This guide will provide our prospective bariatric surgery patients with answers to some of the questions our patients often ask during consultations or support groups. These answers are just for informational purposes, but since every person is different, it’s important to discuss your questions and concerns directly with your surgeon at New York Bariatric Group.
What is obesity?
The simple definition of obesity is excess fat tissue. To quantify what excess is, physicians use the body mass index or BMI as a measurement of excess fat tissue. Your BMI is calculated by dividing your weight in kilograms by your height in meters squared or going to our website and entering your information. A BMI of 22-25 is considered normal, 25-30 overweight, 30-35 obese, 35-40 severely obese, and more than 40 morbidly obese. Our bariatric surgery specialists and most insurance companies consider individuals with a BMI of 40 as candidates for surgery, as well as those with a BMI of 30 with a life-threatening complication from their obesity. You can find out your BMI by using our MBI calculator.
Why should you consider surgery for obesity?
Obesity is a very serious medical disease. The alternative to living with obesity would not be any more an option than living with treatable cancer or heart disease. There are many negative impacts of severe obesity on an individual’s life. Obesity can damage joints, muscles, bones, and internal organs. The chance of heart disease, diabetes, sleep apnea, infertility, osteoarthritis, venous insufficiency, gallbladder disease, and certain cancers are increased by obesity. As your weight increases the risks of medical problems increase. There are many social and psychological implications of being obese. Prejudice at school and at the workplace is not uncommon. There is an increased incidence of depression in those affected by morbid obesity. Recent published studies show that severely overweight individuals have a life expectancy of 10 years less than non-obese members of the population. In fact, the National Institutes of Health has a consensus statement on morbid obesity and determined that surgery is the only effective long-term means of weight loss in patients that suffer from morbid obesity. There have been many publications recently that have documented these benefits. Gastric bypass surgery as well as lap sleeve gastrectomy can prevent the progression and mortality associated with Type II diabetes in morbidly obese adults. With medical weight loss, most patients lose weight only to relapse and regain their weight. Exercise and making better food choices are still important. But surgery is a great aid in helping you to reach your goals of living a longer and healthier life. It also promotes long term success. At the New York Bariatric Group, we believe that the most effective long term success in weight loss is achieved by exposing the patient to a multi-disciplinary approach that combines surgery with sound pre-surgery education and superior post-operative support which helps a patient to maximize their weight loss and adjust to their lifestyle change.
What causes obesity?
Obesity or excess fat like many diseases can have multiple factors that contribute to it. Those factors can also vary from patient to patient. In its simplest explanation, the body stores excess energy in fat and obesity occurs when the energy you take in exceeds the amount of energy burned. Obesity is not caused by a lack of willpower but is multi-factorial. There is definitely a genetic component of obesity. Many people work in office settings, children stay inside and play video games and don’t live an active lifestyle. Being active is what burns energy. At the same time, the prevalence of fast food in the US has grown at alarming rates. This combination of the population becoming less active combined with easy access to fast foods with lots of calories and energy has led to an obesity epidemic. Our focus in obesity treatment here at the New York Bariatric Group is to reduce caloric intake and increase exercise to help burn energy and fat. The important thing to remember is that whatever the cause of obesity is, we at the New York Bariatric Group can help that patient to overcome the problems quickly, with less stress and significantly better long term results than through any other means.
When should surgery be considered?
There are many reasons for exploring surgery for obesity. Some people have serious illnesses such as diabetes, sleep apnea, hypertension, heart disease, or degenerative joint disease caused by excess weight. For others, the primary motivation is the psychological impact the weight is having on their lives. Whatever the reason, it is essential to realize that surgery for obesity is a major operation that can have complications. Making the decision to have surgery requires careful thought. The first step in considering any surgery should always be self-education. That is why we have created many patient education tools that can be found on our website. If you meet the criteria for NYC weight loss surgery your next step today should be to register for one of our free seminars held several times each month online at our website.
How can surgery make me lose weight?
There are two ways the gastrointestinal tract can be altered to cause weight loss. The stomach can be made smaller so that a person feels full after eating less food. The second mechanism is bypassing a portion of the intestines that the food comes in contact with. As a result, you don’t absorb all of the calories that you eat, causing malabsorption. Different operations use these two mechanisms in various ways. Some operations are pure gastric restrictive procedures. Many combine gastric restriction with moderate malabsorption. It is important to realize that there is no perfect operation, therefore we discuss the advantages and disadvantages of all potential procedures with our patients. Together we can decide which option best addresses your particular needs.
Why can I expect surgery to work, when I failed so many other weight loss remedies?
Surgery provides a controlled mechanism that is with you everywhere you go. While it is still important to make good decisions and exercise on a regular basis, surgery makes these goals realistic for our patients. Studies show that not only do patients who have bariatric surgery lose more weight than those who only diet and exercise, they are able to keep it off long term. It is important to understand though that surgery is a tool. After bariatric surgery you must change your eating habits and exercise regularly. If not, you will experience unpleasant side effects or even weight gain. On average, patients lose between 60 to 80% of their excess weight and keep the majority off for an extended period. At the New York Bariatric Group, we will do everything we can to ensure your success after bariatric surgery, and have a healthier, happier, and longer life.
What is the worst thing that can happen after obesity surgery?
The worst thing that can happen is that someone can die. However, the risk of surgery is far less than the risk of staying obese. It is very important to choose a bariatric surgeon that is a leader in the field and experienced in handling complications that can arise during obesity surgery. At the New York Bariatric Group, our specialists certainly meet these criteria. Potential complications include, but are not limited to, the risk of anesthesia, infection, leaks, bleeding, blood clots, hernias, and wound complications. This is not stated to frighten you, but to remind you that this is a big decision and not without risks.
What about the size of my incision?
We believe that a minimally invasive approach is the best way to perform bariatric surgery procedures. At our practice , a majority of the surgeries are performed using a minimally invasive technique, either laparoscopically or robotically. These surgeries are performed via the laparoscopic or robotic method where 5-6 tiny incisions are made in the abdomen and surgical instruments are inserted through ports. The New York Bariatric Group is among a select group of surgeons in the country now offering single incision laparoscopic surgery (SILS) LAP-BAND and sleeve gastrectomy which is performed through a single incision hidden in the belly button. This results in much quicker recovery and almost scarless surgery. No one is more experienced than the surgeons at the New York Bariatric Group in this procedure. Ask your doctor if you are a candidate for the new SILS technique.
What are the advantages of minimally invasive procedures?
Minimally invasive surgery is performed through small incisions over the abdomen. The surgeon is able to see the entire operative field using a television monitor. Advantages include a reduction in potential wound complications, less occurrence of hernias, less time under anesthesia, and a faster return to full activity. It is important to understand that these types of operations are more technically challenging and, patients should seek out experienced bariatric surgeons, who have advanced training in the field of bariatric surgery, whose practice mainly consists of this type of surgery and have performed it regularly with great success.
What are the risks of surgery?
We wish to emphasize to our patients that all bariatric surgery operations are major procedures and can have serious risks. The national average mortality rate for bariatric surgery is 0.5%. Although rare, major early complications include bleeding and leakage of intestinal contents causing infection and requiring additional surgery, as well as blood clots amongst others. Wound complications, infections, and hernias can occur. Additionally, there is a small risk of malnutrition and vitamin deficiency. This list is far from exhaustive. While most of these issues rarely arise, the major point is that these procedures should only be done when necessary and by surgeons who have experience in this area.
Will my insurance cover the operation?
After you complete the preoperative work-up, our staff will write a letter to your insurance company. We explain to them that weight loss surgery is NOT a cosmetic procedure, but is an operation which will help you avoid major health problems later in life. Most insurance companies will usually cover the procedure if you meet the criteria. Unfortunately, some insurance policies have a clause that absolutely excludes coverage of weight loss surgery. Unfortunately, there is little to be done in this situation, short of changing insurance companies.
Is there a weight limit for weight loss surgery?
There is no absolute limit for minimally invasive weight loss surgery. People with a BMI greater than 60 have slightly higher risks due to pre-existing comorbid conditions. We usually attempt to perform all procedures in a minimally invasive fashion with small incisions.
Is there a minimum weight required for obesity surgery?
First it is necessary to calculate your body mass index, or BMI. You can check your BMI on our website HERE. For most insurance approvals, the lower limit for weight loss surgery is BMI 40. However, if you have major health problems related to obesity like diabetes, hypertension, sleep apnea you may be a candidate with a BMI as low as 30.
I had previous abdominal surgery. Can my surgery still be performed laparoscopically?
After any abdominal surgery you will develop some adhesions or “scars” inside your abdomen. In most cases previous abdominal surgery is not a problem when performing weight loss surgery. If your surgeon is well-trained in laparoscopic techniques, you definitely remain a candidate for laparoscopic weight loss surgery. The surgeons at the New York Bariatric Group are exceptionally trained in minimally invasive techniques and have performed many operations on patients with previous surgery with excellent results.
Will I be able to get pregnant after gastric bypass surgery?
Women have had healthy babies after weight loss surgery but must follow some rules. You MUST NOT get pregnant during the first 18 months after gastric bypass surgery. If you were to get pregnant during this period your fetus could suffer from abnormal development due to malnutrition. After 18 months it is perfectly safe to get pregnant. Weight loss surgery may make it easier to conceive after you lose the weight. Plus, with the improvement in preoperative health problems like diabetes and hypertension, your chance of a healthy pregnancy is improved. With LAP-BAND® surgery you can even get pregnant sooner than 12 months after surgery.
Will I be miserably hungry after weight loss surgery since I'm not eating much?
Most patients say “NO”. In fact, for the first 4-6 weeks many patients have almost no appetite. Over the next several months the appetite returns, but it tends not to be a ravenous type of hunger, and “satisfaction” is gained by eating less.
How will alcohol affect me after surgery?
You will find that even small amounts of alcohol will affect you quickly. Even one standard bar drink may be too much! You will have higher blood levels with smaller amounts consumed and this is also more toxic on your liver. Patients who drive or operate equipment are cautioned to take this into consideration when drinking, although not part of the question we encourage patients not to drink carbonated beverages and to moderate their drinking of coffee, tea, and high in caffeine beverages. These drinks can cause the pouch that is formed through surgery to expand.
How long will I be in the hospital after the surgery?
Most patients will go home from the hospital in 2 days for laparoscopic gastric bypass surgery and go home the same day or spend one night in the hospital for the LAP-BAND®
How long after the surgery can I return to work?
Most patients can usually be back to work in 7-10 days after the laparoscopic gastric bypass. Everyone heals differently with different pain tolerances and this can vary among patients. Dr. Garber once had a patient that operated a construction crane for a living and returned to work 7 days after the surgery.
What are the advantages of having my obesity surgery with the New York Bariatric Group?
New York Bariatric Group is one of the top facilities for single incision laparoscopic Adjustable Gastric Band and gastric bypass surgery in the tri-state area. One of the major advantages of choosing New York Bariatric Group for obesity surgery is the high number of weight loss surgeries performed. As a result, both the professional and ancillary staff are familiar with the unique needs of obesity surgery patients. We are also at the forefront of the newest technologies in bariatric surgery.
After I lose weight can I lose the LAP-BAND®?
Even though it is removable, the Lapband is meant to stay with you as a permanent tool. If the LAP-BAND® were removed you would no longer have the tool that helped you lose the weight and you would gain all the weight back and maybe add some. You would no longer feel full after eating small portions and would get hungry quicker after eating small meals. Instead, you would probably start eating large meals again. It is a great feature to know that if the LAP-BAND® were to be removed the anatomy is back to its natural state. Unless there is a medical reason to remove the LAP-BAND® we encourage our patients to leave the LAP-BAND® in for the rest of their lives.
How do I choose the right procedure for me?
Selecting a bariatric procedure is an individual choice. You should consider going to a weight loss surgery seminar and talking to people who have had surgery, which can be done by attending a support group. You should consider the basic attributes of the procedures and decide what is important to you, what is right for your personality, and the situation. Your surgeon can help you come to a decision based on your medical history and the data available. You should certainly ask questions and discuss your individual situation with your surgeon. We want you to make the decision that is right for you.
What makes a patient successful after surgery?
There are two keys to success. Using your surgery as a tool and following up with your surgeon. Those are critical regardless of which procedure you have done. Weight loss surgery is a tool to help make lifestyle changes. It is important to make some behavior and nutritional modifications in order to make the tool work optimally. For example you will be instructed to avoid high calorie liquids like milkshakes because they will pass quickly through your stomach and you will not get the benefit of having had the procedure. Grazing or snacking also allows you to eat too many calories particularly if you are making poor food choices. Successful patients are also those that make the time to exercise regularly, slowly building up their conditioning with cardio activity. Follow-up with your surgeon is also critical. It is not only important to make sure that you are healthy, but it is also important to keep you on track with using your new tool properly. And of course if you have a LAP-BAND®, having your band adjusted to meet your body’s needs is essential to have it work best. We hope to see you for years after your surgery and consider our patients to be patients for life.
How will I know when my LAP-BAND® needs to be adjusted?
You will get your first adjustment about 5 to 6 weeks after surgery. We wait this time to give you an opportunity to get used to living with the band. It also assures that the swelling around the stomach has subsided. After the first adjustment, your following adjustments will be determined by how you feel. If you are hungry often that is an indication that you need to have the band tightened by adding fluid. In addition, there may be times when we will need to remove fluid from your band if you are having difficulty swallowing or are having acid reflux. Those are symptoms that your band may be too tight. Adjustments are individual for everyone. Patients are tempted to compare how fluid in their band to how much their friend has, but everyone’s stomach senses band tightening differently. So comparison is meaningless. You will need to determine how you feel and discuss it with your surgeon. Our goal with adjustments is to get you to the point when you are getting full quickly, staying full for a long period of time, and are losing one to two pounds per week.
Will I have sagging skin after weight loss surgery?
As you lose weight exercise may improve the hanging skin by increasing muscle tone. You can also help your skin through good nutrition and hydration. Some patients find loose skin enough of a problem to have plastic surgery. They can dress so that it is not apparent. If you decide to have surgery we can refer you to a plastic surgeon. Sagging skin is a common concern prior to surgery but sagging skin is much less of an issue than the health problems caused by excess weight.
Who is a candidate for single incision LAP-BAND® and lap sleeve gastrectomy surgery?
The single incision technique involves making only one incision hidden in the belly button instead of the traditional five incisions. This technique cannot be used for all patients. Females and patients with lower BMI’s are the best candidates for this procedure. The procedure can also be performed on lower BMI males. As our experience and the equipment we use improves, larger BMI patients may also qualify for this technique. Previous upper abdominal surgery may also preclude the chances of having a single incision. At the New York Bariatric Group we have one of the largest experiences with single incision surgery in the US and teach other surgeons across the country. We recommend you discuss this option with your surgeon at the time of your consultation.
