The changes to your life are nothing short of dramatic. While almost everyone focuses on the benefits of weight loss surgery, few are willing to admit that living with the decision can be very difficult and at times complicated. Yes, the majority of surgery, patients will lose between 75 and 100 pounds but it’s not without its costs. Do not make the mistake of minimizing these costs as they will be with you for the rest of your life.

Consider…

1. Because you’re eating so much less, taking vitamins, minerals and supplements will need to become part of your daily life. Or not talking a one a day vitamin, but usually, a handful of very strong and potent vitamins to maintain your health.

2. You will think twice and sometimes three times before eating anything dense like a one half slice of bread. This is because it takes longer for this type of food to digest which means it sets in your stomach longer. And it sets at the top of your stomach as your stomach acids work to digest and break down the complex carbohydrates. Some days it will be no problem, while others it will cause painful heartburn and discomfort. Oh, you also won’t ever be certain each time you take a bite, whether it will be okay or not.

3. Think about your favorite food smells. Imagine Pizza, warm cinnamon rolls in the morning, fresh baked bread or a hot hamburger right off the grill. Now imagine living with those smells throughout your life and realize that the most you can half at any one sitting is a single bite or two. Now reread the above problem that he may face when you do have that bite or two.

4. Feeling full and feeling satisfied are not the same thing. While weight loss surgery does work, it only works on the physical side of weight control. That is, you cannot physically eat very much at any one sitting. Well, surgery will quickly make you feel full with just a couple of bites of food, that food isn’t very satisfying. This is because the feeling of fullness isn’t that deep down in your gut satisfaction you feel after eating a full meal. No it’s more of a full that if you eat another bite, you will surely get sick and vomit type feeling.

5. You will live in a society where food is as much a social event as fueling your body with energy. Business lunches, evening dinners with your loved ones and attending a friends or family event that includes eating becomes problematic.

These are just some of the things that you should consider before committing to gastric weight loss surgery. It’s easy to focus strictly on the weight loss aspect without thinking about how this radical, though safe surgical procedure will change your life forever.

Is weight loss surgery right for you?

This is a decision each of us must carefully make. There are several steps that each of us will take as we determine if bariatric surgery is the right choice at this time.

Following is an outline of the steps required by a well-qualified bariatric center. To these steps there are additional steps that may be required on an individual basis or by your insurance carrier. Please note that these steps are my personal summary that I have outlined to assist me in understanding them better. You need to follow the steps of your own medical professional and surgical team.

Steps Towards Weight Losss Surgery

1. Attend informational seminar.

2. Confirm your insurance coverage for weight loss surgery.

3. Complete and submit an extensive application to the Bariatric Center.

4. Lifestyle Visits

a. Evaluation with Bariatric Surgeon

i.Review personal history and health status.

ii.Discuss the amount of pre surgery weight loss required.

iii.Discuss the importance of support from family and friends.

iv.Discuss the necessary tests that will be done prior to surgery.

v.Discuss the types of weight loss surgery and their risks.

vi.Discuss the requirements for compliance of the bariatric surgery guidelines and the commitment to follow them.

b. Visit with Nurse Case Manager

i.Review of necessary steps leading to surgery.

ii.Discuss and receive answers to any question.

iii.Preoperative teaching session and review of education book.

c. Evaluation with Psychologist

i.Thorough psychological evaluation.

ii.Discuss the impact of the necessary lifestyle changes.

iii.If needed a course of therapy will be recommended.

iv.Discuss and receive a list of community resources for support.

d. Evaluation with Bariatric Dietician

i.Review your usual eating patterns.

ii.Review the impact of surgery on food intake and absorption of nutrients.

iii.Bariatric nutritional guidelines before and after surgery.

iv.Discuss a reduced calorie diet if required to lose weight prior to surgery.

e. Evaluation with physical therapist

i.Evaluation and design of a structured activity and fitness program.

ii.Discussion of educational resources to increase knowledge of the beneficial effects of activity and exercise.

iii.Review activity log.

iv.Review breathing, stretching and strengthening exercises.

f. Extended dietary program if required by the insurance company.

5. Review Committee: Once the above has been completed a multidisciplinary team will meet to review the evaluations and assess readiness for surgery.

6. Preoperative Nutrition Classes: Attend group nutrition classes in preparation for how to eat after surgery.

7. Insurance Approval and Pre-authorization: Once approved by the review committee and all necessary insurance requirements have been complete a case manager will work with the insurance company for approval.

8. Preoperative Appointment: Once approved by the insurance company a preoperative appointment will be scheduled with the surgeon and a surgery date assigned.

a. Meeting with Anesthesiologist

i.Review of your past anesthesia experience and sedatives.

ii.Receive advice of anesthesia and sedatives.

iii.Examination of airway.

iv.Discussion of medications to be taken prior to surgery.

9. Preadmission Testing (PAT): One week prior to surgery a preadmission screening will be performed.

a. Meet with anesthesiologist and a nurse.

b. Have any necessary lab work performed.

c. Receive and discuss information regarding hospital stay.

Preparing for Surgery

1. Follow the surgeon’s advice as to which medications to continue. If advised to stop certain medications you will be told which ones and when you should stop taking them.

2. Smoking: If you are a smoker you are required to stop smoking prior to surgery and are strongly advised against restarting at any time in the future following surgery.

3. Start to practice new habits.

a. Journaling: Become aware of and keep a written record of habitual patterns as well as the reasons behind your eating. Pay close attention to situation (other than hunger) that trigger you to eat and not these in your journal.

4. Begin or Continue Physical Activity

a. Engage in activities to improve overall mobility, flexibility, muscle strength and endurance. Conditioning improves surgery outcome including health, recovery and feeling and reduces complications.

5. Begin the Practice of Healthful Eating Habits

6. Review All Educational Materials to assist in the learning of the permanent life style changes to be made.

7. Practice Deep Breathing: The practice of deep breathing for 5 minutes each morning and each evening helps with the recovery from surgery.

8. Preoperative Weight Loss: For those of us that are “apple shaped” losing weight prior to surgery makes the surgery easier to perform resulting in a better outcome.

Here are a few of the studies and articles that I have read during this decision making process. These studies have informed me that not only is there the prospect of death from complications that can be associated with the surgery. These prospects are higher for us older men then they are for the general population. Am I willing to face these risk in order to perhaps live a better, longer life after the surgery? This is a decision that only I will be able to make in consultation with my doctors. Here are a few of the articles that I have read during this decision making process. If you have articles you would suggest please be sure to let us know.

JAMA – The Journal of the American Medical Association

Early Mortality Among Medicare Beneficiaries Undergoing Bariatric Surgical Procedures

ABSTRACT

Context Case series demonstrate that bariatric surgery can be performed with a low rate of perioperative mortality (0.5%), but the rate among high-risk patients and the community at large is unknown.

…………

Results A total of 16 155 patients underwent bariatric procedures (mean age, 47.7 years [SD, 11.3 years]; 75.8% women). The rates of 30-day, 90-day, and 1-year mortality were 2.0%, 2.8%, and 4.6%, respectively. Men had higher rates of early death than women (3.7% vs 1.5%, 4.8% vs 2.1%, and 7.5% vs 3.7% at 30 days, 90 days, and 1 year, respectively; P<.001). Mortality rates were greater for those aged 65 years or older compared with younger patients (4.8% vs 1.7% at 30 days, 6.9% vs 2.3% at 90 days, and 11.1% vs 3.9% at 1 year; P<.001). After adjustment for sex and comorbidity index, the odds of death within 90 days were 5-fold greater for older Medicare beneficiaries (aged 75 years; n = 136) than for those aged 65 to 74 years (n = 1381; odds ratio, 5.0; 95% confidence interval, 3.1-8.0). The odds of death at 90 days were 1.6 times higher (95% confidence interval, 1.3-2.0) for patients of surgeons with less than the median surgical volume of bariatric procedures (among Medicare beneficiaries during the study period) after adjusting for age, sex, and comorbidity index.

Conclusions Among Medicare beneficiaries, the risk of early death after bariatric surgery is considerably higher than previously suggested and associated with advancing age, male sex, and lower surgeon volume of bariatric procedures. Patients aged 65 years or older had a substantially higher risk of death within the early postoperative period than younger patients.

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American Family Physicians

A peer reviewed journal of the American Academy of Family Physicians

Bariatric Surgery Reduces Mortality Rates

Background: Bariatric surgical procedures are becoming increasingly common and can lead to significant long-term weight loss in properly motivated patients. However, it is less clear whether these procedures improve health outcomes. Observational studies have had conflicting conclusions about the effect of general weight loss on cardiovascular mortality, although the American Cancer Society has reported decreased mortality rates with intentional weight loss. Several retrospective cohort studies have also reported decreased mortality rates in patients who have lost weight after bariatric surgery. Sjöström and colleagues examined the effects of different bariatric surgery techniques on long-term survival.

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NPR -National Public Radio

Weight-Loss Surgery: It’s Not for Everyone

by Patricia Neighmond

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ASMBS -American Society for Metabolic and Bariatric Surgery

RATIONALE FOR THE SURGICAL TREATMENT OF MORBID OBESITY

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