Weight Loss Topics
Psychological Evaluation All insurance companies require psychological evaluation with clearance prior to the pre certification process for weight loss surgery.
Nutrition Consult The nutrition professional is an integral part of multidisciplinary bariatric care. He or she is charged with nutritional assessment, diet education regarding postoperative eating behaviors, and preoperative weight loss efforts. All insurance companies require nutritional evaluation with clearance prior to the pre certification process for weight loss surgery.
Preoperative Medical Evaluation Medical assessment prior to bariatric surgery is similar to abdominal operations of the same magnitude. Thorough history and physical examination with systematic review is used to identify comorbidities that may complicate the surgery. Consultation with PCP and our surgeon is necessary to optimize medical conditions to reduce preoperative risk.
Guidelines For Preoperative Preparation
- A psychological evaluation is commonly part of the preoperative work-up of bariatric patients.
- Treated psychopathology does not preclude the benefits of bariatric surgery.
- Preoperative weight loss may be useful to reduce your liver size and improve access for the operation, but at PVSA we do not mandate preoperative weight loss.
Most non-surgical weight loss programs are based on some combination of diet/behavior modification and regular exercise. Unfortunately, even the most effective interventions have proven to be effective for only a small percentage of patients. It is estimated that less than 5% of individuals who participate in non-surgical weight loss programs will lose a significant amount of weight and maintain that loss for a long period of time.
According to the National Institutes of Health, more than 90% of all people in these programs regain their weight within one year. Sustained weight loss for patients who are morbidly obese is even harder to achieve. Serious health risks have been identified for people who move from diet to diet, subjecting their bodies to a severe and continuing cycle of weight loss and gain known as “yo-yo dieting.”
The fact remains that morbid obesity is a complex, multifactorial chronic disease. For many patients, the risk of death from not having the surgery is greater than the risks from the possible complications of having the procedure.
That is the key reason that in 2000, approximately 40,000 weight loss surgical procedures were performed and why the American Society for Bariatric Surgery estimates that 50,000 weight loss surgical procedures will be performed in 2001. Patients who have had the procedure and are benefiting from its results report improvements in their quality of life, social interactions, psychological well-being, employment opportunities and economic condition.
In clinical studies, candidates for the procedure who had multiple obesity-related health conditions questioned whether they could safely have the surgery. These studies show that selection of surgical candidates is based on very strict criteria and surgery is an option for the majority of patients.
You may choose to research weight loss surgery on your own via the Internet or through your local library. As with any search for medical information, be sure that your sources are responsible recognized experts in the field you are investigating. An excellent resource for weight loss surgery is the American Society for Bariatric Surgery.
Although the results of weight loss surgery can be drastic, there are potential risks and complications. Before making your decision, you should be well informed. These steps are necessary if you are to give what is called “informed consent” for the procedure. Informed consent is a legal term meaning that a patient agrees that they have received and understood enough information about a procedure’s benefits and risks to allow them to make a decision that is right for them. Your surgeon will require you to sign a consent form before performing your procedure. Before you sign a consent form, you should have a solid understanding of what is about to take place. You should know what you would need to do to live well after the operation. And you should be aware of the signs or symptoms of complications to look for which may occur after your surgery.
In many cases, patients are required to show proof that their attempts at dietary weight loss have been ineffective before surgery will be approved. More important, however, is the commitment on the part of the patient to required, long-term follow-up care. Most surgeons require patients to demonstrate serious motivation and a clear understanding of the extensive dietary, exercise and medical guidelines that must be followed for the remainder of their lives after having weight loss surgery (see Life After Surgery).
Doctors who prescribe and supervise diets for their patients usually create a customized program with the goal of greatly restricting calorie intake while maintaining nutrition. These diets fall into two basic categories:
Low Calorie Diets (LCDs) are individually planned so that the patient takes in 500 to 1,000 fewer calories a day than he or she burns. Very Low Calorie Diets (VLCDs) typically limit caloric intake to 400 to 800 a day and feature high-protein, low-fat liquids.
Many patients on Very Low Calorie Diets lose significant amounts of weight. However, after returning to a normal diet, most regain the lost weight in under a year. Ninety percent of people participating in all diet programs will regain the weight they’ve lost within two years.
Behavior modification uses therapy to help patients change their eating and exercise habits. Like low-calorie diets, behavior modification, in most patients, results in short-term success that tends to diminish after the first year.
If diet and behavior modifications have failed you and surgery is your next option, it is important to understand that diet and behavior modification will be instrumental to sustained weight loss after your surgery. The surgery itself is only a tool to get your body started losing weight – complying with diet and behavior modifications required by most surgeons would determine your ultimate success.
A National Institutes of Health survey of 13 studies concludes that physical activity:
- Results in modest weight loss in overweight and obese individuals
- Increases cardiovascular fitness, even when there is no weight loss
- Can help maintain weight loss
New theories focusing on the body’s set point (the weight range in which your body is programmed to weigh and will fight to maintain that weight) highlight the importance of exercise. When you reduce the number of calories you take in, the body simply reacts by slowing metabolism to burn fewer calories. Daily physical activity can help speed up your metabolism, effectively bringing your set point down to a lower natural weight. So when following a diet to attempt to lose weight, exercise increases your chances of long-term success.
Examples to get you started: Park at the far end of parking lots and walk Take the stairs instead of the elevator Cut down on television Swim or participate in low-impact water aerobics Ride an exercise bike
Overall, walking is one of the best forms of exercise. Start out slowly and build up. Your doctor, or people in a support group, can offer encouragement and advice. Incorporating exercise into your daily activities will improve your overall health and is important for any long-term weight management program, including weight loss surgery. Diet and exercise play a key role in successful weight loss after surgery.
Weight loss drugs can have serious side effects. Still, medications are an important step in the morbid obesity treatment process. Before insurance companies will reimburse/pay for weight loss surgery, you must follow a well-documented treatment path.
“Since many people cannot lose much weight no matter how hard they try, and promptly regain whatever they do lose, the vast amount of money spent on diet clubs, special foods and over-the-counter remedies, estimated to be on the order of $30 billion to $50 billion yearly, is wasted.” (New England Journal of Medicine)
Diet. The modifications made to your gastrointestinal tract will require permanent changes in your eating habits that must be adhered to for successful weight loss. Post-surgery dietary guidelines will vary by surgeon. You may hear of other patients who are given different guidelines following their weight loss surgery. It is important to remember that every surgeon does not perform the exact same weight loss surgery procedure and that the dietary guidelines will be different for each surgeon and each type of procedure. Gastric By-Pass and Laparoscopic Adjustable Gastric Band Dietary Guidelines have been provided below. What is most important is that you adhere strictly to your surgeon’s recommended guidelines.
The following are some of the generally accepted dietary guidelines a weight loss surgery patient may encounter:
- When you start eating solid food it is essential that you chew thoroughly. You will not be able to eat steaks or other chunks of meat if they are not ground or chewed thoroughly.
- Don’t drink fluids while eating. They will make you feel full before you have consumed enough food.
- Omit desserts and other items with sugar listed as one of the first three ingredients.
- Omit carbonated drinks, high-calorie nutritional supplements, milk shakes, high-fat foods and foods with high fiber content.
- Avoid alcohol.
- Limit snacking between meals.
- Dietary Guidelines for Gastric Bypass Surgery & Sleeve Gastrectomy Surgery
- Recomendaciones Alimentarias Para La Cirugia de Baipas Gastrico Y La Cirugia de Gastrectomia Vertical en Manga
- Laparoscopic Adjustable Gastric Band Dietary Guidelines
- Guias Dietarias Para La Cirugia de Banda Ajustable Gastrica Laparoscopica
Going Back to Work. 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 six weeks of their procedure. Patients who have had a minimally invasive laparoscopic procedure may be able to return to these activities within a few weeks.
Birth Control & Pregnancy. It is strongly advised that 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 a most important requirement.
Long-Term Follow-Up. Although the short-term effects of weight loss surgery are well understood, there are still questions to be answered about the long-term effects on nutrition and body systems. Nutritional deficiencies that occur over the course of many years will need to be studied. Over time, you will need periodic checks for anemia (low red blood cell count) and Vitamin B12, folate and iron levels. Follow-up tests will initially be conducted every three to six months or as needed, and then every one to two years.
Support Groups . The widespread use of support groups has provided weight loss surgery patients an excellent opportunity to discuss their various personal and professional issues. Most learn, for example, that weight loss surgery will not immediately resolve existing emotional issues or heal the years of damage that morbid obesity might have inflicted on their emotional well-being. Most surgeons have support groups in place to assist you with short-term and long-term questions and needs. Most bariatric surgeons who frequently perform weight loss surgery will tell you that ongoing post-surgical support helps produce the greatest level of success for their patients.
Weight Loss FAQ
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. There are many factors that contribute 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 intake of steroids and hypothyroidism.
Genetic Factors. Numerous scientific studies have established that your genes play an important role in your 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, whom 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.
- 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.
We probably have a number of 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.
The Pima Paradox. 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. Why not?
The leading theory 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 two hours a week.
The Pima apparently have a genetic predisposition to gain weight. And the environment in which they live – the environment in which most of us live – makes it nearly impossible for the Arizona Pima 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 & 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.
- More than 100 lbs. over your ideal body weight, or
- Have a Body Mass Index (BMI) of over 40, or
- 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
- Unable to achieve a healthy body weight for a sustained period of time, even through medically supervised dieting
Use our BMI Calculator to calculate your Body Mass Index. Note that these are approximate values, and are intended to be used only as a rough guide.
|Height||Ideal Weight||Height||Ideal Weight|
|4′ 6″||63 – 77 lbs.||4′ 6″||63 – 77 lbs.|
|4′ 7″||68 – 84 lbs.||4′ 7″||68 – 83 lbs.|
|4′ 8″||74 – 90 lbs.||4′ 8″||72 – 88 lbs.|
|4′ 9″||79 – 97 lbs.||4′ 9″||77 – 94 lbs.|
|4′ 10″||85 – 103 lbs.||4′ 10″||81 – 99 lbs.|
|4′ 11″||90 – 110 lbs.||4′ 11″||86 – 105 lbs.|
|5′ 0″||95 – 117 lbs.||5′ 0″||90 – 110 lbs.|
|5′ 1″||101 – 123 lbs.||5′ 1″||95 – 116 lbs.|
|5′ 2″||106 – 130 lbs.||5′ 2″||99 – 121 lbs.|
|5′ 3″||112 – 136 lbs.||5′ 3″||104 – 127 lbs.|
|5′ 4″||117 – 143 lbs.||5′ 4″||108 – 132 lbs.|
|5′ 5″||122 – 150 lbs.||5′ 5″||113 – 138 lbs.|
|5′ 6″||128 – 156 lbs.||5′ 6″||117 – 143 lbs.|
|5′ 7″||133 – 163 lbs.||5′ 7″||122 – 149 lbs.|
|5′ 8″||139 – 169 lbs.||5′ 8″||126 – 154 lbs.|
|5′ 9″||144 – 176 lbs.||5′ 9″||131 – 160 lbs.|
|5′ 10″||149 – 183 lbs.||5′ 10″||135 – 165 lbs.|
|5′ 11″||155 – 189 lbs.||5′ 11″||140 – 171 lbs.|
|6′ 0″||160 – 196 lbs.||6′ 0″||144 – 176 lbs.|
|6′ 1″||166 – 202 lbs.||6′ 1″||149 – 182 lbs.|
|6′ 2″||171 – 209 lbs.||6′ 2″||153 – 187 lbs.|
|6′ 3″||176 – 216 lbs.||6′ 3″||158 – 193 lbs.|
|6′ 4″||182 – 222 lbs.||6′ 4″||162 – 198 lbs.|
|6′ 5″||187 – 229 lbs.||6′ 5″||167 – 204 lbs.|
|6′ 6″||193 – 235 lbs.||6′ 6″||171 – 209 lbs.|
|6′ 7″||198 – 242 lbs.||6′ 7″||176 – 215 lbs.|
|6′ 8″||203 – 249 lbs.||6′ 8″||180 – 220 lbs.|
|6′ 9″||209 – 255 lbs.||6′ 9″||185 – 226 lbs.|
|6′ 10″||214 – 262 lbs.||6′ 10″||189 – 231 lbs.|
|6′ 11″||220 – 268 lbs.||6′ 11″||194 – 237 lbs.|
|7′ 0″||225 – 275 lbs.||7′ 0″||198 – 242 lbs.|
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/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/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/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% 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. For more information on Heartburn, its causes and possible cures, visit www.heartburnhelp.com.
Depression. Seriously overweight persons 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. The inability or diminished ability to produce offspring.
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 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.
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. They may, as part of routine evaluation for weight loss surgery, require that you consult with a dietician/nutritionist and a psychiatrist/therapist. This is to help 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 ironclad guarantees in 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, dieticians and other forms of continuing education.
Ultimately, the decision to have the procedure is entirely up to you. After having heard 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.
Indication. Weight loss surgery is typically reserved for those individuals 100 pounds or more overweight (Body Mass Index [BMI] of 40 or higher) who have not responded to other less invasive therapies such as diet, exercise, medications, etc. In certain circumstances, less morbidly obese patients (with BMIs between 35 and 40) may be considered for surgery (patients with high-risk co-morbid conditions and obesity-induced physical problems that are interfering with quality of life).
Important Considerations. Surgery should not be considered until you and your doctor have evaluated all other options. The proper approach to weight-loss surgery requires discussion and careful consideration of the following with your doctor:
- 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.
- A decision to elect 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 (approved in the United States) are not reversible.
- 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 reoperations.
- Success of surgical treatment must begin with realistic goals and progress through the best possible use of well-designed and tested operations.
Complications and Risks. 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:
- Complications due to anesthesia and medications
- Deep vein thrombosis
- Leaks from staple line breakdown
- Marginal ulcers
- Pulmonary problems
- Spleen injury*
*Removal of the spleen is necessary in about 0.3% of patients to control operative bleeding.
If surgery is performed laparoscopically and complications occur during the operation, your doctor may choose to perform open surgery.
Calculate Your BMI BoxAre you a candidate for weight loss surgery? Body mass index or BMI is a measure of body fat based on height and weight that applies to adult men and women. Learn More
Attend a Free SeminarThe first step is to attend our educational seminar. The seminar will provide you with the information about the weight loss operations we perform including risks and benefits of each operation. Learn More
Request A ConsultationTo request a consultation for weight loss surgery with Dr Burritt Haag you must first attend one of our monthly educational seminars. Learn More
Join A Support GroupWe offer support groups to enhance your success during your weight loss journey. Support groups are required by your health insurance prior to having your operation. Learn More
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Find out about our free informational seminar on bariatric surgeries including Gastric Bypass, Laparoscopic Adjustable Gastric Band, and Sleeve Gastrectomy