Frequently Asked Questions - FAQ's

Introduction

Obesity is currently rising at epidemic proportions in the United States. Despite the fact that an estimated 40 billion dollars are spent on weight reduction, 50 to 60% of the adult population is overweight or obese. In 6-8% of these individuals, obesity is so severe that they have a condition called morbid obesity. After attempting multiple diets including dietary counseling, pharmaceutical agents, liquid diets and numerous other methods of losing weight, an increasing number of people are considering surgery to help control their weight.

This guide will provide our prospective bariatric surgery patients with answers to many of the questions regarding our Long Island practice and gastric bypass or LAP-BAND® Adjustable Gastric Band surgery, here in New York. We have treated more than 2000 people at our program in Long Island for gastric bypass or one of the other surgeries we offer for obesity. The questions are based on the issues discussed when most patients are inquiring about surgery and subjects mentioned in our monthly support groups. The initial questions will help you understand why obesity surgery works and provide information about the advantages and disadvantages of obesity surgery. The different procedures we offer are also described. Post-operative modifications in diet and lifestyle are also included.

Most people seek out bariatric surgery because of the increasing burden their weight is placing on their quality of life and their health. We know how severe obesity can impact your everyday life here in New York. Bariatric surgery is effective for more than 90% of candidates, but comes at the cost of an operation that forces you to change your eating behavior. It is certainly not an easy way out and is not for everyone.

In addition to this information, each of you are invited and urged to attend our monthly support groups that focus on many of the issues discussed below. In addition, we will be glad to answer questions when we meet with you in consultation. Contact the office of Dr. Shawn Garber, MD FACS and staff at 516-616-5500 to set up an appointment.

What is obesity?

The definition of obesity is excess adipose or fat tissue. Since it is difficult to measure an individual’s body fat, and easy to measure weight, most refer to obesity as being very overweight. A more accurate number utilized by clinicians, is body mass index or BMI. Your BMI is calculated by dividing your weight in kilograms by your height in meters squared. A BMI of 22-25 is considered normal, 25-30 overweight, 30-35 obese, 35-40 severely obese and more than 40 morbidly obese. Our bariatric surgery specialists and most insurance companies consider individuals with a BMI of 40 as candidates for surgery, as well as those with BMI of 35 with a life threatening complication from their obesity.

Why would you consider surgery for obesity?

Obesity is considered a very serious medical disease. There are many negative impacts of severe obesity on an individual’s life. Obesity can damage muscle, bones, and internal organs. The chance of heart disease, diabetes, sleep apnea, infertility, osteoarthritis, venous insufficiency, gallbladder disease, and certain cancers are increased by obesity. As your weight increases the risks of medical problems increases. There are many social and psychological implications of being obese. Prejudice at school and at the work place is not uncommon. There is an increased incidence of depression in those affected by morbid obesity.

The physicians at our practice in Long Island stress that gastric bypass or LAP-BAND® Adjustable Gastric Band surgery for obesity is not the first option that should be used to treat your weight problem. It is recommended to try and lose weight without an operation. Unfortunately, for many individuals who have been unsuccessful with diets, drugs, nutritional and psychological counseling and exercise programs, long term weight loss is not possible without surgery. In fact the National Institutes of Health had a consensus statement on morbid obesity and determined that surgery is the only effective means of weight loss in patients that suffer from morbid obesity.

The quality of life and health for many obesity surgery patients in New York and elsewhere has improved since having bariatric surgery. There have been many publications recently that have documented these benefits. Gastric bypass surgery can prevent the progression and mortality associated with Type II diabetes in morbidly obese adults by a study from East Carolina University. With medical weight loss, most patients lose weight only to relapse and regain their weight. Exercise and making better food choices is still important. But surgery is a great aide in helping you to reach your goals of living a longer and healthier life. It also promotes long term success.

What causes obesity?

Obesity means excess fat. The body stores excess energy in fat and obesity occurs when energy you take in exceeds the amount of energy burned. Obesity is not caused by a lack of willpower but is multifactorial.

There is definitely a genetic component of obesity. Many people work in office settings, children stay inside and play video games and don’t live an active lifestyle. Being active is what burns energy. At the same time, the prevalence of fast food in the US has grown at alarming rates. This combination of the population becoming less active combined with easy access to fast foods with lots of calories and energy has led to an obesity epidemic.

Our focus in obesity treatment is to reduce the caloric intake and increase exercise to help burn energy and fat. The metabolic rate can only be increased by improving the amount of muscle you have. Increased exercise leads to increased muscle.

When should surgery be considered?

When patients have failed multiple medical weight loss methods surgery becomes a good option. Potential patients at our Long Island practice should realize that while surgery provides the best chance of lasting weight loss, it comes at the cost of an invasive operation that carries risk.

There are many reasons for exploring surgery for obesity. Some people have serious illnesses such as diabetes, sleep apnea, hypertension or degenerative joint disease caused by excess weight. For others, the primary motivation is the psychological impact the weight is having on their lives. Whatever the reason, it is essential to realize that surgery for obesity is a major operation that can have complications. Making the decision to have surgery requires careful thought.

How can surgery make me lose weight?

There are two ways the gastrointestinal tract can be altered to cause weight loss. The stomach can be made smaller, (gastric restriction) so that a person feels full after eating less food.

The second mechanism is bypassing a portion of the intestines that the food comes in contact with. As a result, you don’t absorb all of the calories that you eat, thus malabsorption occurs.

Different operations use these two mechanisms in various ways. Some operations are pure gastric restrictive procedures. Many combine gastric restriction with moderate malabsorption. It is important to realize that there is no perfect operation, therefore we discuss the advantages and disadvantages of all potential procedures with our Long Island office patients, be it gastric bypass surgery, the LAP-BAND® System or another procedure. Together we can decide which best addresses your particular needs.

Why can I expect surgery to work, when I failed so many other weight loss remedies?

Surgery provides a control mechanism that is with you where ever you go. While it is still important to make good decisions and exercise on a regular basis, surgery makes these goals realistic for our patients in New York. After bariatric surgery you must change your eating habits. If not, you'll experience unpleasant side effects. On average, patients lose between 50 to 80% of their excess weight and keep the majority off for an extended period.

What is the worst thing that can happen after obesity surgery?

The worst thing that can happen is that someone can die. It is very important to choose a bariatric surgeon that is a leader in the field and experienced in handling complications that can arise during obesity surgery. Our New York bariatric surgery specialists certainly meet this criteria. Potential complications include, but are not limited to, the risk of anesthesia, infection, bleeding, blood clots, hernias and wound complications. This is not stated to frighten you, but to remind you that this is a big decision and not without risk.

What about the size of my incision?

We believe that a minimally invasive approach is the best way to perform the bariatric surgery procedures. At our practice in Long Island, gastric bypass surgery is performed via the laparoscopic method where 5-6 tiny incisions are made in the abdomen and surgical instruments are inserted through ports. The LAP-BAND® Adjustable Gastric Band is also placed via the laparoscopic method.

What are advantages of laparoscopy?

With laparoscopy, it is not necessary to cut through the muscle. Surgery is done through small incisions. The surgeon is able to see the operative field using a television monitor. Advantages include a reduction in potential wound complications, less occurrence of hernias and a faster return to full activity. For gastric bypass patients in New York, this approach is ideal for appropriate candidates. It is important to emphasize that even when surgery is done through small incisions; it is still a major operation.

What are the risks of surgery?

We wish to emphasize to our New York patients that all bariatric surgery operations are major procedures and have serious risk. The national average mortality rate for gastric bypass surgery is .5%. Major early complications include leakage of intestinal attachments causing infection and requiring additional surgery, bleeding, blood clots, and any other complications that may occur after major gastric surgery. Wound complications, infections, and hernias can occur. Additionally, there is the risk of malnutrition and vitamin deficiency. This list is far from exhaustive.

While most of these issues rarely arise, the major point is that these procedures should only be done when necessary and by doctors who have experience in this area.

Will my insurance cover the operation?

After you complete the preoperative work-up, our staff will write a letter to your insurance company. We explain to them that weight loss surgery is NOT a cosmetic procedure, but is an operation which will help you avoid major health problems later in life. Most insurance companies will usually cover the procedure if you meet the criteria. Unfortunately, some insurance policies have a clause which absolutely excludes coverage of weight loss surgery. Unfortunately, there is little to be done in this situation, short of changing insurance companies.

Is there a weight limit for laparoscopic weight loss surgery?

There is no absolute limit for laparoscopic weight loss surgery. People with a BMI greater than 60 have a higher chance to be converted to an open procedure. We usually attempt to perform all procedures laparoscopically with small incisions.

Is there a minimum weight required for obesity surgery?

First it is necessary to calculate your body mass index, or BMI. To get to our BMI calculator, click here. The lower limit for weight loss surgery is 40 or higher. If you have major health problems related to obesity like diabetes, hypertension, sleep apnea you may be a candidate with a BMI as low as 35.

Will I be asked to stop smoking?

Patients are required to stop smoking at least one month before surgery. Smokers have significantly higher post-operative complications including pneumonia, stricture formation, and ulcers to name a few.

I had previous abdominal surgery. Can my surgery still be performed laparoscopically?

After any abdominal surgery you will develop some adhesions or "scars" inside your abdomen. In most cases previous abdominal surgery is not a problem when performing the gastric bypass laparoscopically. Any previous abdominal surgery, especially upper abdominal surgery increases the chance of needing to be converted to an open procedure. If your surgeon is well-trained in laparoscopic techniques, you definitely remain a candidate for laparoscopic weight loss surgery. Dr. Garber has performed many operations on patients with previous surgery with excellent results.

Will I be able to get pregnant after gastric bypass surgery?

You MUST NOT get pregnant during the first 12-18 months after surgery. If you were to get pregnant during this period your fetus could suffer from abnormal development due to malnutrition. After 12-18 months it is perfectly safe to get pregnant. Weight loss surgery may make it easier to conceive after you lose the weight. Plus, with the improvement in preoperative health problems like diabetes and hypertension your chance of a healthy pregnancy is improved.

What happens to the lower part of the stomach that is bypassed?

In the gastric bypass procedure, the stomach is left in place with intact blood supply. In some cases it may shrink a bit and its muscle or lining (the mucosa) may atrophy, but for the most part it remains unchanged. Remember the stomach has two main functions. First it is a reservoir for food. Secondly, it is a chemical factory. The lower stomach still contributes to the function of the intestines even though it does not receive or process food - it makes intrinsic factor, necessary to absorb Vitamin B12 and contributes to hormone balance and motility of the intestines in ways that are not entirely known.

How big will my stomach pouch really be in the long run?

This can vary by surgical procedure and surgeon. We feel the size of the pouch is very important to the overall success of the operation. Because we feel so strongly about this, we measure the small stomach pouch in every case. Even though we have done literally thousands of these operations we measure every one. The size starts at 15 cc and over time will stretch slightly but not much. Like blowing up a balloon, the pouch is easier to distend if it is bigger. The pouch size does appear to be a very important part of the operation’s long-term success. Even though the pouch stays small, patients will be able to eat more as the months go by because scars become more supple with time and the outlet will enlarge slightly giving the additional capacity needed so that patients can avoid too much weight loss and the risk of becoming malnourished.

Is gastric bypass surgery reversible?

Gastric bypass surgery is considered a permanent operation. However, it can be reversed for medical reasons only if you suffered from severe malnutrition which is extremely rare. None of your organs are removed from the body so theoretically the surgery can be reversed. Dr. Garber has never had to reverse any patient with this surgery.

Will I be miserably hungry after weight loss surgery since I'm not eating much?

Most patients say “NO”. In fact, for the first 4-6 weeks many patients have almost no appetite. Over the next several months the appetite returns, but it tends not to be a ravenous type of hunger and “satisfaction” is gained by eating less.

How will alcohol affect me after surgery?

You will find that even small amounts of alcohol will affect you quickly. Even one standard bar drink maybe too much! You will have higher blood levels with smaller amounts consumed and this is also more toxic on your liver.

What are the long-term side effects of the gastric bypass surgery?

If you follow-up with your doctor on a regular basis there should be no long term side effects except for increasing your life span by 10-15 years. If you don't take your vitamins or calcium supplements you could suffer from osteoporosis.

How long will I be in the hospital after the surgery?

Most patients will go home from the hospital in 2 days for laparoscopic gastric bypass surgery and 1 day for the Lapband.

How long after the surgery can I return to work?

Most patients can usually be back to work in 7-10 days after the laparoscopic gastric bypass. Everyone heals differently with different pain tolerances and this can vary among patients. Dr. Garber once had a patient that operated a construction crane for a living and returned to work 7 days after the surgery.

What are the advantages of having my obesity surgery with the New York Bariatric Group?

New York Bariatric Group is one of the top facilities for LAP-BAND® Adjustable Gastric Band and gastric bypass surgery in New York and Long Island and is located in New Hyde Park, NY.

One of the major advantages of choosing New York Bariatric Group for obesity surgery is the high number of weight loss surgeries performed. As a result, both the professional and ancillary staff are familiar with the unique needs of obesity surgery patients.