How do I start the process?
What’s the next step?
You need to contact your insurance company. You can find their customer service number on the back of your insurance card. You are responsible for contacting your insurance company and verifying that your policy does cover weight loss surgery! Complete this step as soon as possible. Ask your insurance company if the following procedures are covered at the Medical University of South Carolina by your insurance plan:
- Roux-en-Y Gastric Bypass (CPT 43644)
- Lapararoscopic Adjustable Gastric Band (CPT 43770)
- Sleeve Gastrectomy (CPT 43775)
How much weight will I lose with weight loss surgery?
If you have a gastric bypass or sleeve gastrectomy procedure, research suggests that you may lose approximately 60-70% of your extra weight over about 18 months. If you have a gastric banding procedure (Lap Band or Realize Band) results are more variable and occur over a longer period of 3-5 years. Weight loss with the band may not start until band is properly adjusted. Expected weight loss depends on many factors, so if you have questions, please contact your team.
How long will it take to lose the weight?
With the gastric bypass and sleeve gastrectomy, the rapid weight loss phase is the first 6 months, and you will lose most of your weight by about 18 months post op. After that time, you can still lose weight, but the weight loss generally plateaus after 18 months. If you have a gastric banding procedure (Lap Band or Realize Band) results are more variable and occur over a longer period of 3-5 years. Research shows that those who maintain regular follow up (through clinic visits, support group meetings, etc.) are more likely to keep the weight off.
Will I keep weight off following weight loss surgery?
After surgery, about 85% of patients keep off about 50% of their extra weight. Some patients will put some weight back on, and few put all of it back on. Weight regain can be due to a variety of factors, so it is critical to follow the nutrition, exercise, and behavior guidelines that your team has recommended. Weight loss surgery is a tool to help you lose weight; the tool requires lifetime maintenance by you. Lifetime follow up after surgery is vital; after the first 2 years we want to see you every year for the rest of your life.
How long will I be in the hospital?
The normal length of stay for laparoscopic gastric bypass or sleeve gastrectomy is 2-3 days. For adjustable gastric band, you typically leave the day of surgery. In the rare event that your surgery is an open gastric bypass or sleeve gastrectomy, your stay will be longer.
How long do I need to eat pureed foods?
For AT LEAST 30 days after your surgery, all foods must be pureed to the texture of baby food/applesauce. You will meet with your Registered Dietitian before surgery to review the post-op guidelines, meet again at 1 week post-op and 1 month post-op to review transitioning to regular textured foods. The diet progression after the band is slightly different and you will be instructed on this by the Registered Dietitian.
After 30 days on pureed foods, how do I transition to a regularly textured diet after weight loss surgery?
After 30 days on a pureed diet, you will need to come in to clinic for a visit with your surgeon and your Registered Dietitian. They will discuss with you a slow transition to a regularly textured diet.
Why do I sometimes get pain when foods first hit my stomach?
If you experience pain when eating, consider both the texture and content of your foods. Your foods MUST be the consistency of baby food/applesauce for the first 30 days. If you are transitioning to a regularly textured diet, start with soft foods and follow the guidelines your Registered Dietitians recommend. Be sure that your food contains no added sugar as this may cause dumping syndrome. Also be sure your bites are not too big, and try eating with a baby spoon/fork and stop after about 1 Tbsp or ¼ cup of food.
Do I need to call the doctor if I vomit?
You may vomit if you eat too fast or too much, drink fluids with meals, introduce a new food to your diet that you no longer tolerate, or if you eat or drink something with added sugar.
Look at what you have thrown up. If it has hulls or pieces in it, this means you did not blend or strain your food well enough. Go back to no-sugar added liquids for your next meal until your stomach settles.
Call your doctor if your vomit is black or red in color or if it looks like coffee grounds or if you throw up for more than 12 hours in a row and you cannot seem to keep anything down.
How long do I need to take Pepcid (or other stomach acid reducer)?
You will take a stomach acid reducer like Pepcid for at least 30 days unless you are told otherwise by your doctor.
How long do I need to crush my medicines following my surgical weight loss procedure?
You do not need to crush any medications, but you may need to cut large pills into pieces for the first few weeks after surgery. Please check with your doctor if you have any questions about your medications.
What kind of vitamin and mineral supplements do I need to take?
Immediately after surgery, you will need to take 2 chewable multi-vitamins (containing iron and thiamin) per day (one in the morning and one at night) plus 500 micrograms of vitamin B-12 (liquid or sublingual which means under the tongue). You will be instructed to start taking calcium citrate supplements at one month post op. You will be taking 1500-2000 mg Calcium Citrate with Vitamin D for the rest of your life, this is typically 6 pills per day. Questions regarding diet and vitamin requirements should be directed to your Registered Dietitian. Use chewable multivitamins during the first month after surgery, then discuss other options at your 1 month post op appointment.
What do I look for in my vitamin and mineral supplements?
MULTIVITAMIN: Your multivitamin must contain iron, folate, thiamin (vitamin B1), and vitamins A, D, & E. Two children’s chewable vitamins such as Flintstones Complete, Children’s Chewable Centrum or any generic chewable brands are acceptable. Take the multivitamins at separate times of the day. Gummy vitamins are NOT acceptable options.
VITAMIN B12: Your vitamin B12 should contain 500 mcg (“micrograms”) of B12. You may take this in a liquid/dropper or sublingual (“under the tongue”) form. You may take the vitamin B12 with your multivitamin. Alternatively you may get a monthly intramuscular shot from your Primary Care Physician.
CALCIUM CITRATE: You need 1200-1500 mg (“milligrams”) of calcium citrate each day. Read the label of your supplement; the form of calcium must be citrate, NOT carbonate. You only absorb about 500 mg of calcium at a time. This means you will always be taking the calcium 3-4 times/day. Take your calcium separately from your multivitamins and iron.
How much protein should I eat each day?
After weight loss surgery, patients need about 60-80 grams of protein each day. Your Registered Dietitians will be meeting with you individually to help you find out how to fit this in your diet.
Should I take a protein supplement?
It is best for you to strive to meet your protein needs through whole foods (lean meats, low- or non-fat dairy, nuts, beans) as these foods provide your body with many nutrients in addition to protein. However, if you are having difficulty eating at least 60 grams of protein per day, protein supplements may help you meet your needs. Discuss protein supplements with your Registered Dietitian.
What is dumping syndrome?
Dumping syndrome is usually caused by food emptying (or “dumping”) too quickly out of your stomach. Foods and beverages with added sugar cause dumping syndrome. Drinking fluids too soon after a meal or eating too fast or eating too much at a meal may also cause dumping. Patients who have gastric bypass are at greatest risk of dumping syndrome.
The symptoms of dumping syndrome are diarrhea, cold sweats, nausea, vomiting, and/or light-headedness, however, each person’s symptoms are different. Dumping can occur anywhere from 30 minutes to 4 hours after eating an offending food.
Why do I need to avoid sugar for life?
Added sugar may cause dumping syndrome. Sugary foods also provide calories without any nutrition and may lessen the amount of weight you lose after surgery. The best way to avoid dumping syndrome is to avoid ALL added sugar as much as possible!
What are sugar alcohols?
Sugar alcohols are sugar replacers that are not well digested and absorbed by the body. Many sugar-free products are made with sugar alcohols. They usually end with “itol” like xylitol, manitol, sorbitol, etc. Sugar alcohols cause diarrhea in many people, even if they have not had bariatric surgery. Some people will tolerate up to 10 grams of sugar alcohols while others may not tolerate sugar alcohols at all so try them cautiously.
What about the sugar in milk and fruit?
Fruit, 100% fruit juice, and milk products have naturally occurring sugar which is tolerated after surgery. When reading the Nutrition Facts Label, you may see grams of sugar listed. However, you only know if sugar has been added to the product by reading the ingredient list for words that mean sugar.
I used to drink milk and now it makes me feel bloated, gassy or have diarrhea. Why is that?
After surgery, some patients no longer tolerate lactose (the natural sugar in milk). Other options include lactose free skim/nonfat milk (Lactaid), fat free no-added-sugar yogurt, and fat free cottage cheese. You may also take Lactaid pills to help you break down the lactose in milk.
What can I do to help with my constipation?
It is quite common to experience constipation after surgery. Pain medication and a pureed diet can contribute to constipation. If you go more than two (2) days after discharge without a bowel movement, take Milk of Magnesia or Miralax as directed on the package. It is important to prioritize fluids; your goal of 64 oz per day will help with bowel function. If not having bowel movements, belly pain and nausea, please call MUSC.