Weight Loss Surgery FAQ’s

Weight Loss Surgery FAQ’s

Weight loss, or bariatric surgery, is a procedure considered by those who are struggling with weight issues, have tried and failed at many diets over the years, or are suffering from conditions that are affected by weight gain such as high blood pressure, diabetes, joint pain or infertility. Aram Jawed, M.D., general surgeon specializing in laparoscopic bariatric and robotic surgery, takes time to answer your questions and help to ease your concerns if you are considering weight loss surgery.

The questions and answers below are for general information. Everyone’s experience with weight loss surgery is unique and specific to their overall health. If you have questions or concerns about weight loss surgery, please reach out to your physician or contact Saint Clare’s bariatric coordinator at 973-989-3047.

What type of surgery is best for me?

There are many types of weight loss surgery options which include:

  1. Purely restrictive procedures - Restrict the amount of food intake
  2. Restrictive and metabolic procedures - Restrict food intake but also target hormones resulting in decreased hunger, increased satiety, and aim to reset metabolism
  3. Restrictive, metabolic, and malabsorption procedures - Restrict food intake, target hunger hormones, aim to reset metabolism, but also redirect food to bypass a portion of the digestive system preventing absorption of fats and sugars.

A weight loss procedure should ideally be tailored to an individual’s needs. In general, co-morbid conditions such as poorly controlled hypertension and diabetes requiring medications are best suited for either metabolic and/or malabsorption procedures. Whereas individuals with lower BMI’s without major uncontrolled co-morbid conditions may do well with restrictive and/or metabolic procedures alone.

Is weight loss surgery SAFE?

Bariatric, or surgical weight loss procedures, have been proven to be safe. It can be as safe as many standard general surgical procedures such as gallbladder, colon, and orthopedic procedures.

What patients fail to realize is that the risk of morbidity and mortality from continuing to live with morbid obesity, especially with conditions such as high blood pressure, diabetes, sleep apnea, and high cholesterol etc., poses a much greater threat than having a weight loss procedure. A minimally invasive surgery, which may cure all of these ailments, may also add an additional 10-15 years onto your lifespan.

Studies demonstrate that after bariatric surgery there is an 89% reduction in mortality. Cancer mortality decreases by 60%. Mortality from diabetes reduced by over 90%. Mortality from heart disease reduced over 50%.

Overall benefits from weight loss surgery offering long term weight loss and resolution of co-morbid conditions can far outweigh the minimal risks of surgery.

*Stats from the American Society for Metabolic and Bariatric Surgery

*University of Oxford. (2009, March 20). Moderate Obesity Takes Years Off Life Expectancy. ScienceDaily.

What does “minimally invasive surgery” actually mean?

Standard of care for weight loss surgery is minimally invasive. This means there are a few small keyhole incisions that are made on the abdomen. With merely a few millimeters in diameter, low profile surgical instruments are inserted into these keyhole incisions. The abdomen is insufflated and the procedure is done under high definition laparoscopic cameras. Procedure and anesthesia time is shortened as laparoscopic procedures are much quicker than open procedures.

Minimal scarring. Healing is rapid as well as recovery and return to work. In fact, all patients are up, walking, and drinking after surgery. Incisional pain is minimal compared to an open surgical procedure. For all these reasons, the risk of complications is extremely low. In addition, there have been significant improvements in surgical technology, ergonomics, and operating room equipment. Future advances in research and development will only accelerate recovery times and reduce complications.

What are the most common risks?

Risks specific to weight loss surgery are minimal. They have become minuscule over the years due to advancements in minimally invasive technology and refinement in surgical technique.

Overall mortality rate is 0.1%. This is lower than a gallbladder removal (0.7%) or hip replacement (0.93%). Overall risk of complications is around 4%.

These are national averages, and Saint Clare’s Dover Hospital is a Comprehensive Center under the Metabolic and Bariatric Surgery Accreditation and Quality Improvement Program. It is so important to make sure to have the procedure at an accredited center.

Risks of complications with all procedures include bleeding, infection, blood clots, and dehydration, which are the majority. There are risks specific to each procedure which should be discussed during your consultation. These risks are significantly minimized with fellowship trained bariatric surgeons and comprehensive peri-operative patient education.

What patients have to consider is the minimal risk of surgery versus the risk of morbid obesity.

Clinical studies have indicated that the risk of premature death with a body mass index greater than 30 is 50-100%! and patients decrease this risk by 30-40% after surgery.

Therefore, the risk of surgery may far outweigh the risk of living with morbid obesity.

Is surgery the easy way out?

Surgery is never the easy way out. Changing biology, causing food restriction, new metabolic set points, and malabsorption are merely tools for significant long term weight loss. Patients will finally be able to keep weight off because they are no longer fighting their inherent biology. However, lifestyle and behavior modification are necessary for long term success. It will be, of course, significantly easier to lose weight and sustain weight loss. It still requires dedication.

If you were asked to dig a large, deep hole with your two bare hands it would be extremely hard, if not impossible. Weight loss procedures provide you with a ‘shovel’ to dig the hole. The task at hand becomes significantly easier. Thus it still requires work and lifestyle changes. Returning to bad habits will, over time, negate all the hard work and dedication put forth to lose weight immediately following surgery.

Will I regain the weight I initially lost?

Many patients state that “I know a person who had weight loss surgery and years later they are just as big as they were before due to significant weight regain.” The problem with this statement is that nobody truly knows the circumstances behind the weight regain. Statistics demonstrate that as many as 50% of patients may regain a minimal amount of weight (5%) back after two to three years. However, they remain successful in their long term weight loss efforts. “Successful” weight loss is defined as greater than or equal to 50% of a person’s excess body weight. Therefore, in order to calculate that number, an individual must take their height and weight to calculate their BMI and compare it to a normal BMI. Half, or 50%, of that difference is the amount of weight that is expected from bariatric surgery. The majority of patients achieve much higher percentages of weight loss. So regaining 50% of their excess weight that was lost is very rare, in which case the surgery was not successful.

There are many reasons for which patients regain weight. Most of these reasons are behavioral. The biology does not change other than hunger hormones and metabolic set points stabilizing. The majority of patients who suffer from significant weight regain can pinpoint reasons for their weight gain. Examples reasons may include stress, loss of a loved one, loss of employment, or economic hardship. In these cases, individuals may turn back to bad eating habits as a coping mechanism.

Unfortunately, no surgical weight loss procedure is immune to liquid calories. Those who consume ice-cream, milkshakes, and sugary alcoholic beverages as coping mechanisms can easily regain weight. In addition, resorting to bad eating habits with high calorie, sugary, or fatty foods including sweets, even in small amounts throughout the day, can lead to weight regain in the long run. It is thus extremely important to curb these habits and the reasons for embarking on a surgical weight loss journey are to eradicate bad eating behaviors.

Unfortunately, economic instability and medical tourism have led many patients to undergo procedures from non-qualified healthcare practitioners. Patients considering the surgery should only go to board certified fellowship trained bariatric surgeons who practice at comprehensive bariatric centers.

Patient who have had the procedure done incorrectly all have the same story. Weight loss surgery is performed, the patient feels good and initially loses weight because they are on a post-surgical restrictive diet while undergoing the healing process. Months later the patient starts feeling hungry again, as they used to prior to surgery. They can no longer fight their hunger and start to regain weight. Time goes by and unfortunately patients regain a substantial amount, if not reaching their preoperative weight again. The patients feel terrible because they have “failed” surgery and it can take them years to again seek help.

In some cases, when patients go back to their original surgeons, they are told that “your stomach stretched out,” when in fact, the procedure was not done correctly the first time. I have unfortunately treated many patients with the same story and had to revise many bariatric procedures in order to provide patients with the long term weight loss tools they were initially seeking.

Does medical insurance cover weight loss surgery?

Insurance does cover a wide array of bariatric procedures for surgical weight loss. This is most dependent upon your Body Mass Index (BMI), a measure of your height and weight. In addition, your co-morbid conditions, or obesity related health problems, are also considered. A BMI greater than or equal to 35 and less than 40 qualifies patients for most bariatric procedures, given that they have one or more co-morbid conditions. Examples of co-morbid conditions include diabetes, high blood pressure, sleep apnea, gastroesophageal reflux disease (GERD) as well as many others. A patient whose BMI is 40 or greater falls within the ‘morbid obesity’ category and weight alone without any other health problems is sufficient to qualify for a bariatric surgery. The specific type of weight loss procedure is determined on an individual basis depending on the patient’s medical history, co-morbid conditions, and personal goals. An individually tailored procedure is the best method for sustaining long term significant weight loss and has been the optimal method for our patients.

How much weight can I expect to lose and how fast?

The amount of weight loss is dependent of multiple factors. The most significant is the type of procedure. Greater weight loss is achieved with metabolic procedures that are restrictive compared to non-metabolic procedures that are purely restrictive. Additional weight loss can be expected with procedures that are metabolic, restrictive, as well as have a component of malabsorption.

In general, most patients can expect to lose a total of 10% of their entire body weight in one month. They can expect to lose one to four pounds per week on average for the next six to nine months. Weight loss is not linear. Patients experience hitting “plateaus” where they have lost a significant amount to weight after a few weeks and then sustain the same weight for the next couple weeks and then start losing again. Everyone is different and for the most part weight loss is achieved in this ‘step-wise’ fashion.

A person who weight 300 pounds would lose 30 pounds in the first month. They would continue to lose a few pounds a week on average for the next few months. They may lose 25 pounds one month and only 10 pounds the next, but will continually be losing weight.

The American Society for Metabolic and Bariatric Surgery (ASMBS) identifies ‘successful weight loss’ as 50% of a patient’s excess weight. Excess weight is defined as the difference between the patients’ starting preoperative weight and the patient’s ideal body weight based on height and weight. Most metabolic procedures achieve far better than 50% of a patient’s excess weight. The majority of my patients lose 70% or more of their excess weight and I see many patients reach 100% of their excess weight.

By one year, the body establishes a new metabolic set point and weight loss reaches a more permanent plateau. At this point the procedure alone has reached the maximum amount of weight loss if will afford a patient. Additional weight loss can still be achieved with further lifestyle changes and increase physical activity.

Can my stomach stretch out back to its original size?

The short answer to this question is ‘no’. Long term success starts with the procedure being done right. The stomach and digestive system, immediately after surgery, is definitely swollen and undergoes a healing and remodeling process. Once finished, the stomach does relax and patients do feel that they can consume more than they could immediately following surgery but not nearly as much as they could preoperatively.

The stomach doesn’t stretch, it ‘relaxes’, but in no way can accommodate preoperative food intake.

Unfortunately, economic instability and medical tourism have led many patients to undergo procedures from non-qualified healthcare practitioners. Patients considering the surgery should only go to board certified fellowship trained bariatric surgeons who practice at comprehensive bariatric centers.

Patient who have had the procedure done incorrectly all have the same story. Weight loss surgery is performed, the patient feels good and initially loses weight because they are on a post-surgical restrictive diet while undergoing the healing process. Months later the patient starts feeling hungry again, as they used to prior to surgery. They can no longer fight their hunger and start to regain weight. Time goes by and unfortunately patients regain a substantial amount, if not reaching their preoperative weight again. The patients feel terrible because they have “failed” surgery and it can take them years to again seek help.

In some cases, when patients go back to their original surgeons, they are told that “your stomach stretched out,” when in fact, the procedure was not done correctly the first time. I have unfortunately treated many patients with the same story and had to revise many bariatric procedures in order to provide patients with the long term weight loss tools they were initially seeking.

What if I’ve had surgery before and failed? Can my surgery be revised?

Absolutely. The importance of having surgery from a well-qualified doctor cannot be stressed enough. Specifically, at an accredited bariatric surgery center with board certified fellowship trained surgeons who specialize in weight loss.

Various tests including cat scans, x-rays, and endoscopy allow us to determine whether a procedure needs a simple revision or a conversion to a more optimal weight loss surgery. Some procedures are reversible. Those that are not, can be revised or converted.

Will I be able to live a normal life afterwards? What lifestyle changes are necessary after surgery?

Yes. In so many cases, not only will you be living a normal life, but a healthier, easier, and more physically active one.

Clinical studies have revealed that despite which procedure was done; quality of life is significantly increased all around. This is in part due to co-morbid conditions such as high blood pressure and diabetes is reduced.

Lifestyle changes necessary after bariatric surgery are:

  1. Dietary - In our practice we refer to the new style of eating as “modified regular diet.” With a restricted stomach size and/or malabsorption component we want to make sure that patients achieve necessary daily requirements of nutrients. Therefore, we recommend focusing on protein consumption before fats and carbohydrates. However, patients do eventually resume their normal diets with this focus in mind.
  1. As patients lose a significant amount of weight it becomes much easier to achieve a healthy amount of physical activity. We recommend that patients increase their active lifestyle as much as possible to further drive their metabolism up.

Major P, Matłok M, Pędziwiatr M, et al. Quality of Life After Bariatric Surgery. Obes Surg. 2015;25(9):1703-1710. doi:10.1007/s11695-015-1601-2

Surg Obes Relat Dis. 2018 Feb;14(2):170-174. doi: 10.1016/j.soard.2017.10.008. Epub 2017 Oct 16.

I’m a foodie. I want to be healthy but don’t want to give up food! What dietary changes are necessary after surgery?

Despite the massive health benefits bariatric surgery may grant, many patients are still concerned that they will not be able to live with the dietary restrictions. This is yet another misconception because what patients do not realize before surgery is that their ‘cravings’ and perception of food will change drastically.

Altering the stomach and digestive system to ‘trick’ or ‘hack’ the body into believing that a smaller quantity of food is sufficient significantly changes chemical signaling to the brain. This is an important concept because what patients used to crave before surgery is actually repulsive after surgery. For example, many patients perceive even small amounts of sugar as too sweet. The cravings before surgery for sweet foods are completely gone! In addition, eating much smaller quantities of food will trigger satiety.

What this means is that patients can actually eat what they want after surgery but their bodies will be completely satisfied with a small portion rather than the whole plate. For example, eating a few ounces of steak will feel as if they ate a giant t-bone. Eating a third of a slice of pizza will feel as if they ate half a pizza pie.

That being said, strict dietary changes are minimal. Patients should avoid carbonated beverages due to the increased gas. Alcoholic beverages as well as any sugary drinks are warned against due to the fact that the effects of alcohol are significantly increased. Foods high in protein are encouraged to be eaten first before carbohydrates such as breads, rice, and pasta which will fill patients up too quickly.

It is important to note that successful patients do on occasion treat themselves and still enjoy a healthy active lifestyle with a new and improved relationship with food.

I want to get pregnant after surgery, any concerns?

Pregnancy is completely safe after bariatric surgery. In fact, losing weight and curing co-morbid conditions such as sleep apnea, diabetes, and hypertension allows for a much healthier pregnancy. Obesity may cause major health problems for the pregnant mother as well as the child. Pregnancy complications associated with obesity may include:

  • Increased risk of miscarriages
  • Worsening or induction of sleep apnea
  • Gestational diabetes
  • Pre-eclampsia - high blood pressure that cause kidney damage
  • Cardiomyopathy
  • Delivery complications and need for C-section

Risks to the baby may include:

  • Stillbirth
  • Birth defects
  • Significantly increased risk of childhood obesity

Significant sustained weight loss afforded by bariatric surgery may cure infertility issues prior to pregnancy. Many women suffer specifically from obesity induced Polycystic Ovarian Syndrome (PCOS) which makes pregnancy extremely difficult. Research also demonstrates that the higher the Body Mass Index (BMI), the harder it is to get pregnant. Obesity can also reduce the effectiveness of In-Vitro Fertilization (IVF). I have treated many patients who have tried for years to get pregnant and spent small fortunes on IVF and hormone therapy only to be unsuccessful. Yet after surgery, their PCOS is cured and they have healthy pregnancies. We recommend waiting a year after weight loss surgery to attempt pregnancy.

Do I have to be on supplements or vitamins forever after surgery?

All patients are initially placed on vitamins, both water-soluble (B vitamins) and fat soluble (Vitamin A, D). The type of surgery a patient has will dictate whether they will need to continue vitamin supplementation. The additive malabsorption procedures such as a gastric bypass will most likely require prolonged vitamin supplementation whereas metabolic restrictive procedures such as a vertical sleeve gastrectomy may not. Blood levels are checked after surgery and levels will determine a specific individual’s vitamin needs.

What about hair loss during weight loss?

Human hair has a two stage growth cycle. The growth phase is referred to as ‘anagen’ and the resting phase is referred to as ‘telogen.’ Surgery itself puts stress on the body. However, specific to bariatric surgery, is the fact that calorie intake significantly decreases. As this happens the body specifically craves protein as protein turnover is reduced. Hair has one of the most rapid protein turnovers within the body.

“Telogen Effluvium” is the name specific to hair loss following bariatric surgery. This is due to hair follicles remaining in the resting phase. It is important to note that the hair follicles do not ‘die.’ Only up to 15% of hair may not grow during the most rapid weight loss following surgery. However, these hair follicles do not stay within the resting phase for more than 6 months following surgery. I tell my postoperative patients who are concerned with their hair that it will all grow back, usually thicker and healthier than it was before. The best way to prevent hair loss as much as possible is to strictly follow the post bariatric dietary guidelines and to take the required amounts of protein and vitamin supplementation.

How long does recovery take? When can I go back to work?

Recovery is different for every individual. Laparoscopic procedures are minimally invasive and therefore the incisions themselves are only millimeters wide. Patients seldom complain of incisional surgical pain and most patients simply take Tylenol with adequate pain control after surgery. Due to anesthesia, driving is restricted to 48 hours following the procedure. Otherwise everyone is encouraged to ambulate and drink immediately after their procedure. Stairs are allowed and patients are encouraged to walk as much as possible. Heavy lifting, pushing, and pulling is restricted for the first few weeks.

Most patients spend one night in the hospital and leave the next morning. I recommend at least one week off work. This is to acclimatize to your new digestive system. I find that if patients return to work too quickly that they easily forget to stick to the strict postoperative dietary regimen that must become second nature following surgery. This increases the risk of dehydration and insufficient protein intake.

Can I exercise after weight loss surgery?

Absolutely. Exercise is encouraged immediately following surgery. This is best in the form of simply walking as much as possible. Walking not only helps to burn calories but also increases blood circulation and helps to prevent blood clots referred to as Deep Vein Thrombosis (DVT). Patients are permitted to do cardio or yoga as tolerated. Lifting, pushing, or pulling significant weight is restricted for the first few weeks following surgery to allow the incisions to heal without undue stress on abdominal wall muscles which may lead to weakness and herniation.

What about loose skin after surgery?

Skin laxity is a major concern for patients following bariatric surgery. First of all, I would like to start off answering this question by quoting a veteran patient of mine who always states, “Considering everything, loose skin is a good problem to have!” What he means by this is the fact that areas of loose skin are the battle scars that prove a successful fight against obesity. Loose skin may be better than diabetes, high blood pressure, sleep apnea, and all the co-morbid conditions that are life threatening.

Factors to consider regarding loose skin after significant weight loss are:

  • Genetics. Where most of the excess weight is carried on the body, individuals vary significantly with regards to where body fat is held. For example, generally men hold much of their weight in the abdominal area whereas women can hold a significant amount of weight in the hips and thighs. Depending on an individual’s genetic build-up, different areas of the body may be more prone to loose skin.
  • Age. As age increases, skin elasticity decreases.
  • Prior Habits. History of smoking has been shown to speed up the aging process of the skin and thus decrease elasticity of the skin.
  • Nutrition. Following surgery patients can optimize skin health by making sure that they are adequately hydrated, taking their vitamin supplementation.

The best way to combat loose skin after surgery is to be cognizant of following the post bariatric diet with protein and vitamin supplementation and staying hydrated. In addition to this, once cleared with no restrictions, strength training programs assist in increasing muscle density and helping to tighten skin. There are many specific exercises one can do depending on their individual needs and body area of concern.

We recommend consideration of plastic surgery or body contouring only after a year from the surgery date once a new metabolic set point is established and surgical weight loss is achieved. That being said, over 95% of our patients do not feel the need to undergo any type of plastic surgery.

What medical conditions improve after surgery?

Significant weight loss resulting from bariatric surgery positively affects every body system.

Starting from head to toe, areas of significant improvement can include:

  • Migraines
  • Psuedotumor Cerebri (pressure around the brain increases causing headaches and vision problems)
  • Anxiety/Depression
  • Obstructive Sleep Apnea
  • Asthma
  • Gastro Esophageal Reflux Disease (GERD)
  • Heart Disease / Cardiovascular Disease
  • Non Alcoholic Steato-Hepatitis (NASH), or Fatty Liver
  • Erectile Dysfunction
  • Urinary Stress Incontinence
  • PolyCystic Ovarian Syndrome (PCOS) / Infertility
  • Venous Stasis
  • Gout
  • Degenerative Joint Disease / Arthritis
  • Diabetes
  • High Blood Pressure
  • High Cholesterol

Many patients suffer from one or more of the above-mentioned conditions that go undiagnosed. They only realize how debilitating it was with the resolution of symptoms after significant weight loss. All of a sudden they can breathe easier, no longer snore at night, have excess energy during the day, and can outrun their children.

There is an astounding 89% reduction in overall mortality. 90% Reduction in death associated with diabetes. 50% Reduction in death associated with heart disease.

In addition to longevity, overall quality of life is significantly improved. This includes, but is not limited to, increases in self-esteem, mobility, sexual function, relationships, and social interactions. Decreases in anxiety, depression, unemployment and disability.