We offer several approaches to weight loss. Through research we have shown that surgical weight loss is much more effective. Medical weight loss has shown up to 10% weight loss, but with high risk of regaining weight. Surgical weight loss can offer up to 70% of your excess body weight lost, depending on which operation you choose and which you qualify for. Typically, the weight loss can be maintained with proper follow-up.
Weight-loss results vary from patient to patient, and the amount of weight you lose depends heavily on your new lifestyle and eating habits. Obesity surgery is not a miracle cure, and the pounds won’t come off by themselves. Surgery is simply a tool that must be used properly for it to work. It is very important to set achievable weight-loss goals from the beginning. A weight loss of 2 to 3 pounds a week in the first year after the operation is possible, but one pound a week is more likely. Twelve to eighteen months after the operation, weekly weight loss is usually less. Remember that you should lose weight gradually. Losing weight too quickly creates a health risk and can lead to a number of problems. Close follow-up is required to make sure you are achieving the weight loss safely. The main goal is to have weight loss that is maintained and prevents, improves, or resolves health problems connected with severe obesity.
All of the weight loss procedures limits food intake. If you feel nauseated or sick on a regular basis, it may mean that you are not chewing your food well enough or that you are not following the diet rules properly. However, it could also mean that there is a problem, so contact your doctor if it persists. Vomiting should be avoided as much as possible as it can cause the reduced stomach to stretch, or in the case of a band, can cause the band to slip.
If a surgery is performed laparoscopically, patients typically spend 24-48 hours in the hospital. It takes most patients about a week to return to work and a month to six weeks to resume exercising. In the case of open surgery or if there are complications, recovery may take longer.
Check-ups with your doctor are a normal and very important part of all weight loss surgery including the LAP-BAND System follow-up. Many surgeons see their patients weekly or biweekly during the first month and every six to twelve weeks for the first year. Adjustments are performed during some of these visits. It is typical for follow-up visits to be scheduled every three to six months during the second and third year, depending on the individual case.
After all three procedures, lifting should be limited for the first month, but return to physical activity can occur nearly right away. The LAP-BAND does not hamper physical activity including aerobics, stretching and strenuous exercise.
Adjustments are often carried out in the office. A fine needle is passed through the skin into the access port to add or subtract fluid. This process most often takes only a few minutes and most patients say it is nearly painless. Occasionally, the adjustments are done under x-ray. They are done there so the access port can be clearly seen. When X-rays are used, your reproductive organs should be shielded.
There are no restrictions based on the access port. It is placed under the skin and subcutaneous tissue on the muscle layer in the abdominal wall, and once the incisions have healed it should not cause discomfort or limit any physical exercise. The only sensation you may experience from the port occurs when you go in for adjustments. If you feel persistent discomfort in the port area, talk to your doctor.
Although the LAP-BAND System is not meant to be removed, it can be removed laparoscopically. Surgeons report that the stomach generally returns to its original shape once the band is removed. After the removal, though, you may soon go back up to your original weight. You may also gain more.
That is not always the case. As a rule, plastic surgery will not be considered for at least a year or two after the operation as, some-times the skin will mold itself around the new body tissue. Give the skin the time it needs to adjust before you decide to have more surgery.
These procedures make you eat less and feel full in two ways—first by reducing the capacity of your stomach and second by increasing the time it takes food to get through the digestive system. After a small meal, the amount of which varies from person to person, you should feel full. If you follow the nutrition guidelines when you choose your food and then chew it well, you should not feel hungry or deprived. Remember that weight loss surgery is a tool to help you change your eating habits. Occasionally the feeling of being deprived can represent a vitamin or mineral deficiency. This is another reason it is important to follow-up with your doctor.
Becoming pregnant can be easier as you lose weight. Your menstrual cycle may become more regular. It is recommended with any weight loss procedure, that you wait approximately one year before trying to become pregnant. At this point your body will be more adapted to handle the stress of bearing a child—significant weight will have been lost, making it easier to carry the weight of a baby. Furthermore, obesity has been linked to stillbirths. Weight loss will benefit not only you, but your child. Children of obese parents become obese 80% of the time.
Yes. When your food intake is limited, it is possible to not get enough vitamins from three small meals a day. At your regular check-ups, your specialist will evaluate whether you are getting enough vitamin B12, folic acid, and iron. Your surgeon may advise you to take extra supplements. All weight loss surgery patients will be required to take life long vitamins.
You should be able to take prescribed medication, though initially after surgery you may need to use capsules, break big tablets in half or dissolve them in water. The goal is to get you off medications! Always ask the doctor who prescribes your medications. Your surgeon may tell you to avoid taking aspirin and other nonsteroidal anti-inflammatory pain relievers because they may irritate the stomach.
Order only a small amount of food, such as an appetizer. Some restaurants may allow you to order off the children’s menu. Most restaurant serving sizes are enough for two or more! If you are ordering alone- take home at least half of the meal. Eat slowly. Finish at the same time as your table companions. You might want to let your host or hostess know in advance that you cannot eat very much.
Alcohol has a high number of calories and breaks down vitamins. An occasional glass of wine or other alcoholic beverage, though, is not considered harmful to weight loss. Carbonation may not be tolerated, however, with a functionally small stomach.
After your stomach has healed, you may eat most foods that don’t cause you discomfort. However, because you can only eat a little, it is important to include foods full of important vitamins and nutrients as advised by your surgeon and/or dietitian. If you eat foods that contain lots of sugar and fat or drink liquids full of “empty” calories, such as milkshakes, the effect of the weight loss surgery will be greatly reduced or even cancelled.
There may be some reduction in the volume of your stools, which is normal after a decrease in food intake because you eat less fiber. This should not cause you severe problems. If difficulties do arise, check with your doctor. He or she may suggest you take a mild laxative and drink plenty of water for a while. Your needs will vary, but you should drink at least 6-8 glasses of water a day.
LAP-BAND patients are outpatient. Gastric bypass and sleeve patients are typically two days in the hospital.
The LAP-BAND procedure typically takes about an hour. Sleeve gastrectomy takes about an hour and a half. Gastric bypass typically takes 2-3 hours. The actual length of the operation depends on many different factors.
On average, people lose between 50–75% of their excess weight at two years. The amount of weight you lose depends on your motivation, how well you adhere to the post-op diet and how much you exercise. Gastric bypass patients tend to lose weight much faster, than the band patient, and the sleeve patients lie somewhere in the middle. All weight loss patients tend to reach the same level of average weight loss after 3-5 years.
You will be prescribed a series of healing diets initially after surgery but after about 6-8 weeks you can eat normal foods, but you simply eat much less. You can go to restaurants, but you will typically order appetizers or eat a portion of an entrée and take the rest of it home. The only special diet after surgery is the first six weeks where you start with liquids and work up to soft solid food. Your dietitian will work with you on healthy eating, because if you do not change your nutrition patterns your weight will come back!
Protein and vitamin deficiencies are a risk after any weight loss operation. LAP-BAND and sleeve patients have less risk of vitamin deficiencies than a bypass because there is no malabsorption, but since less food is taken in, vitamins are required lifelong. Chewable, dissolvable and liquid vitamins are easier for some patients. Our center recommends certain formulations of vitamins for each individual patient. Gastric bypass patients will need additional supplements for calcium, iron and B12. Surgery patients will have blood work drawn to check vitamin levels several times in the first year and then yearly.
Laparoscopic or “minimally invasive” surgery is performed by making tiny incisions in the abdomen and using specialized instruments to accomplish surgery with less pain and quicker recovery. A small fiberoptic camera provides the image for the surgeon to operate.
You can eat normal foods in smaller quantities. You will learn to chew your food well. Some surgery patients learn that high-fiber foods may be difficult to pass through their small gastric pouch. LAP-BAND patients learn that fresh bread and sticky rice may be hard to pass. You will learn to eat to the point of feeling full and then stop. Eating too much at once or not chewing well will cause negative side affects that will hopefully reduce the likelihood of improper eating habits again. It will be hard to gulp large quantities of liquids so you will need to drink water throughout the day so you don’t get dehydrated. You will need to concentrate on the number of grams of protein you are eating and be cognizant of calorie intake, especially “empty calorie” intake- that is, calories with limited nutritional value. We teach you which foods are “empty calories”. Sugar gives you a lot of calories that will need to be burned, or will otherwise turn to fat in the body. You should eat sugar-free foods and use sugar substitutes like Equal or Splenda. We assist you with nutrition classes and support groups with cooking demonstrations. Things like milkshakes and ice cream are very high in fat and sugar. You don’t have to avoid them altogether, but having these types of foods on a regular basis will make the operation fail—you won’t lose any weight. You should also drink sugar-free drinks and low-fat milk. Carbonation is not well tolerated with your stomach anatomy altered. There is no longer a large reservoir to hold the excess gas, so most patients avoid any carbonation. Protein is very important. The body needs 60 grams of protein per day. You should eat your protein first, because you can only eat a half of a cup of food for each meal. If you eat a half of a cup of salad, you will not be getting any protein and then will have to play catch-up, which is hard to do when you have such a small stomach. The whole point of weight loss surgery is that you lose weight without feeling starved or deprived.
Most patients go back to work about one to two weeks after surgery. We ask anyone doing manual labor or heavy lifting avoid lifting for 4 weeks after surgery to limit the risk of post-op hernia. Light duty may be an option for you until then.
Exercise will help you lose weight. At first, we ask you to walk, or do something physical for thirty minutes per day and gradually increase your exercise as you lose weight. The most successful weight loss surgery patients are those that exercise in addition to the caloric restriction provided by surgery. Water aerobics are easier to do for patients with joint pains and arthritis. Our fitness center is available for all surgery patients.
One of the reasons weight loss surgery is so successful is because the background hunger so typical of dieting goes away. This is due to decreased levels of Ghrelin (the hunger hormone.) Ghrelin levels initially drop drastically after all weight loss surgery. Patients no longer crave food and sometimes, if you can believe it, have to be reminded to eat!
Some hair loss is typical of weight loss. This means more hair in the brush or shower drain. You do not go bald. Watching your vitamin (esp. zinc & biotin) and protein intake certainly helps reduce this, but all patients that lose a significant amount of weight will experience some hair loss. It will grow back. Hair loss usually occurs during the first year.
Once your insurance company approves the surgery (which varies from days to months- depending on the insurance company), we can typically get surgery scheduled in approximately one to two weeks, but we set a goal date once you are submitted. Timing depends upon how many studies (labs, x-rays, etc.)any medical clearances you need prior to the operation. Sleep studies and echocardiograms can take several weeks to get results. Patients who don’t need a lot of studies can obviously get the surgery completed in a short time. The longest time period is waiting to hear back from your insurance company. Sometimes it takes up to six months or longer to get a response.
There has been an increase in the number of insurance companies that will cover surgery. Other companies will soon follow their lead. Call your insurance company and ask them what their policy is regarding weight loss surgery. Use the worksheet we provide at our seminar or located on our forms page to help talk to your insurance company.
Some companies take two weeks; some take six months or longer. It varies from one company to another.
The restrictive component of weight loss surgery works by filling a small gastric pouch with food that sends a signal to your brain that you are full and to stop eating. If you drink liquid with your meals, it will flush the solid food out of your pouch and will decrease the success. For best success, you should stop drinking 30 minutes before you eat and not drink for one hour after you eat.
Not at all for the first six weeks. They can cause slippage of the LAP-BAND and leaks in gastric bypass and sleeve patients. After six weeks, they can cause a lot of crampy gas pains, but are less harmful to the surgery. If you let them go flat, you can drink soft drinks.
Symptoms of vitamin deficiency can include anemia, neurological alterations, skin changes, and other metabolic abnormalities. These are difficulty to diagnose and may take time to correct. The best way to treat vitamin deficiencies is to prevent them. Vitamins, calcium, and iron supplements should be taken for life after weight loss surgery. This is particularly important after gastric bypass. We suggest specially formulated vitamins for surgery patients.
Yes. Some medications will need to be crushed or taken in liquid form early after the surgery due to swelling. Eventually you should be able to take most medications normally. Large tablets will need to be cut in half. Extended release or long acting medications, as a general rule, cannot be crushed or cut in two. This will reduce their effectiveness and an immediate release medication will be needed. The goal of surgery, however, is to get you off most medications!
The LAP-BAND is easily reversible since it does not involve cutting or rearranging your intestines in any way. The gastric sleeve is irreversible. The gastric bypass has been reversed with limited success and is a major operation with much higher risks than even a gastric bypass. Patients should think of a gastric bypass as permanent.
Everyone reacts to pain differently. Some patients have discomfort around the keyhole incisions for a few days, some need pain medications for 2 weeks. Occasionally patients experience shoulder discomfort which is related to the gas placed during surgery which irritates the diaphragm nerve that goes to the shoulder. About 5-10% of people experience significant nausea after the general anesthetic. We aggressively treat nausea and pain with medications.
Most patients can drive after 4-5 days, once off pain medications. The pain level must be low enough so that you would be able to slam on the brakes if needed.
A small cup size, approximately 250 mls. Patients are on series of healing diets: liquids then a pureed diet for the first few weeks and by 6-8 weeks should be able to eat all food types. Some patients experience food intolerances which may change through the post-operative course. If you can no longer eat your favorite food, that doesn’t necessarily mean you can never eat it. All surgery patients go through a course on how to eat properly after surgery. All patients also get a manual, similar to a user’s manual to walk you though the steps in use of your new tool.
We’ll set an initial post-operative appointment approximately 1-2 weeks post op. Generally we then see you again at 6 weeks, 3 months, 6 months, and as needed, then yearly for at least 5 years and ideally lifelong.
Recent data suggest that 6-30% of patients will have plastic surgery for removal of excess skin. Few patients require skin fold reduction surgery after weight loss. If you are younger it is not so likely as your skin is still fairly elastic and can remodel. For older patients with high BMIs, or if you have recurrent infections in a skin fold it may be required. We usually would wait until at least 12-18 months from surgery (when your weight loss will have plateaued) and then consider if any skin surgery is needed.