How long after metabolic and bariatric surgery will I have to be out from work?

It depends on the surgery you have. For the laparoscopic adjustable gastric band, most people are able to return to work within a week. For the gastric bypass, sleeve gastrectomy, or duodenal switch, you should consider being off work for two to three weeks. If you have a desk job, you are likely to be able to return to work earlier. If your job is physically demanding and requires heavy lifting or physical activity, a longer period off work may be necessary. If there are questions, patients should consult with their surgeons.

When can I start exercising again after surgery?

Walking is encouraged early post-surgery and, thereafter, on a regular basis to increase your physical activity level. Aerobic activities such as brisk walking, stationary biking, elliptical machines, etc. may be engaged almost immediately after surgery and are limited generally by the degree of discomfort that these activities cause. You may engage in swimming once your surgeon has determined that the wounds have healed sufficiently. Activities that are more strenuous or that involve lifting weights are generally discouraged for three weeks after surgery. This can vary so consult with your surgeon first.

Can I have metabolic and bariatric surgery if I have had other abdominal surgery procedures in the past?

The general answer to this is yes. Most of the commonly performed abdominal operations such as C-section, gall bladder surgery, appendectomy, tubal ligation, hysterectomy and minor hernia repair of the belly button rarely impact the ability to have bariatric surgery. However, if you have had prior surgery for hiatal hernia or reflux, intestinal surgery involving removal of a portion of the small intestine or colon, or have had a major hernia repair with a large mesh, it could impact the type of surgery you can have or the ability to do it laparoscopically through small incisions. It is important to recall all prior surgeries and let your surgeon or nurse know about them during the evaluation process. If you have had a major abdominal surgery, it is very helpful if you can obtain the operative reports as well.

Can I have metabolic and bariatric surgery if I have type 2 diabetes?

Yes, bariatric surgery has been shown to improve or cause remission of type 2 diabetes. There is evidence that procedures such as gastric bypass, sleeve gastrectomy and duodenal switch work through pathways such as gut hormones as well as through the weight-loss these procedures produce to cause the improvement or remission of type 2 diabetes. Studies find a greater than 95 percent of patients have improvement of type 2 diabetes with bariatric procedures and up to 85 percent have remission of their diabetes with these surgeries. Some studies have even reported improvement of type 1 diabetes mellitus following bariatric procedures. The adjustable gastric band also results in improvement or remission of diabetes; however, this results solely from the weight-loss that results from the band. Therefore, the improvement or remission of type 2 diabetes seen with the band tends to be slower and occurs in a smaller percentage of patients compared to the other surgeries.

Can I have metabolic and bariatric surgery if I have heart disease?

Yes, surgery leads to significant improvement in conditions associated with or contributing to heart disease, including lipid abnormalities, an enlarged heart, vascular and coronary disease and hypertension. However, if you have heart disease, you will need medical clearance for bariatric surgery from your cardiologist.

When can I get pregnant after metabolic and bariatric surgery? Will the baby be healthy?

Bariatric surgeons generally recommend that patients wait approximately 18 months after surgery to become pregnant due to the possibility of nutrient deficiencies during the weight-loss period. Obesity is a major cause of infertility and with weight-loss you fertility levels may increase. It is important to practice effective contraception other than birth control pills during this period in avoid getting pregnant. With appropriate nutrition and vitamin/mineral supplementation, bariatric surgery does not cause growth or development problems for offspring. In fact, studies find that women who had bariatric surgery have improved pregnancy and offspring outcomes than those who are affected by severe obesity and have not had bariatric surgery. These improvements include a reduced rate of preeclampsia (an increase in blood pressure leading to chronic high blood pressure) and gestational diabetes, a lower incidence of stillbirths, and fewer miscarriages. The offspring of bariatric surgery patients are also less likely to be underweight or overweight at the time of birth.

Will my skin sag after and bariatric surgery? Will I need to have plastic surgery? Will my insurance pay for plastic surgery?

Whether or not your skin will sag after surgery depends upon several things including how much weight you lose, your age, your genetics and whether or not you exercise. Generally loose skin is well hidden by clothing. Some patients will choose to have plastic surgery, which is the only solution for removing the excess skin. Most surgeons recommend waiting at least 18 months before having plastic surgery, but you should consult with your surgeon before doing so. Plastic surgery for removal of excess skin is rarely covered by insurance because it is generally considered cosmetic. In some instances, removal of excess skin is necessary for medical reasons, i.e. skin irritation, ulceration or infection, pain, sexual function problems or hygiene issues; although it is more likely to get insurance to pay for the plastic surgery in these cases, it is still unlikely that insurance will pay. Many post-operative patients utilize compression garments to help with the appearance of excess skin. Many different types of compression garments can be found online.

Will I lose my hair after bariatric surgery?

Some hair loss is common following surgery and typically occurs between the third and sixth months following surgery. This is a result of several factors including the physiologic stress, the emotional stress of the adjustments and the nutritional stress following surgery. This is temporary, and adequate intake of protein, vitamins and minerals will help to ensure hair re-growth.

Will I have to take vitamin and minerals after surgery and will my insurance pay for these?

Vitamin and mineral supplements are necessary in the weight-loss period and certain vitamin/mineral supplements are needed life-long, depending upon the type of surgery you have. Insurance typically does not pay for vitamin and mineral supplements. However, you can pay for vitamins and minerals out of a flex medical account, which is a pre-tax account from your income that can be used for medical expenses.

If my insurance company will not pay for the surgery, are payment plans available?

There are loan programs available to cover the cost of health expenses, including loans for metabolic and bariatric surgery. Furthermore, metabolic and bariatric surgery is a health expense that you can deduct from your income tax. If you are not able to qualify for a loan, the Obesity Action Coalition (OAC) produces a helpful guide, titled “Working with Your Insurance Provider – A Guide to Seeking Weight-loss Surgery.” This guide can help you work with your provider and advocate for the treatment to be covered. You can view the OAC guide on their website.

If I am self-pay but I have health insurance, will my insurance company pay the cost of postoperative complications?

Often the complication is reported under a separate code and the insurance company will pay. However, this may not always be the case.

Will I have to go on a diet before I have surgery?

Yes. Most bariatric surgeons put their patients on a pre-operative diet, generally for 2-3 weeks prior to surgery, in order to shrink the liver and reduce fat in the abdomen. This greatly helps with the surgery and makes the surgery safer. Additionally, some insurance companies require a physician-monitored diet three to six months prior to surgery as part of their coverage requirement.

Will I have to diet or exercise after the procedure?

Yes. Surgery is just a tool that will enable you to lose weight. Although surgery does produce changes in your body that help with the initial weight-loss and maintenance of the weight-loss, it is ultimately up to you to make lifelong changes to be successful. This includes making right food choices, controlling portions, taking vitamin and mineral supplements as directed, getting plenty of fluid, rest and regular exercise. In addition, sufficient sleep and stress control may help to improve long-term weight-loss success and maintenance. Without these lifelong changes weight regain is likely to occur.

How do I get a letter of necessity?

To qualify for insurance coverage, a letter of necessity from your primary care physician is required. The letter will need to include information pertaining to current weight, height, body mass index, the co-morbidities associated with your obesity, your past diet history and why the physician feels it is medically necessary for you to have bariatric surgery. Your bariatric surgeon will often have a sample letter of necessity for you to take to your primary care physician.

Can I go off some of my medications after surgery?

With weight-loss you may be able to go off or reduce the dosage of many of the medications you take for obesity-associated co-morbidities, such as blood pressure, heart disease, arthritis, lipid abnormalities, and type 2 diabetes. If you have a gastric bypass, sleeve gastrectomy or a duodenal switch, you may even be able to discontinue using or to reduce the dosage of your diabetes medications in the early period following surgery.