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Am I a candidate for bariatric surgery? |
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What would make me a non-candidate for surgery? |
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What are the benefits of surgery? |
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Are there risks associated with bariatric surgery? |
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Is there anything that can be done to decrease the risks? |
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Will my insurance cover this procedure? |
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What if my insurance doesn't cover the procedure? |
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How long will I be in the hospital? |
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How soon will I be able to return to work? |
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Will I need to take vitamin supplements after surgery? |
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What about follow-up? |
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How much weight will I lose? |
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Will I need plastic surgery because of excess skin? |
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What about pregnancy after bariatric surgery? |
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If I successfully complete the online patient education, will a live seminar with the surgeon be required? |
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Am I a candidate for bariatric surgery?
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The National Institutes of Health have studied morbid obesity and determined that bariatric surgery is considered medically necessary in patients who have a body mass index (BMI) of 40 kg/m2. This is the equivalent of being about 100 pounds above your ideal body weight. Patients are also considered a candidate if they have a BMI between 35 and 40 kg/m2 if they suffer from a serious medical condition such as Type 2 diabetes, hypertension or sleep apnea.
If you are considering bariatric surgery you should also be aware of and willing to make the necessary lifestyle changes.
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What would make me a non-candidate for surgery?
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At this time patients with a BMI of less than 35 kg/m2 are generally not considered candidates for bariatric surgery. There is ongoing research looking at offering bariatric surgery to patients with a BMI of between 35 and 40 kg/m2.
There may be certain medical conditions that may prevent you from having bariatric surgery. Our surgeons evaluate each patient to determine if bariatric surgery is an option.
We would be happy to discuss your individual situation with you -- call us at 314-966-9640.
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What are the benefits of surgery?
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Bariatric surgery serves as a tool to assist you in weight loss. Many of the benefits of bariatric surgery are related to improvement in other medical conditions as a result of the weight loss. Conditions such as diabetes, hypertension, sleep apnea, and high cholesterol may be resolved or improved after surgery.
Our patients also describe to us an improved quality of life and the ability to participate in activities that were too difficult prior to their weight loss.
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Are there risks associated with bariatric surgery?
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There are risks and potential complications, including death, associated with all surgical procedures. Morbid obesity may increase your surgical risks. It is important that your surgeon have as much information as possible about your medical and surgical history so that he can discuss your risks, benefits and alternative treatments with you, and thus allow you to make an informed decision about bariatric surgery.
Risks include but are not limited to bleeding, infection, pulmonary embolism, gastrointestinal leak (for RYGB and sleeve gastrectomy), band slippage (for LAGB) and injury to surrounding organs.
The surgeon will discuss the benefits and risks of surgery at the educational seminars and again at your office consultation.
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Is there anything that can be done to decrease the risks?
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It is important that you are as healthy as possible prior to surgery. Please discuss your plans for bariatric surgery with your primary care physician to determine if you are medically stable. Having optimal control of conditions such as diabetes and hypertension may decrease your risk.
You will be asked to begin a diet prior to surgery. Your surgeon or our registered dietitian will discuss the length and type of diet with you. The rationale for this diet is to shrink the liver which lies in close proximity to the stomach. The liver stores fat so pre-operative weight loss and shrinkage of the liver may make it easier for the surgeon to perform the surgery.
Stop smoking! Cigarette smoking or other tobacco usage increases your immediate post-operative risks for blood clots, bleeding, poor healing, and respiratory complications. It can also increase your longterm risk for ulcers.
Begin an exercise program prior to surgery. Exercise may improve your cardiopulmonary status. Be sure to discuss an exercise program with your doctor before you begin to determine if the program is appropriate for your medical situation.
Surgery done by an experienced bariatric surgeon in a facility that is experienced in the care of the bariatric surgery patient may decrease your risks. Our team of surgeons have done hundreds of bariatric surgical procedures. DesPeres Hospital has an experienced team of nurses, medical consultants and ancillary staff to care for you before, during and after your hospital stay.
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Will my insurance cover this procedure?
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Many insurance plans do cover bariatric surgery. Let us verify your specific benefits. Please call our office so that we can get the name of your insurance company and your identifications number. Once we verify your benefits (usually in less than 48 hours) we will be able to call you back and give you information regarding your benefits including coverage and the specific criteria that your insurance has for bariatric surgery. We will also be able to tell you financial information such as deductible and out of pocket expenses.
If it is determined that you do have benefits, we still must generally submit a pre-determination letter and documentation to prove medical necessity. Once we submit the letter it may take anywhere from a few days to a few weeks to receive a response.
In the event that your insurance does not cover bariatric surgery, there are some alternatives to consider.
Does my employer offer more than one insurance plan at open enrollment? If so, does one of the other plans include coverage for bariatric surgery?
Does the plan that my spouse has include bariatric surgery coverage? If so, can I be added to that plan?
Do I want to pay for this surgery myself? If this is an option, please call our office at 1-866-215-9151. We will be happy to discuss specific financial information with you.
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What if my insurance doesn't cover the procedure?
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The MyNewSelf Surgical Weight Loss Program will communicate with your insurance company to
determine if you have benefits for bariatric surgery.
Unfortunately, some insurance companies do not cover bariatric surgery due to an exclusion in the
plan. Listed below are some options to consider in the event you do not have benefits for weight
loss surgery.
♦ Your employer may offer more than one insurance plan at open enrollment time. If so, do any of those plans provide coverage?
♦ You may have the opportunity to purchase benefits on a spouses plan. If your primary plan has an exclusion for weight loss surgery, your secondary plan may cover your surgery.
♦ You may pay for the surgery without insurance coverage. Call us for cash pay pricing information -- 314-966-9640.
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How long will I be in the hospital?
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Generally, patients who have the laparoscopic adjustable gastric banding will spend the night in the hospital and be discharged the next day. Patients who have the Roux-en-Y Gastric Bypass or Sleeve Gastrectomy will generally spend two nights in the hospital.
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How soon will I be able to return to work?
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Most patients who have the Laparoscopic Adjustable Gastric Banding can return to work after 1 week. For patients who have Gastric Bypass or Sleeve Gastrectomy the average return to work is 2 weeks. Time off of work may vary depending on the type of work you do. Your bariatric surgeon will discuss your individual situation with you.
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Will I need to take vitamin supplements after surgery?
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A multivitamin is recommended for all patients who have had bariatric surgery. Additional supplementation of Vitamin B12, calcium, iron and thiamine may be necessary depending on the surgical procedure. Your surgeon and the dietitian will discuss this with you prior to surgery.
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What about follow-up?
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Your surgeon will see you back approximately 1 week after surgery. For patients who have had LAGB, your first adjustment will generally be 4-6 weeks after surgery. You will need to be seen frequently to determine the need for further adjustments.
Patients who have the RYGB or sleeve gastrectomy are generally seen at 1 week, 1 month, 3 months, 6 months and 1 year post-operatively and then annually.
I t is imperative that you continue to follow-up with your bariatric surgeon and/or the support staff including the nurses and dietitian. Bariatric surgery requires a long-term commitment between the patient, the surgeon and the program!
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How much weight will I lose?
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Weight loss will vary from patient to patient. There are a number of factors that can influence your weight loss including age, pre-operative weight, gender, and compliance with follow-up, dietary guidelines and lifestyle changes including exercise.
Generally, patients who have laparoscopic adjustable gastric banding will lose about 50 % of their excess body weight. The majority of the weight is lost in the first year but continues over a period of 2-3 years. Patients must have regularly scheduled follow-up with the surgeon for adjustments in order to achieve maximum success.
Patients who have the Roux-en-Y Gastric Bypass average a weight loss of 60- 80% of excess body weight. Most patients will lose most of their weight in the first year. Some patients may experience about a 20% weight regain but will generally maintain a 60-70% loss of excess body weight.
Sleeve Gastrectomy patients average 50- 60% of excess body weight lost. As with the gastric bypass most of the weight is lost within the first year. Because we do not yet have long term data on the sleeve gastrectomy, weight regain may be a possibility and a conversion to another bariatric procedure may be necessary.
Please keep in mind that bariatric surgery is only a tool. Patients must learn to utilize that tool effectively. We are here to help you by providing ongoing educational classes with our registered dietitian and support groups to assist you with making the necessary lifestyle changes.
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Will I need plastic surgery because of excess skin?
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Significant weight loss may lead to excessive skin in areas such as the neck, abdomen, arms, and thighs. For some patients the excessive skin may cause problems with skin irritation and rashes. For others it may be bothersome from a cosmetic perspective. A plastic surgeon will be able to determine the type of procedure that is needed and if there is medical necessity. It is recommended that you wait until you have lost most of your weight before considering plastic surgery. Click the link for a physician referral
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What about pregnancy after bariatric surgery?
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Morbidly obese women may often have problems with fertility and the ability to become pregnant. Obesity may also increase the risk of complications during pregnancy.
Pregnancy is not advised during the first year when the most rapid weight loss is occurring as it may deprive the fetus of essential nutrients that it needs to grow. Because weight loss may improve fertility it is imperative that a reliable form of birth control be used following surgery. Women who are contemplating bariatric surgery and future pregnancy should discuss this with their obstetrician/gynecologist.
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If I successfully complete the online patient education, will a live seminar with the surgeon be required?
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No. However, we still recommend that you come to a live seminar so you can meet the surgeon(s) and benefit from the group's questions.
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