Question 1

What is the difference between gastric sleeve and gastric bypass?

Accepted Answer

Gastric sleeve (sleeve gastrectomy) removes about 80% of the stomach, leaving a banana-shaped tube. It is simpler, has no intestinal rerouting, and preserves normal digestion but may cause reflux in some patients. Gastric bypass (Roux-en-Y) creates a small stomach pouch and reroutes the small intestine, combining restriction with mild malabsorption. Bypass typically produces slightly more weight loss (65-80% vs 60-70% excess weight loss), has higher diabetes remission rates, and can treat existing reflux but requires lifelong vitamin supplementation due to bypassed intestine. Your bariatric surgeon will recommend the best option based on your BMI, health conditions, and goals.

Question 2

How much weight will I lose after bariatric surgery?

Accepted Answer

Weight loss varies by procedure and individual factors. Gastric sleeve patients typically lose 60-70% of excess body weight within 12-18 months. Gastric bypass patients lose 65-80% of excess weight. Duodenal switch produces the highest weight loss at 70-85% of excess weight but has more nutritional considerations. For example, if you are 100 pounds over your ideal weight, you might expect to lose 60-80 pounds with surgery. Maximum weight loss usually occurs at 12-24 months, followed by some stabilization or modest regain of 5-10% in the following years with proper lifestyle maintenance.

Question 3

Is bariatric surgery safe?

Accepted Answer

Modern bariatric surgery has an excellent safety profile when performed by experienced surgeons at accredited centers. The mortality rate is approximately 0.1-0.2%, similar to gallbladder removal and lower than hip replacement surgery. Serious complications occur in about 3-5% of patients and may include bleeding, infection, leaks, blood clots, or bowel obstruction. Minimally invasive (laparoscopic) techniques have significantly reduced complication rates. Choosing an MBSAQIP-accredited center and high-volume surgeon further reduces risk. The long-term health risks of remaining severely obese typically far exceed the surgical risks.

Question 4

Will my insurance cover bariatric surgery?

Accepted Answer

Many commercial insurance plans cover bariatric surgery when medical criteria are met, typically BMI of 40+ or BMI 35-39.9 with obesity-related conditions like diabetes, sleep apnea, or hypertension. Most insurers require pre-operative requirements including 3-6 months of supervised medical weight loss, psychological evaluation, and nutritional counseling. Medicare covers bariatric surgery at MBSAQIP-accredited centers. Some states mandate bariatric coverage. Your bariatric program will have insurance specialists who can verify your coverage and guide you through the approval process. Self-pay options with financing are available for those without coverage.

Question 5

How long is the recovery after bariatric surgery?

Accepted Answer

Most bariatric surgery patients spend 1-2 nights in the hospital after laparoscopic procedures. You can usually return to sedentary work in 1-2 weeks and resume full activities, including exercise, in 4-6 weeks. Diet progression is gradual: clear liquids for the first week, then pureed foods, soft foods, and finally regular food by 6-8 weeks post-surgery. You will need to eat slowly, chew thoroughly, and eat much smaller portions permanently. Most patients feel significant energy improvement within the first month as they begin losing weight.

Question 6

Will I need to take vitamins after bariatric surgery?

Accepted Answer

Yes, lifelong vitamin and mineral supplementation is required after bariatric surgery. At minimum, all patients need a high-quality bariatric multivitamin, calcium with vitamin D, and vitamin B12. Gastric bypass and duodenal switch patients have higher supplementation needs due to intestinal bypass and malabsorption. Iron supplementation is often needed, especially for menstruating women. Your bariatric team will monitor your labs regularly (every 3-6 months initially, then annually) and adjust supplements as needed. Taking your vitamins consistently is one of the most important factors for long-term health after surgery.

Question 7

Can I get pregnant after bariatric surgery?

Accepted Answer

Yes, and many women experience improved fertility after weight loss surgery as obesity-related hormonal issues resolve. However, you should wait 12-18 months after surgery before becoming pregnant to allow your weight to stabilize and ensure adequate nutrition. During this rapid weight loss period, pregnancy is not recommended. Once cleared, bariatric patients can have healthy pregnancies but require close monitoring of nutrition and vitamins by both their bariatric team and obstetrician. Women of childbearing age should use reliable contraception immediately after surgery, as fertility often improves rapidly with weight loss.

Question 8

What happens if I regain weight after bariatric surgery?

Accepted Answer

Some weight regain is normal (typically 10-15% of lost weight) after the initial weight loss honeymoon period. Significant regain can occur if eating habits return to pre-surgery patterns, grazing occurs throughout the day, or high-calorie liquid intake (alcohol, sugary drinks) becomes regular. If you experience significant regain, your bariatric team can help identify causes and solutions. Options include nutritional counseling, behavioral intervention, medical weight loss support, and in some cases, revision surgery to repair a stretched pouch or convert to a more effective procedure. Early intervention for weight regain leads to better outcomes.

Question 9

What is dumping syndrome?

Accepted Answer

Dumping syndrome is most common after gastric bypass and occurs when food (especially sugar and simple carbohydrates) moves too quickly from the stomach pouch into the small intestine. Early dumping (15-30 minutes after eating) causes nausea, cramping, diarrhea, dizziness, and sweating. Late dumping (1-3 hours after eating) causes low blood sugar symptoms like weakness, shakiness, and sweating. While uncomfortable, dumping syndrome is not dangerous and actually helps many patients avoid high-sugar foods. It can be prevented by avoiding sugary foods, eating slowly, not drinking with meals, and choosing protein and complex carbohydrates.

Question 10

Am I too old for bariatric surgery?

Accepted Answer

Age alone is not a contraindication for bariatric surgery. Many surgeons perform successful procedures on patients in their 60s and even 70s when overall health permits. Older patients often have more obesity-related conditions that improve significantly with surgery. However, the risk-benefit analysis is individualized. Your bariatric surgeon will evaluate your overall health, functional status, and ability to comply with post-operative requirements. Older patients may have longer recovery times and should have realistic expectations. Studies show that older patients still achieve significant weight loss and health improvements, though results may be somewhat more modest than younger patients.

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