1. What is weight loss surgery and how does it work?
1. The concept of surgery to control obesity grew out of the results of operations for stomach cancer or severe ulcers where portions of the stomach or intestines were removed.  Because patients who underwent these procedures tended to lose weight, some physicians began to use these operations to treat severe obese patients.  The first operations that were widely used for severe obesity was the intestinal bypass.  This operation, first used more than 40 years ago, produced weight loss by something called “malabsorption”.  The idea was that patients could eat large amounts of food, which would be poorly digested so that the body could not absorb the calories.  Even though this surgery is no longer used in its original form, modified techniques of this surgery is being performed today.  In addition to malabsorption, a restrictive component was added, creating the patient to only be able to consume small amounts of food and malabsorbing at the same time.
2. The two surgical procedures promote weight loss that are performed at MMC are: 

1. Restriction:  gastric banding is a surgery that limits the amount of food that the stomach can hold by having an adjustable silicone band being placed around the upper part of the stomach.  This creates a new small pouch with the larger part of the stomach below the band.  The pouch above the band can only hold a small amount of food so that you feel full sooner and the feeling lasts longer.
2. Malabsorptive:  Roux-en-Y gastric bypass.  The American Society of Bariatric Surgeons and the NIH consider this procedure to be the gold standard for surgical weight loss.  This procedure surgically creates a small stomach pouch, bypasses the larger native stomach and the first segment of the small intestine called the duodenum, where most absorption takes place.  The patient not only eats smaller amounts to food, but what they eat is not absorbed, thus creating large weight losses.

2. Who is a candidate for weight loss surgery?
1. Although there may be some exceptions depending on each individual, the following criteria must be met before a candidate is accepted for a surgical weight loss procedure

1. Demonstration of one or more supervised non-surgical weight loss attempts for 6-12 consecutive months within the last year. They can be from one of the following:
1. weight reduction programs such as Weight watchers or a registered dietitian
2. a physician monitored medication program
3. Monthly visits with your primary care physician where diet is mentioned and weights are monitored.

2. Willingness to make necessary changes in eating habits and demonstrated motivation toward weight loss
3. Absence of medical problems that would make surgery/anesthesia hazardous
4. Must be between 18 and 62
5. At least 100 pounds over the recommended weight for  your age, height and gender or have a Body Mass Index of 40 or greater
6. If there is a Body Mass Index of 35-39 there needs to be documented medical problems such as hypertension, diabetes, joint problems, pulmonary function abnormalities or any other medical conditions that would be improved or alleviated by weight loss.

3. Is weight loss surgery right for me?
1. For those who remain severely overweight when non surgical approaches have failed, or for people who have obesity related diseases, surgery may be the solution.  Answers to the following questions can help in your decision to undergo weight loss surgery:

1. Unlikely to lose weight successfully with further non surgical measures
2. Well informed about the surgical procedures
3. Determined to lose weight and improve your health
4. Aware of how your life may change after the operation
5. Aware of the potential for serious complications

4. What are the long range results of surgery?
1. With the altered size of your stomach and by eating only the amount of food recommended in your diet, your daily food intake will be decreased.  With this will come a weight loss of as much as five to six pounds per week (with the bypass) or one to two pounds per week (with the band) for the first twelve to eighteen months.  The rate at which you will lose weight will decrease gradually until you reach a stable healthy weight.  Additional weight can be lost with a concentrated effort including the incorporation of exercise into your life.  In addition to looking better, weight loss improves most obesity related conditions, including diabetes, sleep apnea, joint problems and hypertension.  Many patients can reduce the number of medications they must take or eliminate medications altogether.  Many patients also report a greater feeling of personal development potential as a result of their renewed sense of self esteem.  There are many factors that contribute to weight loss.  Among the most important are your age, gender and initial weight at the time of surgery.  Your willingness to make the necessary adjustments in your present habits is essential to the ultimate success of the procedure.

5. What are the potential risks?
1. Any surgery entails a certain amount of risk, and complications cannot always be avoided.  It should be noted that the risks/complications listed are rare, however, if they happen it may require a revisional surgery. Therefore, before making the decision to undergo surgery it is important to consider the following:
2. With the gastric Lap Band System some risks/complications are:

1. Gastric perforation or tearing in the stomach
2. May not provide the necessary feeling of having had “enough to eat”
3. Nausea and vomiting
4. Outlet obstruction
5. Pouch dilatation
6. Band migration/slippage

3. With the Gastric Bypass some risks/complication are:

1. Pulmonary embolism (blood clot in the lungs)
2. Blockage where the tissues are sewn or stapled together
3. Leakage from the staple or suture line
4. Pneumonia
5. Infection
6. Bleeding
7. Gallstones
8. Vomiting
9. Insufficient weight loss
10. Death

6. Will I have to do this alone?
1. The answer is NO.  Here at MMC we offer a multidisciplinary team approach meaning that you will have the support of not only the bariatric surgeon, but the clinical program director, the dedicated psychologist and registered dietitian.  In addition, there are monthly support group meetings in which people who are considering the surgery, waiting or have had the surgery attend.  Those who attend the support group meetings are more successful because the environment of the groups help to improve  your self esteem while keeping your motivated and on track

7. Is weight loss surgery covered by health insurance?
1. Many insurance companies do not cover these procedures.  Insurance providers understand that severe obesity can contribute to multiple health problems.  The knowledgeable staff at the Bariatric Surgery Center at MMC will work with you and your insurance company to help make the necessary financial arrangements.