Bariatric Surgery Frequently Asked Questions (FAQs)

Who qualifies for bariatric surgery?

Bariatric surgery may be considered for severely obese, motivated individuals who have failed at other attempts to lose weight.

Obesity is a complicated, multi-factorial, progressive, life-threatening, genetically-related, costly disease with multiple obesity-related health conditions such as diabetes, high blood pressure, high cholesterol, sleep apnea and joint problems.

Severe obesity (or morbid obesity) is defined as someone being at least 100 pounds overweight and/or a Body Mass Index (BMI) above 40. People who have a BMI of 35-39 need to have a serious medical condition to be considered.

Many obese people spend a lifetime struggling with their weight, suffering with the associated serious health problems and the social isolation. Many try diets, exercise, behavioral therapy or drugs. Most have found these methods unsuccessful, regaining most if not all of the weight they intended to lose.

In recent years, the medical community has developed and improved several surgical operations intended to give severely obese people a safe, effective and durable way to lose weight. A growing number of obese people are choosing a surgical solution to weight loss and discovering improved health and quality-of-life.

How do I prepare for bariatric surgery?

UW Health bariatric surgeons know that surgery is only one of many "tools" you will need to lose weight and keep the weight off. Our team will gauge your ability to adopt the recommended lifestyle changes well before your surgery. We encourage you to learn and read as much as you can about weight loss or bariatric surgery in our Patient Resources (link to page). You can start making healthy lifestyle changes today.

Suggestions for healthy lifestyle changes:

• Identify the barriers to making changes in your life. One of the greatest obstacles to change is not people's intentions but their ability to enact them. List the factors that might make it difficult for you to enact change in your life.
• If you smoke or use tobacco, quit now. UW Health requires no tobacco use three months prior to bariatric surgery.
• Keep a daily health journal to track your positive behavior changes.
• Learn how to set realistic goals.
• Begin a physical activity routine. There is no substitute for movement.
• Begin to adopt healthy eating choices and behaviors.
• Surround yourself with individuals who are encouraging and motivating.
• Develop alternative coping skills (relaxation techniques, positive self-statements).
• Participate in a bariatric Internet chat room.

Our health psychology assessment:

• Evaluates your psychological and emotional fitness for surgery and ability to conform to necessary lifestyle changes.
• Diagnoses previously undiagnosed problems such as depression, bulimia or other eating disorders.
• Identifies behaviors that may interfere with life-long weight loss success.
• Aids in preparation for life after substantial weight loss.
• Uses this information to tailor treatment plans and recommendations to your specific needs and to optimize the care you receive.

How will bariatric surgery affect my daily diet?

It is necessary to establish a healthy diet after surgery. All of the food choices you made that contributed to your weight struggle need to be evaluated and changed. The main principles to follow are low fat, low sugar and high fiber.

You will be given information to help you to make these changes as you go along in the program.

More about post-surgery nutrition (pdf)

Some eating strategies that would be useful to begin adopting now include:

• Chew your food thoroughly
• Eat slowly
• Be mindful of what you are eating and tasting

Every patient is expected to start a high-protein liquid diet two weeks prior to surgery. This diet better prepares patients for surgery by facilitating weight loss, reducing the size of the liver and preparing patients for the post-operative diet. You will learn more about this at our nutrition class prior to surgery.

What can I expect after surgery?

The UW Health bariatric surgery program believes that more important than the number of pounds lost is the overall improved health gained after bariatric surgery. The true measure of the operation's success is the improvement or even elimination of many obesity conditions.

Studies have shown that hypertension, sleep apnea and cholesterol imbalances improve markedly after weight loss surgery. Many patients with Type II diabetes find their blood sugar levels are completely normal within one year.

What are the risks and/or complications associated with bariatric surgery?

Certain risks and complications are associated with any bariatric procedure, including:

• Intestinal leak
• Acute stoma obstruction
• Incisional hernia
• Port or wound infection
• Nutritional deficiencies
• Death

Your UW Health Team will review and explain all potential complications with you in detail prior to deciding on a surgical option.

What can I expect for follow-up care?

Immediate post-operative care:

• Anticipate staying in the hospital one or two nights for a laparoscopic gastric bypass and either going home the same day or staying one night for the laparoscopic adjustable gastric band.
• Most patients can return to work at least part-time within one or two weeks of laparoscopic surgery.
• Some patients may require light-duty restriction until one month after surgery.
• Please begin aerobic exercise (e.g., light walking) immediately after surgery.
• Complications may extend your hospital stay and recovery period.

Activity is vital following surgery. We ask that you increase your activity well before surgery. This will improve weight loss, energy level and cardiovascular system as well as help minimize potential post-operative complications.

Activity is the key to maximizing and maintaining weight loss, and you will begin full activities six weeks after your operation.

Intermediate post-operative care:

Laparoscopic adjustable gastric band patients will see various members of the UW Health team at:

• Two, four and six weeks, and three and six months after surgery
• Annually for an indefinite period
• The first adjustment is made four weeks post-op and approximately every four weeks until properly adjusted

Gastric bypass patients will see various members of the UW Health team at:

• Two and six weeks, and three and six months after surgery
• Annually for an indefinite period
• Vitamin deficiency is a potential complication after gastric bypass surgery and we will monitor a full complement of lab values on a routine basis

Long-term post-operative care:

Long-term follow-up is an important and required component of the program. Patients who keep all follow-up appointments lose more weight and do better overall. We follow well over 75 percent of our surgery patients on an annual basis.

Will my insurance cover the costs associated with surgery?

The following are very basic insurance insights about bariatric surgery. Please note that each employer may purchase a different plan and the information below may not apply. Please call your insurance plan or employer benefits department for the most current and accurate information.

• Most PPO or indemnity insurers such as WPS, BCBS, CIGNA, Humana, Aetna and Anthem typically require a six-month physician supervised diet within the last year or two, three to five years of medical history that includes diagnosis of obesity and documentation of any previous weight loss attempts and exercise programs. Sometimes structured programs such as Weight Watchers or Jenny Craig are acceptable. Depending on your insurance plan, the supervised diet can be done with your primary care provider or a registered nutritionist. Along with body mass index (BMI) documentation requirements, documentation of obesity related medical conditions may be required. Please contact your benefits plan for specific information.
• Medicare, a national government plan, offers bariatric surgery to their beneficiaries if they have a BMI greater than 40 or if BMI is 35-39 must have at least one severe medical condition such as diabetes, hypertension, obstructive sleep apnea or cardiac disease. One can only have surgery at a recognized Center of Excellence. Documentation of a medically supervised diet is required. Medicare pays 80 percent of charges.
• Medicaid/Badgercare, Wisconsin state government aid, offers both the gastric bypass and the adjustable gastric band procedures to those with a BMI greater than 40 with at least one severe medical condition such as diabetes, hypertension, obstructive sleep apnea or cardiac disease. Medicaid/Badgercare requires completion of a six-consecutive month, physician-supervised diet within the last 12 months. There must be documentation by your physician and nutritionist for six months in a row as well as a severe medical condition such as uncontrolled diabetes, hypertension or sleep apnea before an appointment can be made. Please refer to the benefits plan for more details.
• Currently the local HMOs exclude (do not cover) bariatric surgery or weight loss surgery.

Please view the getting started video for more answers to your questions.