​​​​​​​​​​​​​​​​​​​​​​Bariatric Sur​gery FAQs

General Questions​

​Is there an age limit for weight loss surgery?

There are pediatric weight loss surgery centers that specialize in surgical weight loss for those under 18 years old. We do not offer weight loss surgery to patients under 18 years old. Patients as old as 74 have had successful weight loss surgery. However, our policy is to take special consideration of patients older than 65. This is because several studies have demonstrated an increased risk of complications in those patients.

Ca​n weight loss surgery prolong my life?

There is strong evidence that weight loss surgery can significantly prolong life. This is especially true for those who have:

• a serious obesity-related health condition
• are at least 100 pounds overweight and
  
• are able to comply with lifestyle changes following surgery. 
  

Large studies have shown both up to an 89 percent reduction in mortality rates and 12 years of additional life expectancy following weight loss surgery.

Can weight loss surgery help other physical conditions?

At one year after successful bariatric surgery, 90 percent of obesity-related medical conditions are either completely resolved or significantly improved.

Type 2 diabetes has been shown to resolve 80 to 90 percent of the time following Roux-en​-Y gastric bypass. 

Gastroesophageal reflux disease, or heartburn, resolves 92 to 98 percent of the time. 

High blood pressure resolves over 60 percent of the time.

Sleep apnea resolves over 80 percent of the time. 

There are nearly 60 different medical conditions related to obesity, including cancer, that can improve or resolve after weight loss surgery.

What do I need to do to get started?

There are two paths you can​ take to begin your journey. 

The first is to contact your primary care physician and discuss your weight-related health concerns.

The second is to register to attend one of our free information sessions. An information session is required before your initial​ consult with a bariatric surgeon.

Financial Questions

What if my insurance company denies coverage for bariatric surgery?

Some insurance companies specifically exclude weight loss surgery from their plans. Others require additional information to cover the surgery. 

Patients sometimes gain insurance approval after appealing the initial decision. This is done by providing additional documentation from a surgeon or referring physician. This would include documentation that:

• indicates surgery is the best therapy to relieve life-threatening, obesity-related health conditions or 
• that the patient has tried other medically-supervised options without success.

If you are uninsured or if your insurance provider does not pay a benefit for weight loss surgery, several financing options are available to help you. Our experienced financial counselors will work with you to explore all of the options available to you. ​Contact us at 706-509-5122 or weightlossfloyd@atriumhealth.org​.​

What can I do to improve the chances that insurance will cover my surgery?

Every weight loss surgery candidate should gather diet records, medical records, medical tests and proof of other attempts at weight loss. This reduces the likelihood of a denial for failure to provide necessary information. Letters from your personal physician and consultants attesting to the medical necessity of treatment are particularly valuable. When several physicians report the same findings, it may confirm a medical necessity for surgery.

For help, contact our Patient Navigator to help determine what financial option is right for you. Contact Maegen by email at weightlossfloyd@atriumhealth.org​ or call 706-509-5122.

Preparation for Surgery

What are the routine tests before surgery?

Patients are asked to provide a complete medical history, recent laboratory results and the results from other physical and mental examinations including the following: 

• complete blood count (CBC)
• ​comprehensive chemistry panel
• cholesterol panel
• thyroid function
• iron levels
  
• vitamin B12 levels
• methylmalonic acid
  
• thiamine
  
• folate
• zinc
• parathyroid hormone
• prealbumin​
  
• H. pylori antigen
• hemoglobin A1C

Other tests, such as pulmonary function, sleep studies, echocardiogram, gastrointestinal evaluation, cardiology evaluation and psychological evaluation may be requested on an individual basis.

Why do I have to have so many medical tests and examinations?

An accurate assessment of your health is needed before surgery to determine your readiness for surgery and to maximize your likelihood of success. Our program offers the safest, most effective intervention for your obesity and may order some additional testing.

Why do I have to have a psychological evaluation?

Bariatric surgery will require significant changes in your lifestyle and will also change your life. 

A psychological evaluation will help prepare you for these changes by giving you coping skills and encouraging behavior modification. 

Additionally, our psychologist will evaluate:

• your understanding and knowledge of the risks and complications associated with weight loss surgery
• whether you have an eating disorder that requires alternative treatment and ​
  
• your ability to follow the basic recovery plan.

What impact does my medical history have on the decision for surgery?

Obesity-related health issues are among the determining factors that may improve your chances of receiving approval for surgery. However, there is a delicate balance of health versus risk that must be considered. 

While weight loss surgery has proven to ​​improve many obesity-related health conditions, individuals who are very sick or who have multiple high-risk complications may not be healthy enough to undergo surgery. 

Your physician will take this information into consideration before making a recommendation.

What can I do before the appointment to speed up the process?

• Work with your physician to ensure that your routine health maintenance testing is current.
• Make a list of all the weight loss attempts you have tried and share it with your doctor.
• Bring any related medical information to your appointment with the surgeon. This includes reports of special tests (echocardiogram, sleep study, etc.) or a hospital discharge summary if you have been in the hospital.
• Check with your insurance provider for a list of preoperative requirements. Some require several months of physician-supervised weight loss efforts. If this is the case, make certain you obtain clear documentation.​​

What are the benefits of laparoscopic surgery?

Typically, patients who have laparoscopic surgery have less discomfort, shorter hospital stays, decreased hernia and wound infection rates, and reduced scarring. They also return to work more quickly.

Will I have a lot of pain?

Every attempt is made to control pain after surgery and to make it possible for you to move about quickly and become active, which speeds recovery. Our staff will work with you to manage your pain immediately following surgery and when you return home. Most patients report minimal discomfort after laparoscopic surgery.

How long do I have to stay in the hospital?

Although it can vary, most adjustable gastric band patients are able to leave the same day as their surgery. Sleeve gastrectomy patients generally go home the day following their surgery,​ and gastric bypass patients typically go home one to two days following their surgery.

How soon will I be able to walk?

Your surgeon will require you to get up and move about almost immediately after surgery​. Patients are asked to walk or stand at the bedside on the night of surgery, and take several walks down the halls the next day and thereafter. Walking is the most effective way to reduce your risk of having a pulmonary embolism.

How soon can I drive?

For your own safety, you should not drive until you have stopped taking narcotic medications and can move quickly and alertly to stop your car, especially in an emergency. Usually this takes seven to 14 days after surgery.

Hospital Stay

What should I bring with me to the hospital?

While basic toiletries (comb, toothbrush, etc.) and a gown may be provided by the hospital, some patients prefer to bring their own. Choose clothes for your stay that are easy to put on and take off. Because of your incisions, your clothes may become stained by blood or other body fluids. 

This is a list of other suggested items to bring that you may find helpful during your stay:

• Reading and writing materials
• Word or number puzzles
• Bathrobe
• Slippers
• Personal care items
  

Life After Surgery

What do I need to do to be successful after surgery?

The basic rules are simple and easy to follow:

• Positive attitude
• Good nutrition
• Exercise
• Follow-up care

Can I get pregnant after weight loss surgery?

Yes, but it is strongly recommended that women wait 18 months to two years after weight loss surgery before becoming pregnant. After about 18 months, your body will have stabilized. Due to the nutritional issues related to both pregnancy and bariatric surgery, you should consult your surgeon as you plan for pregnancy.

With gastric bypass, what happens to the lower part of the stomach that is bypassed?

The stomach is left in place with intact blood supply. In some cases, it may shrink a bit and its lining (the mucosa) may atrophy, but for the most part, it remains unchanged. The lower stomach still contributes to the function of the intestines even though it does not receive or process food. Watch animation

How big will my stomach pouch really be?

What will the staples do inside my abdomen? Is it okay in the future to have an MRI test? Will I set off metal detectors in airports?

The staples used on the stomach and the intestines are very tiny in comparison to the staples you use in the office. The staple materials are also non-magnetic, which means that they will not be affected by MRI and will not set off airport metal detectors.

What if I'm not hungry after surgery?

It's normal not to have an appetite for the first month or two after weight loss surgery.  Patients state that prior to surgery they would “live to eat” but now they “eat to live."

Is there any difficulty in taking medications?

The absorption of most medications will remain the same after surgery. Most pills or capsules are small enough to pass through the new stomach pouch. Extended release medications are an exception​. If you take this type of pill, you should talk with your primary care physician about having it changed if you notice decreased effects.

Most medications are tolerated following weight loss surgery. But patients should use caution when taking a non-narcotic pain medicine such as Motrin, Advil, ibuprofen, aspirin, Aleve or other nonsteroidal anti-inflammatory drugs (NSAIDs).  If you must take these NSAIDs, you may. However, we advise patients to also take an acid-reducing pill such as Prilosec OTC (over the counter) to help protect their stomach against the ulcer forming properties of the NSAIDS.

Is sexual activity restricted?

Patients can return to normal sexual intimacy when wound healing and discomfort permit. Studies have demonstrated an increase in sexual desire and satisfaction following weight loss surgery.

Will I be asked to stop smoking?

Patients are required to stop smoking at least six weeks before surgery and to remain smoke free for the remainder of their life.

If I continue to smoke, what happens?

Smoking increases the risk of lung problems after surgery, can reduce the rate of healing, increases the rates of infection and interferes with blood supply to healing tissues. Also, it will increase the possibility of stomach ulcers after surgery.

How can I know that I won't just keep losing weight until I waste away to nothing?

Patients may begin to wonder about this early after surgery when they are losing 20 to 40 pounds per month, or when they have lost more than 100 pounds and they are still losing weight. 

Two things happen to allow weight to stabilize. First, a patient's ongoing metabolic needs (calories burned) decrease as the body sheds excess pounds. Second, there is a natural gradual increase in calorie and nutrient intake over the months following weight loss surgery. The stomach pouch and attached small intestine learn to work together better. There some expansion in pouch size over a period of months. In the absence of a surgical complication, patients are unlikely to lose weight to the point of malnutrition.

What can I do to prevent excess hanging skin?

When skin loses its elasticity and is unable to return to its previous shape, some patients will choose to have plastic surgery to remove it. Generally, only 10 percent of patients seek plastic surgery consultation. 

Insurance generally does not pay for this type of surgery (often seen as elective surgery). However, some do pay for certain types of surgery to remove excess skin when complications arise from these excess skin folds. Surgeons generally will not recommend surgery for skin removal until at least 18 months after your surgery and when weight loss has been stable for three months.

Will exercise help with excess hanging skin?

Exercise is good in so many ways that a regular exercise program is recommended. Unfortunately, it has not been proven to prevent excess skin.

Will I be miserably hungry after weight loss surgery since I am not eating much?

Somewhat surprisingly, most patients say they transition from “living to eat" to "eating to live” with good control of their hunger. Even if hunger eventually returns, the restriction gained by the small stomach pouch helps provide relief of hunger after minimal food intake.

What if I am hungry?

This is usually caused by consuming the wrong types of food, especially starches (rice, pasta, potatoes). Be absolutely sure not to drink liquid with food since liquid washes food out of the pouch, and avoid starches that will cause an insulin surge, which can lead to hunger.

Will I have to change my medications?

Your doctor will determine whether medications can be stopped when the conditions for which they are taken improve or resolve after weight loss surgery. 

For medications that need to be continued, the vast majority can be swallowed and absorbed, and will work the same as before weight loss surgery. Usually no change in dose is required. 

Two classes of medications that should be used only after talking with your surgeon are diuretics (fluid pills) and nonsteroidal anti-inflammatory drugs (NSAIDs -- most over-the-counter pain medicines). NSAIDs may create ulcers in the small pouch or the attached bowel. Therefore, they should only be taken when approved by your surgeon. Since patients consume less fluid after surgery, the need for diuretics diminishes and places patients at risk for dehydration.

What is a hernia, and what is the probability of an abdominal hernia after surgery?

A hernia is a weakness in the muscle wall where an organ (usually the small bowel) can push through. Approximately 20 percent of patients develop a hernia after an open procedure. Only about 1 percent of patients that have laparoscopic surgery will develop a hernia. Most of these patients require a repair of the herniated tissue.

Is a blood transfusion required during surgery?

Very infrequently. Our surgeons are very conservative and cautious about administering blood products.

What is DVT, and is it preventable?

DVT, or deep vein thrombosis, is when a blood clot forms deep in a vein, especially in the calf and pelvis. It is not completely preventable, but preventive measures will be taken, including:

• Early ambulation (moving around)
• Special calf exercises
• Blood thinners
• Compression boots

Will I lose hair after surgery? How can I prevent it?

Some patients experience thinning hair after surgery. This usually occurs between the fourth and eighth month after surgery. Consistent intake of protein at mealtime is the most important prevention method. Other recommendations include taking a daily zinc supplement, adequate iron intake and drinking plenty of fluids.

Does hair growth recover?

If patients experience hair thinning, most experience natural hair re-growth after an initial period of loss. Frequently it is more full than prior to surgery.

What are adhesions, and do they form after ​surgery?

Adhesions are scar tissues formed inside the abdomen after surgery or injury. Adhesions can form with any surgery in the abdomen. For most patients, these are not extensive enough to cause problems and are rare following laparoscopic surgery.

What is Candida syndrome, and is it preventable?

Some patients have a type of yeast present on the surface of their skin, intestine or vagina at the time of surgery. This leads to overgrowth in certain circumstances. A whitish coating may occur on the tongue or throat. 

Candida syndrome is associated with a frothy mucus, nausea, difficulty swallowing, sore throat, loss of taste and appetite, and, occasionally, abdominal bloating and diarrhea. It can be caused by the use of most antibiotics and some other medications, by stress, by a reduced immune response and by Type 2 diabetes. 

There are several effective medications available for treating the overgrowth of yeast or Candida.

What is sleep apnea?

Sleep apnea is a sleep disorder where a person repeatedly stops and then restarts breathing while sleeping. Sleep apnea often shows rapid improvement after surgery. In most patients, there is a complete resolution of symptoms by six months following surgery.

Diet

How long will I have to wait to eat solid foods after surgery?

We recommend a period of four weeks or more without solid foods after surgery. A liquid diet, followed by puréed foods, will be recommended for at least four weeks until adequate healing has occurred. We will provide you with specific dietary guidelines for the best post-surgical outcome. Read our Nutritional Guidelines

What are the best choices of protein?

Protein is a vital part of a diet. Without protein, our bodies cannot function properly. After bariatric surgery, it is important to eat sufficient protein every day. Getting enough protein helps speed wound healing, preserve your lean body mass, enhance your fat-burning metabolism and minimize hair loss. Here are a few protein suggestions:​

• Add chopped or puréed cooked meats to vegetables, soups or casseroles
• Blend peanut butter into a yogurt smoothie
• Add hard-boiled eggs to salads or sandwiches
• Spoon vanilla yogurt over fresh or canned fruit
• Make a fruit plate with cottage cheese
• Blend cottage cheese with a little bit of lemon juice and seasonings for a vegetable dip
• Add powdered milk to soups, hot cereal, sugar-free cocoa or sugar-free pudding
• Use cottage cheese to stuff pasta shells

Why drink so much water?

When you are losing weight, there are many waste products to eliminate, mostly in urine. Some of these substances tend to form crystals, which can cause kidney stones. 

A high water intake protects you and helps your body rid itself of waste products efficiently. This promotes better weight loss. 

Water also fills your stomach and helps prolong and intensify your sense of satisfaction with food. If you feel a desire to eat between meals, it may be because you did not drink enough water in the hour before.

What is dumping syndrome?

For patients who have had a gastric bypass where the stomach pylorus is bypassed​, eating sugars or other foods that contain many small particles on an empty stomach can cause dumping syndrome. Your body handles these small particles by diluting them with water. This reduces blood volume and causes a shock-like state. 

Sugar may also induce insulin shock due to the altered physiology of your intestinal tract. 

The result is a very unpleasant feeling. You may break out in a cold clammy sweat, turn pale, feel "butterflies" in your stomach and have a pounding pulse. Cramps and diarrhea may follow. This state can last for 30 to 60 minutes and can be quite uncomfortable. You may have to lie down until it goes away. 

This syndrome can be avoided by not eating the foods that cause it, especially on an empty stomach. A small amount of sweets, such as fruit, can sometimes be tolerated at the end of a meal.

Why can't I snack between meals?

Snacking, nibbling or grazing on foods, usually high-calorie and high-fat foods, can add hundreds of calories a day to your intake. This defeats the restrictive effect of your operation. Snacking will slow down your weight loss and can lead to a regain of weight.

Why can't I eat red meat after surgery?

You can, but you will need to be very careful. We recommend that you avoid it for the first several months. 

Red meats contain a high level of meat fibers (gristle), which prevent you from separating it into small parts when you chew. The gristle can plug the outlet of your stomach pouch and prevent anything from passing through, a condition that is very uncomfortable.

How can I be sure I am eating enough protein?

Eating 60 to 70 grams of protein a day is generally enough. Check with your dietitian to determine the right amount for your type of surgery.

Is there any restriction of salt intake?

No, your salt intake will be unchanged unless otherwise instructed by your primary care physician.

Will I be able to eat "spicy" foods or seasoned foods?

Most patients can enjoy spices about three to six months following surgery.

Will I be allowed to drink alcohol?

You will find that even small amounts of alcohol will affect you quickly. It is suggested that you drink no alcohol for the first year. Thereafter, with your physician's approval, you may have a glass of wine or a small cocktail.  Alcohol provides empty calories and can lead to stomach irritation.

Will I need supplemental vitamins?

Yes, you will be required to take supplements for the rest of your life. 

What vitamins and supplements will I need to take after surgery?

The need for nutritional supplements will vary depending on the type of surgery you have and on your own specific health needs. 

All patients will need to take a daily multivitamin for the rest of their lives, as well as calcium and vitamin B12. 

Some patients will require iron supplements as well. Women are more susceptible to iron deficiency, especially if they are still menstruating.

Do I meet with a nutritionist before and after surgery?

We require patients to consult with a nutritionist both before and after surgery to ensure successful outcomes. A bariatric dietitian will continue to meet with you at each of your follow-up appointments.

Will I get a copy of suggested eating patterns and food choices after surgery?

We provide patients with materials that clearly outline the expectations regarding diet and compliance to guidelines for the best outcome based on your surgical procedure. 

After surgery, health and weight loss are highly dependent on patient compliance with these guidelines. 

​You must do your part by restricting high-calorie foods, by avoiding sugar, snacks and fats, and by strictly following the guidelines set by your surgeon.