Q&A: Bariatric Surgeons Answer Your Weight Loss Surgery Questions
Since January, the bariatric surgeons over at Jefferson Health have been schooling us on everything weight-loss-surgery-related (see: here and here). It turns out: you had a lot of questions—even more than we could fit into our Health Chat. So, to make sure all of your questions are addressed, we asked bariatric surgeons Fernando B. Bonanni Jr., MD and David S. Tichansky, MD, FACS to answer them here.
Don’t see your question? Don’t worry: they offer information sessions for potential candidates.
1. What should I expect on my very first visit?
Bonanni: Lots of information on the program to gather and for the program to give you. The first steps require some information exchange, interview and physical exam. You will meet with bariatric surgery team members and your surgeon. During the meeting with your surgeon, the two of you will go over the different surgical options and talk about the best course of action.
2. How long after the first appointment will the actual surgery take place? Will I have to wait long?
Bonanni: When your surgery takes place depends on how long it takes you to fulfill the program requirements and your insurance requirements. All programs expect you to go through an educational process, see a psychiatrist and a nutritionist. Sometimes a patient is required to be evaluated by another form of specialist before surgery, such as cardiology and pulmonology. Insurance companies usually have at least the same requirement. Many want you to see nutritionist for 3 – 6 months before they will approve surgery. The answer to this question depends on your program, insurance requirements, and personal needs.
3. If I have recently been diagnosed with diverticulitis, would I still be a candidate for any of the weight loss surgeries?
Tichansky: Yes, diverticulitis will not interfere with either procedure (sleeve gastrectomy or gastric bypass surgery).
4. I currently weigh 206 lbs. Does that make me a candidate? If so, will it be covered by insurance?
Tichansky: It would depend on your height and the presence of any weight-related medical conditions. If your BMI is greater than 35 and you have a weight related medical condition such as type 2 diabetes, high blood pressure, heart conditions, asthma or joint problems, then you would likely be a good candidate. Insurance typically covers weight loss surgery. It is best to check with your current insurer or get in touch with one of our offices and we can help determine if the surgery will be covered.
5. I know the physicians said you can get pregnant after surgery, but is there a chance the baby’s health could be affected? Are there situations where conceiving is difficult?
Bonanni: Yes, you can get pregnant after surgery. We advise not to get pregnant for a period of about 18 months after a surgery that involves bypassing the intestine such as a gastric bypass or duodenal switch. The reason is to be sure that your nutrition is stable before you need to provide nutrition for two people. We have many patients who have enjoyed normal and healthy pregnancies. After this waiting period, a pregnancy should be normal. If your surgery requires supplements, then those supplements should continue during pregnancy. If you get pregnant sooner and you have had a procedure that uses malabsorption, you should be under the watchful eye of your bariatric program and your obstetrician. There are no situations that make conceiving difficult. In fact, the opposite is true. Since obesity causes infertility, it is not infrequent that patients will have a surprise pregnancy because they become fertile as they lose weight.
6. Will the surgery have higher risks if I have diabetes?
Bonanni: Every and any surgery has more risk when you are a diabetic. This is why we do the surgery, so we can cure your diabetes. You would continue on medications or insulin as instructed before surgery but often, after surgery, your medicine and insulin needs decrease rapidly. Many patients leave the hospital after weight-loss surgery no longer needing oral medications or injected insulin for their type 2 diabetes.
7. I am 59 years old and I weigh 310 pounds and have diabetes. Would I be a good candidate for this type of surgery?
Tichansky: It would depend on your height. If your BMI is greater than 35 with diabetes, then you would likely be a good candidate. Contact Jefferson Health’s bariatric program and we can help determine if bariatric surgery is the best course of action.
8. Does anyone ever get plastic surgery for the excess skin? Do you recommend? Does insurance cover that?
Bonanni: Many people, after bariatric surgery, could undergo plastic surgery but only 8 to 11% do have plastic surgery. All insurance company policies are different. Coverage would depend on your insurance and the type of excess skin surgery you need. Usually, your plastic surgeon will take pictures and contact your insurance company for approval.
9. Are there any potential risks with having ovarian cysts or uterine fibroids, and wanting to have bariatric surgery?
Tichansky: Routine ovarian cysts or uterine fibroids would not directly increase risks of bariatric surgery.
10. Is there a risk of paralysis or nerve damage with bariatric surgery? What are the chances of that?
Bonanni: In general, there is no risk for paralysis because the surgery does not involve nerves, brain, or spinal cord. However, patients who are overweight will sometimes get numbness and tingling (parathesias) after being on the OR table for some time. This comes from excess weight on your nerves in your legs, arms, hands and feet. This usually goes away within hours to days.
11. What would the costs be (an estimate) for a person without medical insurance and who is hoping to lose (over time) about 50 pounds?
Tichansky: Cost largely depends on the treatment options chosen for weight loss. Costs vary from hundreds to thousands of dollars across the spectrum of treatment. Contact one of our offices and we can help you navigate the cost of the surgery.
Don’t forget: if you still have questions, you can attend an informational seminar with Jefferson Health.This is a paid partnership between Jefferson Health and Philadelphia Magazine