Bariatric surgery, also known as weight loss surgery, is a significant medical procedure designed to help individuals struggling with severe obesity achieve substantial and lasting weight loss. It's not a simple fix, but rather a powerful tool that, when combined with lifestyle changes, can dramatically improve health and quality of life. This article provides a comprehensive checklist to guide you through the preparation process, ensuring you are physically and mentally ready for this life-altering journey.
Understanding the Eligibility Criteria
In the United States, eligibility for weight loss surgery is primarily determined by the National Institutes of Health (NIH) guidelines, which focus on body mass index (BMI). The guidelines generally require candidates to have a minimum BMI of 40. People with a BMI of 30 to 34.9 (Class I obesity) are now eligible for bariatric surgery if they have one obesity-related diagnosis or have not been able to achieve significant weight loss or improved comorbidity using more traditional non-surgical methods. For Asian populations with a BMI higher than 27.5, bariatric surgery should be considered a viable option. Those with a BMI 35+ are surgical candidates regardless of co-morbidities.
Beyond BMI, candidacy also depends on your willingness to commit to long-term monitoring and lifestyle changes. Weight loss surgery might not be suitable if you are unwilling or unable to participate in long-term monitoring or to make the required lifestyle changes.
Initial Steps and Considerations
1. Information Gathering
- Attend a Bariatric Surgery Seminar: Many hospitals, like Temple, offer free seminars conducted by expert bariatric surgeons.
- Research Different Procedures: Understand the various types of bariatric surgery available, such as gastric bypass, sleeve gastrectomy, and adjustable gastric banding (Lap Band). Choosing the right type of bariatric surgery is an important decision that should be made carefully, with input from your doctor and other medical professionals.
- Consult with a Physician: Discuss the pros and cons of surgery and confirm if you meet the BMI requirements.
- Speak with Others: If possible, talk to individuals who have undergone bariatric procedures.
2. Understanding the Commitment
- Acknowledge the Long-Term Nature: Bariatric surgery is a long-term commitment that requires significant effort and dedication to maintain lasting changes.
- Recognize It's a Tool, Not a Cure: Bariatric surgery is a great tool to help you manage your weight, but it's just that - a tool - and takes a lot of hard work and preparation for it to work.
- Prepare for Lifestyle Adjustments: Understand that successful surgery, paired with diet and exercise, shifts obesity from a disease that you battle to a choice you can control.
Pre-Surgery Preparation Checklist
1. Psychological and Emotional Preparation
- Start Thinking About Why You Eat: Bariatric surgery is not brain surgery, so if you eat for other reasons besides hunger, say stress, boredom, habit, emotion, you’ll still struggle with managing the head hunger.
- Keep a List of Non-Food Ways to Cope with Stress: Losing the ability to eat to cover up an emotion, or even boredom, can feel like the loss of a friend.
- Practice Using These Methods: Start practicing using these methods before surgery so you’ll know which methods work for you. Keep your hands busy, such as with coloring, crocheting, building a mode or get out of the house. Try going for a walk or running an errand. Have a list of support people you can call or meet - family, friend or a fellow bariatric surgery patient.
- Mental Health Evaluation: Discuss your mental health history with a psychologist, including any experiences with depression or eating disorders.
- Address Social Factors: Talk about social factors that could impact your ability to lose weight, such as employment or housing.
- Prepare for Social Changes: You may be surprised to find out how much food plays a role in your social life or in your own personal identity.
2. Nutritional Preparation
- Meet with a Registered Dietitian: Learn about the necessary dietary changes you'll need to make both before and after your surgery. Meeting with a registered dietitian gives you an opportunity to learn about the necessary dietary changes you'll need to make both before and after your surgery.
- Practice Eating on a Schedule: After surgery, you’ll need to eat a protein-based meal every three to four hours. If you’re not eating this way now, the transition to multiple mini-meals a day is hard to fit in.
- Map Out a Schedule: Map out a schedule of when and what to eat. Food prep is the key for many to stay on track.
- Eat Like You’ve Already Had Surgery: In other words, slow down and chew, chew, chew. Digestion is quite different after surgery.
- Prioritize Protein: At meal times, protein takes priority.
- Start Building a Safe Food Environment: Start building a safe food environment to help weed out mindless eating.
- Consider Vitamin and Supplement Needs: You may also need to take vitamins and supplements to make sure your nutritional needs are met.
- Pre-Surgery Weight Loss: We typically require that you lose some weight before having weight loss surgery.
3. Physical Preparation
- Incorporate Regular Exercise: Along with adjusting your diet, one of the most important components of your plan will be regular exercise. If you never exercise, don’t be intimidated - walking, and doing beginner workouts on YouTube or free workout apps are both good options.
- Undergo Medical Assessments: Before being approved for bariatric surgery, your care team will assess your heart and lung function to make sure that your body is strong enough to withstand the stresses of the procedure.
- Additional Tests: Other tests may be needed, too, based on your health status and the type of surgery you're having. Some patients with gastrointestinal symptoms may need to have an endoscopy, for instance.
- Stop Smoking: For patients who smoke, you must quit all forms of tobacco for at least two months prior to seeking weight loss surgery and well in advance of your surgery.
- Address Anesthesia Considerations: Since some risk factors associated with excess weight can affect the way anesthesia is administered, it's important to plan for those ahead of time.
- Manage Sleep Apnea: For instance, your anesthesiologist may need to consider airway management plans if you have obstructive sleep apnea, since the condition can make it more difficult to insert a breathing tube.
4. Practical Preparations
- Understand Insurance Coverage: Many insurance plans offer full or partial coverage for bariatric surgery.
- Submit Required Documentation: You may be required to submit documentation proving your candidacy, including your BMI and any weight-related health conditions, such as diabetes or high blood pressure, that make you eligible for the procedure.
- Plan for Post-Surgery Recovery: Understand that successful surgery, paired with diet and exercise, shifts obesity from a disease that you battle to a choice you can control.
- Prepare for Dietary Progression: Post-surgery, you'll start with a liquid diet and slowly transition to eating very soft foods. After a while, you can slowly start to re-introduce regular foods.
- Assemble a Support Network: This could include friends and family members who are able to provide emotional and physical support before, during, and after.
- Pack for Your Hospital Stay:
- Comfortable Clothes
- Personal Hygiene Products
- Medication List
- Reading Materials
- Earbuds/Headphones
- Electronics & Chargers
- Comfort Items
- Water Bottle: Dehydration is a common side effect of bariatric surgery, so having plenty of water on hand will be essential during the recovery process.
- Slip-on Shoes
- Your Favorite Pillow or Blanket
5. Develop Healthy Habits
- Treat Your Water Bottle Like It’s You Third Arm: Dehydration is one of the biggest post-op complications.
- Sip Throughout the Day: You won’t be able to drink large amounts of fluid at one time. Instead, you’re sipping ALL day.
- Avoid Hour-Long Gaps: If you don’t drink for even one hour, it will be difficult to make up for that time.
- Keep Yourself Accountable: Most successful weight losers are tracking something - protein or calories, fluid intake, weight, steps, and/or exercise.
- Track Your Progress: Other people weigh or measure all their food or eat off the same plate or container.
- Take Pictures! The before and after pictures can be very motivating. You don’t always feel or see progress every day, so looking back on where you’ve come from, both physically and mentally, is rewarding.
- Don’t Compare Yourself to Others: Everyone has their own story and struggles and everyone will overcome it in different ways.
- Remember Individual Variation: Keep in mind that everyone will lose weight at different rates and in different ways. Someone who starts off heavier has more weight to lose.
Post-Surgery Expectations and Long-Term Commitment
- Follow Up Regularly: Losing weight and changing your lifestyle the first year is the “easy” part, keeping the weight off is more challenging.
- Build a Strong Relationship with Your Bariatric Team: Follow up helps build a strong relationship with your bariatric team and allows you to share challenges.
- Monitor Your Health: Follow up also provides the opportunity to makes sure you are on track and check blood work for vitamin deficiencies.
- Continue Healthy Habits: Bariatric surgery patients must still be committed to making positive dietary and lifestyle changes after the procedure to maintain their results.
- Embrace the Journey: For individuals who have undergone bariatric surgery, life after the procedure can be a remarkable journey of physical and mental transformation.
The Role of a Multidisciplinary Team
From preparing for surgery to recovering and adjusting to life afterward, you’ll be guided by your surgeon, multiple physicians, nurse practitioners, physician assistants, nurses, dietitians, psychologists, and other coordinators. At Temple, we’re proud to help our patients achieve the best possible results with the support of a strong, multidisciplinary team.
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