Bariatric Care - Frequently Asked Questions
1. Why is Clinically Severe Obesity Treated with
Surgery?
2. Who is a Candidate for Bariatric Surgery?
3. How Does Bariatric Surgery Work?
4. What are the Different Kinds of Bariatric Procedures?
5. How is Laparoscopic Bariatric Surgery Different from
Open Surgery?
6. How Much Weight Do Most Patients Lose?
7. What Kind of Diet Do You Follow After Surgery?
8. What Happens to All of the Excess Skin?
9. What are The Risks Associated with Bariatric Surgery?
10. Will My Insurance Company Cover the Cost of this
Procedure?
1. Why is Clinically Severe
Obesity Treated with Surgery?
Clinically severe obesity carries with it serious health dangers,
including an increased risk of heart disease, diabetes, hypertension,
and even death. Since dietary and medical treatments have been largely
ineffective in treating clinically severe obesity, the medical
profession has turned to surgery as a low risk, more effective
treatment.
2. Who is a Candidate for
Bariatric Surgery?
A patient with a Body Mass Index (BMI) of 40 or more (at least 100
pounds over ideal weight). Click on this
Body Mass Index link to determine your BMI.
BMIs between 35 and 40 may also be considered if accompanied by a
high-risk comorbid condition such as life-threatening cardiopulmonary
problems (i.e., severe sleep apnea, Pickwickian syndrome, and
obesity-related cardiomyopathy) or severe diabetes mellitus.
A patient with a BMI of 35-40 who also has obesity-induced physical
problems that interfere with lifestyle may also be considered (i.e.,
obesity prohibits a person from being treated for a joint disease, or
body size problems preclude or severely interfere with ones employment,
family function and/or ability to walk).
A candidate for bariatric surgery at Ellis Hospital is required to
meet one of the BMI criteria discussed above and have a letter of
medical necessity from his/her primary care physician. Please review the
required steps for weight loss surgery
candidates provided on this site.
3. How Does Bariatric
Surgery Work?
In order to understand how bariatric surgery works, it is important
to understand how the body's gastrointestinal tract works (see diagram
below). After you swallow food it enters the stomach, which acts as a
holding tank for food. From the stomach, small amounts of food are
released into the digestive tract. Bile from the liver and enzymes from
the pancreas enter the duodenum (first part of the small bowel) and aid
in the digestion and absorption of the food. Most absorption of food
takes place in the duodenum.
There a several different types of bariatric operations, but most
surgeries entail two main components:
1.) Reducing the volume of the stomach by removing or bypassing a
portion of the stomach. This means that the stomach can only hold a
limited amount of food before a person feels full.
2.) Directing bile and pancreatic enzymes away from the food, so that
digestion and absorption of food is delayed - takes place further down
in the jejunum (small bowel).
4. What are the Different
Kinds of Bariatric Procedures?
Since there are various types of bariatric procedures, a surgeon will
determine which one is the most appropriate for each patient. Among the
most common procedures performed are:
Roux-en-Y Gastric Bypass - this is the most frequently performed
bariatric procedure, and is considered to be the gold standard in weight
loss surgery. The Roux-en-Y surgery closes off most of the stomach,
through stapling, to decrease the amount of food a patient can eat, and
also rearranges the small intestine to reduce the amount of calories
that a patient's body can absorb.
Adjustable Gastric Banding - this is a laparoscopic procedure in
which the surgeon places an adjustable elastic band around the upper
section of the stomach to create a small pouch that restricts food
passage.
5. How is Laparoscopic
Bariatric Surgery Different from Open Surgery?
Both open and laparoscopic procedures follow the same principles, and
both result in similar excess weight loss in patients. Open bariatric
surgery is performed through one incision that is made from just below
the patient's breastbone to above the navel. During laparoscopic
surgery, small incisions are made to a patient's abdomen and the surgeon
performs the operation with the aid of a small video camera that is
attached to a laparoscope and inserted into one of the incisions. The
surgeon views the video images taken from inside the body on a TV
monitor, and performs the procedure accordingly. Gas is used to expand
the abdomen during surgery.
Open Procedure
 |
Laparoscopic Procedure
 |
Laparoscopic surgery generally takes less time to perform than open
surgery and patients recovery times are shorter than with open surgery.
6. How Much Weight Do Most
Patients Lose?
Weight loss depends on many factors, including, but not limited to, a
patients starting weight, age, body metabolism, ability to exercise and
type of operation. The average weight loss for a bariatric patient is
approximately one third of his/her starting weight. Typical and
satisfactory weight loss with the laparoscopic adjustable band is 1-2
pounds per week, where as the gastric bypass may result in the weight
loss of 15-20 pounds per month, with this amount becoming less over
time.
Eighty to 90% of patients keep the weight off in the first two years
following surgery, and 50% of patients keep the weight off over a five
year period.
7. What Kind of Diet Do You
Follow After Surgery?
After surgery, your pouch will only hold one to two ounces of food,
so you will need to have a healthy diet and consume a variety of foods
in order to get the vitamins and minerals you need. To help prevent
deficiencies, your doctor will prescribe a multivitamin, protein powder
and a calcium supplement. In addition, other supplements may be
prescribed. The post-surgery diet progresses from clear liquids, taken
immediately after surgery, to soft foods, which include meats fruits,
vegetables and some grains.
8. What Happens to All of
the Excess Skin?
Exercise can help address the issue of excess skin following
bariatric surgery, but depending on how overweight a patient is,
exercise alone may not be sufficient. Reconstructive surgery is an
option for reducing the amount of excess skin; however, it should only
be considered at least one year after surgery when the patients weight
has stabilized. Reconstructive surgery is offered at Ellis Hospital.
Talk with your doctor about whether this option is right for you. He/she
can refer you to a plastic surgeon.
9. What are The Risks
Associated with Bariatric Surgery?
As with any operation, there are risks and side-effects associated
with bariatric surgery. Potential complications include bleeding, blood
clots and breathing problems, and side-effects include increased risk of
developing anemia and bone disease, such as osteoporosis. The risk of
death associated with bariatric surgery is low - less than .5%.
Bariatric surgery will change the way you eat and how your body
digests and absorbs food. Adherence to recommended nutritional and
exercise guidelines are paramount to ensuring optimal results.
Following discharge from the hospital, patients should contact their
physician if they develop any of the following symptoms:
- Persistent fever (over 100.5 F)
- Bloody bowel movement
- Increased abdominal swelling or pain
- Persistent nausea or vomiting
- Persistent cough and shortness of breath
- Difficulty swallowing
- Generalized weakness
10. Will My Insurance
Company Cover the Cost of this Procedure?
Since the government now considers obesity to be a disease, most
insurance carriers, including Medicare, will cover bariatric procedures
as long as the patient is eligible. Please note that you are required to
get approvals from your individual insurance plan throughout the
bariatric surgery process. For managed care and HMO patients, please
remember to get referrals when necessary from your primary care
physician. If your insurance does not cover these procedures, you may
discuss other options by calling our office at 518.243.1313.
*Note: Illustrations on this page provided courtesy of Ethicon
Endo-Surgery, Inc.
- a Johnson and Johnson Company.