Weight Loss Surgery
East Carolina University
A Description of Our
Program: Before, During,
and After…
Goals and Objectives
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Describe obesity and health effects of
obesity
Describe weight loss surgeries offered
by East Carolina University (ECU)
Describe pre-operative work-up and
post-operative care related to weight
loss surgery
Our Informational Materials
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This information is not intended to persuade you
to have surgery and should NOT be considered
medical advice.
Only you, your family, your medical doctor, and
your surgeon know if bariatric surgery is right for
you.
Further information regarding the appropriate
surgery for you will be discussed in person with
the surgeon if you come to the first visit.
Why have your surgery with ECU?
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We are involved in research.
We have an array of services aimed at
providing care to morbidly obese clients
and their families.
We genuinely want to help you reach your
goals.
Our surgeons are highly qualified experts.
Choosing a Surgeon
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You or your primary care doctor may choose a
specific surgeon from our practice.
The surgeon that you select may require
additional personal or medical information in
order to schedule an appointment.
Once you have established a relationship with
our surgeons, you should then follow only their
advice and educational materials.
What’s My Body Mass Index (BMI)?
One factor used to
determine if
you qualify for
surgery
 Measures obesity
based on weight
and height
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Different Perceptions of Society
In the Past:
 Obesity was seen as a weakness or failure of
individual.
 Diet and exercise were prescribed treatments.
 Weight loss surgery was viewed as dangerous and
extreme.
Now in the Present:
 Obesity is considered a disease and the cause of
many serious health conditions.
 Surgery has gained acceptance as the only
proven method to treat this disease.
What are the impacts of Obesity?
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Social Implications: Unfortunately, this is still an
acceptable form of social discrimination.
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Economic Implications:
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Personal cost = $15,568 per year (diets, food, prescriptions)
National cost = $200 billion
• $93 billion in medical bills
• $33 billion on weight-loss products/services
Medical and Health Implications with BMI > 30
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70% increase in coronary artery disease
75% increase in stroke
400% increase in diabetes
55% increase in mortality
Co-Morbidities with Obesity
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Heart Disease
High Blood Pressure
Congestive Heart
Failure
Degenerative Joint
Disease
Stress Incontinence
Gallbladder Disease
Fluid retention
(legs/feet)
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Diabetes
Sleep Apnea
Depression
Shortness of
Breath
Irregular
Menstrual Cycles
Acid Reflux
DVT (Blood Clots)
Clinical Terms to Describe Levels of Body Fat
Who Qualifies for Weight-Loss Surgery?
Normal Weight
(BMI 18.5 to 24.9)
Overweight
(BMI 25 to 29.9)
Obese
(BMI 30 to 34.9)
BMI 18.5-24.9
BMI 25-29.9
BMI 30-34.9
Severely Obese
(BMI 35 to 39.9 )
BMI 35-39.9
Morbidly Obese
(BMI 40 or more)
BMI > 40
Characteristics of Potential
Candidates
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100 pounds above your Ideal Body Weight
Body Mass Index:
- 40 or greater with no co-morbidities
- 35 or greater with co-morbidities
Age of 18 to 65+ (assessed on an individual
basis)
Failed attempts at weight loss
Health complications related to obesity
No psychological contraindications
Understanding the surgery/risks
Compliance with diet/exercise requirements
What Surgery is Right for Me?
REMEMBER…..
 All surgery has
risks.
 Not all patients are
candidates for
surgery.
 Discuss your
options with your
surgeon at your first
visit.
Most Common Surgical Options
Gastric Bypass (GBP)
LAP-BAND System
Roux-en-Y Bypass
Restrictive and
malabsorptive
Restrictive
Roux-en-Y Gastric Bypass
Advantages
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Rapid initial weight loss
Laparoscopic approach is possible
Longer experience in USA
Takes 1-2 hours
Disadvantages
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Stomach cutting, stapling and
intestinal re-routing required
Portion of digestive tract is bypassed,
resulting in nutritional deficiencies
“Dumping syndrome” can occur
Non-adjustable
Extremely difficult to reverse
Early Post-Operative Gastric
Bypass Potential Complications
Death (.5 to 1.5%)
 Pneumonia
 Abdominal
Infection
 Heart Attack
 Leak from the
Bowel
 Wound Infection
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Spleen Injury
 Bowel
Obstruction
 Anastomotic
Narrowing
 Bleeding
 Pulmonary
Embolus
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Late Post-Operative Gastric
Bypass Potential Complications
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Wound (Incisional) Hernia
Staple Line Breakdown
Bowel Obstruction
Weight Gain
Nutritional Problems
Ulcer at the Anastomosis
Roux-en-Y Gastric Bypass
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It significantly restricts the amount of food that
you can consume.
You will have “dumping syndrome” if you eat
sugar or fats.
You should expect 70% of excess weight loss.
Patients must consume 3 small high protein
meals per day.
Vitamin deficiency/Protein deficiency are
usually preventable with adequate protein
intake and vitamin supplements.
What is Dumping Syndrome?
Stomach contents move too rapidly through the
small intestines following surgery.
 Does not happen with the band.
 Avoid by following prescribed diet
Symptoms:
Rapid heart beat, headache, sweating,
nausea, dizziness, diarrhea, sleepiness,
lightheadedness, stomach cramping
The LAP BAND System
Advantages
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Lowest mortality and complication rate
Least invasive surgical approach
No stapling, cutting, or intestinal
re-routing
Adjustable
Reversible
Low malnutrition risk
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Takes 1 hour in outpatient surgery
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Disadvantages
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Slower initial weight loss than Gastric
Bypass
Regular follow-up critical for optimal
results: Need adjustments
Requires implanted medical device
LAP BAND Potential Complications
Early Complications:
Gastric or esophageal perforation or injury
Death < 0.1%
DVT/ pulmonary emboli
Bleeding
Splenic injury
Wound infection
LAP BAND Potential Complications
Late Complications:
Band slippage
Band erosion
Port infection
L
LAP BAND Procedure
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Moderately restricts the volume and type of
foods able to be eaten.
It is the only procedure that is adjustable.
You should expect 40-50% of excess weight
loss.
Requires the most effort of all procedures to
be successful.
Sleeve Gastrectomy
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Removes 2/3 of the stomach
Can be used as a single stage
procedure
Complications:
 Typically less than 0.5%
Advantages:
 There is no dumping syndrome.
 There is no malabsorption.
 Provides for early satiety (feeling of fullness)
Sleeve Gastrectomy
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It is a surgery on only the stomach, no rerouting of the intestines or anastomosis.
The only insurance covering the sleeve is
BCBS insurance at this time.
Candidates are determined by the
physician.
This is the preferred surgery for kidney
transplant and dialysis patients .
You should expect 60-70% excess weight
loss at 2 years.
How to Maintain Your Success
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Surgery gives you the tool to assist with weight
loss.
Patients must be committed to making the
emotional and physical changes necessary after
weight loss surgery.
The commitment will ensure successful weight loss
and long-term weight maintenance.
Lack of exercise, poorly balanced meals,
constant grazing, eating processed carbohydrates
and carbonated beverages are some causes of
weight regain.
Good habits of food intake and exercise will need
to be practiced for the rest of the patient’s life.
Comparing Weight Loss
Source: O’Brien et al. Obesity is a Surgical Disease: Overview of Obesity
and Bariatric Surgery, ANZ J Surg, 2004; 74: 200-204.
Your Appointments With the Surgeon
and the Surgery Practice
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You will have three visits with your surgeon before your surgery.
Your first visit is called your “New Patient Visit”.
At this visit, you will do the following:
- Talk with the surgeon about the procedure.
- Explore financial and insurance requirements.
- Have a brief physical exam.
- Determine preoperative evaluations you may need.
- See the Referral Coordinator to have pre-op tests and
consults arranged if your insurance does not require a waiting
period.
- We will remind you to STOP NICOTINE PRODUCTS! You must
be nicotine-free 3 months prior to surgery, as well as after
surgery!
- Complete a few tests before going home.
At the “New Patient” Visit
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Psychological evaluation
Nutrition evaluation
Upper Gastric Exam
Blood testing (lab work)
Anesthesia Consult
Chest X-Ray
Electrocardiogram
Arterial Blood Gas
Possible Pre-Operative Evaluations
(Your surgeon may determine you need these additional
tests before your second visit.)
 Other Lab Work
 Colonoscopy
 Sleep Study
 Upper gastric
endoscopy
 Consult with cardiologist
 Consult with pulmonologist
 Consult with vascular
doctor
 Ultrasound of the abdomen
3 or 6 Month Program
Depending on your insurance company,
you may have to complete a six month
diet and exercise program. Please refer
to the example progress note in your
purple folder. When you contact our
office, we will inform you if this is your
insurance requirement. If you do require
a program, you will need to complete 4
months prior to being scheduled for your
preoperative tests and consults.
Scheduling your appointments
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Please do not miss your appointments.
Remember that rescheduling may mean
prolonging your process.
If you repeatedly miss an appointment or
fail to show up for an appointment
without notice, you may be dismissed
from the program. This surgery is a
lifestyle change, and we want you to be
successful in your weight loss journey!
Making The Decision
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Once your consults and tests are completed, you will
have your second visit, called the “Decision Visit.”
You will see your surgeon in the clinic and review test
results.
All questions about the surgery are answered.
You will review the risks and benefits of the surgery
with the surgeon, along with research opportunities.
You will receive a prescription for a diet that we will
discuss and expect you to begin 2-3 weeks before
surgery.
Prescription Diet Before Surgery
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We will give you the prescription for Optifast,
which will be in the form of shakes (and the
choice of one soup if you like) in place of
meals.
This prescription is not usually covered by
insurance. It is approximately $71 per week.
This diet will allow you to jumpstart your weight
loss journey.
At your next appointment, we will go into further
detail regarding your pre-operative diet.
Insurance Approval Process
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After your “Decision Visit”, our office will begin
the approval process if you are an adequate
candidate for surgery.
We will mail or fax your evaluations, diet and
exercise history, letters of clearance, and
personal letter from our office to your specific
insurance company.
This approval process may take as long as 6-8
weeks.
Insurance Tips to Remember
You MUST meet the requirements of all the insurances that
you have prior to submitting for approval.
Depending on your insurance company, the approval
process may be lengthy (6-8 weeks).
You must check your SPECIFIC policy (or policies) to make
sure weight loss surgery is a covered benefit.
If your insurance company denies your request for surgery,
the appeal process may be started. This can be quite
lengthy and involved, so it is important to know from the
beginning your specific insurance company’s criteria. We
will help you to the best of our ability to meet these
requirements, but it is ultimately your responsibility to be
familiar with your individual insurance policy.
Insurance Coverage Approval
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When we receive insurance approval,
we will contact you with your third
appointment and surgery date!
Your third appointment is the “History
and Physical”.
History and Physical Appointment
Includes the following:
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Brief physical exam
Discussion of surgery, risks and benefits
Consent forms signed
Update lab work and tests if necessary
Must have support person present or your
surgery may be cancelled
Helpful Hints Prior to Surgery
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This is a weight-loss program! Any weight gain
could result in prolonging, rescheduling, or
cancelling your surgery.
YOU MUST QUIT NICOTINE PRODUCTS! We may
require a nicotine test prior to having surgery in
order to ensure you have stopped.
Smoking raises the risks associated with surgery.
Smokers who undergo surgery are more likely than
non-smokers to experience anesthesia-related
complications, infections, heart attack, stroke,
pneumonia or death. They are also more likely to
have a longer hospital stay.
Taken from Consumer Guide to Bariatric Surgery website.
Day of Surgery
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You will be admitted to the Ambulatory Surgery Unit
(ASU).
An IV will be started.
You will be given an antibiotic and additional
teaching by the nurse.
After you have been prepared for surgery, you will
go to the operating holding area.
Your family may wait in the family waiting area and
will be contacted after the operation.
Recovery
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Hospital Stay: Open surgery (3 to 4 days)
Laparoscopic (2 to 3 days)
LAP BAND (1-2days)
Out of Work: Open surgery (4 to 6 weeks)
Laparoscopic (2 to 4 weeks)
LAP BAND (1 to 2 weeks)
No driving for 1-2 weeks following surgery
No heavy lifting (anything over 10 pounds) for one
month after surgery
Gastric Obesity Procedure (GOP)
Diet Following Surgery
Level I Diet:
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This starts after surgery and lasts for 2 weeks.
Two ounces (1/4 of a cup) of Bariatric
Advantage in place of meals.
Between “meals” you may have two ounces of
non-sweetened, non-carbonated beverages.
You MUST SIP WATER all day long.
Carbonated or sugary drinks are not allowed.
Home Diet Following Surgery
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We will give you specific details about
your diet following weight loss surgery.
Generally this consists of:
Drastically limiting volume
Limiting the consistency of food
Limiting the types of food
Tips for Eating After Surgery
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Do not drink liquids with meals, either
drink 30 minutes before or 30 minutes
after.
Chew your food well.
Take small bites of food.
Eat meals over a 30 to 45 minute time
span.
Eat meals on a small plate and use a
baby spoon.
Eating after LAP BAND
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Small volumes 2-3 oz. of healthy foods
Similar restrictions as the gastric bypass
When you are not “filling up” then an
adjustment needs to be done.
Band may need to be adjusted 3-4
times in first year.
Diet is modified after each adjustment.
How Much Weight Can a Patient Expect
to Lose Following Surgery?
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Depends on the surgery and the follow-up
75% of excess weight with Gastric bypass at
the end of one year
45% of excess weight with Band but increases
to 65% at 2-3 year follow up with adjustments
Amount of weight loss varies from person to
person
Must be compliant with follow-up
Plastic Surgery Consult Following
Surgery
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There may be excess skin on the chest, abdomen,
arms and legs.
We can refer you to a plastic surgeon when:
-Your weight is stable (usually 12-18 months).
- Your nutritional status is adequate.
Your surgeon will ultimately decide when this
referral is appropriate.
Insurance rarely covers these procedures.
Document issues with your primary care doctor
now and after surgery.
Tips to Remember!
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After surgery, all vitamins and medications
need to be one of the following:
CRUSHED
CHEWABLE
LIQUID FORM
Please speak with your primary care doctor
and pharmacist to help adjust these
medications. Some drugs are NOT safe to
crush.
Vitamins and Medications after Surgery
(Required for Life)
LAP BAND
Gastric Bypass
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2 chewable
multivitamins daily
(ex: Flintstones)
Calcium Citrate or
Tums, 1000 mg daily
Vitamin D 800 iu daily
Vitamin B-12 250 mcg
daily
Ferrous Sulfate elixir 325
mg daily (menstruating
women only)
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2 chewable
multivitamins daily
(ex: Flintstones)
Calcium Citrate or Tums
1000 mg daily
Vitamin D 800 iu daily
Protein and Vitamins after Weight
Loss Surgery
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You must consume sufficient amounts of protein
after surgery. Protein speeds wound healing,
preserves lean body mass, and enhances fat
burning. Always eat your protein first.
Take 2 chewable multivitamins daily.
Vitamin B-12 is needed to boost metabolism and
enhance weight loss efforts.
Calcium is important for bone health.
Vitamin D aids in absorption of Calcium. Deficiency
is linked to a host of chronic diseases.
Anemia can occur in menstruating women after
surgery and is due to iron deficiency.
Pregnancy following Surgery
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Females should not become pregnant
for at least 12 to 18 months following
Gastric Bypass. Pregnancy prior to this
could result in fetal demise or neural
tube defects.
After the band surgery, it is best to
maintain a stable weight loss and
plateau prior to becoming pregnant.
You must follow what your surgeon tells
you is best; inform the surgeon if you
plan on having children after weight loss
surgery.
Follow-Up After Gastric Bypass
Surgery
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Lifelong commitment
Every 2 weeks for first
month after surgery
Every 3 months for the
first year after surgery
Yearly for a lifetime
Lab work is checked
at every visit.
Follow-Up After LAP BAND Surgery
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Life long commitment
2 weeks and 6 weeks after surgery
At 6 weeks, you may have your first
adjustment.
Monthly for first year
After first year, surgeon will decide
how often to see you.
Lab work checked every 3 months.
Exercise
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Exercise is an important part of your weight loss
journey. Remember, surgery is a tool to help you
reach your goals. You must do your part as well!
You will work up to doing exercise daily for 30 to
45 minutes per day
Exercise options can include:
-Walking
-Jogging
-Bike riding
-Weight Training
-Aerobics
-Water aerobics
-Swimming
Support Groups
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We encourage you to join a support group prior
to surgery and maintain participation with the
support group after surgery.
Ideally, you should attend the support group
offered by your surgical practice.
Our Support Group is the 3rd Tuesday of each
month at 6 pm. It is located at 517 Moye Blvd.
Making An Appointment
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The next step in pursuing weight loss surgery is
having a visit with a qualified bariatric
surgeon.
If you already have an appointment with a
weight loss surgeon, please keep the
appointment, or if you are no longer
interested, please contact the office to
cancel your appointment.
Conclusion
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Thank you for reviewing our informational material. We
look forward to working with you in the future, and we are
available to answer any questions you may have.
Please type in the following web address in your internet
browser to receive your certificate,
http://www.ecu.edu/weightlosssurgery/certificate.cfm
Please print out the following certificate and sign. This
certificate is proof that you have completed our online
orientation. Please write down any questions you may
have on the space provided. You must bring this form with
you to your first appointment with the surgeon, as this is a
requirement for our program.
We look forward to seeing you soon!
Thank You!!