Common Questions About Weight Loss Surgery, Answered

If you’re considering weight loss surgery and have done some online research, you’ve no doubt learned what a complicated topic it is. Here’s a look at many of the most common weight loss surgery questions, with detailed answers from credible sources. Many of the answers depend on multiple factors, such as how much you weigh before surgery, what your body mass index (BMI) is before surgery, which procedure you undergo, and how you adapt to post-op nutrition and exercise guidelines. But the information will give you a good start on what you need to know.

How quickly do you lose weight after weight loss surgery?

Recovery after bariatric surgery typically requires a clear-liquid diet for a period of time, followed by a full-liquid diet, then a transition to a pureed diet, progression to a soft-foods diet, and then the slow reintroduction of solid foods in restricted amounts. This diet protocol in itself jump-starts a significant weight loss in the first month after surgery. 

In a 2014 study of 32 patients aged 16-60 who underwent gastric surgery and introduced solid food three weeks post-op, the average percentage of total weight loss was 9.7%, and the average percentage of excess weight loss was 23%. This means that for a person who is 100 pounds overweight, average weight loss in 30 days would have been 23 pounds. Men tend to lose weight more quickly than women, and those with the most weight to lose tend to lose weight more quickly.

How much weight can you lose after weight loss surgery?

The American Society for Metabolic and Bariatric Surgery (ASMBS) estimates these results for the most common types of weight loss surgery:

Gastric bypass results in the most significant weight loss. By the end of three months, the average loss is about 33% of your excess weight; that number jumps to 50% by the end of six months, and can be as high as 70% after a year. 

The variations in the amount of weight lost, in addition to the type of surgery, are due to individual differences in starting BMI, health conditions, and success in adhering to post-recovery nutrition and exercise guidelines.

How risky is weight loss surgery?

All surgery carries risks, and weight loss surgery is no exception. However, experts weigh the risk of surgery against the risk of health conditions caused or exacerbated by living with severe obesity, such as diabetes, high blood pressure, heart disease, stroke, sleep apnea, osteoarthritis, some cancers, gallbladder disease, and mental illnesses like depression and anxiety. Weight loss surgery has a positive impact on many of the above conditions, leading to a healthier and perhaps longer life than living with the conditions would have allowed.

Data published in the Journal of Clinical Endocrinology and Metabolism notes that bariatric surgery is “remarkably safe,” especially when other health conditions are taken into account. Data gathered from 495 surgeons at 272 ASMBS Centers of Excellence in treating more than 110,000 patients showed a hospital mortality rate of 0.14%. And in a 2012 article that compared mortality rates for gastric bypass, gastric sleeve and gastric banding procedures for a total of 270,000 patients, the 30-day mortality rate was equally low: 0.14% for gastric bypass, 0.08% for gastric sleeve, and 0.03% for gastric banding.

There are other risks associated with weight loss surgery, especially in the recovery phase; they can include nausea and vomiting, constipation, wound infection, gastrointestinal leaking, “dumping syndrome,” hypoglycemia, bowel obstruction, diarrhea, gallstones, and nutritional deficiencies. Good surgical centers emphasize post-op care that addresses the possibilities of complications resulting from your procedure.

What is the safest weight loss surgery?

A 2018 study that reviewed data collected over 10 years, between 2005-2015, specifically set out to compare weight loss and safety between different types of weight loss surgeries. The data included more than 65,000 patients aged 20-79 who had surgery at 41 health systems that are members of the National Patient-Centered Clinical Research Network. 

About 49% of the patients had gastric bypass surgery; 45.6% had sleeve gastrectomy surgery; and about 4.6% had gastric banding procedures. 

The study’s conclusion was that patients lost the most weight with gastric bypass surgery, but it also had the highest rate of adverse events in the first 30 days — defined as the need to re-operate; the need for other non-surgical procedures, such as endoscopy; and the occurrence of pulmonary embolism, or death. 

The rate of such events for gastric bypass patients was 5%;  for gastric banding patients, 2.9%; and for sleeve gastrectomy patients, 2.6%. Sleeve gastrectomy had the lowest rate of adverse effects. 

What is the least invasive weight loss surgery?

Because nearly all gastric surgery procedures are now done laparoscopically, the level of invasiveness is far less than it used to be. The differences now tend to be between those surgeries that are minimally invasive and others that are non-invasive.

Minimally invasive surgeries include gastric bypass, gastric sleeve, and Lap-Band procedures. These require small incisions in the abdomen through which surgical tools and a small camera are used. Non-invasive procedures include gastric balloon and endoscopic sleeve gastrectomy; both are done endoscopically, which means the surgeon inserts the surgical tools, the camera, and/or the balloon through the mouth while the patient is sedated.

Of these procedures, gastric balloon is the least invasive.

What is the most effective weight loss surgery?

Surgery is most effective for you if it meets your individual needs and accomplishes the intended goal. You and your doctor are most able to consider your desired weight loss, your existing health conditions, and your greatest chance of success.

However, because weight loss surgeries tend to be compared by the amount of excess weight lost and maintained, the study mentioned above, titled “The Comparative Effectiveness and Safety of Bariatric Procedures for Weight Loss,” determined the following:

• Patients who had gastric bypass surgery lost 31% of their weight in 12 months and maintained 26% of their loss for five years 
• Patients who had gastric sleeve surgery lost 25% of their weight in 12 months and maintained a 19% loss for five years
• And patients who underwent gastric banding lost 14% of their weight in a year and maintained a 12% loss for five years.

Is weight loss surgery painful?

Other than typical healing of the incisions made during surgery, most pain associated with weight loss surgery relates to food and eating post-op. Abdominal pain can be caused by overeating, eating too fast, dumping syndrome, irritable bowel syndrome, constipation, ulcers, acid reflux (GERD), or, in the case of gastric banding, band slippage. 

In the case of gastric bypass or gastric sleeve, where the stomach has undergone major reduction and reshaping, it’s possible to develop a hernia, adhesions from scarring, or ulcer disease. Pain associated with food and nutrition issues can typically be managed by learning which foods to avoid and how to eat more slowly and carefully.

Pain associated with body-function issues can be diagnosed (often by endoscopy) and may sometimes require revisional surgery.

What foods can you eat after weight loss surgery?

Regardless of which procedure you undergo, you will need to follow a restricted diet in the weeks after the surgery. The first stage is a clear-liquid diet, which consists of broths, decaffeinated coffee or tea, and 100% fruit juice.

Starting about a week after surgery and continuing for two to three weeks is a liquid and pureed diet, which includes such things as protein shakes, yogurt, strained soup, pureed vegetables, and even pureed meat for lean protein.

The next stage is soft foods, which include everything up to this point as well as such things as scrambled eggs, cooked vegetables, cottage cheese, and canned meats, such as tuna or chicken. Once you begin this stage, expect it to last for a month or two.

And when you’re ready to move on to solid foods, which is a decision you’ll make with your doctor, you will focus on eating slowly, chewing foods until they are almost of a liquid consistency, and gradually increasing the amount you eat until it totals about a cup. 

Your main focus will be on protein, ideally between 60-100 grams per day. You’ll need to limit carbohydrates and avoid sugary or starchy foods, partly because they lack nutritional value and partly because they can cause weight gain. And you’ll avoid liquids that encourage weight gain, such as alcohol or sugar-sweetened sodas and juices.

In all stages, you’ll drink water daily to avoid dehydration, and you’ll add vitamins and supplements to your diet to make up for what you won’t get through food.

Does insurance cover weight loss surgery?

If you have health insurance through your company, there’s a chance you will have some sort of coverage for weight loss surgery. But the practice is far from standardized; it varies by state, by employer, and by insurance carrier. Some employers are self-insured and decide for themselves which healthcare aspects they will cover. Other employers must purchase a “rider” for weight loss surgery coverage.

If your health insurance is through your employer, the choice will have been made at the company’s benefits level as to whether weight loss surgery will be covered. If it is, you then must meet the insurance company’s criteria for whether your surgery is necessary. This determination will be made with the help of documentation and recommendation from your primary care doctor.

Typical coverage from an insurer for gastric bypass or gastric sleeve surgery includes 80% of the “customary and usual” anesthesia fee, the surgeon’s fee, and the hospital’s fee. You may be required to pay a copay, which can range from a minimal amount to as high as a few thousand dollars. 

Some insurers cover a portion of costs incurred post-surgery, such as diet and fitness plans, nutritional supplements, or support groups. Medicare will cover gastric bypass surgery for people 65 and older who have a BMI of 35 or higher and a weight-related health issue, such as diabetes or heart disease.

Six states require group health plans to include treatment for morbid obesity: Georgia, Illinois, Indiana, Maryland, New Hampshire and Virginia.

How much does it cost to get weight loss surgery?

Depending on procedure, here are the costs of some bariatric surgeries:

What’s the recovery time for weight loss surgery?

In most cases, count on being out of work for a week to two weeks. Of course, this is affected by the procedure you had, the rate your body heals, and your adaptation of the new diet guidelines you need to follow. 

Gastric bypass, gastric sleeve and Lap-band patients typically need two weeks, endoscopic sleeve gastrectomy patients and gastric balloon patients may need just three or four days, since those procedures involve no incisions.

Weight Loss Surgery Timeline: From First Consult to Bariatric Surgery

How long does it take to get approved for weight loss surgery?

This can vary depending on the speed of your doctor in supplying needed documentation to receive pre-approval, the speed of your insurance company in its decision-making, and on whether you have to reapply — many patients do. The ASMBS says that about 25% of patients considering weight loss surgery are denied coverage three times before they receive approval. The amount of documentation needed and the back-and-forth between you, your surgeon, and your insurance company can easily take anywhere from a few weeks to months.

How do you qualify for weight loss surgery?

First, calculate your BMI. You typically qualify for bariatric surgery if:

• You have a BMI of 40 or above, or are 100 pounds overweight
• You have a BMI of 35 or above, and an obesity-related health condition such as type 2 diabetes, high blood pressure, sleep apnea, or heart disease; and
• You haven’t been able to lose weight over a period of time despite multiple efforts, and
• You are able to follow the required post-op nutrition and exercise plan. 

Do you have more questions? Ask Dr. Naim

Dr. Joseph Naim opened his Los Angeles practice in 2004, and has performed thousands of weight loss surgeries in the last 15 years. He is the former medical director of bariatric surgery at St. Mary Medical Center of Long Beach, and he completed a fellowship in minimally invasive bariatric surgery at University Medical Center of Princeton, N.J.

If you have more questions and would like to consult with Dr. Naim personally, he would be happy to meet with you. Just call 855-766-2411 or click here to schedule a free consultation at Soma Weight Loss.