Bariatric surgery is not a single surgical procedure; it is a lifetime commitment to a new lifestyle. It is a process of pre-surgical counseling on nutrition, behavior, and lifestyle as well as post-surgical follow-up and education for up to five years following surgery.

Before
Bariatric clinics require a number of pre-surgery assessments and educational programs regarding nutrition, behavioral issues, and lifestyle. Before surgery, you will typically attend a nutrition class on normal digestion and absorption. You will learn what impact bariatric surgery can have on your nutrition; the stages your diet will follow after surgery; the importance of protein, vitamin, and mineral supplementation; and potential nutritional problems and solutions.

Prior to surgery, you will also meet with a bariatric psychologist to assess the emotional, behavioral, and psychosocial factors that can affect your post-surgical experience. You will learn about successful behavior modification and management of typical psychological issues that follow surgery.

You also might be required to attend a lifestyles class or support group that allows you to meet other patients considering bariatric surgery and get answers from others who have undergone these procedures. Surgeons might also attend these meetings to address any questions or concerns about the surgery.

During
All four types of bariatric surgery can be performed open or laparoscopically. For open surgery, the surgeon creates a single incision to open the abdomen (4 %" to 6" for women, and 5 %" to 7 " for men). For laparoscopic surgery, the surgeon makes several small incisions in the abdominal wall for a small video camera and surgical instruments. Open surgery is more common, but more and more clinics are offering laparoscopic procedures. In general, laparoscopic patients experience less pain following surgery, find it easy to breath, have fewer wound complications, and have a faster recovery.

After
Following surgery, physical changes begin quickly. Within two weeks, many patients lose up to 20 pounds. By six months, your weight loss will change your body drastically. By 18 to 24 months, you can expect to have lost 70-80% of your excess body weight. Also, most medical complications and co-morbidities associated with obesity-including diabetes and hypertension-are greatly improved.

Your nutritional education will continue. Issues covered will typically be new dietary and supplementation guidelines, reading food labels, exercise guidelines, strategies for dealing with changing meal patterns, and potential new challenges. You might also consult with the bariatric psychologist to help you deal with any adjustment issues.

Tips for Getting Surgery Approval

• You'll need a letter from your primary-care physician recommending you for bariatric surgery. The letter must include your BMI.
• It's a good idea to contact your insurance company before you begin the process to determine what requirements you'll need to meet for coverage.
• You'll need to select a bariatric clinic. Your primary care physician can recommend a clinic and/or surgeon, or you can do your own research.
• You will make an appointment with the bariatric clinic to begin the process. This typically includes a visit with the surgeon, a psychological assessment, and nutritional assessment.