The term originated from the Metropolitan Life Insurance Company. They found that being more than 100 pounds over your “ideal weight” was a significant risk to life.
People who are obese commonly have medical problems. Some of the associated problems you may have could include high blood pressure, high cholesterol, heart problems, degenerative joint problems, obstructive sleep apnea and diabetes.
If I have medical problems will they go away if I have the surgery?
As you lose weight and improve your eating habits, many people with medical problems will see an improvement. There is no guarantee that the surgery will get rid of pre-existing medical problems. However, most people with Type 2 diabetes, sleep apnea, and gastro-esophageal reflux (GERD) should improve or even have these disorders disappear once they have lost 80 pounds. Although there is no guarantee that pre-existing medical problems will disappear, your health will continue to improve as you lose weight.
Is obesity a glandular problem?
While some obese people do have glandular (endocrine) problems such as diabetes, this is a very uncommon cause of obesity in Americans.
How do I know if surgery is right for me?
Your physician will examine you and use a chart called the Body Mass Index (BMI) to evaluate how much you should weigh based upon your height. Your previous attempts at weight loss will also be considered. We know that making a decision for surgery can be difficult. You will need to think about the risks, possible complications and the life style changes you will need to make and commit to for the rest of your life. You should discuss this with your physician so you can make the decision that is right for you.
If I decide to have the surgery how long will it be before I lose weight?
Your weight loss will be gradual over the next 18 – 24 months. Shortly after two years, you should be at or close to your acceptable weight. National statistics show that after five years, the mean percent of excess weight lost ranges from 48 to 74 percent. However, you need to continue with your exercise program recommended by your surgeon and healthcare team. You can achieve these results as long as you make a life-long commitment to change your life style.
How long will I be in the hospital?
Most people will be in the hospital for four or five days.
Is obesity a psychiatric problem?
Currently, it is felt that obesity is not a psychiatric illness.
Why is a psychological evaluation required before surgery?
The decision to have gastric bypass surgery requires a thoughtful examination of the benefits and risks involved. Additionally, to be successful, a person must be capable of breaking old habits and adopting a healthier lifestyle. A healthy, positive state of mind is essential for successful long-term weight loss.
In addition to pre-operative evaluations, many patients find it helpful to attend individual or group counseling sessions after their surgery. Vineland Counseling Service, a service of South Jersey Healthcare, offers both group and individual counseling for people who have had gastric bypass surgery. Pre-operative evaluations and counseling are also available.
Outpatient Program
Vineland Counseling Service
76 South State Street
Vineland, NJ 08360
Phone: 856-691-4617
Fax: 856-691-6553
What topics are covered in the mandatory pre-operative class?
This class has been designed to provide information that will assist you on your journey to a healthier lifestyle. Topics will include understanding gastric bypass surgery, making good food choices after surgery, the importance of regular physical activity, and psychological issues that commonly challenge gastric bypass patients.
What causes obesity?
Obesity is caused by many factors. It is linked to the foods we eat, physical inactivity and medical illnesses. Genetics can also play a part by affecting your metabolism.
How do I know that I have severe obesity?
A physician will examine you. They will obtain your height and weight then refer to a special chart that will assist them in determining if you are obese. Another definition is being 100 pounds or more greater than your ideal weight for your height.
If I have surgery and lose weight, how long will the weight stay off?
A 10-year follow-up series from the University of Virginia reported a weight loss of 60 percent of excess weight at five years. At 10 years, the same follow-up series reported a weight loss of 55 percent of excess weight was achieved.
Patients who make permanent improvements to their eating habits and commit to healthy life style generally achieve the best results. Results are dependent upon your commitment to a healthier lifestyle.
What are the major risks with surgery?
Most surgeries go well, without any complications. Infection and blood clots are the two serious complications that concern us the most. To avoid these complications, we use antibiotics and blood thinners. Once you and your surgeon have decided that surgery is the right option for you, your surgeon will discuss the risks associated with this surgery with you in detail.Click here for more information about risks.
Will I need blood?
Most of the time you will not need blood. However, if you do, you should know that your surgeon will make the decision based upon what is best for you and your recovery.
What type of surgery is done?
The operative procedure that we perform most often is called the Roux-en-Y Gastric Bypass.
Why does the Roux-en-Y Gastric Bypass work better than other types of operations for weight loss?
Weight loss has been shown to occur more rapidly and over a longer period of time with gastric bypass than with staple gastroplasty.
The reason for superior weight loss with gastric bypass stems from the small degree of malabsorption caused by bypassing nearly all of the stomach and the first two feet or more of the small intestine. When the small intestine is bypassed, you absorb less fatty foods. To date, obesity surgeons and the major obesity physician societies accept this operation as being the most effective, long-term weight reduction procedure. Additionally, having a smaller gastric pouch limits you to eating two to three ounces at a time before feeling full.
The muscle fibers of the stomach right next to the esophagus, where the small gastric pouch is created, stretch less over time so your pouch will remain a reasonable size. This part of the stomach has the most nerve endings that result in a feeling of fullness. This procedure also produces consistent weight loss secondary to the “dumping syndrome”, which prevents you from taking in large quantities of high-sugar liquids. To date, weight loss with gastric bypass has been more consistent than with gastric staple gastroplasty.
How long has surgery been done for weight reduction?
Gastric operations for treatment of morbid obesity were introduced in 1967.
How does the surgery work to help you lose weight?
Gastric reduction surgery restricts oral intake by closing off the upper part of the stomach using intestinal staples so eating small quantities of food makes you feel full.
What is the success rate of surgery for weight loss?
Surgeons who perform obesity surgery have a difficult time determining how to claim a success rate. The amount of weight you lose should not be the only criteria to evaluate success. However, most people will lose approximately 50 to 80 percent of their excess weight. Many patients lose 80 percent of their excess weight in about 18 months. The amount you lose will depend upon your commitment to maintaining healthy eating habits and regular physical activity. Patients who follow a regular exercise program can achieve even better results.
Also, you will need to look for improvement in your health status. The majority of people will see an improvement in their health before they reach their goal for weight loss.
How long does the surgery take?
We reserve approximately one-and a half to three hours for surgery. Some of this time is taken by the operating room staff to prepare for the surgery. After your surgery you will be in the Recovery Room for several hours.
What is the dumping syndrome?
Sometimes a patient may have a problem with certain foods. If you eat something and then develop diarrhea or severe abdominal cramping, this is called dumping syndrome. Dumping happens when simple carbohydrates (sugars) are dumped too quickly from the stomach into the intestines. Your body dilutes sugars by bringing fluid from other body tissues into the intestines. This leads to abdominal fullness, nausea and crampy abdominal pain followed by diarrhea. Other symptoms that you may have include dizziness, faintness, cold sweats, clammy skin, heart palpitations, and a feeling of warmth. You can avoid this by not eating certain foods, avoiding food that is high in sugar and by following your nutritional plan that was prescribed by your surgeon.
Why do some people say that they have no appetite after they have had this surgery?
This loss of appetite may be related to changes in production of Ghrelin—a peptide hormone usually secreted by the stomach. This hormone is known to be associated with hunger. Normally, the level of Ghrelin in your blood stream will increase before breakfast, lunch and dinner and decreases after eating. When someone is dieting the blood levels of Ghrelin dramatically increase, making compliance with the diet very difficult.
What does it mean if I stop losing weight after a couple of months?
Weight loss after gastric bypass surgery is gradual and occurs at the greatest rate during the first several months. Over the long term, consistency rather than rapid weight loss is emphasized.
After a few months, the rate of weight loss will gradually decrease. This is because the weight that is lost is fat (adipose tissue) rather than lean body mass (muscle). Therefore, the more fatty tissue that is lost, the less remaining fat there is to be lost.
Patients whose weight stabilizes after a loss of 60 percent of their excess weight are considered successful. The main reasons for weight loss to stop after surgery are poor food choices and frequent snacking. In almost every case, these bad habits can be corrected by minor changes or substitutions in the diet. Your dietitian can also assist you in making healthy, appropriate food choices. This is one of the reasons regular follow-up appointments are so important after this type of surgery.
How big will my scar be?
Your incision will be approximately four to six inches down the middle of your abdomen.
What is my responsibility if I think surgery is right for me?
After you and your surgeon discuss the surgery, the risks and benefits for you, you will need to decide if you are going to have this surgery done. You will need to make a life- long commitment to change your eating habits and to exercise, which will help to improve your health. Your instructions will be individualized to meet your needs and goals.
Will the surgery be painful?
You will have some discomfort after the surgery; however, we will keep you as comfortable as we can with appropriate medications. The staff will use a pain scale of 0 – 10, which they will teach you, so we can help you with pain management.
Will I need help at home?
Yes. For the first couple of days or weeks you may need someone to assist you depending upon your progress.
Preparing ahead of time, before your surgery, can minimize the amount of help required. Having the laundry done, house cleaned, bed linens changed and appropriate food items purchased will reduce the need for extra help.
How long until I can drive and get back to normal?
The ability to drive varies with each individual. Getting “back to normal” will depend upon your progress after your surgery. Your surgeon will advise you based upon how well you are doing in your recovery.
When will I be able to get back to work?
We recommend that most people take four to eight weeks off after their surgery. However, your surgeon will discuss this with you and make a recommendation based upon how well you are recovering from your surgery. If your job is sedentary, you can usually return to work in 4 weeks.
Will I need any special equipment at home to help me after my surgery?
You may not need any additional equipment. While you are in the hospital, our case management team will see you. They will evaluate your discharge needs. If you require anything, they will discuss this with you and your surgeon. Your case management team will assist in making the arrangements before you are discharged.
When can I have sexual intercourse?
The time to resume sexual intercourse should be discussed with your surgeon.
If I am going to have the surgery, do I need to see any other doctors or healthcare clinicians?
Yes. All prospective patients in our program who are considering gastric bypass surgery undergo screening and pre-operative interviews with a psychiatrist, the clinical dietitian and other members of the healthcare team. You may also need to see a cardiologist, pulmonologist and internal medicine physician or your family physician.
Once the screening is completed, is there anything else that I need to do?
Once the screening has been completed you will need to have a barium Upper GI contrast study and an ultrasound of the gallbladder. The Upper GI is done to determine if you have peptic ulcer disease, polyps or gastric reflux disease. Depending upon your medical conditions, your surgeon may recommend that you also have an Upper Endoscopy done.
The ultrasound of the gallbladder is done to see if you have gallstones. If gallstones are found, your surgeon may recommend that your gallbladder be removed as part of the gastric bypass surgery or in a separate procedure.
None of these tests are painful.
If I am using a CPAP/BiPAP machine at home will I still need it after surgery?
Yes. When you have your visit with the Pre-Admission Nurse for your surgery we ask that you bring your machine with you. The Respiratory Therapist or Pre-Admission Nurse will discuss your machine and settings.
On the day of your surgery please bring your machine and supplies with you. You will be using your machine after your surgery. The hospital does have CPAP/BiPAP machines; however, we have found that patients do better with their own equipment. The use of these machines may actually be reduced after weight loss is achieved.
Can my family stay overnight with me in the hospital?
No. We do not encourage the family to stay in the hospital room with you overnight. It is in your best interest that you get as much rest during the night as you can. The nursing staff has been trained to care for people who have this type of surgery and will take good care of you. We have made arrangements with area hotels for our patients’ families to obtain a reduced rate.
Will I need to exercise after my surgery?
Yes. Walking is strongly encouraged as soon as possible after surgery. We encourage you to get out of bed the first day after surgery. By the time you go home, you should be able to walk without difficulty.
By the end of the first month, you should be walking 30 minutes every day. It would be in your best interest before you have surgery to find some place where you can exercise. We also offer a specialized program with reduced rates at The Fitness Connection, a service of South Jersey Healthcare. Your surgeon will discuss with you what is the best program for you.
As I lose weight, what will happen with the loose flabby skin on my arms and abdomen?
Your surgeon will discuss with you the option of having surgery to remove the excess skin.
If my surgeon and I agree that this type of surgery is best for me, what are some of the expectations you have for me?
We expect you to keep all preoperative appointments, including scheduling of lab tests and x-ray tests. We expect you to cooperate with the hospital staff when they encourage you to get out of bed the morning after surgery, walk in the hallways, use your incentive spirometer for your lungs and follow your nutrition guidelines. It is very important for everyone to work together to achieve our common goal of an uncomplicated, rapid recovery and discharge from the hospital.
It is vital that you follow the diet restrictions without exception while in the hospital and after you are discharged. To prevent complications, the amount you eat and drink must be limited. This limited volume also aids in the healing process of your suture line. Finally, it is important that you keep all post-operative appointments.
How do I make arrangements for surgery?
Once you and your surgeon agree that surgery is the right option for you, the surgeon’s office staff will instruct you on what appointments for tests and education you need to obtain before you can have surgery. You will be given a schedule to assist you in scheduling all of your tests and appointments in a timely fashion.
Where will I go right after my surgery?
Once your surgery is finished, you will go to the Post Anesthesia Care Unit (PACU) where you will be cared for by registered nurses until you are ready to be taken to your room.
Depending on the medical problems you might have, your surgeon may place you in the Intensive Care Unit (ICU) for a couple days before being transferred to the Post Intensive Care Unit (PICU). If you do not require the Intensive Care Unit, you will be admitted to the Post Intensive Care Unit. The nurses on both units are trained to care for people who have this type of surgery.
What can I expect after the surgery?
You will have an intravenous catheter (IV) through which fluid will be infused into your vein. This will help to prevent dehydration and allow us to give you the antibiotics that your body will need after surgery.
You will have a nasogastric tube. This tube passes through the nose into the stomach. The purpose of this tube is to provide rest for your stomach after the surgery. You will have this tube for about two days. Depending upon your progress, your surgeon will determine if you can have ice chips while the tube is in.
You will have a Foley catheter that will empty the urine from your bladder. You will probably have this catheter for the first couple of days.
There will be an abdominal binder to help support the abdomen while your incision heals. You will continue to use this binder when you go home. Depending on how your body heals after the surgery, your surgeon will instruct you on how long to use the binder.
You will have compression stockings on your legs to help prevent blood clots and help the blood in your legs to circulate more efficiently.
There will be a drain connected to a small drainage system that has a pouch on the end. This system is called a Jackson Pratt. Your surgeon will place a small drain near your incision to help remove fluid that may be around your incision. The small pouch at the end of the drain, which is a little bigger than an egg, will hold any drainage from your incision. Your surgeon will determine how long the drain remains depending upon how well your body heals. If you need to empty the Jackson Pratt when you are discharged, the nurses will teach you how.
You will also need to do breathing exercises. You will be taught how to use a lung exercise product called an incentive spirometer. This will help you to take deep breaths to open all of the air sacs in your lungs and prevent you from developing pneumonia.
What can I eat after surgery?
Depending on your condition, your surgeon will determine what you can have. You may start off with ice chips. Your surgeon will determine how often and how many ice chips you may have.
Why do I have to use a nasogastric tube after surgery?
For the first couple of days you will have a nasogastric tube (NGT). This tube is inserted during the surgery. It is a small tube that passes through the nose and ends in the stomach. The tube will be connected to a wall suction unit to help keep the stomach empty so healing can begin. Depending upon your surgeon and how well you are doing you might be able to have ice chips while the tube is in.
Will I have more tests done after my surgery?
Yes. Usually on your second or third day after surgery, you will go to radiology for an Upper GI test. You may still have your nasogastric tube. You may need to drink a special fluid for the test, or the radiology technician may insert the fluid through your nasogastric tube. The purpose of this test is to check for any leaks from the stomach or intestines into the abdominal cavity.
After I am discharged from the hospital, when can I expect to have my first office visit with my surgeon?
You will have your first post-operative office visit with your surgeon within one week of your discharge from the hospital.
After my first visit with my surgeon, how often will I need to see my surgeon?
After your first post-operative office visit, your surgeon will see you based upon your progress and previous medical conditions. Your follow-up visits will be individualized. Usually you will see your surgeon every six weeks for the first three months. Your visits will then be approximately every two or three months for the rest of the year.
After you have reached your one-year anniversary, you will see your surgeon every six to 12 months for an indefinite period of time.
The frequency of your follow-up visits will depend on your progress. Your surgeon will discuss this with you at your first post-operative office visit.
What nutritional supplements are necessary after surgery?
You will need to take a multivitamin with iron every day for the rest of your life. Children’s and adult multivitamins are available in chewable and liquid forms. In addition to a multivitamin, you may require supplements of calcium, iron and vitamin B12. Your surgeon will tell you what vitamins to take and when you need to start these.
Is there any benefit to a support group? Do you have one?
Yes. There is always a benefit when you can share with someone who is going or has gone through a similar experience. Our support group meets 4th Wednesday of the month at SJH Fitness Connection 2nd floor conference room, at 7PM. For more information, you call 856-641-8398.
Are there any web sites that I can visit to obtain additional information?
Yes. One of the most frequently used sites is: http://www.obesitysurgery.com./. You can also use MSN or Yahoo and type in Bariatric Surgery. Two additional web sites you can check are http://www.obesitysurgery.com./and http://www.obesitysurgery.com./
South Jersey Healthcare does not endorse any web sites related to information about weight loss surgery. As with any information obtained from the Internet, please evaluate the information with your health care team