FAQ—Pre-operative Phase

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Is it true that there is a link between diabetes and being overweight?

Yes. There are two main types of diabetes. Both types are caused by problems in how a hormone called insulin works. Type 1 diabetes most often appears in childhood and causes high blood sugar when the body can't make enough insulin. The more common form, is Type 2 diabetes. Type 2 diabetes is linked to obesity and physical inactivity. With this form of diabetes the body makes insulin but can't use it properly. At first, a body overproduces insulin to keep blood sugar normal, but over time the body looses its ability to produce enough insulin to keep blood sugar levels in the healthy range. Over a long period of time high blood sugar levels and diabetes can cause heart disease, stroke, blindness, kidney failure, leg and foot amputations, and pregnancy complications. Diabetes can be a deadly disease: over 200,000 people die each year of diabetes related complications.

How does weight relate to type 2 diabetes?

Carrying extra body weight and body fat go hand and hand with the development of type 2 diabetes. People who are overweight are at much greater risk of developing type 2 diabetes than normal weight individuals. Being overweight puts added pressure on the body's ability to properly control blood sugar using insulin and therefore makes it much more likely for you to develop diabetes. Almost 90% of people with type 2 diabetes are overweight.

What impact do my medical problems have on the decision for surgery and how do the medical problems affect risk?

Medical problems such as serious heart or lung problems can increase the risk of any major surgery. On the other hand, problems that are related to the patient's weight may also increase the need for surgery. In other words, a variety of medical problems will usually not prevent the surgeon from recommending Weight Loss Surgery if it is otherwise appropriate.

Is there anything I can do to improve my risk at the time of surgery?

Yes.

  • No smoking: Smoking has a significant influence on your outcome including the chance of dying around the time of surgery. Everyone knows that smoking creates lung problems, but the unavoidable reality is that a history of smoking also leads to a 5-10 fold increase in the following risks: infection, heart attack, and even Deep Vein Thrombosis (DVT) or Pulmonary Embolism (PE).
  • Weight loss before surgery: It appears that the body (heart, lungs, etc.) suffers the most from obesity when it is at very heavy weights. Surprisingly, great benefit comes from the loss of 10 or 20 pounds with more loss being even better. We also find that excess weight tends to come out of the abdomen (probably the liver) first; so, just a few pounds can make it much easier for your surgeon to perform the surgical procedure. (No one will be "disqualified" from gastric bypass because they have lost too much weight in preparation for the surgery!)
  • Exercise before surgery: Get your heart and lungs in the best possible shape by doing whatever physical exercise you can tolerate. Starting an exercise program before surgery is also the best bet on keeping a regular exercise program following surgery.
  • Mental preparation: Try to approach the surgery as the beginning of a whole new phase in life. If the patient approaches it with thorough education and with determination to make the best of the opportunity, the chances of success are very high. If the patient slides into the operation and aims for it to have minimal impact on his/her life then the prospects are not as good. One concrete thing that a prospective patient can do along these lines is actually practice the post surgery diet. This will give the patient a practical idea of what they are getting into, with the side benefit of some weight loss. Also, there is good data that shows that risks are lower for patients who come into a gastric bypass having lost 5-10 pounds versus those who have eaten many "last meals" in preparation for the surgery. Another practical suggestion for mental preparation is to attend a monthly support group - much can be learned from other patients that the surgeons and staff cannot teach.

What can I do before the appointment to speed up the process of getting ready for surgery?

Adhere to the following steps:

  1. Establish a relationship with a primary care physician, if you don't already have one. Work with that physician to get "caught up" on your routine health maintenance testing: for women this could be an annual exam and Pap smear and (if over 40) a mammogram. For men this might include a Prostate Specific Antigen (PSA) exam. Anyone over 50 years old should undergo colonoscopy if they have not already done so. Also, consider whether you exhibit the symptoms of Obstructive Sleep Apnea and if so then work with your physician to get this evaluated and treated.
  2. Initiate contact with your health insurance company to learn about their criteria to cover Weight Loss Surgery. Don't be put off if the insurer tells you it is not covered - this is often a maneuver the insurer uses to reduce their cost of care.
  3. Bring any pertinent medical data with you to your appointment to see your surgeon; this would include reports of special tests (echocardiogram, sleep study, etc.) or hospital discharge summary if you have been in the hospital.
  4. Bring a list of your medications with dose and schedule.
  5. STOP SMOKING.

What if I have had a previous bariatric surgical procedure and I'm having problems?

The first option is to contact your original surgeon - it is highly preferable for the original surgeon to take care of a surgical problem because he/she is most likely to know the correct solution based on his/her knowledge of your surgical anatomy. If you have relocated too far away from your original surgeon or there is some other reason that it's not reasonable for that surgeon to participate in your care then we may be able to help. We will need to have an operative report from your first operation; it will be up to you to obtain that from your original surgeon's office. We may first want an Upper Gastrointestinal (GI) X-ray or scope performed that demonstrates there's a correctable surgical problem.

What about insurance coverage?

Insurance companies and employers coverage for morbid obesity is constantly changing. We have developed a dedicated staff who will be happy to assist you during the insurance approval process.

My doctor doesn't believe in surgery for weight loss - what should I say to him/her?

First try to understand the origin of the negative opinion. Has the doctor seen bad outcomes in his patients after bariatric surgery? Bad outcomes do happen, but in appropriately selected patients the risk of surgery is less than the risk of continuing with morbid obesity.

Does the doctor simply not know much about the operation? Physicians are like other people in that they do not trust what they do not know. Bariatric surgery is only now becoming widely accepted and many physicians do not have much exposure to it.

Once you understand the objection as well as possible then ask your doctor two questions:

  1. Is your excess weight a significant medical problem (does it put you at significant risk for development of weight related medical problems)? This is "yes" by definition in people with a BMI > 40.
  2. What treatment does the doctor propose? The sad fact is that there is no therapy other than surgery that has demonstrated significant weight loss in morbidly obese patients for more than two years.