Catherine Ko, MS, RD, CDE By Catherine Ko, MS, RD, CDE, Joe Cinocca
Reviewed by Asok Doraiswamy, MD
Working as a Dietitian for the last 7 years, the majority of my clients have been referred to me for what their doctor calls “weight management.” Some clients get their referral simply because they want to lose the weight. Other clients get the referral because they want to prepare for their bariatric surgery.
Losing weight through lifestyle changes in diet and exercise are considered lucrative and “big business”. There are dozens of diets, protein shakes, beverages, nutrition bars and things created to curb your appetite and help you shed those unwanted pounds. Sometimes, these lifestyle products give conflicting information and everyone in this industry seems to have an opinion about the effectiveness or value of the products they promote.
Weight loss through a bariatric surgery is drastically different; it is specific and very technical. This option has gained awareness in the last decade, but there is a sense of hesitancy on whether to pursue this life-changing direction. All aspects on whether to proceed to the life-changing surgery is far from being discussed enough.
Over the course of my tenure, I have seen patients in the pre-bariatric stage, as well as the post-bariatric stage. The insight I have gained throughout this process has been rewarding and for that I am truly grateful. When they become my patient, they gain an encourager and “extra passenger” on that long car ride down Weight Loss Boulevard. I have seen their triumphs and their setbacks.
The goal of this article is to share my knowledge about bariatric surgery and give you some basic information, in the form of Frequently Asked Questions (FAQ) :
Who is qualified for Bariatric Surgery?
From the insurance company perspective, anyone who has a Body Mass Index (BMI) of 40 or a BMI of 35 with comorbidities is eligible. Comorbidity means anyone with a disease commonly associated with obesity. Issues such as high blood pressure, high cholesterol or high blood sugar would qualify. On paper, any of these two requirements makes you eligible, but in reality bariatric surgery is usually pursued by people who have a much higher BMI than 40.
How much weight will I lose?
The consensus from scientific literature suggests patients that undergo bariatric surgery will lose approximately 70% of their excessive body weight. This number should never be confused with total body weight.
How much weight will I really lose?
Our clients have typically lost between 25% – 33% of their pre-surgery weight after twelve months of surgery.
Example : A 41 year-old man that is 5’10” tall and weighs 400 lbs would be expected to weigh between 265-300 pounds after a year.
The honest answer to this question is that the amount of weight loss will differ amongst each patient. Sticking to your diet, initiating portion control and getting exercise are paramount towards this new you.
Is Bariatric Surgery right for me?
There are a myriad of health benefits gained from significant weight loss. I cannot emphasize enough about the importance of an individualized healthy weight. Before you make this life-changing decision, you need to take a few things into consideration:
- You may still be overweight
Technically, you are still considered to be “overweight” if your BMI is greater than 25.
It’s very important that you maintain perspective, depending on your pre-bariatric BMI level. Most people that opt to have the bariatric surgery are still considered “overweight”, even if they are able to drop ⅓ of their current weight. BMI is just a hard calculation. It doesn’t apply to everyone. The point of reference I make to my clients is that their ultimate weight loss goal should be to pursue their 18 year-old weight. This gives them a great visual and a challenge to push themselves towards that benchmark. - Loose skin is absolutely real
One of the biggest complaints I receive is about loose skin. Many insurance carriers may or may not cover skin removal surgery. This struggle is real and something for you to consider as a potential extra expense, many months or even years after the bariatric surgery. - More weight loss requires the same effort
In the beginning, the weight comes off very quickly with not much effort. Your mind and body are adjusting to the smaller storage space in your stomach. Digestion pathways are being reworked and you are learning what is best for your body. Once your weight stabilizes, the real work enters the picture. Exercise and diet diligence is necessary to continue the journey. The emotional rollercoaster that most patients ride is inevitable at some point. The highs are enormous and the lows are crushing. The attitude and effort you put forth is going to be the deciding factor in how much weight you actually lose. - No more food binges
Your stomach size has been drastically reduced. Mentally, it is hard to completely adjust to this new reality. Your taste buds may change. The way your body processes your favorite foods may be different. Aches and stomach pains may result, which will cause you to rethink what you eat. Your new dietary routine will have influence over every aspect of your life, including social events and entertainment activities. The consequences of heavy beverage or food binges can result in awkward moments.
At the end of the day, bariatric surgery is a highly personal and major decision you are making in your life. It’s not something you should take likely. The best advice I can give you, as an outpatient dietitian that prepares people for this surgery and then helps people maintain their weight goals after the surgery, is to lose some weight on your own before the big day.
When I first started out, I used to wonder why the client should even bother losing the weight until after the surgery. It seemed so pointless. The epiphany is that there is real beauty in losing some pounds before the surgery.
- By losing some pounds before you get to the facility, you enter at a much lower weight, have some good momentum and are already in the mental state to kick it into a higher gear, once the procedure is finished. Bariatric surgery is not some miracle magic wand that lets you lose unlimited pounds. Even if it’s 5 or 10 pounds, losing that weight before you go onto the operating table is something nobody else can take away from you. This is about your willpower and preparing yourself for one of the biggest challenges of your life. Losing weight before your procedure leads to a lower final weight overall.
- When our body undergoes weight loss, our liver reduces in size. This gives the surgeon more room to perform the surgery and lowers the risk for complications. Decreasing this risk can result in a more seamless recovery and path towards the new you.
- By losing weight before the procedure, you are already figuring out routines and mental systems to utilize post-surgery. It doesn’t matter if you are a proponent of low-carb, keto, low-cal, paleo, mediterranean, intermittent fasting, weight watchers or fasting. Losing the weight on your own terms gives you a default mode to engage if/when those other ideas don’t pan out. This basic concept is one of several keys to your long-term success.
This article is designed to give you some things to consider before you take the big plunge towards major weight loss. Hopefully it provided you some insight to reality!
