• Step-By-Step Guide to Surgical Weight Loss

    Surgical weight loss surgeons prepare for surgery.At the Center for Surgical Weight Loss, we have a team of highly experienced individuals to help support and guide you to success with weight loss surgery. Our comprehensive team includes surgeons, nurse practitioners, dietitians, psychologists and support staff who are specially trained to help you through all of the steps in this process.
     

    Step 1: Do I qualify for weight loss surgery and will my insurance cover it?

    The first step is to determine if you qualify for weight loss surgery. Qualifying for surgery is based on national guidelines. If you fall into any of the categories below, you are likely a surgical candidate.

    • A BMI of 40 or greater, or at least 100 pounds overweight
    • A BMI of 35 or greater accompanied by one or more obesity related diseases such as diabetes, hypertension or sleep apnea.

    Determine your BMI with an interactive calculator.
     

    Additionally, you need to be 18 years of age or older, overweight for more than 5 years and commit to lifelong follow-up and healthy lifestyle changes.

    Most insurance plans do provide coverage for weight loss surgery if you meet the above criteria. However, there may be some circumstances when a company might not offer this particular benefit. It is important to check your specific policy to ensure that surgery is covered.

    Your insurance policy may also have some additional requirements that need to be met prior to surgery such as a period of supervised weight loss, outside medical evaluation, documentation of previous weight loss attempts or documented weight history. Our team is very experienced with working with the insurance companies to obtain coverage and will speak with you about possible requirements when you come for an initial consultation. 

    Step 2: Attend an Information Session 

    Anyone who is interested in weight loss surgery is required to attend one of the program's information sessions before calling to make an appointment. You may pre-register for an information session online or by phone. Walk-ins are also welcome. This is your opportunity to meet one of our surgeons, a nurse practitioner and learn more about the basics of weight loss surgery. One of our patients may also be present to share their experience with you. This is a great opportunity to have some of your questions answered about weight loss surgery. Family members and friends are always welcome to join you. In the future, you also may have the option to view and complete this through our website.

    Register for an information session at Lahey Hospital & Medical Center in Burlington or Lahey Outpatient Center, Danvers.

    Step 3: Schedule and attend your first appointment

    The day after you attend the information session call 1-855-WEIGHT-8 and choose the option for surgical weight loss to make your first appointment. Consultations take place at Lahey Hospital & Medical Center, Burlington on Tuesdays and Thursdays and at Lahey Outpatient Center, Danvers on Fridays. Please note that you should plan to be here for about 4 hours.

    Please complete all of the paperwork given to you at the information session prior to your first appointment. Printable copies of the required forms are below:
     

    When you come to your initial consultation, you will watch an introductory video about our program and then meet with one of our nurse practitioners, dietitians and psychologists. Each of these visits will last 45 minutes to 1 hour.

    The nurse practitioner will review your past medical history to help determine if you are a good candidate for bariatric surgery from a medical perspective. You will also review the surgical options and be able to ask any questions regarding the surgeries and insurance requirements at that time. The nurse practitioner will provide you with a plan that outlines future appointments, and any requirements that need to be met prior to surgery, such as further testing or support for current medical problems to make you safer for surgery.

    The dietitian will review your current dietary intake, make recommendations about meal structure and healthy choices, and educate you on how to change your eating behaviors for surgery. You will be given a set of goals that must be met before surgery.

    The psychologist will meet with you to ensure that there is not any underlying depression, anxiety or other mental health concern that needs to be better supported/treated prior to surgery. If you have outside behavioral health specialists, we will likely request a letter of support for surgery from them.

    After your consultation, all of the providers meet to determine if there are any concerns about you moving forward with surgery. There may be some additional requirements that are added to your plan of care after this meeting. If this is the case, you will be contacted. It is rare that you would be told that you are not a candidate for some form of surgery at this visit.
     

    Step 4: Start an exercise program and lose some weight before surgery

    You will be asked to start an exercise program or increase your current exercise habits. Our recommendation is to exercise for at least 30 minutes at least 5 days per week. We understand that some individuals may have health conditions, such as joint problems, that make it hard to complete exercise. We will give you some ideas on how you might be able to exercise under these circumstances. If you can not put a lot of pressure on your legs, you can always consider exercising in a pool or using your arms for exercise. You may also be eligible for a supervised exercise program offered at Lahey Outpatient Center, Danvers.

    We will also talk to you about losing some weight prior to surgery. This will be discussed with you at your initial consultation and we will continue to review this at each visit before surgery. Typically we ask that you lose about 10 percent of your excess weight (ex. 10 pounds for somebody 100 pounds overweight); however, this may be slightly different from patient to patient based on your weight and how you carry your weight. This weight loss makes for an easier and less risky surgery. We will help you meet this requirement.

    Step 5: Come to your preoperative appointments and complete preoperative testing

    You will likely have one or more visits with the nurse practitioner prior to surgery. At these visits, we will make sure that you are completing the appropriate preoperative tests, your health is stable, you are exercising and you have a good understanding of the surgical procedures.

    You will need to meet with the dietitian one or more times before surgery to assess progress on your healthy eating behaviors. At these visits you will focus on improvements that you can make to meet preoperative weight loss goals and review the preoperative nutrition and exercise recommendations. Surgery is just a tool and we need to be sure that you understand and can demonstrate making the long term changes in your lifestyle.

    At your initial consultation the nurse practitioner will determine if you need any particular testing before surgery. Some individuals may need to undergo testing for sleep apnea based on the initial evaluation by the nurse practitioner. Other individuals may need some heart tests, such as an EKG or stress test. In some circumstances we may ask that you be evaluated by a heart or lung specialist to make sure that you are healthy enough to have surgery. If you have any medical conditions such as heart disease, high blood pressure, depression or diabetes that are not well enough controlled, we will hold off on surgery until these are more stable.
     

    Step 6: Meet with your surgeon

    Once you are making appropriate changes in your eating and exercise behaviors, you will have your appointment with your surgeon. This may be four or more weeks after your initial consult. At this visit, you will further discuss your surgical options and decide on which surgery is best for you. In most cases you will be able to pick your surgery. However, there may be some instances where a particular surgery is better for you based on your medical history or preoperative testing. This is typically when scheduling your surgery will be discussed. Often your surgery will occur 2 months after this visit.

    The surgeon may also recommend that additional diagnostic tests be completed and also give a final weight loss recommendation. This is to make sure that you are as well prepared for surgery and as healthy as possible to decrease your surgical risk.

    Step 7: Attend the pre-surgery skills groups and an optional support group

    All patients must attend a set of 4 classes led by one of our psychologists in advance of surgery. These classes focus on eating mindfully, identifying triggers for inappropriate eating and establishing useful coping mechanisms. You also discuss how to recognize hunger and satiety and how these sensations change after surgery. Our patients have found these topics to be very helpful in making healthier lifestyle changes.

    You may also wish to attend a support group meeting prior to your surgery. Support groups are attended by patients who are preparing for surgery or have undergone surgery. It can be a great way to gain support for long term success and learn more about the surgical process. Meetings take place on the second Monday of each month from 6 to 7:30 pm in the 6 Central waiting room at Lahey Hospital & Medical Center, Burlington.
     

    Step 8: Quit smoking

    If you are a current smoker, you will be required to quit smoking at least two months before surgery. If you continue to smoke, surgery will not be performed, since this can greatly increase the risks associated with surgery. You can also develop serious complications if you start smoking again after surgery. We can refer you to a smoking cessation program through Lahey Hospital & Medical Center for support in quitting or you can work with your primary care provider.

    Step 9: Final pre-surgical appointments

    Within the 30 days before your surgical date, you will return for a series of pre-surgical appointments. This will include a history and physical exam completed by one of our nurse practitioners or your surgeon. At this appointment, we will ensure that you are still healthy enough to have surgery. You will also meet with members of the anesthesia team in the preoperative center. Lastly, you will attend a two hour teaching class with a nurse practitioner and dietitian. We will talk about how to prepare for surgery, what will happen during your surgery and hospital stay and review postoperative recommendations. The dietitian will review your diet advancement after surgery and recommended protein and vitamin/mineral supplements.

    Step 10: Surgery

    Time to surgery from initial consultation can depend on several factors including health status, demonstration and understanding of healthy lifestyle changes and insurance requirements. The quickest progression to surgery is typically three months.

    Depending on the procedure you and your surgeon have selected, and whether there are any circumstances that affect the speed of your operation, your surgery should last from two to three hours. Most patients will stay in the hospital for one to two nights after surgery

    Step 11: We want to help you for the rest of your life!

    Weight loss surgery requires a lifetime commitment. Following your surgery, you will continue to see members of the surgical weight loss team frequently in the first month, but then every three to six months for a year or two, and then annually after that. Research shows that if you are consistent with following up, you may be more likely to keep your weight off long-term. It is also important that you have blood work checked on an annual basis for the rest of your life to check for vitamin and mineral deficiencies. This can also be completed by your primary care doctor if you prefer.

    We want you to know that there will always be somebody from the weight loss surgery team to help and support you as you progress. We have 24 hour coverage for our patients, and being a Center of Excellence, our staff is well trained to help you with any question or concern that you might have after your surgery.

    We also offer additional postoperative supports including patient support groups and weight management classes run by one of our psychologists to help you stay on track with keeping your weight off for life.