.
Dr. Mirza is certified by the American Board of Surgery, is a fellow of the American College of Surgeons, and is a member of the society of the American Gastrointestinal and endoscopic surgeons (SAGES) and the Society of Laparo-Endoscopic Surgeons (SLS).
Contact Bariatric Care Centers today, toll-free at 713-339-1353, for a free consultation about whether weight loss surgery is right for you.
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