Surgery for Weight Loss - 21 Questions to Ask
by Brandon Cornett
The popularity of weight loss surgery has exploded in recent years. In fact, the number of Americans undergoing surgery for weight loss has quadrupled since the late 90’s. As more and more people turn to surgery as the solution for their obesity, the need for consumer information becomes increasingly important.
In the spirit of consumer information, the Bariatric Learning Center has assembled this list of 21 questions a person should ask when considering bariatric weight-loss surgery.
1. Do I really need surgery for weight loss success?
Is weight loss surgery the only answer for you, or is there a better path to losing weight? This should be the first question you answer before considering any other question on this list. After all, this is surgery we are talking about here.
Bariatric (weight loss) surgery has exploded in popularity over the last couple of years, partly due to all of the media coverage it gets. Many surgery providers have slick brochures and websites that make surgery for weight loss seem like a simple but effective solution. What you have to remember is there is nothing simple about surgery.
So before you can decide if surgery for weight loss is right for you, it’s wise to ask yourself the next question on this list.
2. Have I exhausted my non-surgical weight-loss options?
Only in very rare cases is surgery the only option for weight loss. For most people, surgery for weight loss is one option of many. Most physicians agree, for example, that good nutrition and exercise are a better and safer alternative to surgery. The question is … have you exhausted these other non-surgical options for weight loss?
3. Have I really exhausted those other options?
I’ve repeated this question to stress an important point about non-surgical alternatives to weight loss success — they are almost always better than the surgical option. Some people will make a half-hearted attempt to lose weight through proper nutrition and exercise, and then give up in frustration. Don’t make this same mistake.
Before turning to surgery for weight loss you should make a serious effort to lose weight naturally. Losing weight naturally (through nutrition and exercise) takes time and effort, but it should always be your first attempt.
If you have answered the questions honestly up to this point, and you have genuinely exhausted your other options for weight loss, let’s move on.
4. Do I know the basic concept of weight loss surgery procedures?
Many people think of bariatric weight-loss surgery as a fat-removal type of approach (such as liposuction). But this is not the case. There are several types of surgery for weight loss, but they all seek to alter the gastrointestinal / digestive process in some way.
Basically, these types of surgeries reduce the stomach’s capacity for food, which has a weight-reduction effect over time. Obviously, this is an oversimplification of weight loss surgery. We will get more specific as we go. For now, it’s just important to realize that this is real surgery with physically altering effects. So it should be considered carefully.
* Learn more about the basics of weight loss surgery.
5. Do I qualify for bariatric surgery?
If you have answered the questions in order, and you’ve determined that surgery for weight loss is the right option for you, the next logical question would pertain to surgery criteria. Most bariatric surgeons use certain criteria to determine whether or not a person is a good candidate for weight loss surgery. Though these criteria will vary from one surgeon to another, certain standards have emerged over time.
Generally speaking, a person will qualify for bariatric surgery when the following conditions have been met:
- The candidate is severely obese with a body mass index over 40.
- The candidate’s daily life is hampered by their obesity.
- The candidate has tried but failed to lose weight through non-surgical means.
- The candidate understands the risks associated with surgery for weight loss.
* Learn more about basic surgery criteria.
6. Do I understand the risks of weight loss surgery?
Every type of surgery has certain risks associated with it, and that includes surgery for weight loss purposes. Even the laparoscopic techniques, which are considered minimally invasive, have potential risks and complications. When considering surgery as a weight-loss option, you have to look at the big picture and factor in the potential risks.
* Learn more about the possible complications of bariatric surgery.
7. Do I understand the life-changing effects I will face after surgery?
Many people view surgery as a “quick-fix” approach to weight loss. But if you speak to somebody who has had such surgery in the past, they will likely point out that this is not the case. Surgery for weight loss is a life-changing event. After all, you are altering your stomach’s capacity and, in some cases, your entire digestive process. Such changes will follow you for life.
So before making your decision about weight loss surgery, be sure to learn about the long-term effects of your chosen procedure (gastric bypass, banding, etc.). These days, there are quite a few blogs and forums online that are frequented by people who have had surgery for weight loss in the past. This would be a great place to get some real-life input from somebody who has “been there, done that.” By gathering information from various sources (including previous patients of bariatric surgery), you will be better able to make an informed decision about your own surgery.
8. Have I researched the different types of weight loss surgery?
As medical science advances, the diversity of surgery options will increase as well. This is true of any type of surgery, including those for weight loss. Over the past few years, for example, new types of surgery for weight loss have emerged, giving potential patients more options that ever before.
But this is not car shopping we are talking about here. This is surgery. So while it’s always good to have options, it also means you have more homework to do. Each type of bariatric surgery has its pros and cons. So in order to understand them all, you have to do plenty of research.
It’s important to conduct your research “far and wide,” as opposed to just reading one book or one website. For example, if you read articles on a surgeon’s website who performs gastric bypass only, those articles will naturally be skewed in favor of gastric bypass as a surgery option — since it is the surgeon’s specialty.
* Learn about the various types of bariatric surgery.
9. Do I understand minimally invasive versus “open” surgery?
These days, many types of surgery have both a laparoscopic method and an “open surgery” method. Laparoscopic surgery is often referred to as “minimally invasive” surgery because it allows for smaller incisions than an open surgery.
Here is the primary difference between these two methods, as they apply to surgery for weight loss …
• Open surgery — The surgeon gains access through a long incision made in the stomach.
• Laparoscopic surgery — The surgeon gains access through one or more small incisions in the stomach. A tiny camera is inserted into one of the other incisions so the surgeon can see to perform the surgery.
* Learn more about laparoscopic weight loss surgery.
10. Do I understand restrictive surgery versus malabsorptive surgery?
All forms of bariatric surgery can be classified as either malabsorptive, restrictive, or a combination of the two. It’s important to understand these terms, because they will have an impact on your lifestyle and long-term health after your weight loss surgery.
• Malabsorptive weight loss surgery — This type of surgical procedure alters your digestion process. As a result, it can lead to the incomplete absorption of certain vitamins and minerals from your food.
• Restrictive weight loss surgery — This type of procedure decreases food consumption by reducing the size of the stomach, usually by dividing the stomach into a small upper pouch (the usable part) and a larger lower portion.
• Combination surgery — Certain types of surgery for weight loss (such as the Roux-en-Y gastric bypass) are both restrictive and malabsorptive. The Roux-en-Y segments the stomach while also reshaping the intestines, thus it combines both concepts into one surgery.
The important thing to remember here is that malabsorptive and restrictive surgeries both have their advantages and disadvantages, and that they will affect your long-term health in different ways. When considering surgery for weight loss, be sure to consider these two concepts and the effects associated with them.
Also, keep in mind that a surgeon or surgery center that specializes in a certain type of weight loss surgery will often tout that type of procedure as being the best. Clearly, these folks are biased on the subject. So in your research, be sure to include less biased sources of information, such as governmental studies, university research and the like.
11. Do I know the cost of weight loss surgery and can I afford it?
For most people considering surgery for weight loss, the cost of such procedures is a major sticking point. Of course, this is assuming that you’ve answered the other questions on this list, that you’ve exhausted your non-surgical options for weight loss, and that you are now ready to move ahead with surgery.
Depending on the type of procedure you choose, surgery for weight loss can cost anywhere from $10,000 to $40,000 … probably more by the time I finish this tutorial. So in addition to the health-related considerations you must make, there are financial ones as well.
Any discussion about the cost of weight loss surgery will inevitably lead to a discussion about insurance coverage. Thus, it is the next question on our list.
12. Will my insurance cover the cost of surgery (or part of it)?
First the good news. Due to the ever-increasing popularity of weight loss surgery (and the increased demands for insurance coverage from patients and doctors alike), more insurance companies are beginning to offer coverage for these surgeries.
Now the bad news. With that being said, there are still plenty of insurance providers who won’t cover surgery for weight loss (or else they make it difficult to obtain such coverage by imposing various restrictions).
Fortunately, this is an easy question to answer. You simply have to ask your insurance provider if they would cover the type of procedure you are considering. Once you are certain you’ll have decent coverage of your surgery, you can move on to the remaining questions on the list.
* Learn more about insurance coverage.
13. Have I found a qualified weight loss surgeon?
So, let’s assume that (A) you have exhausted your non-surgical options for weight loss, (B) you have researched the various types of surgery and chosen the one that’s best for you, and (C) you have determined that your insurance company will cover the cost of surgery.
Now you must ask the question: “Who is going to perform my surgery?”
When screening your potential surgeon, find out how much experience he or she has performing the type of surgery for weight loss that you’ve selected. Choosing the best surgeon may very well mean you’ll pay more for the surgery, but isn’t your health and wellbeing worth it?
You should also find out if the surgery center is part of a “co-op” team, or if they only provide the surgery itself. These days, many weight loss surgery centers partner with nutritionists, exercise specialists and other health professionals to treat the “whole person,” as opposed to just performing the surgery. If that kind of comprehensive treatment is important to you, you might consider one of these facilities.
14. Does the surgeon make me feel comfortable?
In many regards, choosing a surgeon for your weight loss procedure is like choosing a surgeon for any other purpose. You want to find a surgeon who is experienced in the field, as well as one who makes you comfortable.
Some weight loss surgeons are highly skilled from a technical standpoint, but lack a pleasant “bedside manner.” While other weight loss surgeons are great with people but less experienced in bariatric surgery. You want to find a surgeon with a combination of these qualities, one who is both highly skilled and easy to talk to.
15. How many weight loss surgeries has the doctor performed?
One of the best ways to pre-qualify a potential surgeon is to consider how many surgeries he or she has performed. In most states, surgeons are required by law to provide potential patients with their surgical history, success rates, etc. So don’t be afraid to ask. It’s your health, after all.
If your potential surgeon performs surgery for weight loss on a regular basis, he or she will be well versed in the latest techniques and technology (not to mention well-practiced in the actual process of surgery). Obviously, this is something you want in a surgeon.
16. Will my surgeon create a good follow-up plan for me?
When choosing surgery as a weight loss option, it’s important to realize that the actual surgery is only the first step of a long path. You will also need to alter your eating habits and, ideally, increase your level of exercise. A weight loss surgeon should establish a post-surgery follow-up plan to help you through all of this, and to monitor your success.
17. What should I do before weight loss surgery to prepare for it?
This is one of the most common questions for people who have decided in favor of surgery for weight loss: What do I need to do before the surgery? Are there any dietary restrictions I must follow? Et cetera.
What’s important to realize here is that your pre-surgery preps should be mental as well as physical. After all, you are making life-altering changes to your body’s chemistry, so you need to have the right mindset about what’s to come.
The physical part of preparing for weight loss surgery should be straightforward, because your surgeon should provide you with a pre-surgery checklist to follow. But the mental side of preparation is something that a surgeon may not be able to help you with.
Here are some tips for mental / emotional preparation prior to surgery:
- Learn everything you can about the weight loss surgical procedure you have chosen, especially the steps you should take after surgery. By being a “quasi-expert” on the subject, you will put your mind more at ease.
- Try to establish a relationship with somebody who has undergone surgery for weight loss in the past. This person can offer emotional support as well as firsthand insight into what you can expect afterward.
- Journals are popular among weight loss surgery patients. Many people use them to chronicle their journey, record their reasons for having the surgery, etc. Consider starting one of your own.
18. What happens after weight loss surgery?
This topic was touched on in question 17, but it deserves a closer examination. Life after surgery will be dramatically different for you, for several reasons. For one thing, your diet and food consumption will change — often dramatically. That’s the whole point of weight loss surgery.
Dietary changes are an important consideration after surgery, but there are others. You should also learn all you can about the average recovery process for your chosen type of surgery, so you will know what to expect (keeping in mind that different people recover in different ways).
Plastic surgery is another common consideration among bariatric surgery patients. By its very nature, bariatric surgery can result in significant weight loss (often in a relatively short period of time). This can lead to excess amounts of loose, sagging skin.
According to the American Society of Plastic Surgeons, about 15% of bariatric surgery patients go on to have plastic surgery after weight loss (also referred to as body contouring). Whether or not you will be part of this 15% is just one more question you must answer.
* Learn more about what to expect after your surgery.
19. What foods should I eat (and avoid) after my weight loss surgery procedure?
As mentioned previously, your food intake after bariatric surgery will be dramatically different than it was before surgery. For one thing, you will be eating smaller meals / smaller portions, due to the reduction in stomach capacity.
Dietary considerations are also important for another reason. If you undergo a malabsorptive type of weight loss surgery (see question 10 above), you may have to take vitamin or mineral supplements due to a lack of natural absorption.
* Learn more about foods and diet after surgery.
20. Do I have a post-surgery exercise plan to improve my overall health?
When researching and planning for weight loss surgery, many patients overlook a critical aspect of life after surgery — exercise.
Surgery for weight loss can help you with the gastrointestinal / digestive aspects of weight loss, but it cannot change the lifestyle that led to the weight condition in the first place. You will have to do that yourself, and exercise is a big part of it.
The patients who experience the best results from bariatric surgery enjoy those results, in part, because they have adopted more active lifestyles. When you think of the various costs associated with surgery for weight loss (financial, physical and emotional), it only makes sense to maximize your post-surgery success and wellbeing. Only with a good exercise program can you get the most out of your weight loss surgery experience.
21. Have I committed myself to further learning on this subject?
If you’ve answered all of the questions above, you will have learned one thing above all else. Bariatric surgery is not a quick fix, but a life-changing event with far-reaching effects. It is therefore important to dedicate yourself to ongoing education on such topics as nutrition and exercise.
Remember, surgery for weight loss only addresses the gastrointestinal / digestive aspects of losing weight. It’s up to you to address the lifestyle factors that led to the excess weight in the first place.
Senior Editor | 
October 4, 2007 3:45 pm