FAQs

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 and 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 surgeries such as C-section, gall bladder surgery, appendectomy, tubal ligation, hysterectomy and minor hernia repair of the belly button do 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

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

Yes, bariatric surgery has been shown to improve type 2 diabetes or put it into remission. There is evidence that surgeries such as the gastric bypass, sleeve gastrectomy and duodenal switch work through both gut hormone and other pathways as well as through the weight-loss that it produces to cause the improvement or remission of type 2 diabetes. Studies find a greater than 95 percent improvement of type 2 diabetes with bariatric procedures and up to an 85 percent remission 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. The improvement or remission of type 2 diabetes, therefore, 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 order to not get 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 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, 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 to 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 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. To view this guide, click here.

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 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 and 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.

Can I have bariatric surgery if I smoke?

Most surgeons will not perform bariatric surgery on a person that smokes and often require a smoke-free period prior to surgery. There are tests that can test the nicotine level in the blood or urine, and many surgeons employ these tests to ensure that patients have quit smoking prior to surgery. It is not only very important to stop smoking prior to surgery, but it is also critical to remain smoke free after surgery because smoking significantly increases the risks of complications even after surgery such as development of ulcers.

What kind of lifestyle changes will I have to make following surgery?

Aside from the most obvious change that takes place with respect to diet, there are a number of other lifestyle changes that have to occur in order to experience success on your weight loss journey.

Eating Habits

Avoid alcoholic beverages.
Avoid high fat, high fiber foods.
Chew slowly during meals.
Don’t drink with meals (it makes you feel full too fast).
Keep snacking between meals to a minimum.
Omit desserts and sugary foods.
Home/Work Life
Your post surgery physical activity level will likely be determined by the type of procedure you have undergone. Most patients can return to work within 1-3 weeks following laparoscopic surgery, while open surgical procedures may be slightly longer. Exercise can typically resume within six weeks or less after surgery.

Follow-up Care

Long term follow-up care will be required annually and sometimes more frequently depending on post-surgical body functions. There will be frequent testing to determine:

Nutritional levels (vitamin B-12, iron, and folate levels, etc.).
Is the patient anemic (i.e., low red blood cell count).
Support

Having the support of family and friends is important; however, equally important is for a person to surround themselves with other weight loss surgery patients who understand the intricacies of weight loss surgery. Weight loss surgery is not a quick fix to repair the years of emotional pain caused by being morbidly obese. The support groups are merely a way for patients to share their challenges and/or success’ with others who have been through similar challenges. In fact, there is typically a big difference between the patients who are involved in a support group on a regular basis and those who attempt their weight loss journey alone. Our surgical team will provide you with a list of support groups to fit your needs.

Pregnancy

For the first 18-24 months after weight loss surgery it’s important that women of childbearing age do not conceive. Pregnancy can be taxing on the body and the potential for fetal damage increases. During this waiting period, it’s important to give the body time to heal and recuperate. For this reason, a surgeon will typically advise you to take every precaution necessary to reduce the chances of becoming pregnant.

Are you a candidate for weight loss surgery?

With over 6 million Americans suffering from morbid obesity, the need for weight loss surgery has become more apparent. Morbid obesity brings with it a plethora of health issues that if left untreated will substantially shorten life expectancy. In fact, morbidly obese adults (those individuals whose weight is twice the ideal amount) are twice as likely to have an early death as compared to a non-obese adult.

Would you like to know if you are a candidate for weight loss surgery? To determine if you are a candidate for surgery, it’s important to know what medically classifies an individual as “morbidly obese”. The following criteria are characteristic of a morbidly obese individual and could qualify you for weight loss surgery:

  • 100 pounds or more over their ideal body weight.
  • BMI (Body Mass Index) of over 40.
  • A BMI of 35-40 accompanied by significant life threatening medical conditions such as Type II diabetes, high blood pressure, heart disease, and severe sleep apnea.
  • Inability to maintain a healthy body weight for a sustained period of time after numerous attempts to achieve weight loss with diet, exercise, medication, hypnosis, therapy, or a combination of methods.
  • Overweight for at least 5 years with many failed attempts at losing the excess weight.
  • Weight loss surgery is often the only option for an obese individual to improve their health. In fact for many patients, the risk of death from not having weight loss surgery is much greater than the potential risks associated with the procedure itself. It’s important that you discuss all of your concerns with our bariatric team. Remember, we’re in this with you, every step of the way.

Please Note: It’s important to remember that weight loss surgery is not the answer for everyone who suffers from obesity. The operation is an elective procedure so it’s imperative that you are well informed on the potential risks and benefits involved. Also, the surgery is not a guarantee to produce and maintain long term weight loss. It’s only the beginning of a lifelong commitment to healthy living that is required if you are to succeed. Following the operation, you will begin the process of making important lifestyle and behavior changes in order to increase your chances of experiencing lasting weight loss and continued good health.

Is bariatric surgery safe?

A surgical procedure of any kind will always involve a certain degree of risk, and bariatric surgery is no exception. In the past, weight loss surgery was viewed as extremely risky. However, with the development of new procedures and advancements in technology, bariatric surgery is a relatively safe solution to morbid obesity. Today, the overall risk of weight loss surgery is fairly low with most patients experiencing few, if any, complications. This is not to minimize the fact that this is still a serious operation, which should only be considered after all other weight loss options have been exhausted.

Once a surgeon has determined that you are a candidate for weight loss surgery, it’s very important that as a patient you reveal all pertinent medical information to your surgical team. The bariatric surgeon will assess the risks involved with your particular surgery and take every precaution necessary to ensure your safety and to reduce the risk of complications.

Regardless of the type of weight loss surgery, it’s important that the decision to undergo surgery is carefully thought out. It’s imperative to weigh the risks of surgery with the long-term risks of remaining obese. Discuss any concerns you might have with your surgical team and your outside support system (family, friends).

Does insurance cover weight loss surgery?

Having health insurance does not guarantee you will be covered for weight loss surgery. Since the cost of this procedure can be very expensive, most patients would not even consider it an option if it were not for insurance or low interest financing. Although weight loss surgery is still considered an elective procedure, it may be covered by your insurance carrier. For this reason, it’s important that you fully understand what “is” and “is not” covered by your insurance provider.

Before you attempt to get authorization, here are some helpful hints to assist you with the authorization process:

  • Read and understand your insurance provider’s “certificate of coverage.”
  • Get a referral and copy of medical records from your primary care physician in order to substantiate your claim.
  • Keep accurate, detailed records of visits to healthcare providers. Also, save receipts for any exercise equipment, fitness programs, diet centers, weight loss drugs and anything else that can assist in the authorization process.

With so many different insurance policies and types of plans among insurance providers, it’s important that you understand the authorization requirements for your individual policy.

The insurance company will typically ask for the following information and documentation (Be prepared to provide these upon request):

  • Current weight, height, and BMI.
  • Verification from a physician that the patient is 100 lbs or more over their ideal body weight.
  • The surgery recommended along with any post operative follow-up care, including nutritional and psychological support.
  • A detailed medical history including co-morbidities (i.e., the presence of one or more diseases in addition to a primary disease).
  • Six (6) months of medical records including a patient evaluation, treatments performed to date, and specific types of lab work done.
  • Six (6) months of a documented dieting and exercise routine (must include dates and results).
  • A psychological/psychiatric evaluation.

Once you have submitted your claim it’s a simple matter of waiting for your insurance provider to respond. At times it can be a frustrating and discouraging process, but don’t give up. If your claim is denied you have the right to appeal the decision. Being denied coverage for surgery happens to many patients and this initial set back does not mean that you’ve reached the end of the road. Some insurance providers may initially deny bariatric surgery claims automatically the first time they’re submitted, and can be more receptive to follow-up appeal letters.

If you have questions about the insurance process, please don’t hesitate to contact our office. Let our experienced bariatric team help you with the authorization process.

What is morbid obesity?

Obesity results from having an abnormally high proportion of body fat which exceeds the body’s skeletal and physical standards. Obesity develops into morbid obesity when an individual is 100 pounds or more over their ideal bodyweight and has a BMI (Body Mass Index) of 40 or higher. Morbid obesity affects an estimated 10 million Americans; a number that has nearly doubled in the last 30 years. Morbid obesity includes one or more serious health conditions or diseases that are a direct result of the excess weight an individual is carrying. These are known as co-morbidities. Co-morbidities result in an individual experiencing some type of significant physical ailment, which in some cases can lead to death. With over 10 million sufferers today, morbid obesity is becoming more than just a serious disease, it’s a national epidemic.

Let our bariatric team help you overcome your battle with obesity! Remember, you do have options. We want to see you succeed on your weight loss journey.

What is a Lap Cholecystectomy?

Laparascopic refers to the type of instrumentation and procedure used for this operation. Laparoscopic technique allows for creation of smaller incisions than those needed when performing open surgery. Cholecystectomy is the surgical removal of the Gall Bladder. Laparascopic Cholecystectomy (also known as Lap Chole) has now become the preferred surgical technique for treatment of symptomatic gallstones and cholecystitis.

What is a Hernia?

A hernia is the protrusion of an organ or part of an organ through the wall of the cavity that normally contains it. A hernia occurs when there is a weakness or opening in your abdominal wall as a result of aging, injury, a previous surgical incision, or a condition present at birth.

Hernias generally grow larger due to pressure on them, such as a loop of your intestine or fatty tissue pushing into the weak abdominal tissue or tear. The result is a sac that forms in the abdominal wall. You may or may not see a bulge at this point.

What is General Anesthesia?

Anesthesia is primarily associated with the loss of painful sensations, which allows surgery or procedures to be performed without causing pain. There are different types of anesthesia. Local anesthesia is rendering a local area of tissue or a part of the body insensitive to pain or sensation. General anesthesia is causing complete unconsciousness and relaxation of the entire body, as well as a loss of painful sensation. General Anesthesia usually requires placement of a  breathing tube (endotracheal) to allow you to breathe while you are rendered unconscious.

 *Individual resultes may vary

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Anish Nihalani, MD, FACS
98 James Street, Suite 103
Edison, NJ 08820
Phone: 732-204-6088
Fax: 732-218-9142
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732-204-6088