Frequently Asked Questions


Generally accepted guidelines from the American Society for Metabolic and Bariatric Surgery and the National Institutes of Health indicate surgery only for those 18 years of age and older. Surgery has been performed on patients 16 and younger. There is a real concern that young patients may not have reached full developmental or emotional maturity to make this type of decision. It is important that young weight loss surgery patients have a full understanding of the lifelong commitment to the altered eating and lifestyle changes necessary for success.
Programs differ in their age limit for performing weight loss surgery. We believe that surgery can be safely performed on individuals over the age of 65. Adjustable gastric banding is often the preferred surgery due to the decreased surgical risks. Your surgeon will discuss your individual options with you.
There is good evidence from scientific research that if you have Type 2 diabetes (or other serious obesity-related health conditions), are at least 100 lbs. over ideal body weight, and are able to comply with lifestyle changes (daily exercise and low-fat diet), then weight loss surgery may significantly prolong your life.

Insurance Issues

There are many different levels of coverage for weight loss surgery. Here are some key steps you should take to obtain information from your insurance company. Our staff will help determine what your specific policy covers. Document every visit you make to a healthcare professional for obesity-related issues or visits to supervised weight loss programs. Document "other" weight loss attempts made through diet centers and fitness club memberships. Keep good records, including receipts.
Payment may be denied because there may be a specific exclusion in your policy for weight loss surgery or "treatment of obesity." Such an exclusion can often be appealed when the surgical treatment is recommended by your bariatric surgeon or referring physician as the best therapy to relieve life-threatening obesity-related health conditions, which usually are covered. If you are told that your policy has an exclusion, you should always ask for a copy of your plan and read the benefit section yourself. Our staff can also assist you to determine what your options may be based on your plan.

Insurance payment may also be denied for lack of "medical necessity." A therapy is deemed to be medically necessary when it is needed to treat a serious or life-threatening condition. In the case of morbid obesity, alternative treatments - such as dieting, exercise, behavior modification, and some medications - are considered to be available. Medical necessity denials usually hinge on the insurance company's request for some form of documentation, such as 1 to 5 years of physician-supervised dieting or a psychiatric evaluation, illustrating that you have tried unsuccessfully to lose weight by other methods.
Gather all the information (diet records, medical records, medical tests) your insurance company may require. This reduces the likelihood of a denial for failure to provide "necessary" information. Letters from your personal physician and consultants attesting to the "medical necessity" of treatment are particularly valuable. When several physicians report the same findings, it may confirm a medical necessity for surgery.
Even if your initial request for pre-authorization is not approved, you still have options available. Insurers provide an appeal process that allows you to address each specific reason they have given for denying your request. It is important that you reply quickly. It is also recommended that, at this point, you enlist the help of an experienced insurance attorney or insurance advocate to properly navigate the complexities of the appeal process. Some insurers place limits on the number of appeals you may make, so it is important to be well prepared and that you clearly understand the appeal rules of your specific plan.

Life After Weight Loss Surgery

In gastric bypass, the stomach is left in place with intact blood supply. In some cases it may shrink a bit and its lining (the mucosa) may atrophy, but for the most part it remains unchanged. The lower stomach still contributes to the function of the intestines even though it does not receive or process food - it makes intrinsic factor, necessary to absorb Vitamin B12 and contributes to hormone balance and motility of the intestines in ways that are not entirely known. In the sleeve gastrectomy procedure, a portion of the stomach is completely removed.
This can vary by surgical procedure and bariatric surgeon. In the Roux-en-Y gastric bypass, the stomach pouch is created at one ounce or less in size (15-20cc). In the first few months it is rather stiff due to natural surgical inflammation. About 6-12 months after surgery, the stomach pouch can expand slightly, and patients end up with a meal capacity of 3-7 ounces. The stomach pouch for the sleeve gastrectomy is long and slender and slightly larger than the gastric bypass. You will ultimately be able to hold about ¾ to 1 cup of good quality food.
Adhesions are scar tissues formed inside the abdomen after surgery or injury. Adhesions can form with any surgery in the abdomen. For most patients, these are not extensive enough to cause problems.
The staples used on the stomach and the intestines are very tiny in comparison to the staples you will have in your skin or staples you use in the office. Each staple is a tiny piece of stainless steel or titanium so small it is hard to see other than as a tiny bright spot. Because the metals used (titanium or stainless steel) are inert in the body, most people are not allergic to staples and they usually do not cause any problems in the long run. The staple materials are also non-magnetic, which means that they will not be affected by MRI. The staples will not set off airport metal detectors.

Adjustable gastric bands also are safe to have an MRI, and will not set off any metal detectors.
Initially, most medications will be taken in liquid form or crushed. Your surgeon will advise you when you may take whole pills.
Both men and women generally respond well to this surgery. In general, men lose weight slightly faster than women do.
Patients MUST stop smoking at least two months before surgery. Smoking increases the risk of lung problems after surgery, can reduce the rate of healing, increases the rates of infection, and interferes with blood supply to the healing tissues. We can refer you to a smoking cessation program to help you achieve this. Please contact us and ask for this referral if you need it.
Many people heavy enough to meet the surgical criteria for weight loss surgery have stretched their skin beyond the point from which it can "snap back." Some patients will choose to have plastic surgery to remove loose or excess skin after they have lost their excess weight. Insurance generally does not pay for this type of surgery (often seen as elective surgery). However, some do pay for certain types of surgery to remove excess skin when complications arise from these excess skin folds. Ask your surgeon about your need for a skin removal procedure.
Exercise is good in so many other ways that a regular exercise program is recommended. Unfortunately, most patients may still be left with large flaps of loose skin.
Depending on the type of surgery, the hormones that help control hunger and “satiety” or feeling full, are altered by the surgical process. . In fact, for the first 4-6 weeks, many patients have almost no appetite. This is particularly true of the gastric bypass or sleeve gastrectomy. Over the next several months the appetite returns, but it tends not to be a ravenous "eat everything in the cupboard" type of hunger. For adjustable gastric band surgeries, the reduction in hunger is more gradual and occurs from "fills" to reduce the size of the outlet of the smaller stomach portion.
Your doctor will determine whether medications for blood pressure, diabetes, etc., can be stopped when the conditions for which they are taken improve or resolve after weight loss surgery. For meds that need to be continued, the vast majority can be swallowed, absorbed and work the same as before weight loss surgery. Usually no change in dose is required.

Two classes of medications that should be used only in consultation with your surgeon are diuretics (fluid pills) and NSAIDs (most over-the-counter pain medicines). NSAIDs (ibuprofen, naproxen, etc.) may create ulcers in the small pouch or the attached bowel. Most diuretic medicines make the kidneys lose potassium. With the dramatically reduced intake experienced by most weight loss surgery patients, they are not able to take in enough potassium from food to compensate. When potassium levels get too low, it can lead to fatal heart problems.
Very infrequently; if needed, it is given after surgery to promote healing.
This is usually caused by the types of food you may be consuming, especially starches (rice, pasta, potatoes). Be absolutely sure not to drink liquid with food since liquid washes food out of the pouch.
A hernia is a weakness in the muscle wall through which an organ (usually small bowel) can advance. With the use of laparoscopic surgery, incisions made are much smaller than traditional open surgery and the risk of hernias is reduced.
Undesired blood clotting in veins, especially of the calf and pelvis. It is not completely preventable, but preventive measures will be taken, including:
  • Early ambulation
  • Special stockings
  • Blood thinners
  • Pulsatile boots