At The Forefront Live: Minimally Invasive Weight Loss Surgeons Answer Frequently Asked Questions
Coming up on At the Forefront Live, obesity is a very challenging
condition. People struggle with weight, and are often frustrated
with a lack of results. Today on At The Forefront Live, we'll
look at bariatric surgery options, and how this can change
lives.
Here at UChicago Medicine, bariatric surgery programs are
tailored for each individual to get the maximum outcome and
benefit. Also today, we'll meet one patient who lost over
80 pounds and gained control over her diabetes. Lynn Yanow
has quite a story to tell, and is a different person today
because of bariatric surgery. That's next, on At the Forefront
Live.
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And welcome to UChicago Medicine, At the Forefront Live.
This is your chance to ask our experts your questions by
typing in the comments section. We'll get to as many as possible
over the next half hour. Remember, this program does not
take the place of an actual visit with your physician.
Joining us today, we have two experts in bariatric surgery,
Dr. Vivek Prachand and Dr. Mustafa Hussain. Welcome to the
program.
Thank you.
First of all, just tell us a little bit about bariatric surgery,
in general, what exactly that entails. I think a lot of people,
when they think of bariatric surgery, they think, you're
just cheating, you're not dieting, you're taking the easy
way out. But that's really not the case.
Thank you for the question. Bariatric surgery is basically
surgery-- which means manipulation of your organs and your
stomach and your intestine-- to really change the way your
body perceives hunger and when it feels full. It works by
changing your anatomy, but also your physiology, which is
the chemical nature of your body's relationship and understanding
to food.
And it works by mechanisms that we partially understand,
but not fully. And we're definitely working on that. But
it's definitely not cheating. It is for people who have tried
several things before, but really need additional help from
us, in terms of losing weight.
And it's really for people who are looking to lose 75 or
100 pounds. So, Dr. Prachand, why is it called obesity or
metabolic surgery, instead of weight loss surgery?
I think that that's a really good question, and I think it's
something that's really changed in the field over the last
5 to 10 years. So the emphasis used to really be about weight
loss in the past, and so we would really be emphasizing how
many pounds people lost, and so forth.
But the American Medical Association, about five years ago,
recognized obesity as a disease. And one of the things that
we've always recognized with these operations is that, in
addition to achieving the weight loss, which is pretty substantial
and sustainable, is the impact on the medical problems related
to obesity.
And so the importance of thinking about obesity and metabolic
surgery is to really keep in mind and emphasize the fact
that these operations also have the opportunity to impact
all the different medical conditions that come along with
obesity, such as diabetes, high blood pressure, high cholesterol,
sleep apnea, severe joint problems.
We even see patients who might benefit from transplantation,
but are too heavy to qualify to undergo a transplant.
Bariatric surgery can really make a difference. We spoke
to one patient who had bariatric surgery here at UChicago
Medicine, and here's her story.
And that has drastically changed my life, not to have to
take insulin shots. I feel significantly better.
Lynn Yanow was taking four insulin shots a day. It was the
only way she could control her diabetes.
I feel better emotionally, physically, and I'm very, very
pleased.
Now, Lynn is much lighter, and off most of her medications,
including those four insulin shots.
As of today, I've lost 80 pounds in six months. And I'm very
excited about that. I would maybe like to lose another 10,
but everyone tells me that I should leave it be.
Lynn chose the bariatric program at the University of Chicago
Medicine, one of the leading programs in the country. She
had the gastric bypass procedure, and is very happy with
the results.
The reason that I chose University of Chicago Medicine is
because they had a program, Dr. Hussein had a program to
go along with the bypass. You had to go to classes, you had
to follow up, there was a whole plan.
What differentiates us from everybody else is, I think, our
experience, our judgment, and our comprehensive evaluation
of patients.
UChicago Medicine offers many options for weight loss. Some
of those options include surgery. There's sleeve gastrectomy,
gastric bypass, and a procedure for extremely heavy patients--
that is only done at about 1% of the centers in the country--
that's called the duodenal switch.
As an institution, we are providing a wide array of options
for patients who are trying to lose weight, whether it's
that 10 pounds you need to lose after Christmas, or it's
that 200 pounds that you've accumulated over years.
Each of these procedures requires a team approach. The patient
will work with several caregivers to assess their challenges
and provide solutions. There is also follow-up after the
procedure, to make sure the patient has the right support
to keep the weight off.
So at a single hospital visit, they will see the surgical
team, they will see our bariatric dieticians, as well as
our psychologist. And so it's a one-stop shop, if you will.
Weight loss isn't easy, and the patients who participate
in the surgical program have struggled with their situations
for years prior. But the positive news is there is hope,
and it can be a lasting change.
Despite all of our biases, we don't know why people are overweight.
It's easy to say they eat more food than they actually burn
off. And while that may be true, we don't understand why
some patients are more efficient at burning off food than
others.
Obesity is a complex issue. It has to do with your genes,
what you're eating, what your habits are, what your social
behavior is, what your psychological situation is. So it's
a complex issue, so it doesn't have just one solution.
Surgery happens to be the most effective way to help people
lose weight, but we realize it doesn't function in a vacuum.
Lynn's family is happy with her outcome, as well. It has
changed her life, and helped her to a healthier existence.
Since I did the surgery, I feel much better about myself.
I am much more confident, I do a lot more things. I do double-takes
in the mirror every time I walk a window, every time. I absolutely
do not believe that I look like this. And I feel very, very
good about it.
It's an interesting story. And it's fascinating to hear the
difference in her life, particularly with her diabetes. So
to your point just a moment ago, it really does make a significant
health difference.
And one thing that you touched upon in the video, Dr. Prachand--
I wanted you to talk maybe a little bit more about this--
is that overall plan. It's not just surgery, but there are
many different aspects and different things that people go
through before the surgery and after. Talk to us a little
bit about how that works, if you will.
Sure. So as was alluded to in the video, we really have a
true multidisciplinary program. And what I mean by true,
as opposed to virtual, is that we literally have our dieticians
and psychologists in the clinic with us.
And we take turns seeing the patients while they're in the
clinic office. And then we discuss and confer amongst ourselves
to really formulate a good game plan.
So this takes place when patients come in for their initial
evaluation. So we identify if there's some particular behaviors
or education that we can work on to really get people ready
to be successful with surgery. And we also have the same
approach in the aftercare.
And all of this is really focused on selecting the patients
that we think will have the best chance of success with surgery,
and getting the best outcomes that we can have after surgery.
So really having that team approach is I think what sets
us quite a bit apart.
And it really sets the patients up for success in the future.
Absolutely.
So we want to remind our viewers that we are taking your
questions, so type them in the comments section. We'll try
to get to as many as possible.
Let's start off talking about the different types of bariatric
surgery available. They were mentioned in the video, but
if you could tell us a little bit about what they are, and
what they entail.
Sure. So there are currently four approved bariatric surgeries
that are performed nationwide. We are one of the only centers
that actually offers all four types of surgeries.
The most common one being performed these days is something
called the sleeve gastrectomy, or vertical sleeve gastrectomy.
Some people call it VSG. This is a procedure that's done
laparoscopically, which means surgery through very small
incisions.
So most of the incisions are about 1/4 of an inch or so.
And this can be done with general anesthesia, and most people
actually wind up leaving the next day. So the sleeve gastrectomy
is a procedure which reduces the size of your stomach by
permanently removing a portion of it.
So I like to tell people, if you think of your stomach like
a big handbag that you can stuff lots of things into, if
you were going somewhere over the weekend. By removing a
portion of it, you basically are trimming it down to where
just the essentials fit in.
So some people say it's a banana shape, or I like to say
from the big handbag, to maybe just like a small purse you
would take to a party, or something like that.
And so that reduces the space where you can fit food, but
also we've learned that actually impacts some hormones in
your body that affect hunger and how full you feel. So it's
not that you feel hungry but can't eat, but it actually changes
the relationship that you have with food. So that's why it's
one of the reasons that it actually works better than restricting
yourself on a diet.
So that's currently the most common procedure. Another procedure
that's performed, also laparoscopically, or using the small
incisions, is called the gastric bypass. Sometimes call it
people call it the Roux-en-Y.
This is a procedure that's been performed actually the longest
for weight loss, since like the '60s or something like that.
And it has a really excellent track record. Because it's
been around, there are some stories out there maybe that
it was not safe in the past, et cetera.
But this is actually is not true. It's a very safe procedure,
likely as safe as all the other procedures. And it has certain
advantages over the sleeve. And sometimes we recommended
for people with severe heartburn or reflux.
We may also recommend it if you have diabetes on insulin,
such as the patient that was highlighted earlier. And it
can be quite effective in getting people off the insulin
that they're on.
The other procedure is a procedure called the duodenal switch,
which is the procedure that we specialize in here at the
University of Chicago. Dr. Prachand was actually the person
to perform it first, using the minimally invasive techniques
here in the Midwest.
And very few centers around the country perform it. It is
a little bit more complex procedure, but also has more rewards.
The duodenal switch is a procedure that affords you the most
weight loss, particularly if you're in the category of people
who may need to lose around 200 pounds. And that's people
whose BMI-- which is body mass index-- is over 50.
And also, it's very effective for people who have very severe
diabetes, that have been diabetic for greater than 10 years
on insulin. And can be a very powerful way to treat that
metabolic disease, that combination of obesity and diabetes.
The last procedure is something called the laparoscopic adjustable
gastric band. Technically we do offer it, but it is a procedure
that is becoming sort of less popular these days, mainly
because it is a device. It is subject to moving and breaking.
And also we've seen over the last few years that the weight
loss is not as effective as some of the other procedures.
And so it is a procedure that is approved, but we are actually
performing it less frequently, these days.
Now, we are getting questions from viewers. I want to get
to those, and try to answer as many as we possibly can during
the program. First question, which you pretty much just answered
but we'll go ahead and throw it at you again, anyway, when
you were talking about the duodenal switch.
This is somebody who says, do you think a person whose BMI
is over 50 should think about surgery? And I guess, the question
would be, then, what types of surgery should they should
they first consider? And either one of you can field that
one.
So you mentioned BMI of greater than 50. So again, BMI stands
for body mass index. And we get that number by combining
height and weight into a formula, and it gives a pretty good
estimate of how much extra fat a person has for their height.
It's not a perfect number, and you'll see a lot of news stories
and a lot of complaining about BMI. But the reality is that,
unless you're an NFL linebacker or a professional athlete,
it actually does a pretty decent job of estimating this.
So just to quickly review, a normal BMI is between 20 and
25. And a person is considered obese if their BMI is greater
than 30. And so we talk about surgery for obesity when the
BMI is 40 or higher, or if it's between 35 and 40 and the
person has other significant medical problems related to
their obesity, as we mentioned earlier.
So when we're talking about BMI of greater than 50, that's
typically somebody who's 150 to 200 pounds overweight. And
typically, and frequently associated with that are those
other obesity-related medical conditions like diabetes, high
blood pressure, and so forth.
So in the past, when gastric bypass was the most common operation
performed, say 15, 20 years ago, what was seen quite frequently
is that patients who had BMIs greater than 50 or 60, they
frequently failed to lose enough weight after they had gastric
bypass, or they would regain a significant amount of weight.
And that's really what prompted our interest in performing
the duodenal switch, because historically, it seemed to be
associated with a greater amount of weight loss. But there
really had not been any head to head studies comparing the
two operations to determine which is actually more effective
for this very difficult-to-treat group of patients with a
higher BMI.
So we did the first study comparing not only the weight loss,
but the impact on diabetes, high blood pressure, and high
cholesterol. And we were the first to find that there was,
in fact, a significant advantage for patients with greater
than a BMI of 50.
Now, that doesn't mean that every patient with the BMI of
greater than 50 should have a duodenal switch. And I think
that one of the key things that we really try to convey to
our patients when they come for an evaluation, and what we
really take most of their time in our conversations and discussions
with patients, is figuring out what the right tool is for
you, as an individual.
Because there's not one operation that's the best for everyone
in all circumstances. And so it's really about finding the
right match between the operation and the patient, taking
to account the fact that each person has a different amount
of weight that they need to lose, each person has different
medical conditions that are related to their obesity, different
side effects of the operations, and different effectiveness,
in terms of weight loss and impact on these medical conditions.
And so that conversation that we have as the surgeon with
the patient is really the key.
So we've talked about people with the higher BMI. So we have
a question from a viewer, somebody without that level of
BMI. And the question is, for someone struggling to lose
25 pounds, would surgery be an option?
Generally, probably not. Again, we don't necessarily go by
how much weight you're overweight, but the BMI. So you would
have to calculate your BMI. But the minimum BMI is basically
40, which correlates to roughly around 100 pounds for people
who are normal height. Or an average height, I should say.
Or if you're a BMI is over 35 and you have a medical condition
closely related to obesity, such as diabetes, high blood
pressure, high cholesterol, or sleep apnea.
Generally, if you're about 25 pounds overweight, you're probably
around a BMI of 30, again, if you're an average height individual.
And around that BMI, generally, the first recommendation
would be intensive lifestyle modification, which is also
the first step for anyone who's trying to lose weight.
So that's, generally, meaning working with a professional,
such as a dietician or a medical specialist that works with
obesity medicine. Or maybe even a therapist or a psychologist
that can help you lose weight. But having those regular visits
with professionals really been shown to affect success with
people trying to lose weight.
And that's one of the nice things about UChicago Medicine.
We do offer services like that, as well, so we can cover
the whole range. How safe is bariatric surgery?
So I think that there is a lot of myths and concerns, when
it comes to surgical safety with these operations. And again,
this, I think, dates back to 20 years ago, when these operations
really were considered to be risky. And frankly, there as
a lot of high-profile cases in the newspapers, and so forth,
as the operations initially started to become more popular.
But over the years, with modifications and techniques and
the management of these patients, using laparoscopic approaches,
instead of the traditional open incision, which required
a pretty large incision extending from the breastbone down
to the belly button.
By using these approaches, and really the management of the
team, the safety today in centers of excellence, such as
ours, is very similar to patients who have gallbladder surgery.
Which is to say that it's a very safe operation.
We have more questions coming from our viewers. I've heard
hair loss can be a common side effect of bariatric surgery.
Is there a way to avoid this, and does it taper off on its
own?
This can happen after bariatric surgery, but it can happen
also if you're losing weight with any other means. When you
do lose a significant amount of weight, particularly quickly,
it is the body's natural response to sort of make sure it's
not wasting resources, if you will.
And not that hair is a waste of a resource, but basically,
it does require protein from your body to make hair. So when
you're in that initial period of rapid weight loss, your
body may say, let's just see what's going on. Make sure we
have enough nutrients for essential functions.
So it may shut down new hair growth for a little bit, and
that may come off as seeing that you're losing hair. Generally,
this is temporary and fully recoverable. And it generally
is not significant to a point where others would notice,
but you may notice that your hair is thinning.
Our dieticians, who are nutritional specialists that we work
with, are very good at counseling our patients through this
period, and making sure that they keep up with the appropriate
protein and vitamin recommendations that can really limit
the amount of hair loss that they experience, and certainly
help with the hair regrow period.
We've got a follow-up question to that. Let's talk a little
bit about the vitamins and supplements and things that people
will take after a surgery like this. How long does that go
on, and how significant is that?
So with all of the operations that we do, taking vitamins
is something that's necessary after surgery forever. Each
of the operations is slightly different, in terms of the
way that the body absorbs and handles different nutrients
and vitamins, but in all cases, because of that reduction
in appetite and because there's less food being taken in,
if you don't get enough in and if your body's not absorbing
in the way that it had been previously, you're at risk of
developing deficiencies.
So taking vitamins every day is an important part of being
as successful as you can be after surgery. I like to tell
patients, you wouldn't want to get a transplant operation
and then not take your immune suppression medication afterwards.
And you have to almost look at vitamins in the same way,
after you have these operations.
One of the common criticisms that people will make when they
talk about bariatric surgery is, oh, people will just gain
the weight back. Is that true? Or what do we do now to try
to prevent that?
So if you look at, let's say 100 people who've had bariatric
surgery, the majority of those patients-- let's say 5, 10
years afterwards-- will be down from the initial point that
they had surgery.
So let's say, if they had 100 pounds to lose, the majority
of them-- that's over 50% of those patients-- will be down
60, 70, 80 pounds. It is very normal, though, after the first
year or two after the surgery, to regain a little bit of
weight.
I tell my patients it's kind of like setting your thermostat.
You should think of surgery as resetting your body's thermostat
of where the normal weight will be. So initially, you will
lose a lot of weight, and your body will then find its new
steady state.
And then everybody regains just a little bit of weight back.
And then it's our job working with the patients to make sure
that that little bit of weight we gain, which is normal,
stays at that level, and doesn't you know skyrocket back
so people are getting excessive amounts of weight back.
There are some patients that do gain a significant amount
of weight back, usually not to the point where they start
off at. But if you if they've lost like 80 pounds, they may
regain back 30, 40 pounds, which is not a result that we
wanted. And we definitely work with them to limit that.
A major way to prevent that from happening is close follow-up
with us, close follow-up with our dieticians, and a continued
understanding that surgery, as we talked about earlier, is
not the easy way out. It is basically a tool to help you
continue to do what you know you should have been doing,
which is modifying your diet, increasing your physical activity,
and the everything else that we normally talk about with
weight loss.
So here's another question right along those lines from a
viewer. For those of us who have had gastric sleeve surgery--
this person was June of 2014-- they've gained some weight
back. They want some motivation or suggestions to kind of
get back on track. What would you tell somebody to jumpstart
that process again, and how would you help?
Sure. So the way that I would begin with that patient is
make sure that they go in to see their surgeon, and re-engage
with the program. Oftentimes, patients will sort of drift
away because of job changes, or they move and so forth. And
if they can come back and see their team, that first step
can help substantially.
Typically, what we would do in that sort of circumstance
is make sure that there's not any sort of anatomic problem
that might be contributing to the weight re-gain. And at
the same time, we would have a full assessment by our dieticians
and our psychologists to make sure that the diet hasn't drifted
or shifted in a negative direction.
And really kind of re-educating and just getting back on
track. And to be honest, I think that that's really where
the value of the long-term follow-up comes in. Because the
reality is that nobody can be perfect every single day, multiple
times a day for the rest of their lives.
We kind of use a ratio of, if you do the right thing 80%,
85% of the time, you're going to be fine. And life happens.
And there's things that happen with regards to employment,
relationships, and so forth, and stresses that can lead to
people kind of getting off the track a little bit.
And we're here for our patients to really get them redirected
and re-engaged and moving forward again.
Here's another viewer question. Not sure why this one is
being asked, but I'm going to go go ahead and throw it out
anyway. They want to know what form of vitamins would they
take. Chewable, gummy, or pills?
That's actually a great question. After bariatric surgery,
we are, generally, altering the anatomy. So the way some
things are absorbed or taken up by your body is a little
different. And that's partially how the surgeries work.
So after certain procedures, we do counsel our patients to
take vitamins that are absorbed better. Sometimes the gummy
vitamins, those are vitamins that can basically dissolve
in water. You chew them in your saliva or spit, and they
dissolve and you can swallow them. And that's adequate for
some of the vitamins.
But some vitamins actually are not well absorbed in that
format, and we may then recommend different combinations
or formulations of vitamins that are better absorbed. Some
vitamins, you may notice, come in a little droplet of oil,
and those may not be good after certain procedures.
So we and our dieticians come up with an individualized plan
for each patient based upon the surgery they had, and also,
actually, their pre-vitamin levels.
You may have noticed in Chicago that it's actually pretty
cloudy today, so that means vitamin D levels are low. And
actually, most people, actually even before surgery, come
in with some low vitamin levels.
And what we do is we actually, before your surgery, check
all those levels, come up with an individualized plan about
what your vitamin regimen should be based on that and the
surgery you've had.
So each patient will vary somewhat in what they'll have to
take, and how they'll have to take it. So here's an interesting
question. How do you make sure that people don't lose too
much weight? I don't know if that's ever a concern with patients,
but how would you handle that?
Well, I think that it is a realistic concern. I think patients
all have in their minds sort of what they would consider
to be a target or a goal weight, if you will. And I would
say that the first step is you have the write operation to
begin with.
As I said earlier, there's not one operation that's best
for everyone in all circumstances. And it's really that initial
determination and decision that we come together with the
patient about the surgery a choice that will significantly
determine, not only the risk of losing too much weight or
also not losing enough weight. So really finding that sweet
spot in between.
So are there certain foods or drinks that will be off limits
after the surgery?
That's a great question. So again, it sort of depends on
the type of procedure you've had. In general, many people
come in thinking that, oh, gosh, I'm going to have to eat
baby food for the rest of my life, or just drink liquids.
That's actually not true at all. Our goal is to get you to
eat normal, healthy food again. And about three months after
the surgery, consistency-wise, there's really no restriction.
So you can eat vegetables again, you can eat meat again,
all those things.
But we do counsel you on the types of foods you should be
avoiding, and foods that work against the weight loss. So
a high-carbohydrate diet, that's, again, a lot of starches,
flour rice, pasta, potatoes. Anything that has that sort
of white color and consistency is generally to be avoided,
mainly for weight loss.
Sugars, sugary things, sweet things. Again, works against
weight loss, but sometimes can make you feel ill after certain
types of surgery. So if you eat something that's very sweet
or high concentrated in sugar, that, again, may not agree
with you, and also is not good for weight loss.
Generally, we tell people to avoid carbonated beverages.
That's things like soda, beer, pop. Again, because as that
gas expands in the stomach that maybe a little smaller, or
in your intestine, that can be uncomfortable and not make
you feel well.
So I would say things to be avoided are carbonated beverages,
high sugars, and then high-carbohydrate foods.
We're about out of time, but I do want to ask this one last
question, and it's concerning insurance. Obviously, if you're
going to have a procedure done, there's always some concern
from the patient's standpoint on whether or not something
like this would be covered by insurance. Can you speak to
that a little bit?
Yeah. So I think that there's a perception out there that
these operations are cosmetic, and in many cases, cosmetic
operations are not covered by insurance. But I think it's
really important to understand that these obesity and metabolic
operations are not cosmetic.
As Dr. Hussain alluded to, these things actually change the
physiology of the body and contribute to the weight loss,
as well as to the improvement in the medical conditions related
to obesity.
And because of that medical aspect, most insurance companies
actually do cover obesity surgery. Although the individual
patient has to look at their plan to see if it's a covered
benefit.
It turns out that, with the reduction in medications and
the overall gain and health that takes place after these
operations in the long run, it's actually a cost savings
to the health care system for individuals to undergo these
operations.
That makes perfect sense. Well, gentlemen, thank you very
much. That was great.
Thank you.
Appreciate it. That's all the time we have for At the Forefront
Live. Thanks to our guests for their participation in today's
program, and thanks to you for watching and submitting questions.
If you want more information about bariatric surgery, please
visit our website site at uchicagomedicine.org, or you can
call 888-824-0200.
Join us for our next At the Forefront Live, where we learn
about minimally invasive robotic cardiac surgery. That's
Monday, February 4th. Also check out our Facebook page for
future At the Forefront Live dates and subjects.
Thanks for watching, and have a great week.
How to Prepare for Your First Appointment
If you are thinking about having surgery, a member of our bariatric surgery team will talk with you over the phone to determine if you might be a candidate. Some of the questions they will ask you may include the following:
- What is your age? (Surgery is only available for adults 18 and older)
- What is your height and weight? (This will be used to calculate your BMI.)
- Do you have any of the following health conditions:
- Congestive heart failure
- Diabetes
- Gastroesophageal reflux disease
- High blood pressure
- Polycystic ovary syndrome
- Pseudotumor cerebri
- Osteoarthritis
- Sleep apnea
- Urine stress incontinence

Frequently Asked Questions about Bariatric Surgery
UChicago Medicine follows guidelines supported by the National Institutes of Health in order to determine a patient's eligibility for weight loss surgery. Rather than using weight, we use body mass index (BMI) as a criteria for surgery — excess fat in relation to height. Individuals are candidates for surgery if:
- Their BMI is greater than 40 or between 35 and 40 with major obesity-related medical problems, such as diabetes, hypertension, hyperchloremic, sleep apnea. Check your BMI.
- They have failed previous attempts at weight loss in a medically supervised program
Before becoming eligible for surgery, you will meet with our surgeons, dietitians, psychologists and members of our nursing staff for a full evaluation.
No, surgery is not a solution for everyone. We only determine whether a patient is right for surgery after a complete evaluation and discussion with the patient. Because weight loss surgery is a life-altering procedure, we want to make sure our patients are committed to making the lifestyle changes needed for a successful procedure and life-long health maintenance.
All major surgery comes with risks, and the risks are different for each patient. At UChicago Medicine, our surgeons have better outcomes than most. During your first appointment, your surgeon will explain your individual risk level.
The amount of weight you lose and how fast you lose it depends on which weight loss surgery you have. Patients who have adjustable gastric banding (Lap-Band) procedures usually lose weight more slowly the first year than those who have gastric bypass (RYGB) or duodenal switch procedures (DS).
In our program, the average patient loses between 68 to 78 percent of his or her excess body weight after RYGB or DS and between 60 to 70 percent after vertical sleeve gastrectomy (VSG). Weight loss with gastric banding is less predictable. The amount of weight loss also depends on your age, gender, starting body mass index and your ability to adhere to lifestyle changes necessary to make surgery a success.
Weight loss surgery has actually been linked with producing a sudden positive change in fertility. Women with fertility problems linked to obesity may begin ovulating regularly for the first time in years post-bariatric surgery. However, women should avoid pregnancy for at least 18 months after surgery. Please discuss any pregnancy plans with your surgeon during one of your clinic appointments.
Insurance coverage depends on your plan. For example, some insurance companies require a patient to be in a physician-supervised weight loss program for at least a year before surgery. Before you come in for your first appointment, please call your insurance company to find out if weight loss surgery is covered. UChicago Medicine has an insurance coordinator who can help you after you are approved for surgery.
If you are interested in weight loss surgery, please call us at 1-773-702-1618. We will discuss our program and your weight loss surgery options.
When you come to your first appointment, please bring the following information:
- Social security number
- Insurance card
- Any paperwork needed by your insurance carrier (managed care referral authorization, for example)
- Any past medical records
- A list of your current medications
- A hand-written food diary
- The name of your primary care doctor
You can see our physicians at the UChicago Medicine Duchossois Center for Advanced Medicine on our main medical campus in Hyde Park as well as at our Orland Park and River East locations.
Plan to be at your first appointment for about two hours. It should take place after you have attended an information session. The surgeon or nurse practitioner will perform an extensive history and physical. Our dietitian and psychologist will also see you at this appointment.
This depends on your insurance provider and the criteria they require, as well as the tests and requirements our team finds necessary.
Your hospital stay will depend on the type of weight loss surgery you have. Generally, hospital stays are between one and three days.
Again, your time off of work will depend on the type of weight loss surgery you have and the type of work you do. In general, plan to take about two to four weeks off of work. While you will not be incapacitated by any means, you will use this period to focus on healthy eating and drinking habits.
Yes. Because your medical condition will change following weight loss surgery, it is essential that you are closely monitored by your primary care doctor. We will keep him or her informed on your progress.
As you start losing weight, you may notice excess skin. The amount of excess skin you experience is due to your weight loss, age and smoking habits. Some patients choose to have surgery to have this skin removed. Learn about body contouring after weight loss procedures performed by UChicago Medicine plastic and reconstructive surgeons.
Yes, but the number depends on your weight loss procedure. All procedures require a lifetime of vitamin supplementation. More supplementation and stricter adherence is required with Roux-en-Y and Biliopancreatic Diversion. Our dietitians will help individualize your vitamin regimen.
Regular exercise is extremely important for maintaining your weight loss. Your bariatric surgery team will help you with the types of exercise you should be doing and how soon after surgery you should start doing them.
Yes. For most people who have experienced major weight loss after weight loss surgery, excess skin can be painful and cumbersome. UChicago Medicine’s board-certified plastic and reconstructive surgeons are highly experienced in body contouring procedures.
Millions of Americans Qualify for Bariatric Surgery. Do You?
[MUSIC PLAYING] Have you ever used a body mass index calculator to get your BMI number? It's easy. Just search the internet for a BMI calculator and plug in your height and weight. Confused about what your number means? Wondering if you really need to be worried about your weight at all? I mean, sure, you've gained a few pounds over the years, but it's not that big a deal, right?
Well, answer these questions. Are you 100 pounds heavier than you should be? When you calculate your BMI, is it over 35? Over 40? Do you also have diabetes, sleep apnea, high blood pressure, or high cholesterol? If you answered yes to two of these questions, you qualify for bariatric surgery.
That's right. You have severe obesity. And ignoring it or taking more pills for your medical problems isn't wise. In fact, your life expectancy is at least seven years shorter than someone who didn't answer yes. If your BMI is really high like 55, you are likely to die 14 years earlier than you would at a normal weight.
It's time to get a sense of urgency about this problem. And it's time to face facts. Obesity is a chronic disease. And it needs to be treated. It's easy to blow it off now because it doesn't hurt or cause a lot of symptoms. But just like cancer and heart disease, it will progress without treatment. And it will end your life early.
If you have obesity, it's not just a willpower problem. You've tried a hundred times to lose weight with diets and exercise, so willpower isn't the issue. It's biology, environment, genetics. And yes, it's behavior too. If you're obese, you just have to own it. It doesn't mean you need to be embarrassed or ashamed. Would you be embarrassed if you were told you had diabetes? No, you would get it treated. Same should be true for obesity.
Unfortunately, many doctors don't have the time or expertise to discuss or treat obesity. There are experts out there, though, that focus their careers on treating this disease. Bariatric surgery programs offer all kinds of treatments for obesity, including medication, endoscopic treatment, and surgery. Learn more about these safe and effective treatment options. Check your BMI and take charge of your health by finding a program near you at this link. [MUSIC PLAYING]
Don’t Believe the Myths. Learn the Truth about Bariatric Surgery.
[MUSIC PLAYING] What do you think of when you hear the words bariatric surgery? If too many complications, or everyone regains all their weight back, comes to mind, then you haven't taken a close look at bariatric surgery outcomes in the last decade. It's true, in it's early days bariatric surgery was not commonly performed or accepted. It was performed through large incisions and complication rates were higher. In the last 20 years, though, a lot has changed. Bariatric surgery is safe. In fact, bariatric surgery is now as safe as gallbladder surgery, hip replacement, and hysterectomy with a mortality rate of 0.2%, which is far lower than most other elective operations performed today.
Speaking of mortality, we also know that people with obesity have a shorter lifespan than people who are not obese. A middle aged man with a BMI of 40 is expected to die seven years earlier than someone who is normal weight. If your BMI is 55, your life will likely be 14 years shorter. For comparison, these are the same early mortality rates seen with normal weight people who are actively smoking.
Why do people with obesity die early? Because obesity causes them to develop heart disease, diabetes, and cancer more frequently than non-obese people. Bariatric surgery on the other hand increases life expectancy. Compared with obese patients who do not have surgery, bariatric surgery patients can expect to live 30% to 40% longer. Why? Because weight loss and metabolic improvements after bariatric surgery make the risk of heart disease, diabetes progression, and cancer decrease dramatically in most patients.
Correct procedures do not cause malnutrition. The two most commonly performed bariatric surgeries today are sleeve gastrectomy and gastric bypass. Both are done laparoscopically, with complication rates less than 5%, and an average hospital stay of one to two days. Both procedures are effective and durable. One year after surgery in a typical patient, the average weight loss is 80 to 100 pounds for sleeve gastrectomy, and 100 to 150 pounds after gastric bypass.
Patients need to take lifelong vitamins after both procedures, but these are not malabsorptive operations that cause severe nutritional deficiencies. In fact, bariatric surgery patients continue to absorb every calorie and every gram of protein that they eat. And they eat a regular, healthy diet in smaller amounts and have normal bowel habits after these operations.
Most patients do not regain all of their weight. Some weight gain is normal in the long run, but only 10% to 15% of patients regain a lot of weight years after surgery. Remember, we're talking about chronic condition here, and we've dramatically changed the trajectory of the disease. Most patients don't maintain their lowest weight after surgery. Their body adjusts to a new set point above that, and over time, a few pounds will come back on. Again, it's normal. Even with some weight gain, patients enjoy a better quality of life, fewer medical problems, and weigh less than if they hadn't had the surgery.
Bariatric surgery should not be a last resort. Like any other chronic disease, the earlier you treat obesity and its metabolic consequences, the better the outcomes. If treated at an early stage, weight loss is better, diabetes remission rates are higher, and years of life are added.
If used as a last resort in a patient with severe medical problems and limited ability to move, we can't expect the same great results. If you were told you had heart disease, you wouldn't wait until you had a heart attack to get treated would you? We all know that if you treat cancer when it's detected early and before it has spread, the chance of a cure is much higher. The same idea applies to treatment for obesity. It's a deadly disease. So why would you wait years to get it treated?
Safe, effective durable lifesaving. Sounds like a great option to treat a life threatening disease. Ask your doctor about referring you to a bariatric surgery program, or find a program close to you by following this link.