Frequently Asked Questions
Q. Who will tell me which bariatric procedure to have?
A. The Surgical Weight Loss (SWL) staff and the surgeons will answer any questions you may have and provide education about each of the surgical options, but we will not be able to tell you which procedure to choose. This is a decision that only you can make after learning the risks, benefits, potential complications, costs and expected lifestyle changes that are associated with bariatric surgery. We are here to educate and support you in your decision. It is important to remember that all bariatric surgeries require dedication and compliance in order for you to be successful.
Q. Will I still be on a “diet” after having bariatric surgery?
A. There will be lifelong dietary recommendations after surgery. We don’t like to think of this as a “diet,” but instead a “lifestyle change.” The new eating behaviors you learn must be adhered to indefinitely, to ensure not only weight loss but also weight maintenance.
Q. Why is protein so important?
A. Beside the fact that protein gives you energy and promotes healing of surgical wounds, a high protein intake is essential in malabsorptive procedures, such as gastric bypass, to compensate for the decreased absorption that results from altered anatomy. Protein helps build and maintain muscle mass and you burn more calories as a result. Dense protein rich foods remain in the stomach pouch longer than soft high fat high calorie foods. This causes patients to feel satisfied for a longer period of time and results in less consumption of fat and carbohydrates. You should always eat your protein source first at every meal. Postoperatively, women require 70 grams of protein and men require 80 grams of protein per day.
Q. Why can’t I drink with my meals?
A. Drinking with meals results in more rapid emptying of solid food from the gastric pouch, eliminating the desired sensation of fullness, and consumption of larger portions. The recommendation is to avoid drinking liquids 30 minutes before and after eating.
Q. What is the expected weight loss after surgery?
A. Gastric bypass patients can expect to lose 75% of their excess body weight in one year. For example, if you are 100 lbs. overweight, you could expect to lose 75 lb. during the first year. Gastric band patients can expect to lose 50-60% of excess body weight in two years. Typical weight loss is 1-2 lbs. per week. Sleeve gastrectomy patients can expect a 45% excess body weight loss at 1 year and 55-80% excess weight loss at two years. These figures may be more or less based on an individual’s compliance to nutritional and exercise guidelines.
Q. Why has my weight plateaued before I reached my goal?
A. Often times patients question why their weight loss has stalled and wonder if they are doing something wrong or if the operation is not functioning properly. Plateaus are not uncommon. Weight fluctuations occur due to many factors including water weight, hydration status, current GI contents, changes in muscle mass, and menstrual cycles. Changes in eating habits that seem harmless can affect weight as well. Grazing throughout the day, binge eating, and poor dietary choices all lead to slow or even ceased weight loss. For malabsorptive surgeries such as gastric bypass, the GI tract adapts over time, allowing for better absorption of consumed food, especially fats. For restrictive procedures such as gastric banding, plateaus may occur if the band is not appropriately tightened. For either type of surgery, lack of compliance to dietary and exercise recommendations will result in poor weight loss.
Q. What are the recommended post-op exercise guidelines?
We encourage you to start walking on the day of surgery and increase the walking each day. Gradually you need to accelerate your pace to increase your heart rate, thereby increasing your metabolism, which promotes the breakdown of fat. You may add aerobic exercise such as swimming and riding a bicycle when you feel able, usually within 6-8 weeks of surgery. Light weight training and sit-ups can be added to help increase muscle mass, improve strength and increase metabolism. Your long-term goal should be to get at least 30 minutes of exercise five days per week.
Q. Why do people regain their weight?
A. A weight regain of up to 15% in 5 years is acceptable. For those people who have a greater weight regain, the issue is most always a result of non-compliance. Patients who maintain good dietary habits and exercise patterns are more likely to keep weight off than those who do not exercise and begin making poor dietary choices. The guidelines that lead to weight loss in the beginning are the same guidelines it takes to maintain a healthy weight 10 years after surgery and for a lifetime. Following the recommendation for a high protein, low fat, low carbohydrate diet combined with a minimum of 30 minutes of daily exercise will lead to long-term maintenance of weight loss and resolution of co-morbidities. It is important to remember that surgery is only a tool, that if used appropriately, can help you achieve a lifelong goal of maintaining good health. You will make an every meal decision as to whether or not you choose success over failure. You are the only one responsible for the choices you make.
Q. What can I do if I have problems or get off track?
A. The single most important thing is follow-up care. We can’t help you if you don’t let us know that you need help. You should never be too embarrassed or ashamed to call or schedule an appointment. Nurses, behavioral health specialists, and dietitians are available to assist you, and appointments can be scheduled the same day you see the surgeon. These services, which were provided before surgery, will continue to be available to you on your lifelong journey. To evaluate, to educate, to support, and to motivate—that’s why we are here…for YOU!
Q. What makes me a candidate for a bariatric surgical procedure?
A. To be a candidate one must:
- Have a BMI of 40, or a BMI of at least 35 with a co-morbidity such as diabetes, hypertension, sleep apnea, arthritis or coronary heart disease
- Be at least 18 years of age
- Weigh < 450 lbs. prior to surgery
- Be willing to quit smoking prior to surgery
- Have made serious attempts to lost weight (minimum of 3 past attempts)
- Not drink alcohol in excess
- Be prepared to attend regular follow-up sessions and to make lifestyle changes
- Be willing to follow a change in eating habits and commit to exercise
- Not be planning on pregnancy for at least 2 years
“The difficulties and struggles of today are the price we must pay for the accomplishments and victories of tomorrow.”
William J.H. Boetcker
“The difference between the impossible and the possible lies in a person’s determination. “
Tommy Lasorda