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Weight Loss Surgery - The Process

Overview
Qualifying for Surgery as a weight loss option
Making an Appointment
Comprehensive Consultation
Financial Considerations
Preparing for Surgery
Life After Surgery

Overview

Weight loss surgery is more than the surgery itself. There is an extensive qualification process and life long commitment to the lifestyle changes after the surgery. John J. Feng, M.D., FACS provides a comprehensive program that surrounds the surgery and provides the highest level of pre and post surgical care.

Qualifying for surgery as a weight loss option

Qualifying for surgery as a weight loss option Weight loss surgery is not right for everyone. You should take in consideration of all the hard work, lifestyle change and motivation it will take after surgery. Obesity surgery is an effective treatment for morbid obesity, although the pounds do not come off by themselves. The surgery is an aid to help achieve lasting results by limiting your food intake.

Learn more about indications and qualifications for weight loss surgery candidacy
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Appointments & Contacts

Making an Appointment

Please contact our office directly by calling our Bariatric Surgery Scheduler at (650) 853-6671.

Comprehensive Consultation

During your initial consultation, Dr. Feng will review and evaluate your medical condition, prior surgeries if any, and medications as well as any pertinent issues regarding the appropriate weight loss procedure. A thorough discussion regarding your surgical options will be presented that fit your personal needs.

Financial Considerations

During your initial Consultation Dr. Feng’s office staff with discuss the Surgery fees and help you with Insurance Pre-Authorization as necessary. Patients should be aware that there are out-of-pocket expenses, and insurance policies may cover one type of weight loss surgery and not another type of surgery. The patient expenses can vary. Patients should contact their insurance company to confirm their policy benefits for weight loss surgery. Certain insurance companies may even further specify which hospitals that surgery can take place.

Preparing for Surgery

After attending a free Information Seminar, you will have your initial comprehensive Consultation with Dr. Feng. Next, you will undergo nutritional evaluation and learn what you need to know about staying healthy while losing weight with bariatric surgery from our Registered Dietician team. Our behaviorist will help with psychological clearance for all of our patients. Finally, some health insurance plans require supporting statements for Bariatric Surgery by your Primary Care Physician. These steps often need to be completed in order to request Insurance Pre-Authorization and usually takes several months.

In addition, a customized list of Pre-Operative Testing will also be necessary to prepare for surgery. Once surgery is approved, you will be instructed to obtain a Pre-Operative History and Physical evaluation with your Primary Care Physician for clearance for general anesthesia for the upcoming Bariatric Surgery,

Patients are asked to lose some weight prior to surgery in a healthy manner to optimize the results of the surgery itself, usually about 10% of their weight. Pre-Operative weight loss has been shown to shrink the liver size which may be enlarged and fatty in an obese person. A grossly enlarged liver that comes from gaining weight can interfere with surgery and possibly put the patient at higher risk for complications.

Patients are asked to stop aspirin and non-steroidal anti-inflammatory drugs (NSAIDs) such as ibuprofen, Advil, Motrin, Naproxyn at least 7 days prior to surgery. Patients on even stronger blood thinners such as Plavix need to stop 10 days prior to surgery. Other medications such as those that treat diabetes should be adjusted and even stopped the day or 2 prior to surgery depending on their type. High blood pressure medications should be taken the morning of surgery, except for diuretics or water pills. All alternative-medicine or herbal medications need to be stopped 7 days prior to surgery.

If you smoke, you need to stop at least 8 weeks prior to surgery to minimize the chance for lung failure, poor healing and other very serious, life-threatening complications. You will be asked to submit a specific test just prior to surgery to confirm this.

The path to preparing for Surgery is designed to evaluate and optimize your medical and mental health in order to establish the best conditions under which to perform elective bariatric surgery. From the time you meet with Dr. Feng, you goal is to remember that it is the first day on the road to a healthier life. Bariatric surgery is only a tool. You have to use the tool properly to succeed.

To mentally prepare yourself

Understand the surgical process and what to expect afterwards.
Talk to people who have had weight loss surgery.
Write a letter to yourself and your surgeon explaining your reasons for having the surgery and outlining your plans to maintain your weight loss after surgery.
Start a journal about your experience. Record how you feel now, the obstacles you encounter, the things you hope to be able to do after surgery.
Get a letter of support from your family. It helps to know you have people behind you, waiting to help.

To physically prepare yourself, strictly follow your doctor's guidelines

These usually include, but are not limited to:

Staying on a carb- and fat-free liquid diet with protein drink supplements with vitamins and minerals guided by the Registered Dietician to shrink your liver for surgery.
Restricting yourself to a clear liquid diet 12-24 hours before surgery.
Stop smoking for at least 2 months before surgery.
Be certain to follow your surgeon's instructions regarding any medications you may be taking to control other health conditions.
Arrive on time, with supplies from home for an overnight hospital stay. If you use special equipment for sleep apnea, you should bring your machine to the hospital.

Routine tests before surgery

Comprehensive Consultation Certain basic tests are done prior to surgery: a Complete Blood Count (CBC) and a Chemistry Panel, which gives a readout of about 20 blood chemistry values. Often a hemoglobin A1c is done to evaluate for diabetes, which is very common in overweight persons. Vitamin D deficiency and evaluation for calcium defiency are checked. H. Pylori bacteria exposure is evaluated since this type of bacteria causes stomach ulcers and other problems. All patients get an upper GI xray to evaluate your stomach for a possible hiatal hernia and an electrocardiogram (EKG), and possibly a chest xray. Women may have a pregnancy test just to make sure. Many surgeons ask for a gallbladder ultrasound if you know you have gallstones. Other tests, such as pulmonary function testing, echocardiogram, sleep studies, GI evaluation, or cardiology evaluation with cardiac stress testing may be requested when indicated.

Life After Surgery

It is very important that you adhere to the recommended dietary guidelines that will be explained in detail in a comprehensive nutrition manual reviewed with you by the Dieticians. The modifications that have been made to your gastrointestinal tract will require permanent changes in your eating habits that must be adhered to for a successful weight loss. The following are some general dietary weight loss surgery guidelines:

Don't drink fluids while eating. Fluids tend to make you feel full before you have consumed enough food.
When it is time to start eating solid food it is essential that you chew your food thoroughly. You will not be able to eat steaks or other chunks of meat if they are not ground or chewed thoroughly.
Avoid carbonated drinks, milk shakes, high-calorie nutritional supplements, high-fat foods and foods with high fiber.
Limit your snacking between meals.
Avoid items with sugar listed as one of the first three ingredients on the food labels.
Avoid alcohol.
Avoid smoking.

Please note that the dietary guidelines may be different for each weight loss procedure that is preformed. For more information, your assigned Registered Bariatric Dietician will review all these guidelines and available for questions throughout your care with Dr. Feng's office staff.

Going Back to Work

Many patients return to full before surgery levels of activity within 4 weeks of their procedure. Patients who had minimally invasive laparoscopic procedure may be able to return to work and normal activity within 2 weeks. Dr. Feng will discuss your options and when your can return to work.

Follow-up testing after Surgery

There are still long-term effects on nutrition, over time you will need periodic checks for anemia and vitamin B-12, folate, and iron levels. Follow-up tests will be conducted every 3-6 months or as needed, and then every couple of years.

Support Groups

There are many weight loss program support groups provided to patients with excellent opportunities to discuss their personal and professional issues. Weight loss surgery will not resolve immediate existing emotional issues or heal the years of damage that obesity might have inflicted on your well being.

Dr. Feng has resources to assist you with short term and long term questions and needs. Dr. Feng has ongoing post-surgical support groups moderated by our psychologist or behaviorist and dieticians to produce the greatest level of success for our patients.

The Importance of Support from friends and family:

The changes in your diet and lifestyle after surgery will last a lifetime. And you'll have a greater chance of long-term success if you surround yourself with people who understand and support your goals.

Things you can do

Help your friends and family members understand why you've chosen a surgical solution. Many people are under the impression that weight loss surgery is an experimental treatment rather than one with more than 40 years of history. Direct them to this web site or others in our Additional Resources section. It's important that they understand that morbid obesity is a disease and that diets don't work for you.
People who are morbidly obese often report that their spouses, or others close to them, seem to discourage weight loss. These people see your weight as part of your identity. Understand that this is a fear of change. Discuss your reasons for having surgery. They need to know that your health is at stake and you will be counting on them to help you during and after surgery.
Attend support groups in your area and bring your family and friends to help them understand. Your surgeon's office will help you here. The free informational seminar is another venue to show your support network what you are going to be going through. Surround yourself with people who share your situation. Ask questions and receive answers in a supportive environment. Form a network to share recipes and exercise tips. It's important for you to know that you are not alone. There are knowledgeable, friendly people available to support and help you.