Are you seeking the answers to weight loss questions and live in Connecticut and the surrounding area? Making the decision to commit to weight loss surgery can often seem frightening, confusing and intimidating. Our surgeons and staff will help guide you through the process, support you and help alleviate all of your fears. They will embrace you as a new member of our family and work with you to help decide which procedure is best suited for your health, lifestyle and life goals.
Many questions are often raised as patients seek to examine the process of having bariatric surgery. We hope the answers to the questions below will enlighten you and offer you the encouragement to continue on a journey that can help transform your life and help you recapture your health. We also invite you to attend one of our free seminars or call our office toll free at 877-659-0011 and we will be glad to answer any questions and address your concerns.
What is obesity?
Obesity is the health epidemic of our era. Our lifestyles, the foods we eat, our lack of exercise and daily pressures to work hard and provide for our families have led to unhealthy living. We need to recapture the health and longevity that is slowly slipping from our grasp.
The numbers are staggering as obesity continues to overtake our loved ones. 60 million of us are obese and are experiencing increasing medical problems and a potential increased risk of dying. The obesity related medical conditions (co-morbidities) include diabetes, asthma, sleep apnea, some cancers, cardiovascular and pulmonary disease, gallstones, heartburn, hypertension, infertility, arthritis, urinary incontinence, back and joint pain and gout.
What is morbid obesity?
Morbid obesity is a severe form of obesity. It affects over 9 million Americans with potentially life threatening health issues as well as creating negative social consequences. It has been linked to shortened life expectancy. A person who is more than 100 pounds overweight or twice their ideal body weight and has a BMI of 40 or a BMI of 35 with multiple co-morbidities (obesity related diseases) is considered morbidly obese. Most patients who are considered morbidly obese are candidates for weight loss surgery.
Am I a candidate for weight loss surgery?
Physical and mental efforts are both needed for successful results to weight loss surgery. Weight loss surgery can be the solution after all
non-surgical approaches have failed. It is also an answer for those suffering from obesity related diseases. It is not a"quick fix" and requires a major commitment from you along with the willingness and desire to make significant life style changes. In addition to our support groups, you will also need the support of your family and friends.
Obesity is most often measured by using a mathematical formula called a Body Mass Index (BMI). It is a measure of body fat based on height and weight that applies to both adult men and women.
The National Institute of Health has established guidelines that are followed to determine the patient's candidacy for surgery. Any patient with a BMI of 35 to 39.5 who suffers with 1 or more major co-morbidities (major obesity related medical problems) or a patient with a BMI of 40 or above, with or without any co-morbidities can be considered for bariatric surgery.
A high or low BMI should not be the sole determining factor for obesity surgery. Individual and family medical history as well as an evaluation of diet and physical activity must be included in evaluating the decision for surgery.
A decision is made only after a complete evaluation is made by our surgeons, psychologists and nutritionists. In addition to meeting the BMI requirements, the patient also has to have a complete understanding of the life altering life style changes they will be making and an unqualified willingness to make that commitment.
How does weight loss surgery make me lose weight?
The stomach is made smaller so that you will feel full after eating less food. There are various types of procedures that accomplish this goal.
Laparoscopic banding restricts the size of the stomach with an adjustable band. Since the size of the stomach that receives the food has been reduced by the band, it has a very limited capacity for food and the patient will feel satiated when it is full.
Laparoscopic gastric bypass redirects food and digestive juices in separate parts of the small bowel. These two channels intersect further downstream in the bowel resulting in malabsorption of nutrients and subsequent weight loss. The stomach pouch is also decreased in size.
With the gastric sleeve a portion of the stomach is removed and the remaining stomach is a long thin pouch. This results in patients having less hunger and feeling the sensation of fullness after eating less food.
The advantages and disadvantages of each procedure should be discussed with your surgeon. He will help you select the one best suited for you.
What are the risks and complications of weight loss surgery?
Risks are an inherent factor in all major surgeries and vary from surgery to surgery and patient to patient. Risks and complications for bariatric surgery are relatively rare. The risks are not only based on the surgery you select but also on the condition of your health. Studies reveal that patients with a high BMI and sleep apnea are subject to a higher risk.
They also reveal that males are subject to higher risks than females
Bariatric surgery is considered a major operation and has a national mortality rate of.1%. Some of the complications that could arise include leakage which might necessitate additional surgery or cause infection; blood clots; bleeding; infections; hernias; iron deficiency anemia, dumping syndrome; strictures; nausea and osteoporosis. For those reasons alone it is imperative that you select a surgeon who has had experience performing a significantly large amount of these operations and who has a proven track record of successfully performing them.
To further reduce the potential for complications and risks you should also take into consideration the necessity of having the operation performed by a Center of Excellence®. To achieve this certification the surgeons, their practice and the hospitals in which they operate must meet the most rigorous standards. They must have a proven track record on patient safety and consistently deliver the highest levels of quality care.
It is important that you understand all of the specific risks related to each procedure and select a surgeon with extensive experience in dealing with all of these potential issues. Our surgeons have this experience and will provide you with all of the necessary information regarding the procedures you are considering. You should not make a decision to have your weight loss surgery without having a complete understanding of all aspects of what you will, and could encounter.
What are the advantages of having my weight loss surgery done laparoscopically?
At Fairfield County Bariatrics 95% of all surgeries are completed laparoscopically. The advantages of laparoscopic surgery include less pain, less potential for wound complications and a quicker recovery period. Laparoscopic surgery requires several small incisions. The surgeon uses a television monitor to view the area where he is performing the surgery. If not done laparoscopically, large incisions are necessary and muscle would have to be cut. Open surgery is painful and large incisions may result in hernias and infection.
How do I decide which procedure is right for me?
There are several surgical options available to the weight loss patient. With guidance from our surgeons, the patient can select the procedure best suited for them.
Our practice has performed over 4500 bariatric procedures and our surgeons are recognized as leaders in performing laparoscopic band surgery, laparoscopic gastric bypass surgery, laparoscopic gastric sleeve surgery, Stomaphyx and revisional bariatric surgeries.
Our surgeons will meet with you, discuss your lifestyle and eating habits, review your medical history and current condition and then assist you in making the selection you are most comfortable with.
How much weight will I lose; how quickly will I lose it and what are the long- term results?
The amount of weight you lose will be based on the procedure you select. With laparoscopic gastric bypass an average of 60% to 80% of excess body weight loss can be expected within the first two years following this procedure. You will lose five to six pounds a week and most of the loss will occur within the first six months following the surgery. The laparoscopic adjustable gastric band will average a 60% excess body weight loss over 5 years. With the band you will lose one to two pounds one week for the first twelve to eighteen months. The rate of weight loss gradually diminishes until the desired loss is achieved and then the weight stabilizes.
The addition of an exercise program helps bariatric patients lose weight more rapidly after surgery. We recommend that our patients begin an exercise program as soon as our surgeon feels that it is the appropriate time to do so.
In addition to helping achieve desired weight loss, an exercise program will also boost your metabolism, decrease risk of cardiac disease, lower blood pressure, tone muscle and increase energy.
Daily physical activity is also instrumental in helping achieve weight loss. Walking, gardening and house cleaning are just a few of our daily activities that will burn calories and contribute to helping lose weight.
Is weight loss surgery covered by health insurance?
Many weight loss surgical procedures are covered by health insurance. When planning for your surgery it is important to determine if your specific health insurance plan covers weight loss surgery. Please be aware that every plan is different and benefits are constantly changing. Unfortunately not every plan has weight loss surgery coverage. Our staff of insurance experts will acquire the necessary information and help you through the process of getting approved for your procedure.
What if my health insurance does not cover weight loss surgery?
If it is determined that you do not have the coverage, please don’t be discouraged. Our office can provide you with various financing options. We can direct you to financing companies who specialize in funding surgical procedures. Packages can be designed to fit within your budget as these companies offer competitive rates.
Why should I have my weight loss surgery at a Center of Excellence®?
Bariatric surgery is a life altering decision and the most effective means to treat morbid obesity and its complications. There are currently several surgical procedures available that will offer lasting and safe control of weight and provide remission of many co-morbidities. Though the safety factor has substantially increased over the years, surgery can still be a challenging undertaking. Uncontrolled complications of morbid obesity and psychosocial challenges necessitate the need for highly skilled support. Bariatric patients can present increased surgical risks and the need exists for a well-trained staff that is capable of dealing with the physical and emotional demands of them. However, the surgeon and staff do not represent the entire picture. Hospital equipment, furniture, instruments and imaging resources must be suitable for the patients who often exceed their ideal body weight by 100 lbs. Centers of Excellence® provide the knowledge, experience and staff to deliver the highest levels of safe and comprehensive bariatric care to the patient.
With the global obesity crisis and the rise in bariatric procedures the need to develop benchmarks for quality and patient safety became apparent. The American Society for Metabolic and Bariatric Surgery (ASMBS) realized this and set out to recognize the surgeons and facilities that provide superior bariatric patient care. The goal was, and is, to advance the safety, efficacy and efficiency of bariatric and metabolic surgical care. Guidelines and rules thave been establised to ensure that the patient will receive the highest levels of care and safety. The ASMBS has developed and administers best-in-class bariatric surgery Center of Excellence® programs around the globe and the world’s largest clinical bariatric surgery patient database
To receive a Center of Excellence® certification, the most rigorous standards in the industry must be met. In addition to meeting those standards, the bariatric surgeon and the facility in which the surgery is performed, must have a proven track record on patient safety and consistently deliver quality care. A commitment to long-term patient care and success by the surgeon and affiliated facility as well as a multidisciplinary team focus necessitates that the qualifications for the ASMBS designations be extensive, research-based and verified through a rigorous site inspection to validate all of the program’s requirements. It is a very thorough process and consistently on going with timely reviews.
The need to have bariatric surgery at a Center of Excellence® was reinforced by the federal government in its Medicare National Coverage Determination. It stipulates that Medicare patients can only be operated on at Centers of Excellence® that have been certified by the ASMBS (or ACS).
Dr. Neil Floch, Dr. Craig Floch, Dr. Abe Fridman and Fairfield County Bariatrics & Surgical Specialists, P.C. have been designated as Centers of Excellence®. The hospitals at which they operate, Norwalk Hospital in Norwalk Connecticut and St. Vincent's Medical Center in Bridgeport Connecticut have also been awarded the Center of Excellence® certification. In 2006 they were among the first in the state to be certified and they have been recertified in 2014.
Will I have to do this alone?
You will not be alone. We offer a comprehensive and multi-dimensional weight loss program that addresses all aspects of a patient’s life. We believe that postoperative nutritional and psychological support are essential elements to the success of our bariatric program. Counseling in these areas contribute to our patients’ success in achieving and maintaining their goals.
Our patients are provided with multiple monthly support groups and preoperative and postoperative nutritional assistance by a registered dietician specializing in helping bariatric patients achieve desired weight loss and optimal results. We also offer multiple monthly psychological support groups that are run by a Licensed Care Social Worker, a Psychotherapist and Exercise Physiologist. Each one is accomplished in their field and experienced in helping the postoperative bariatric patient achieve desired weight loss and optimal results.
We are committed to the long-term success of each patient and support them on their journey. We will provide you with unending support and guidance through out your post-operative period and beyond. Our team, including the surgeons, office staff and support groups will always be at your side to encourage and support you.
Is weight loss surgery reversible?
The laparoscopic gastric band is reversible since the internal anatomy is not altered. The laparoscopic gastric bypass is also reversible but it is a much more complex procedure to do so. The laparoscopic sleeve gastrectomy is a nonreversible procedure. The specific details regarding your procedure should be discussed with our surgeons.
Can I become pregnant after weight loss surgery?
It is safe to become pregnant after gastric bypass bariatric surgery but it is recommended that the patient wait until 18 months after the surgery when weight stabilizes. The reason we ask for this delay is to prevent the mother and newborn from suffering possible malnutrition. After band surgery you do not have to wait an extended time to become pregnant. The band can be adjusted so that you do not lose too much weight too fast. Rapid weight loss and malnutrition can affect a growing fetus. Before you get pregnant it is important to discuss it with your weight loss surgeon and your obstetrician. They may want to run tests to make certain that your vitamin and mineral levels are ideal for pregnancy.
Can I smoke and have weight loss surgery?
You should not. You cannot have weight loss surgery unless you have been off nicotine and tobacco products for at least one month. This also includes the nicotine patch and nicotine gum. Smoking will damage and interfere with the workings of your heart and lungs and it paralyzes the lining of the air passages. Smoking also significantly increases the possibility of having complications after surgery such as ulcers and severe pain.
If I am interested in weight loss surgery, what is my first step?
We ask that you attend one of our free weight loss seminars. They are the best place to learn more about bariatric surgery. You will have the opportunity to meet one of our surgeons, have the procedures explained and have all of your questions answered. Seminars are held throughout each month and are conveniently located all over Connecticut. If you would like to attend a free seminar, please fill out the form or call toll free 877-659-0011. If it is difficult for you to attend a seminar please call us toll free at 877-659-0011 and ask for one of our patient advocates.
What should I bring to my first appointment with the surgeon?
Please bring the following with you and it will enable us to expedite the process: Insurance card, social security number, driver’s license or photo ID and a referral authorization if required by your insurance company.
What happens during the first appointment?
You will have the opportunity to meet with your surgeon. He will discuss the various options you have and help you select the type of surgery best suited for your medical condition and life style needs. You will also be given the opportunity to meet with our other team members.
Based on the surgical procedure you have chosen, as well as your BMI and past/current medical conditions, additional consultations will be arranged with the following: your primary care physician, Nutritionist (required), Mental Health Counselor or Psychiatrist (required) and gastroenterologist. Many patients will have to see a pulmonologist, endocrinologist or cardiologist.
Please be aware that insurance companies will not approve surgery without consultations from a nutritionist and a mental health counselor. Unfortunately, not all medical insurances cover these expenses. You may incur fees for these visits "out of pocket". Your insurance may then reimburse you according to the terms of your individual plan.
In addition to the consultations mentioned above, the doctor may order one or more of the following blood tests and/or radiological exams: Blood Test for H. Pylori, Thyroid screen (blood test), Ultrasound of the gallbladder to rule out Stones, Upper GI Series, upper endoscopy and additional tests as needed or recommended by another medical specialist.
Your primary care physician may be asked to examine you to provide
pre-operative clearance stating that you are physically able to undergo the procedure.
After the first appointment how long will it take before I have surgery?
The surgery date is contingent upon the requirements of your insurance company. It can vary from 4 weeks to 6 months. This depends upon the possible need to do a 6 month medically supervised diet as required by your insurance company.
How long will I have to stay in the hospital after surgery?
The surgery you elect to have will determine the length of your hospital stay. The hospital stay for patients who undergo the Laparoscopic Roux-en-Y Gastric Bypass procedure is usually two days. Patients who have the Laparoscopic Adjustable Gastric Banding procedure may go home the same day or stay overnight. This depends upon your insurance coverage and most importantly, your medical condition. The Laparoscopic Sleeve Gastrectomy generally requires a 2 day hospital stay. Before you are discharged, you will receive full instructions for your care at home.
How long will I be out of work after surgery?
Here too, the length of time you remain home from work depends on the procedure you chose to have. You will be out of work for 3 days to one week following a banding procedure and 1-2 weeks following a gastric bypass and 1-2 weeks following a sleeve gastrectomy.
Will I continue seeing my primary care physician after surgery?
It is important that you continue seeing your primary care physician with regularly scheduled appointments. After weight loss surgery your medical condition will change and the treatment you were receiving prior to your surgery will change as a result of it. You will also have to meet regularly with your surgeon.
Will I have to take vitamins?
The surgery you elect to have will determine the vitamin regimen you will be required to be on. A multivitamin and 1200 mg of a chewable or liquid calcium citrate is required daily after any surgery. Bypass patients also have to immediately take a daily acid blocker (Prevacid Solutabs or Aciphex) and vitamin D and B12 sublingual weekly. All patients will be tested to determine their iron and vitamin D levels. If they are low then it will be necessary to take iron and vitamin D.
What foods will I be able to eat and drink after surgery?
You will have to follow specific eating guidelines consisting of five diets that your dietitian will have explained to you. For the first three weeks after your weight loss surgery, your diet will consist of liquid/pureed food or the first three Stages of the diet. This includes foods that are liquid to soft in consistency. Examples of soft consistency foods are scrambled eggs, cottage cheese, sugar-free yogurt, hot cereal and mashed potatoes. You can also drink non-carbonated fluids that are sugar-free and caffeine-free. Good choices are water, milk, sugar-free flavored drinks and high-protein liquid supplements. Your dietitian will recommend liquid supplements to meet your nutritional needs during this time.
As your tolerance builds, you will progress to a Stage 4 soft diet and then to a Stage 5 regular food diet. Your "new" stomach is roughly the size of an egg. It will stretch to the size of a cup in about a year. You can avoid discomfort and complications if you do the following:
- Eat small, frequent meals (five or six) throughout the day. (Your stomach will be too small to hold large meals.)
- Chew all foods slowly and thoroughly. (It may take you up to an hour to complete your meals and snacks.)
- Do not drink fluids 30 minutes before or 30 minutes after your meal. Be sure to drink in sips.
- Do not drink fluids with your meals. Your smaller stomach may not be large enough to hold fluids and food at the same time.
- Do not eat sweets.
Avoid foods that cause any discomfort. You might consider keeping a diary of the foods you eat, as well as any foods that are difficult to tolerate. Your diary will help you identify which foods cause discomfort. During follow-up visits, you can use your diary to report any foods you cannot tolerate. Your dietitian will help you plan healthful, appropriate meals. You also will be guided in selecting a variety of foods that are rich in vitamins, minerals and protein so you will stay well nourished. Your dietitian will recommend a multivitamin/mineral supplement. Digestive distress, such as gas and constipation, is common in the first few weeks following bariatric surgery. Unless your physician instructs you otherwise, you can use over-the-counter gas relief medications and stool softeners. If you are constipated, you can add extra fiber to your diet by eating applesauce, oatmeal, and pureed prunes.
To prevent dumping syndrome, DO NOT eat or drink the following:
- Beverages containing caffeine such as coffee, tea or chocolate
- Citrus food or juices such as orange, grapefruit, lemon or lime
- Carbonated beverages
- Sugar and sweeteners such as dextrose, fructose, mannitol, sorbitol, white sugar, brown sugar, syrup, molasses, candy, jelly, desserts, jams or preserves
- Sweetened beverages including regular soda, coolers, drink mixes, Kool-Aid, fruit punch or undiluted fruit juice
In addition it is important to:
- Eat only canned or very tender, well-cooked fruits and vegetables.
- Do not eat any raw fruits or vegetables, except bananas.
- Do not eat the skins of any cooked vegetables or fruit.
What happens if I cheat on the post-surgical diet? Can that cause"dumping syndrome"?
After experiencing the results of "first time" cheating, most patients do not cheat again. Eating food with high calorie content can cause "dumping syndrome" which can make the patient experience nausea, vomiting, bloated stomach, diarrhea, excessive sweating, increased bowel sounds, dizziness as well as emotional reactions.
Should I exercise after weight loss surgery?
Exercising helps bariatric patients lose weight more rapidly after surgery. Establishing a gradual exercise and physical activity program is a key to helping achieve desired weight loss. We recommend that our patients begin an exercise program as soon as our surgeon feels that it is the appropriate time to do so.
Following bariatric surgery, the patient takes in fewer calories and less than their body needs to operate. As a result, the body, in its search for energy, begins to burn muscle instead of fat. If your body consumes the unused muscle instead of fat you would lose muscle mass and strength. Exercising alters the metabolism so the body would burn fat instead of muscle. In addition to helping achieve desired weight loss, an exercise program will also boost your metabolism, decrease risk of cardiac disease, lower blood pressure, tone muscle and increase energy.
Daily physical activity is also instrumental in helping achieve weight loss. Walking, gardening and house cleaning are just a few daily activities that will burn calories and contribute to helping lose weight.
We realize the importance of an exercise and physical activity program but will only suggest it when we feel you are physically ready for it. It will be done in graduated stages so that you will be able to do it without experiencing difficulty. Among our support groups is one that specializes in exercise.
Why do I have to drink so much water after my surgery?
The process of losing weight requires a heavy load of waste products to be eliminated. Most of them are in the urine. Some of these waste products can create crystals that in effect cause kidney stones. Consuming a great deal of water will protect you from the formation of those stones as the water helps your body rid itself of the waste products efficiently. As a result there is a greater success in weight loss.
Will I be able to have alcohol after my surgery?
Small amounts of alcohol will affect you much sooner after your surgery than it did prior to having the surgery. Your blood levels will rise from the alcohol consumption and the alcohol can also be toxic to your liver. Patients should refrain from the use of alcohol for one year after surgery. Following that, it should be consumed infrequently and in small amounts. Alcohol is high in calories and will negatively affect the weight loss process.
What will I be able to do about excess skin?
As time progresses after your weight loss surgery and you lose weight, you will begin to notice excess skin. Age and skin elasticity are factors in this happening. Some patients decide to have plastic surgery one to two years after their weight loss to remove skin folds around the abdomen. If you should decide that you would want to pursue this, we have experienced plastic surgeons who are available to consult with you.
Does the stomach ever stretch back to a larger size after bypass surgery?
The size of the stomach will gradually stretch and allow for increased food capacity. However it will not stretch back to its original size. After surgery the stomach size is restructured to hold 1 ounce of food. It generally remains that size for about 12 months when it then begins to expand slightly and increase in size to hold 4 – 6 ounces for each meal.
Does weight loss surgery have any affect on the types of medication that I can take?
Anti-inflammatory drugs can sometimes cause ulcers by irritating the intestinal tract’s inner linings. For that reason aspirin or aspirin containing medication should also be avoided. Many medications related to
co-morbidities (diabetes, blood pressure) will no longer be needed or the dosage for them will be dramatically reduced after weight loss surgery.
Is there a possibility that I could lose hair?
A reduction in protein intake can create hair loss. Some nutrients, including protein are often malabsorbed after bariatric surgery. Once the shortened intestine begins to work effectively malabsorbtion will then stop. Hair loss may start to appear three to five months after surgery and is usually a temporary condition. It will stop once a sufficient amount of protein is consumed. Our nutritionists will help you with a protein rich diet to help with the hair loss issue. The use of Biotin as a vitamin supplement may be helpful in slowing or treating hair loss after surgery.
Can I regain some of the weight that I lose following the surgery?
Some patients do regain some of the weight that they lose after their surgery. Consuming high fat and high sugar foods that are not part of the bariatric diet program will add to weight gain. Weight loss surgery is a tool to losing weight. It is essential that you also follow the dietary guidelines presented to you by your surgeon and dietician.
Why should I select Fairfield County Bariatrics as opposed to other surgeons offering bariatric surgery?
Fairfield County Bariatrics & Surgical Specialists, P.C. is Connecticut’s premier weight loss surgery practice, offering the highest standard in Laparoscopic weight loss surgery.
Dr. Neil Floch is the Director of Minimally Invasive Surgery & Bariatrics at Norwalk Hospital. Dr. Craig Floch is the Director of Bariatrics at St. Vincent’s Medical Center. The doctors, their practice and both Norwalk Hospital and St. Vincent's Medical Center in which they operate have all been certified as Centers of Excellence®.
Our practice has performed over 4500 weight loss procedures and our surgeons are available 365 days a year. Patients can be assured that one of our specialists will always be available to them before and after surgery.
We have assembled a team of surgeons, physician assistants, medical assistants, nutritionists, psychologists, insurance coordinators and office staff members that specialize in Bariatric procedures. We are ready to help you succeed when other weight loss methods have failed.
We understand that the path to permanent weight loss is a life-long journey and our program is designed to assist you along each step of the way.
Our expertise has enabled us to design a comprehensive and multi-dimensional weight loss program that addresses all aspects of the patient’s life. We are committed to the long-term success of each patient and support them on their journey.