FAQ about Surgical Weight Loss

Obesity becomes “morbid” when it reaches the point of significantly increasing the risk of one or more obesity-related health conditions or serious diseases (also known as co-morbidities) that result either in significant physical disability or even death. According to the National Institutes of Health Consensus Report, morbid obesity is a serious disease and must be treated as such. It is a chronic disease, meaning that its symptoms build slowly over an extended period.

As you read about morbid obesity, you may also see the term “clinically severe obesity” used. Both are descriptions of the same condition and can be used interchangeably. Morbid obesity is typically defined as being 100 lbs. or more over ideal body weight or having a body mass index (BMI) of 40 or higher.

The reasons for obesity are multiple and complex. Despite conventional wisdom, it is not simply a result of overeating. Research has shown that in many cases, a significant, underlying cause of morbid obesity is genetic. Studies have demonstrated that once the problem is established, efforts such as dieting and exercise programs have a limited ability to provide effective long-term relief.

Science continues to search for answers. But until the disease is better understood, the control of excess weight is something patients must work at for their entire lives. That is why it is very important to understand that all current medical interventions, including weight loss surgery, should not be considered medical cures. Rather, they are attempts to reduce the effects of excessive weight and alleviate the serious physical, emotional and social consequences of the disease.

• Contributing Factors. The underlying causes of severe obesity are not known. However, there are many contributing factors that can lead to the development of obesity including genetic, hereditary, environmental, metabolic and eating disorders. There are also certain medical conditions that may result in obesity, like hypothyroidism or the intake of steroids.
• Genetic Factors. Numerous scientific studies have established that genes play an important role in a person’s tendency to gain excess weight.The body weight of adopted children shows no correlation with the body weight of their adoptive parents, who feed them and teach them how to eat. Their weight does have an 80 percent correlation with their genetic parents, even if they have never met. Identical twins, with the same genes, show a much higher similarity of body weights than do fraternal twins, who have different genes.We probably have several genes directly related to weight. Just as some genes determine eye color or height, others affect our appetite, our ability to feel full or satisfied, our metabolism, our fat-storing ability, and even our natural activity levels.Certain groups of people, such as the Pima Indian tribe in Arizona, have a very high incidence of severe obesity. They also have significantly higher rates of diabetes and heart disease than other ethnic groups.The Pima Indians are known in scientific circles as one of the heaviest groups of people in the world. In fact, National Institutes of Health researchers have been studying them for more than 35 years. Some adults weigh more than 500 pounds, and many obese teenagers are suffering from diabetes, the disease most frequently associated with obesity.But here’s a really interesting fact—a group of Pima Indians living in Sierra Madre, Mexico, does not have a problem with obesity and its related diseases. The leading theory to explain this states that after many generations of living in the desert, often confronting famine, the most successful Pima were those with genes that helped them store as much fat as possible during times when food was available. Now those fat-storing genes work against them.

  Though both populations consume a similar number of calories each day, the Mexican Pima still live much like their ancestors did. They put in 23 hours of physical labor each week and eat a traditional diet that’s very low in fat. The Arizona Pima live like most other modern Americans, eating a diet consisting of around 40 percent fat and engaging in physical activity for only 2 hours a week.The Pima apparently have a genetic predisposition to gain weight. And the environment in which they live in Arizona makes it nearly impossible for them to maintain a normal, healthy body weight.

• Environmental Factors. Environmental and genetic factors are obviously closely intertwined. If you have a genetic predisposition toward obesity, then the modern American lifestyle and environment may make controlling weight more difficult.Fast food, long days sitting at a desk, and suburban neighborhoods that require cars all magnify hereditary factors such as metabolism and efficient fat storage.For those suffering from morbid obesity, anything less than a total change in environment usually results in failure to reach and maintain a healthy body weight.
• Metabolism. We used to think of weight gain or loss as only a function of calories ingested and then burned. Take in more calories than you burn, gain weight; burn more calories than you ingest, lose weight. But now we know the equation isn’t that simple.Obesity researchers now talk about a theory called the “set point,” a sort of thermostat in the brain that makes people resistant to either weight gain or loss. If you try to override the set point by drastically cutting your calorie intake, your brain responds by lowering metabolism and slowing activity. You then gain back any weight you lost.
• Eating disorders and medical conditions. Weight loss surgery is not a cure for eating disorders. And there are medical conditions, such as hypothyroidism, that can also cause weight gain. That’s why it’s important that you work with your doctor to make sure you do not have a condition that should be treated with medication and counseling.

There are several medically accepted criteria for defining morbid obesity. You are likely morbidly obese if you are:

• more than 100 lbs. over your ideal body weight;
• have a body mass index (BMI) over 40;
• have a BMI of over 35 and are experiencing severe negative health effects, such as high blood pressure or diabetes, related to being severely overweight; or
• unable to achieve a healthy body weight for a sustained period, even with medically supervised dieting

Use our BMI Calculator to calculate your Body Mass Index.

Obesity-related health conditions are health conditions that, whether alone or in combination, can significantly reduce your life expectancy. A partial list of some of the more common conditions follows. Your doctor can provide you with a more detailed and complete list.

• Type 2 diabetes. Obese individuals develop a resistance to insulin, which regulates blood sugar levels. Over time, the resulting high blood sugar can cause serious damage to the body.
• High blood pressure or heart disease. Excess body weight strains the ability of the heart to function properly. The resulting hypertension (high blood pressure) can result in strokes, as well as inflict significant heart and kidney damage.
• Osteoarthritis of weight-bearing joints. The additional weight placed on joints, particularly knees and hips, results in rapid wear and tear, along with pain caused by inflammation. Similarly, bones and muscles of the back are constantly strained, resulting in disk problems, pain and decreased mobility.
• Sleep apnea or respiratory problems. Fat deposits in the tongue and neck can cause intermittent obstruction of the air passage. Because the obstruction is increased when sleeping on your back, you may find yourself waking frequently to reposition yourself. The resulting loss of sleep often results in daytime drowsiness and headaches.
• Gastroesophageal reflux or heartburn. Acid belongs in the stomach and seldom causes any problem when it stays there. When acid escapes into the esophagus through a weak or overloaded valve at the top of the stomach, the result is called gastroesophageal reflux, and “heartburn” and acid indigestion are common symptoms. Approximately 10–15 percent of patients with even mild, sporadic symptoms of heartburn will develop a condition called Barrett’s esophagus, which is a pre-malignant change in the lining membrane of the esophagus, a cause of esophageal cancer.
• Depression. Seriously overweight people face constant challenges to their emotions: repeated failure with dieting, disapproval from family and friends, sneers and remarks from strangers. They often experience discrimination at work, cannot fit comfortably in theatre seats, or ride in a bus or plane.
• Infertility. In women, obesity can lead to interruption of the menstrual process and other issues. Obesity in men can affect their sperm count and quality.
• Urinary stress incontinence. A large, heavy abdomen and relaxation of the pelvic muscles, especially associated with the effects of childbirth, may cause the valve on the urinary bladder to be weakened, leading to leakage of urine with straining, coughing, sneezing or laughing.
• Menstrual irregularities. Morbidly obese individuals often experience disruptions of the menstrual cycle, including interruption of the menstrual cycle, abnormal menstrual flow and increased pain associated with the menstrual cycle. This can also lead to fertility issues.

Weight loss surgery is major surgery. Although most patients enjoy an improvement in obesity-related health conditions (such as mobility, self-image and self-esteem) after the successful results of weight loss surgery, these results should not be the overriding motivation for having the procedure. The goal is to live better, healthier and longer.

That is why you should make the decision to have weight loss surgery only after careful consideration and consultation with an experienced bariatric surgeon or a knowledgeable family physician. A qualified surgeon should answer your questions clearly and explain the exact details of the procedure, the extent of the recovery period and the reality of the follow-up care that will be required. As part of routine evaluation for weight loss surgery, you should be required to consult with a dietitian/nutritionist and a psychiatrist/therapist. This is to help you establish a clear understanding of the post-operative changes in behavior that are essential for long-term success.

It is important to remember that there are no iron-clad guarantees with any kind of medicine or surgery. There can be unexpected outcomes in even the simplest procedures. What can be said, however, is that weight loss surgery will only succeed when the patient makes a lifelong commitment. Some of the challenges facing a person after weight loss surgery can be unexpected. Lifestyle changes can strain relationships within families and between married couples.

To help patients achieve their goals and deal with the changes surgery and weight loss can bring, most bariatric surgeons offer follow-up care that includes support groups, dietitian appointments and other forms of continuing education.

Ultimately, the decision to have the procedure is entirely up to you. After having all the information, you must decide if the benefits outweigh the side effects and potential complications. This surgery is only a tool. Your ultimate success depends on strict adherence to the recommended dietary, exercise and lifestyle changes.

Lap band surgery is not right for everyone. Here are some of the criteria for lap band surgery we will consider when evaluating your candidacy for obesity surgery.

Surgery should not be considered until you and your doctor have evaluated all other options. As with all surgeries, there are risks associated with this procedure. If complications occur during the operation, your doctor may choose to perform open surgery. Your doctor must first determine if you are an appropriate surgical candidate.

The proper approach to weight-loss surgery requires discussion and careful consideration with your doctor. You should understand:

• These procedures are in no way to be considered as cosmetic surgery.
• The surgery does not involve the removal of adipose tissue (fat) by suction or excision.
• The decision to have surgical treatment requires an assessment of the risk and benefit to the patient and the meticulous performance of the appropriate surgical procedure.
• These weight loss surgical procedures are not reversible (except for the adjustable gastric band in some situations).
• The success of weight loss surgery is dependent upon long-term lifestyle changes in diet and exercise. Problems may arise after surgery that may require additional surgeries.
• Success of surgical treatment must begin with realistic goals and progress through the best possible use of well-designed and tested operations.

As with any surgery, there are operative and long-term complications and risks associated with weight loss surgical procedures that should be discussed with your doctor. Possible risks include, but are not limited to:

• Bleeding*
• Complications due to anesthesia and medications
• Deep vein thrombosis
• Dehiscence (a condition known as “wound separation”)
• Infections
• Leaks from staple line breakdown
• Marginal ulcers
• Pulmonary problems
• Spleen injury*
• Stenosis

*Removal of the spleen is necessary in about 0.3% of patients to control operative bleeding.

We perform most weight loss surgeries laparoscopically (minimally invasively with smaller incisions and tools); however, if complications occur during the operation, your surgeon may need to perform open surgery.

Gastric bypass surgery is considered the “gold standard” of weight loss surgery. It produces significant long-term weight loss (60 to 80 percent excess weight loss)

There are two types of second weight loss surgical procedures: conversion surgery and revisional surgery.

No, gastric bypass surgery  is not reversible and requires a lifetime commitment.

We do not mandate a liquid diet or weight loss unless your physician specifically requests it before your surgery. However, it is important that you not gain any weight once you have started our weight loss program. Review the dietary guidelines we provided during your consultation and let us know if you have any questions.

Our staff works hard during the process to make sure that you are approved for surgery by your insurance provider. If you have any questions, please let us know.

If you are having sleeve gastrectomy or gastric bypass surgery, you will be required to stay in the hospital two nights and will typically go home on the morning of the third day. Be sure to arrange for your transportation in advance, bring your own protein drink and comfortable clothes to wear home.

Make sure you have some support for at least the first 24 hours after surgery and when you go home from the hospital.

The first few months after surgery will be very challenging because you will not be eating like you previously did. We encourage you to advantage of our support group and follow your dietary guidelines. Your daily goal is to have 3 meals per day with maybe a small snack. Each meal should have at least 20 grams of protein. The ideal protein range is 60–90 grams per day. Make an appointment with our dietitian after surgery.

Your ability to resume pre-surgery levels of activity will vary according to your physical condition, the nature of the activity and the type of weight loss surgery you had. Many patients return to full pre-surgery levels of activity within 6 weeks of their procedure.

We strongly advise women of childbearing age use the most effective forms of birth control during the first 16 to 24 months after weight loss surgery. The added demands pregnancy places on your body and the potential for fetal damage make this an important requirement.

If you have any problems or questions, please call our office. Our office is open weekdays from 9 AM to 5 PM, and one of our surgeons is always on call when the office is closed.

Alcohol has a high number of calories and breaks down vitamins. An occasional glass of wine or other alcoholic beverage, though, is not considered harmful to weight loss.