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Common Questions and Answers About Weight Loss Surgery

Who is a candidate for weight loss surgery?

Weight loss surgery is not right for everyone. You should take in consideration of all the hard work, lifestyle change and motivation it will take after surgery. Obesity surgery is the most effective treatment for morbid obesity, although the pounds do not come off by themselves. The surgery is an aid to help achieve lasting results by limiting your food intake mainly by reducing hunger when you eat correctly.

Additionally, patients with complex medical conditions and limited mobility increase the surgical risks; patients are thoroughly evaluated and considered on a patient-by-patient basis. Individuals may be candidates if they meet the NIH Guidelines for morbid obesity surgery.

Click here for more information on the NIH Guidelines.
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How much weight can I expect to lose after surgery?

How much weight can I expect to loose after surgery? The amount and rate at which you lose excess body weight varies depending on the type of surgery, the starting weight, and compliance with dieting, exercise, and vitamin intake.

How soon should I see weight loss after surgery?

You can lose as much as 10-20 pounds in the first 2 weeks after surgery and as much as 30-45 pounds in the first month, again depending on the factors above.

Will I need plastic surgery to eliminate excess skin?

The amount of excess skin especially in the abdominal area depends on the amount of weight lost after bariatric surgery (the more weight lost, the more excess skin), age (younger patients may have better elasticity in their skin than older patients), exercise (some patients notice less excess skin if they've adhered to aggressive abdominal exercise regimens while losing weight to help tone those areas), and genetics (some patients notice that their parents have less loose skin than others). Loose skin in the face, neck, arms and legs are very likely to occur regardless of these factors mentioned.

Can I drink alcohol after undergoing surgery?

No. We encourage you not to drink alcohol after surgery. It is dangerous since alcohol rapidly enters the intestine in all the procedures and can become unexpectedly toxic. Alcohol also contains too many calories and will slow or limit weight loss.

What are the dietary guidelines after weight loss surgery?

Liquids for the first 3 weeks after surgery, then pureed foods for another week, followed by soft foods for a week and then regular, high protein foods afterwards. Lifelong vitamins and even protein drink supplements are required.

Is exercise an important factor after weight loss surgery?

Exercise is critical to successful weight loss, as well as long-term cardiovascular health. Remember, weight loss surgery only minimizes calorie intake if done correctly. Daily exercise allows for the excess fat in your body to be burned off.

What happens if I do not obey my dietary guidelines after surgery?

If you do not follow the guidelines after having bariatric surgery, you can still be obese and malnourished at the same time.

Can I get pregnant after weight loss surgery?

Women are advised not to become pregnant and thus use reliable forms of birth control for the first 1 1/2 - 2 years after surgery. Nutritional issues are already of the utmost concern for the patient, and would be putting a growing fetus at high risk during this time. Some patients may even need to wait longer depending if they have reached their goal weight or if there are nutritional problems occurring after surgery.

What are the surgery options?

How do I qualify for surgery?

Indications/qualifications (Click here to calculate your body mass index - BMI)

You must be at least 18 years of age. If you are over 64 years old, you must be referred by your doctor and be in good health, since surgery is higher risk in patients over 60 years old even with testing before surgery.
Your body mass index (BMI) is greater than 40 kg/m². Or you are about 100 pounds overweight for men or 80 pounds overweight for women?
Your BMI is between 35-39.9 kg/m² and you have a serious obesity-related health problem, such as diabetes, high blood pressure, heart disease, sleep apnea or degenerative joint disease
Overweight for more than 5 years
You have taken serious attempts to lose weight and only had short term effect
You do not drink alcohol in excess
You do not smoke
You are not diagnosed with Prader-Willi Syndrome
You have no serious disease that may have caused your obesity, such as steroid-secreting tumors as in Cushing's Syndrome
Have no serious untreated, underlying psychiatric disorders, or current issues with substance abuse, or narcotic dependency
You are willing to be monitored by specialists who are treating you
An understanding of the operation and the lifestyle changes you will have to make to lose weight and well nourished
Be medically healthy enough to tolerate major surgery
You are not extremely limited in activity. You must be able to perform aerobic and anaerobic exercise as with any weight loss program

Why weight loss surgery?

Weight loss surgery can offer successful long-term improvement in medical conditions such as improved cholesterol, diabetes, high blood pressure, joint disease and sleep apnea. The National Institute of Health has endorsed surgical weight loss an effective method for the treatment of morbid obesity.

What are the risks of weight loss surgery?

Serious complications can occur with any surgery; fortunately complications remain extremely low. Specific and proper patient preparation, selection along with Dr. Feng’s experience markedly reduces the risk and complications of weight loss surgery. Look over each of the surgeries since they all have their own specific and general common risks, even the risk of death as with any surgery performed under general anesthesia.

What are the benefits of weight loss surgery?

Click here to see the benefits to weight loss surgery
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Does Laparoscopic Surgery decrease the risk?

No. Laparoscopic operations carry the same risk as the procedure performed as an open operation. The benefits of laparoscopy are typically less discomfort, shorter hospital stay, earlier return to work and reduced scarring and other wound issues like hernias.

Will I have a lot of pain?

Every attempt is made to control pain after surgery to make it possible for you to move about quickly and become active. This helps avoid problems and speeds recovery. Often several drugs are used together to help manage your post-surgery pain. While you are still in the hospital, a Patient Controlled Analgesia (PCA), which allows you to give yourself a dose of pain medicine on demand, may be used by your physician. Various methods of pain control, depending on your type of surgical procedure, are available. Ask your surgeon about other pain management options.

How long do I have to stay in the hospital?

As long as it takes to be self-sufficient. This means being able to drink enough liquids, no significant nausea nor vomiting off nausea medications, and good pain control on oral pain medications. Although it can vary, the hospital stay (including the day of surgery) can be out patient for a laparoscopic gastric band procedure (Lap-Band®) where you go home the same day, 1-2 days for a laparoscopic Roux-en-Y gastric bypass or vertical sleeve gastrectomy, 2-3 days for a laparoscopic duodenal switch, and 3-7 days for an open surgery of any type.

Will the doctor leave a drain in after surgery?

No. Drains are not routinely placed. If a small tube is placed, it is usually removed a few days after the surgery. Urinary catheters are also not routinely placed.

If I have surgery, what can I expect when I wake up in the recovery room?

Some doctors will provide a Patient Controlled Analgesia (PCA) or a self-administered pain management system, to help control pain. Others prefer to use an infusion pump that provides a local anesthetic in the surgical site to control pain without the side effects of narcotics. As with any major surgery, you are in danger of death from a blood clot or other surgical side effects. Statistically, the risk of death during these procedures is less than 1 percent. Your doctors will have assessed you for risks and prepared accordingly.

All abdominal operations carry the risks of bleeding, infection in the incision, thrombophlebitis of legs (blood clots, especially in older patients), lung problems (pneumonia, pulmonary embolisms), strokes or heart attacks, anesthetic complications, and leaks and blockage or obstruction of the intestine. These risks are greater in morbidly obese patients.

How soon will I be able to walk?

Almost immediately after surgery doctors will require you to get up and move about. Walking also decreases the risk of getting life-threatening blood clots. Patients are asked to walk or stand at the bedside on the night of surgery, take several walks the next day and thereafter. On leaving the hospital, you may be able to care for all your personal needs, but will need help with shopping, lifting and with transportation.

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 7-14 days after surgery.

Will I be able to continue smoking after weight loss surgery?

No. We do not recommend smoking after surgery. We encourage you to stop smoking at least 3 months before surgery. We routinely check your blood levels of nicotine and byproducts to make sure nothing is in the blood. Smoking and nicotine products greatly interferes with wound healing and increases risks of severe complications such as leaks, infection, heart and lung complications, risk of death.

I heard that you can loose hair after weight loss surgery; is this true?

Yes. Hair loss is usually related to hormonal changes due to rapid weight loss. Of course, if there are problems with inadequate nutrition, hair loss may also be related to malnutrition that needs to be checked and corrected. In general, once the patient reaches their goal weight, hair growth returns if there was hair in the area prior to surgery.

How can I prevent hair loss after my surgery?

Most patients experience some hair loss after surgery that cannot be prevented. Some patients have found success in taking "hair and nail supplements" found at most vitamin stores. These vitamin formulations contain extra B vitamins, flax seed oil, coenzyme Q and other supplements that may help. Results are not guaranteed.

What is Dumping Syndrome?

Eating sugars or other foods containing many small particles when you have an empty stomach can cause dumping syndrome in patients who have had a gastric bypass or BPD where the stomach pylorus is removed. Your body handles these small particles by diluting them with water, which 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 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 30-60 minutes and can be quite uncomfortable - you may have to lie down until it goes away. You may experience excessive fatigue. 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 well tolerated at the end of a meal.

What are some recommended readings after weight loss surgery?

A Complete Guide to Obesity Surgery: Everything you need to know about weight loss surgery and how to succeed by Bryan G. Woodward
Weight Loss Surgery: Understanding and Overcoming Morbid Obesity by Michelle Boasten
Weight Loss Surgery: Finding the thin person hiding inside you by Barbara Thompson
Eating Well after Weight Loss Surgery by Patt Levine and Michele Bontempo-Saray

What are the differences between traditional and minimally invasive approaches for surgery?

Minimally invasive approaches for surgery has been shown in studies to have less pain, smaller scars and wound problems such as hernias, earlier discharge from the hospital and earlier return to routine activities and work when compared to traditional, open, larger-incision surgery for weight loss surgery patients.

Does insurance pay for weight loss surgery?

Most insurance plans cover weight loss surgery, especially the hospitalization portion but some may not cover any or all the surgeon's fees. Patients should be aware that there are out-of-pocket expenses, and insurance policies may cover one type of weight loss surgery and not another type of surgery. The patient expenses can vary; patients should contact their insurance company to confirm their policy benefits for weight loss surgery.

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