Weight-loss surgery, also called bariatric surgery, has proved to be effective in significantly and quickly reducing the amount of excess body fat in obese individuals.
All the main operations are good and have impressive success rates. However, the people who get matched with the best operation for them, who sort out their aftercare and make on-going lifestyle and dietary changes, are the people who consistently have the best long-term results.
Here are the main procedures that you and your surgeon may consider:
The gastric balloon device is often associated with weight-loss surgery but in fact it is not a surgical procedure.
The gastric balloon is a highly-effective form of non-surgical weight-loss intervention.
It is recommended for patients who are overweight, which is defined as having a Body Mass index (BMI) of 27 or more who have struggled to lose weight through diet and exercise alone.
How the Gastric Balloon Works
The gastric balloon is a soft silicone sac which is placed into the stomach. The balloon is inserted empty and then filled using sterile saline.
Once in place, the balloon takes up volume in the stomach, so that the patient needs to eat much less before the stomach sends ‘feeling full’ signals to the brain. They therefore stop eating
sooner and consumer fewer calories.
The balloon stays in place for 6 months, after which time it is deflated and removed.
Benefits of the Gastric Balloon
Patients can expect to lose up to 3 stone in the first 6 months with the gastric balloon. It is a good option for patients who are looking to kick-start their diet and healthy eating regime which they will then carry on themselves.
The gastric balloon is also sometimes used for morbidly obese patients who need to lose weight to improve their health before having a gastric bypass procedure, which is invasive surgery. As the balloon is not a surgical procedure, recovery is much faster and the procedure is much safer, requiring no anaesthetic.
Gastric balloons are normally carried out under light sedation. It is a relatively straightforward day-case and requires no overnight stay.
Gastric Balloon Diet
In order to be successful with the gastric balloon, patients need to commit to change their dietary habits for life. The balloon is a useful tool to start the process.
As with other weight-loss surgery procedures, a special staged ‘gastric balloon diet’ will be recommended. However, patients are able to move through the liquid and soft diet stages very much faster and after 10 days should be eating a ‘normal diet’.
Patients will be consuming fewer calories, so it is all the more important to make good choices as to what food is consumed. A healthier, balanced diet is essential after gastric balloon.
The gastric band, also known as the ‘lapband’ is the most popular weight-loss procedure in the UK today (although other surgical procedures are gaining ground).
It is a surgical solution to achieving weight-loss results and is recommended for patients who are overweight or obese with a Body Mass Index (BMI) over 35, or over 30 if there are already obesity-related health concerns.
Popularised by celebrities, it now appeals to people from all walks of life, offering a clinically proven means of achieving weight-loss where diet and exercise have failed.
How the Gastric Band Works
The gastric band works to restrict the amount a person can eat by reducing their appetite and reducing the stomach’s capacity.
The band device is placed around the top of the stomach to divide it into a characteristic hour-glass shape. The top half of the stomach feels full faster. Food then passes into the lower section of the stomach and is then digested as normal.
The patient feels fuller sooner and for longer and therefore loses weight simply by eating less.
Benefits of Gastric Band Surgery
The key benefit of the gastric band over other forms of surgery is that it is adjustable and even reversible if required. Adjustability means that the patient’s weight-loss can be controlled. In the early months, the band will be tightened a number of times after surgery in order to provide greater restriction on the stomach. This accelerates weight loss, although that is always in a controlled manner as it is not desirable to lose too much weight very quickly.
Once the weight loss target has been met, the band will usually be loosened slightly to provide ‘optimal restriction’ so that the weight-loss can be maintained for the long term.
Gastric band surgery is normally carried out under general anaesthetic as a laparoscopic, or ‘keyhole’ procedure. Patients should expect to spend a night in hospital before leaving to recover at home.
Gastric Band Diet
In order to be successful with the gastric band, patients should expect to change their dietary habits. A staged ‘gastric band diet’ will be advised by the surgeon.
Firstly, before having surgery, patients are usually required to follow a pre-operative diet to reduce the size of the liver to make surgery as safe and as straightforward as possible.
After surgery, patients initially follow a liquid diet, gradually progressing through a pureed diet to a soft diet and then eventually to a normal diet.
Throughout these stages, it is vital to follow medical and dietary advice. Patients will be consuming fewer calories after surgery, so it is all the more important to make good choices as to what food is consumed. A healthy, balanced diet is key to this.
The gastric sleeve is also sometimes known as ‘sleevectomy’ or ‘sleeve gastrectomy’ procedure. It is a highly-effective form of weight-loss surgery with clinically-proven results. Patients can expect to lose 30-50% of their excess weight in the first year alone.
It is recommended for patients who are seriously overweight, or obese with a Body Mass Index (BMI) of 35 or more, which is defined as being ‘severely obese’.
How the Gastric Sleeve Works
The gastric sleeve procedure involves removing part of the stomach to create a smaller, slimmer stomach pouch, which has a characteristic ‘sleeve shape’.
After surgery, a smaller stomach means that there is a lower capacity for food, so patients feel full sooner and for longer.
In addition, the part of the stomach that is removed is associated with the production of the hunger hormone ghrelin, so this further represses the patient’s appetite.
Benefits of Gastric Sleeve Surgery
The key benefit of the gastric sleeve is that it is a less invasive form of surgery compared to the gastric bypass, yet offers more aggressive weight-loss results than the gastric band for those patients that fall into the severely obese or morbidly obese categories.
Gastric sleeve surgery is normally carried out under general anaesthetic as a laparoscopic, or ‘keyhole’ procedure, although in certain cases an ‘open procedure’ may be undertaken. Patients should expect to spend 2-3 nights in hospital before leaving to recover at home.
The gastric sleeve may also be converted to a gastric bypass later. For some patients it is performed as ‘step 1’, enabling them to lose weight and be healthier before the full gastric bypass is completed.
The good news is that after weight loss, obesity-related conditions, such as diabetes (type 2), high blood pressure or sleep apnoea can be expected to improve considerably and go into remission.
Gastric Sleeve Diet
In order to be successful with the gastric sleeve, patients should expect to change dietary habits and a staged ‘gastric sleeve diet’ will be advised by the surgeon.
Before surgery, patients are usually required to follow a pre-operative diet to reduce the size of the liver to make surgery as safe and straightforward as possible.
After surgery, patients initially follow a liquid diet, gradually progressing through a pureed diet to a soft diet and eventually a normal diet.
Throughout these stages, it is vital to follow medical advice. Patients will be consuming fewer calories, so it is all the more important to make good choices as to what food is consumed. A healthier, balanced diet is essential after gastric sleeve surgery.
The gastric bypass is the most invasive weight-loss surgery procedure offering the greatest potential weight loss. It is suited to those with a significant amount of weight to lose and offers clinically proven results.
It is recommended for patients who are overweight or obese with a Body Mass Index (BMI) over 40, which is defined as ‘morbidly obese’. At this weight, the patient often has obesity-related conditions, such as diabetes (type 2), high blood pressure or sleep apnoea. This makes losing weight a very high priority in order to improve the patient’s health and quality of life.
How the Gastric Bypass Works
The gastric bypass procedure involves creating a new stomach pouch, which will literally be the size of a golf ball or egg; limiting the amount that the patient can eat.
Then, a section of small intestine is attached to the stomach pouch, allowing food to bypass most of the small intestine so that the body’s absorption of calories and nutrients is significantly reduced.
The procedure therefore works on two levels. Due to the small stomach capacity, the patient will be far less hungry and will want to eat much smaller portions as they will be satisfied very quickly when eating. In addition, due to the bypass, the food that they do eat will be absorbed less readily by the body. Therefore gastric bypass patients achieve high levels of weight loss.
Gastric Bypass Diet
In order to be successful with the gastric bypass, patients should expect to change their dietary habits and a staged ‘gastric bypass diet’ will be advised by the surgeon.
Before having surgery, patients are usually required to follow a pre-operative diet to reduce the size of their liver to make surgery as safe and as straightforward as possible.
After surgery, patients initially follow a liquid diet, gradually progressing through a pureed diet to a soft one and then eventually to a ‘normal’ diet.
Throughout these stages it is vital to follow medical advice. Patients will be consuming fewer calories, so it is all the more important to make good choices as to what food is consumed. A healthier, balanced diet is essential after gastric bypass surgery.
In addition, gastric bypass patients will be required to take supplements ….vitamins and minerals for the rest of their life. Blood tests on a regular basis are also recommended so that any deficiencies are spotted early and can be rectified.
The mini-gastric bypass procedure is restrictive and malabsorptive. This means that the procedure reduces the size of your stomach, restricting the amount you can eat. The procedure also reduces absorption of food by bypassing up to 6 feet of intestines. Gastric bypass and the mini-gastric bypass are both malabsorptive and restrictive procedures. Gastric sleeve and the Lap Band are restrictive procedures.
Why Was The Mini-Gastric Bypass Created?
The mini-gastric bypass was developed to reduce operating time, simplify the procedure and reduce complications. Recent studies show that it does reduce operating time, may lead to similar weight loss (some studies show that mini-gastric bypass may actually produce more weight loss), and reduce overall complication rates compared to gastric bypass surgery.
Why Doesn’t Everyone Choose Mini-Gastric Bypass?
Mini-gastric bypass is currently not covered by most insurance carriers. And there are not enough surgeons trained on this procedure. While more data is showing up that supports the claims that mini-gastric bypass surgery is equal to or slightly better than gastric bypass surgery, there is still not enough data to warrant insurance coverage and mass adoption.
Mini-gastric bypass is a quicker operation compared to traditional laparoscopic gastric bypass surgery. Operating times are reduced, on average by 50 minutes.
- The stomach is divided with a laparoscopic stapler. Most of the stomach is no longer attached to the esophagus and will no longer receive food. Your new stomach is much smaller and shaped like a small tube.
- Between 2 to 7 feet of intestines are bypassed. The surgeon will attach the remainder of the intestines to the new stomach.
- Food now flows into your small tub-like stomach and then bypasses between 2 to 7 feet of intestines where it resumes the normal digestive process in you’re the remaining intestine.
Benefits of Mini Gastric Bypass Compared to Gastric Bypass Surgery
- Shorter operating time.
- Less re-routing of the intestines.
- One fewer anastomosis (connection of intestines), which in theory means less chance of a complication.
- Technically easier for the surgeon.
- Similar weight loss and recovery.
Additional Risks With Mini-Gastric Bypass Compared To Gastric Bypass
- Severe acid-reflux. Because the pouch is small and the remainder of the stomach is still connected to the intestines. It is possible for gastric juices to travel down the intestines and into the new pouch.
Recovery, Pain and Complications
Recovery, pain and complications are very similar to traditional gastric bypass surgery.
After surgery you will have some belly pain, particularly at your incision sites. The incision sites, typically 5, are between 5mm and 12mm in length. This is where the surgeon inserted ports to access your abdomen.
You will typically be required to stay overnight in the hospital. Occasionally patients are kept an additional day for observation.
Once you are home, you’ll be required to follow a strict diet. A liquid diet (soft food) is usually required for the first two weeks after surgery. This may include protein shakes, water, pureed soft foods, and soup. Follow the instructions from your surgeon. After two weeks, soft foods are introduced. And after a month you’ll be back to normal foods. However, you’ll be asked to follow a new diet that will include more protein, vegetables and fruit. Your stomach is much smaller and there is no room for junk food (you need to maximize nutrients from every bite you eat).
Pain is usually not an issue. Yes, you will be in some pain. This is particularly true during the first two weeks and is very evident when you twist your torso. Pain can be managed well with medication.
You’ll be encouraged to get up and move every day after surgery. The first few days usually include walks around the house. After a week you may be asked to take 20 minute walks twice a day. Gradually increasing exercise is encouraged with each week after surgery. Again, follow your surgeons instructions.
Be prepared to be tired as you lose weight fast and adjust to a lower calorie diet. Fight through this phase. It does pass. A regular exercise routine will help your body adjust.
Complications are similar to gastric bypass surgery. They range in severity from minor to significant.
Minor complications include hernias at the surgical site, ulcers, and minor incision infections.
Major complications typically occur within the first three weeks after surgery. Significant complications include staple line leaks, pulmonary embolisms, and strictures, among other risks. These should be managed promptly by your surgeon. Before surgery you should be made aware of the risks and signs and symptoms of these complications.
Should You Choose To Have Mini-Gastric Bypass?
It’s difficult to say. And most surgeons have differing opinions on this. Currently, there is not enough data, nor enough surgeons offering the procedure to give a definitive answer. As with all weight loss procedures, discuss this and all of your options with a qualified bariatric surgeon.
The duodenal switch (DS) procedure, also known as biliopancreatic diversion with duodenal switch (BPD-DS) or gastric reduction duodenal switch (GRDS), is a weight loss surgery procedure that is composed of a restrictive and a malabsorptive aspect.
CHOOSING A WEIGHT-LOSS SURGERY PROVIDER
Having a weight-loss procedure is a big, life-changing decision and it is important to choose a reputable company, experienced surgeon and reliable bariatric-surgery team.
You will need to look at reputations, what is offered, costs, aftercare provision and location when making your decision.
I would always recommend choosing a group within your own country and ideally not too far away for appointments and speedy action for any problems that may arise.
Many, many groups offer the same basic package and are competitive on initial price. However, I would urge anyone looking for a provider to check the aftercare package. How often will you get a post-op check-up; how many times will you see the dietician or bariatric nurse; do they have a support group associated with the hospital/clinic for additional support; and do they have an interactive website (perhaps with forum or advice) to help on the weight-loss journey and put you in touch with other patients?
Also do they offer some food advice beyond the dietician….recipes, updates on food products, ways to keep active and some emotional eating strategies by those who have travelled the weight-loss surgery road?
Good after-care includes the provision of these and a full team of nurses, dieticians and counsellors to help patients succeed…so don’t sell yourself cheap…they really do matter.
This page has been written as a quick guide to the most popular weight-loss surgery procedures. For more information on topics like success rates, risks, funding etc I recommend that you visit the charitable website – http://wlsinfo.org.uk/
CHOOSING A SURGEON FOR WLS
Although the title of this review is “Choosing a Surgeon”, the key to successful bariatric surgery is choosing the right “team”. The patient’s journey doesn’t start in the operating theatre; it starts in the careful pre-operative assessment phase- by surgeon, anaesthetist, dietician and specialist nurse. In some cases other professionals such as psychologists, gastroenterologists and endocrinologists complement this assessment. The Bariatric Multi-Disciplinary Team (MDT for short) provides your care from the day of assessment onwards. The surgeon is central to the team in providing the actual bariatric procedure, and understandably patients will focus on this, but as a surgeon myself I know that the MDT is the key to long term weight-loss and quality of life.
The route to bariatric surgery generally takes two forms- a self-funded pathway (private surgery, either carried out in the UK or abroad) or through the NHS. I have mapped out the various stages involved in these pathways, and will briefly go through each step. Bariatric units must adhere to the highest possible standards- they should only offer surgery to patients who meet national criteria. In the United Kingdom this means patients must satisfy the NICE criteria. A recent Radio 4 report identified private surgeons who were prepared to offer bariatric surgery to patients whose BMI was lower than the NICE criteria. Fortunately, this is an uncommon finding in the bariatric field, but patients need to be aware that sharp practice can take place.
SELF-FUNDED (UNITED KINGDOM) – Choosing Your Surgeon
The General Medical Council maintains a specialist register with the names of all consultant surgeons in the United Kingdom. Your surgeon should be on that register. He or she will hold a CCT/CCST (Certificate of Completion of Training/Certificate of Completion of Specialist Training). At present there is no difference between these two certificates. Your surgeon will need to hold a Fellowship of one of the royal college of surgeons (FRCS). More recently surgeons have to obtain the FRCS (General Surgery), this is a specialist exam taken by surgeons before they are awarded their CCT. Surgeons who perform bariatric surgery are most likely to have been trained in upper gastrointestinal (stomach, gullet, liver and pancreas) surgery.
There are a number of professional organisations to which your surgeon can belong, such as the Association of Upper Gastrointestinal Surgeons (AUGIS) or the British Obesity & Metabolic Surgery Society (BOMSS). Membership of these societies can mean they are up to date with the latest techniques, although this cannot be guaranteed.
Every surgeon offering bariatric surgery should be competent. It is vital that you ask your surgeon the following questions:
Where and how were you trained?
Bariatric surgery is new to the UK. There is only a small number of experienced surgeons- therefore as the demand for surgery grows; new surgeons will need to be trained. A surgeon who has been trained by an experienced surgeon is likely to have been taught how to the procedure safely and efficiently. Beware the occasional surgeon who has not been trained!
How many procedures have you done?
It is tempting to assume that doing lots of operations means the same as doing lots of operations well. The number of cases is an indicator of quantity, but may not reflect quality. That said, quality surgeons tend to attract a large quantity of work. For more inexperienced surgeons, ask about the training and mentoring they have had, or whether a more senior colleague is on hand for advice etc.
The most important question, however, is
What are your outcomes?
Your surgeon should know the expected weight loss for each operation they do- make sure they give you their figures, not just the national averages. The same applies to their complication rates. The important compilations you need to know about are
1. Mortality (Death) Rate
Bariatric surgery is generally safe. The safest procedure is the gastric band (mortality rate 1 in 2000 cases). The gastric bypass and duodenal switch have a mortality rate of around 1 in 200 cases.
The commonest causes of death are a clot on the lungs (pulmonary embolism or PE) arising from a clot in the veins of the legs (deep vein thrombosis or DVT), or leaks from any join-ups made in the operation.
2. Pulmonary Embolism and Deep Vein Thrombosis Rate
Ask your surgeon what steps they use to prevent this from happening. An effective way is injections of heparin that take place before surgery and for a period after surgery (around 1-3 weeks).
3. Leak Rate
4. Other Complications
This includes wound infections and chest infections. Most minor complications would fall into this category.
The answers to these questions should give you an idea of whether this surgeon is for you.
Choosing your Bariatric Unit
Your surgeon should not be working alone. They should be part of a dynamic multi-disciplinary team (MDT). The team should have a specialist anaesthetist, dietician and nurse. The team should be able to call upon other specialists, as needed e.g. psychologists.
It is an unfortunate fact that many in the medical and nursing profession have a negative attitude towards the obese patient. They see obesity as an expression of gluttony and self-neglect, not as a serious medical condition. Patients who undergo bariatric surgery are at a very vulnerable stage and a careless comment or remark can be very hurtful. Having surgery performed in a specialist unit where the medical and nursing staff are sympathetic and understanding to the needs of the obese patient is so important. In addition, a specialist unit will have all the equipment that bariatric patients need – simple things such as larger beds and chairs, individual rooms with walk-in showers (not baths) but also hoists and moving equipment.
In many ways performing bariatric surgery is the easy part of the bariatric journey! The difficult bit comes after surgery. Bariatric patients need to be followed up for life. This is because problems can arise at any time and follow-up allows them to be picked up early – before they become problematic. For example, the gastric band patient who notices increased heartburn may be at risk of a band slippage.
All patients should be seen around 6 to 8 weeks following surgery. Patients with a gastric band need to be seen monthly until the band is set correctly. It can take up to a year or more for a band to be set right and the patient using it correctly. Once a band has been set and working, patients tend to be seen 3-4 monthly for a year and then yearly afterwards. Gastric bypass and duodenal switch patients tend to be seen at 3-6 month intervals for the first one or two years and then yearly. Blood tests are performed at 6 months to one-year intervals following surgery.
Named Surgeon or “Package Deal”?
One of the great benefits of paying for the operation yourself is the ability to choose who does your operation and where it is done. Remember, that follow-up is essential and this why many patients decide to go local – to a surgeon or unit close to home. Many patients have gained a lot of information regarding surgery from sites like wlsinfo and may decide to have a specific surgeon perform their operation, even though it means travelling further for follow-up. Other patients may find that the cost of the surgery is a significant factor and choose a “package deal” offered by companies that advertise on the television or Internet. The choice between a named surgeon and a package deal is a personal one, and one that will take into account factors such as cost, surgical reputation and distance for follow-up.
Please make sure you are fully informed of how you will be followed up. Important questions include-
- Are complications covered in the price?
- How many times will I be seen in the first 1-2 years?
- Will I be charged for my follow-up appointments?
- Will I be charged for band fills or blood tests?
- How can I contact you if there is a problem?
- Will I be charged for emergency advice?
Only you can make that final decision regarding who does your operation, but please remember to ask all the questions that this article contains. Any reputable bariatric unit will have this available to you before you have surgery.
In recent times we have seen an increase in “health tourism”. It is possible for patients to travel abroad to have surgery. This is an attractive option for many, particularly as the initial costs can appear to be cheaper. There are a lot of experienced bariatric surgeons in Europe, some of who have pioneered this kind of surgery and whom I would have operate on myself. But I would only do so if I were resident in the country where that surgeon worked and could get there quickly if problems developed.
The reason for this is safety. Safety doesn’t just mean a safe operation; it means safe follow-up and access to help in emergencies. The ability to afford to commute on a regular basis to the country where you had your operation is not widespread I’m afraid. Many patients see surgery as a one-stop cure; they have their operation and believe everything will be all right. It is a sad fact that many commercial groups promote this false impression and ultimately patients pay the price. Let me be clear on this – if you are not followed-up then problems can and will occur. There is also the growing problem in NHS resources being used to correct problems arising from surgery abroad. Finally, the healthcare systems abroad are not the same as we have in the United Kingdom. There are different credentialing schemes for surgeons and hospitals. If problems occur, could you navigate your way through the complaints system of a foreign hospital in a foreign language – would you even know who to complain to? At least with an NHS hospital there are hundreds of willing solicitors who specialise in medical negligence that would be delighted to help you!
So, I would not recommend surgery abroad but if you are considering it please ask your surgeon the questions in this article.
BARIATRIC SURGERY ON THE NATIONAL HEALTH SERVICE
It is a common misconception that bariatric surgery is not available on the NHS. The NICE guidelines make a clear case for bariatric surgery and therefore NHS trusts are expected to provide it. However, the NHS is a finite resource and money does not grow on trees – this means that NHS trusts are quite stringent in who they provide bariatric surgery to.
The NHS considers bariatric surgery a special case. This means that unlike cancer surgery or treatment for chest infections, bariatric surgery is funded differently.
The people who hold the purse strings are the “primary care trust” or PCT. Each area has its own PCT (this applies to England, but similar structures are found elsewhere in the UK, for example the health boards in Northern Ireland). The PCT has to approve funding before surgery can take place on the NHS.
Funding is considered on a case-by-case basis, and not all cases are funded- even if the NICE criteria are fulfilled. It can be a long process to get funding approval, often involving a lot of upset and disappointment.
The journey towards bariatric surgery on the NHS starts with your General Practitioner. If you fulfil the NICE criteria your GP can apply directly to the PCT for funding. The PCT will consider your case and give a decision. If they agree, then they will refer you on to a bariatric unit for assessment for surgery. I’m afraid that you don’t have much choice in where you go for surgery; the PCT contracts out the bariatric surgery to designated providers, and on the whole you have to go where the PCT tells you. At present, this can mean a non-local service (for example in Northern Ireland, the surgical providers are based in mainland Britain). However, some PCTs have contracted out work to a number of surgical providers allowing some patient choice to be exercised. I suspect patients given a choice of providers will vote with their feet and choose to go to units that have the best reputation.
It sounds so easy on paper doesn’t it? All I need to do is satisfy the NICE criteria (tick), talk to my GP (tick) and they apply to the PCT.
And here is the first stumbling block- the NICE criteria are very strict regarding the fact that patients must have tried anti-obesity drugs and specialist weight management clinics. Many GPs are unaware of obesity issues and do not see it as a serious disease; they may have reservations about anti-obesity drugs or the use of specialist clinics. In the worst cases I am aware that some GPs have refused to get involved in the management of obesity because they think the surgery is purely cosmetic- despite the enormous amount of scientific evidence to the contrary. If you find yourself in this situation I would suggest pointing them towards this website, and as a last resort consider changing your GP.
The next stumbling block is at the PCT. Their criteria for offering bariatric surgery can be stricter than the NICE criteria. Remember, they have only a limited amount of resources and the budget for bariatric surgery must also cover other special cases. The number of patients with morbid obesity is enormous- it is just not possible for any PCT to provide surgery for everyone. Most of the patients that are funded by the PCT are heavier than the NICE criteria, usually with a BMI of 45 or greater, because these are the patients at greatest risk from their weight.
Do not despair if the PCT turns down your funding- each case is assessed on its own merits, which means there is scope to work with your GP to present the best evidence that you would benefit from surgery.
The road to NHS surgery is long, but so worthwhile in the end- do not give up!
Information courtesy of http://www.wlsinfo.org.uk
Conor Magee MD FRCS FRCS (Gen.Surg.)
Specialist Registrar in Oesophago-Gastric Surgery
Phoenix-Health Bariatric Fellow
SOME TIPS FOR THOSE IN THE USA
Choosing a Surgeon: Time-Tested Tips
Choosing a surgeon for your weight loss surgery can be one of the biggest decisions you make on the journey. You may not have much choice if you’re in an HMO or your insurance limits your options. If you’re self-pay or in some PPOs or other healthcare plans, though, you may have tons of choices. How can you get the surgeon that will you give you the tools you need to lose weight successfully?
These are some of the basic tips for choosing a surgeon.
- Choose one with plenty of experience.
- Read reviews.
- Ask for recommendations from your primary care doctor and any friends or family members who are weight loss surgery patients.
- Find out about follow-up care and dietary support.
- Use your gut. It’s often good at telling which surgeon is right for you.
Do You Understand Everything?
Communication is a big part of weight loss surgery success. You need to understand what is happening to you and what your surgeon and nutritionist ask you to do. When choosing a surgeon, ask all of your questions about the procedure and the after care.
Don’t blame yourself if you don’t understand what your surgeon answers. It’s your surgeon’s job to explain everything in terms you can understand. If you can’t understand and can’t get the surgeon to explain, it may be time for you to move on. This is too important of a decision to risk going with someone who cannot communicate.
This Is as Good as It Gets
It’s only natural to think things will get better, but don’t count on it when you’re choosing a surgeon. If surgeons don’t have time to meet with you and explain everything now, they won’t have time later. If you can’t get an appointment with the nutritionist now, it’s not going to be any easier later.
In short, surgeons are putting their best foot forward when they’re trying to get you to commit to surgery with them. If they’re not satisfying you now, they’re not going to meet your expectations later. Go find a surgeon who starts off by going beyond your expectations – plenty of outstanding surgeons are out there!
Information courtesy of http://www.BariatricPal.com
WLS FREQUENTLY ASKED QUESTIONS
Q I am considering surgery but don’t know which one to opt for – what is the best?
A There isn’t a ‘best’ as such just the one that suits you which your surgeon will discuss with you and then help you to make a decision but here are the major ones that can be considered http://www.bariatriccookery.com/surgery
Q Does weight-loss surgery hurt – I’m not great with pain?
A You will be given the very best of care by your bariatric team while in hospital and this includes pain relief. Pain varies widely between patients but here’s a guide as to what you can expect http://www.bariatriccookery.com/wls-hurt-great-pain
Q What do I need to take into hospital with me?
A Your hospital will give you a list of what you can and cannot take, avoid taking any valuables. Some other ‘extras’ may make your stay more comfortable. Here’s what other patients have recommended http://www.bariatriccookery.com/check-list-hospital-stay
Q I’m unsure what I shall be eating after surgery – isn’t it just less of what I’ve been eating in the past?
A No, sorry it isn’t. The bariatric eating regime is about eating the right foods in the right quantities, at the right time and in the right order. This link will explain much more but do follow the guidelines given to you by your own bariatric team. http://www.bariatriccookery.com/bariatric-cookery-eating
Q I know I will have to take some vitamins, minerals and supplements after surgery but which ones?
A Your team will give you a schedule specific to you and your surgery (and perhaps also based on your blood tests) but here’s some general guidelines from the experts http://www.bariatriccookery.com/vital-vitamins-supplements-wls
Q How much should I be eating after weight-loss surgery – I don’t know if I’m eating enough or too much?
A This will depend on your stage after surgery – immediately afterwards you will be eating very little, mainly drinking fluids, then progress to pureed food then soft food and eventually chewable food. If you want to check on your portion size for a guide then look at http://www.bariatriccookery.com/suffer-portion-distortion
Q I have heard and been warned about ‘dumping syndrome’ and felt awful yesterday after eating something off plan. Was this dumping syndrome?
A Dumping syndrome is not an experience anyone would want to experience – you might have experienced mild dumping or a ‘hypo’. Here’s an explanation of the difference and what to do if you experience either http://www.bariatriccookery.com/hypo-dumping-syndrome
Q I have hit a bit of a plateau and am concerned about weight regain what should I do?
A Read some solutions and ideas to address this on http://www.bariatriccookery.com/weight-regain
Q What can I eat at home for lunch or take into work/the office for my meal that is bariatric-friendly?
A Here are some ideas that can be eaten at home or taken to work in a lunch box http://www.bariatriccookery.com/work-skool-lunchbox-ideas
Q I’ve started to ‘test’ my surgery and find myself eating some of the wrong things again. Can you help me with some ways of overcoming this?
A Many surgeons will say they fix your stomach but not your brain and it’s easy to go back to poor eating habits and ‘mindless eating’. Here are some solutions to ‘mindless eating’ but if things get bad do seek some psychological help http://www.bariatriccookery.com/mindless-eating-solutions
Q I have lost so much weight which I am pleased about but am not happy about the excess skin I am left with. Can I get body contouring on the NHS to deal with this?
A Just like bariatric surgery on the NHS it can be a bit of a postcode lottery when it comes to the funding of body contouring after wls. So much will depend upon the severity of your problem, the funding available in your area and the support that you get from your own GP or bariatric team in putting you forward for consideration. Here’s the latest guidelines (not implemented as yet, and may not be) on the subject http://www.bariatriccookery.com/massive-weight-loss-contouring-guidelines