How effective is bariatric surgery?

That’s a difficult question to answer, every patient is different, every patient’s motivation is different, and no two patients are going to have the exact same anatomy or outcome. Does effective mean you lost the exact amount of weight you intended to lose? Does it mean you are skinnier than your friend? Does it mean you now fit into the jeans from high school you’ve kept around hoping you’d get back in them one day? The effectiveness of your procedure depends not only on Dr. Barnes and the program he has developed, but it depends a lot on you, and your commitment to your own weight loss goals.

From a statistical standpoint, the maximum weight loss occurs within the first 10 months after surgery.

  • Laparoscopic Roux-en-Y gastric bypass an average of 75 to 80% of excess body weight occurs, many achieve 100%. Overall >95% lose greater than 50% excess body weight.
  • Laparoscopic sleeve gastrectomy an average 60 to 70% with some achieving 100% excess weight loss.
  • Lapband an average of 35% of excess weight loss at 1 year. Some patients continue to lose 10% EWL per year after.  Some have higher results.

How can I prepare for weight loss surgery?

You can prepare by taking the appropriate lifestyle changes necessary during the months prior to surgery. In our program you will meet with a registered dietitian every time you come to the office, she will educate you on diet and exercise. Take the information you learn and apply it to your everyday routine before surgery. Start working out or exercising more, get up and take a walk after dinner, go to the park play with your kids, etc. Including the lifestyle changes you plan on making after surgery into your life before surgery will greatly help in preparing you for surgery.

Make sure you have a strong support system whether that is your spouse, or your kids, maybe your best friend, or another patient who happens to be going through the program at the same time. Having people in your life to motivate you and support you is extremely important. Those people will be able to pick you up and encourage you to workout when you just aren’t feeling like it, they will be there for you when you get frustrated or when you really feel like cheating on your diet. Bariatric surgery is a lifestyle change, and for that change to be as seamless as possible, the people in your life need to know what you are going through. That’s not to say you should tell everyone you know, “Hey, I’m having bariatric surgery!!” but you will need a few people on your team, cheering you along throughout the process.

Why is pre- and post-operative nutrition education necessary?

As a bariatric patient you will need to adopt new diet and exercise habits. These changes are hard and it takes time to break old habits, and form new ones. Having an on staff registered dietitian is our way of making sure all your nutrition needs can be answered.

Why do I need to have a psychological evaluation?

The primary reason is because; insurance requires a psychological evaluation in preparation for bariatric surgery. Its also important for Dr. Barnes to make sure you as the patient understand the changes you are about to make, not only in your diet and exercise habits, but the physical change your body is going to undergo as well.

How long after bariatric surgery will I have to be out from work?

After surgery Dr. Barnes would like his patients to take two weeks off of work. Again, every patient is different and every recovery process is different, at minimum you would be off of work for a full week. You will also be on a lifting restriction; no lifting over 15lbs for six weeks.

When can I start exercising again after surgery?

Right away!! Before you leave the hospital, the nurses will have you up and walking around the floor. Taking short gentle walks first and increasing steadily is key. It’s also important to start slowly, and listen to your body, and Dr. Barnes! If you are planning on lifting weights, you will need to refrain from lifting anything heavier than a 15lb dumbell for six weeks. If you play any contact sports, you will need to make sure you play a “low impact” position, avoid aggressive competition, think participation. Build on your workouts slowly over several weeks. If you swim as a form of exercise, you need to obtain clearance from Dr. Barnes to make sure your wounds are fully healed before entering into private or public pools.

Can I have bariatric surgery if I have had previous abdominal surgery?

Yes. Make sure to be very open and honest with your surgeon and anesthesiologist about any previous procedures. If you have documentation of those procedures, operative reports, office notes, etc. make sure to bring those to the office so they can be appropriately filed in your chart. It is likely Dr. Barnes will want to know as much as possible about prior abdominal operations.

Can I have surgery if I have a hernia?

Yes! Depending on the type of hernia, size, location, etc. Dr. Barnes can also fix the hernia when you are under anesthesia for your bariatric surgery.

Does type 2 diabetes make surgery riskier?

Potentially yes. Be sure to listen to Dr. Barnes as well as the doctor who is managing your diabetes around the time of surgery. The RNY and sleeve gastrectomy start the cure or improvement for DM II right after surgery, independent of weight loss, in the majority of patients.

Can I have laparoscopic surgery if I have heart disease?

Yes. All of our patients are required to either pass a stress test, which can be administered during clinic in the office or see a cardiologist and obtain pre-operative cardiac clearance. Often times, bariatric surgery improves most problems related to heart disease including; high blood pressure, coronary disease, vascular disease, high cholesterol, and lipid problems.

When filling out your paperwork, be sure to list all cardiac related problems; personal and family. If you are on blood thinners of any type, let Dr. Barnes know, and expect special instructions before and after surgery.

Can I get pregnant after bariatric surgery? Will the baby be healthy?

Yes! Many women are much more fertile after surgery. Statistics show birth control pills are not as effective in heavy patients. They are also not reliable during the time your weight is changing. When losing weight quickly, menstrual periods can be very irregular, and you could end up pregnant when you least expect it. For this reason it’s important to practice other methods of birth control during your medically supervised weight loss period and for the first year after surgery.   In addition, some patients who previously were unable to become pregnant will be able to soon after the surgery.

Dr. Barnes recommends waiting 12 months after surgery before actively trying to get pregnant. You have to remember, you chose to have bariatric surgery and during your weight loss journey you need to focus on yourself, you need to get to a healthy weight where you are comfortable and happy before trying to get pregnant.

Kids born after their mothers’ surgery are LESS likely to be affected by obesity later in life, due to activation of certain genes (hyperlink internal) (epigenetics) during fetal growth. There is also less risk of needing a C section.

Will I need plastic surgery? Does insurance pay for plastic surgery?

Many patients have some lose or sagging skin, its often more temporary than expected. Between 6 and 18 months, you will experience the most changes. Every patient is different; your physical appearance depends on several things; age, genetics, smoking or non-smoking, how much weight you lose, how often you exercise. Generally lose or excess skin can be well-hidden by clothing, though many patients choose to wear compression garments (can be purchased online).

Some patients may need plastic surgery to remove excess skin, many surgeons recommend waiting until at least 18 months post op or maintaining a healthy consistent weight for 6 months, before proceeding with skin removal surgery.

Plastic surgery can be covered by insurance if it’s medically necessary. Removal of abdominal or breast skin for reasons of moisture, hygiene, and rash issues, could be covered by insurance. Other areas of the body including, arms may not be covered because they are considered purely cosmetic. Contacting a plastic surgeon post operatively for a consultation is never a bad idea, their office will be able to help you figure out your insurance benefits when the time comes!

Will I lose my hair after bariatric surgery?

Every patient is different, but potentially yes. You could experience some hair loss. You will be taking a multivitamin every day for life. Depending on your diet, you might need a higher dose of certain vitamins. You will also need to maintain your yearly follow up visits with Dr. Barnes, bariatric patients need to have labs checked yearly. This will help ensure you are getting the right nutrition help you need, and prevent malnutrition and hair loss further down the line.

Will I have to go on a diet before I have surgery?

Yes. You should be changing and improving you eating habits, during the 3 or 6 months of medically supervised weight loss. Dr. Barnes requires a 2 week liquid diet, in the weeks leading up to surgery. And clear liquids only in the 24 hours prior to surgery. The liquid diet helps shrink your liver, helps reduce fatty tissue in the abdominal area, and gives better visibility to him and his assistant surgeon during your operation.

Will I have to diet or exercise after the procedure?

No and yes.

One of the benefits of the RNY gastric bypass and the sleeve gastrectomy is the massive reduction in grehlin production resulting in decreased hunger for months and sometimes longer after the surgery.  (Grehlin is a hormone that is released by the stomach, travels to the brain and puts the thoughts of eating into your mind)  This makes dietary changes much easier in the postoperative period.

You don’t need to specifically go on a diet after the procedure. You need to change your diet; you need to have a better healthier relationship with food. These changes are much easier with a decrease or absence of hunger.  Food won’t be a source of comfort anymore, it needs to be thought of as what it is, its nutrition. Its fuel for your body, it gives you the energy you need to workout, to walk around, to get up in the morning. Its not a crutch, its not a comfort, it’s a resource you use to provide for your body and your new lifestyle.

You will need to exercise. Don’t think of exercise as spending an hour in the gym sweating till you can’t sweat anymore. Exercise can be found in many different forms of activity; it can be walking the dog, it can be swimming laps in the pool, it can be playing with your kids, or joining a rec soccer league, it can be walking around your office building with coworkers before you all go to lunch, or you could walk to lunch. There are multiple forms of exercise that get your up and moving, find something you love to do and commit to it. Be active, participate, and move around, after all a more active healthier lifestyle is one of biggest benefits of bariatric surgery.

Will I be able to stop taking some of my medications after surgery?

Potentially yes. As you lose weight you may be able to reduce or eliminate some of your medications. Consult your prescribing physician or Dr. Barnes before stopping any medications post operatively.   Roughly, 60 to 90 % of diseases caused by morbid obesity resolve after surgery and significant weight loss.

What if my insurance doesn’t cover bariatric surgery? Are payment plans available?

We accept care credit as a form of financing your surgery. Local and national banks also have loan programs available to cover the cost of health expenses in regards to bariatric surgery. Repairing a hernia and adding a bariatric procedure at the same time is also a way to help minimize costs.

Contact our office directly to gather information on what other financing options might be available to you.

What is the Medically Supervised Weight Loss Period?

This is the period of time leading up to your surgery where you are required to do monthly visits, and weigh-ins to make sure you are properly educated and complying with the guidelines your insurance company has set in place.  Every insurance company has different requirements in regards to the medically supervised weight loss period, some insurance policies require 3 months, and some require 6 months. There are even a few plans that require 12 months.

Contact our office directly to gather information regarding your plans specific requirements for the coverage of bariatric surgery.

How do I get a letter of necessity? And why do I need one?

Some insurance plans/policies require this type of documentation; either from Dr. Barnes, or a primary care provider before approving surgery. Many plans will just accept the initial consultation note from Dr. Barnes. Its best to find out from your insurance company directly what they are expecting in terms of a letter of necessity.

Typically if an insurance company wants of letter of necessity, they are looking for information pertaining to you current weight, height, BMI, other problems related to obesity, your past success or failures in regards to diet history, and why the physician feels surgical intervention is appropriate at this time.

If your insurance company requires a letter of necessity from a primary care doctor. Our office will be able to give you a sample letter, or help you convey what you need to your primary care doctors office.