Frequently Asked Questions
How do I make an appointment with a bariatric surgeon at Jefferson?
Scheduling an appointment is easy: Simply call 1-800-JEFF-NOW or use our online appointment request form. However, before you schedule a consultation, be sure you have addressed the items we've outlined on the Preparing for Your Consultation page.
How do I know if I am a good candidate for bariatric surgery?
The Jefferson Bariatric and Metabolic Surgery Program uses the National Institutes of Health (NIH) guidelines to determine eligibility for bariatric surgery. If you are 100 pounds overweight, or 75 pounds overweight with an obesity-related condition (for example, high blood pressure, diabetes or sleep apnea), you're likely a candidate for surgery. However, we will review your medical history to further determine eligibility.
How do I choose between a gastric bypass and sleeve gastrectomy surgery?
The sleeve gastrectomy is a relatively straight forward procedure that reduces the size of the stomach and offers excellent weight loss results with less nutritional concerns and less long-term complications. In the simplest terms, gastric bypass delivers more weight-loss benefit but comes with greater risk of complications. Some patients simply aren't comfortable assuming the risks of gastric bypass.
In light of recent data that shows poor long-term outcomes and high rates of long-term complications with gastric banding, we have stopped performing adjustable gastric banding at Jefferson.
For many patients, the biggest consideration is the amount of weight you will lose on average. People who have a gastric bypass surgery typically lose more than those who have sleeve gastrectomy. For example, if you are 200 pounds overweight, you will lose, on average 110 pounds with the sleeve gastrectomy and 120 to 140 pounds with a gastric bypass.
Ultimately, though, if you are a good candidate for one procedure you are usually a good candidate for both and the choice is yours – you need to feel comfortable with your decision.
What do I need to bring with me to my first appointment?
You can find a complete "to-do" list on our Preparing for Your Consultation page.
What will happen at my first consultation?
A lot will happen at your first consultation, so you should plan to be here for a few hours. First, we will review your health history questionnaire (which you will receive in the mail from us). You will meet with the surgeon and dietitian. We will discuss the benefits and risks of the procedures and address all of your questions. We'll start arrangements for you to have a psychiatric consultation, a sleep study and a cardiac consultation. We’ll also arrange for some outpatient routine testing, which you may be able to get that day.
Will my insurance cover the surgery?
Most insurers cover the surgery if it is medically necessary – and if you meet the NIH criteria, it is medically necessary. You can learn more about the approval process at our Insurance Considerations for Bariatric Surgery page.
How much does the surgery cost if my insurance doesn't cover it?
We do offer cash-pay options for this type of surgery. The actual fees for the hospital, anesthesia and surgeon are variable based on actual patient costs, but generally speaking, the total fee ranges from $25,000 to $30,000.
How can I best prepare my body for surgery?
There are some important ways you can prepare for surgery:
- Be as active as you can. If your physician approves it and you’re physically able, start walking every day.
- If you're using tobacco, stop. This is critically important, as you can’t have weight-loss surgery if you're actively using tobacco. And the longer you quit before surgery, the easier it will be not to resume after surgery.
- Try to eat as healthfully as you can. Taking in less fat before your surgery will make your surgery and recovery easier.
Can my family and friends help me through this process?
We strongly encourage you to get your family and personal support network involved in your decision to pursue weight-loss surgery. They can help you through the decision by acting as a supportive sounding board. They can help you make good food choices and recover to your normal activities postoperatively.
Also, they need to be as prepared for life after surgery as you are. If you have a spouse and/or children, it’s essential that they be aware of the benefits and risks of what you're undertaking and the lifestyle changes you’ll be making after surgery. Those who are closest to you have the best ability to help you be successful (or to undermine your success).
What are the potential risks of this surgery?
We've already outlined the benefits and risks of fully laparoscopic roux-en-Y gastric bypass, laparoscopic and sleeve gastrectomy surgery. The bottom line is this: with bariatric surgery the benefits are great, but there is a slight risk of a serious complication that could even possibly lead to death.
Of course, every surgery has risks. Ultimately, the risks of this surgery are less than the risk of a morbidly obese person doing nothing about his or her weight and not very dissimilar from many other types of abdominal surgery.
What medical tests will I have to undergo before my surgery?
To limit risk, we have our patients undergo extensive testing before surgery. The routine tests include:
- Blood tests
- Chest X-ray
- Cardiac consultation (and any tests that the cardiologist deems necessary)
- Sleep study (to evaluate for sleep apnea)
- Upper endoscopy to examine the stomach for inflammation or lesions, which could increase the risks of leakage, ulcers or erosion of the band
What should I purchase before going in for my surgery?
The best thing to do is to purchase the liquids and protein drinks you will consume for your liquid diet after surgery. Try a few varieties to see what you like and dislike. That way, you'll know what you like – and have it on hand – before the taste-altering effects of the surgery influence your choices.
Why is it better to have laparoscopic versus traditional open surgery?
With laparoscopy, weight-loss surgeries are similar on the inside – but with less pain, shorter hospitalizations (two days for gastric bypass and sleeve) and quicker recoveries for the patients. In fact, weight loss patients who have laparoscopic surgery are able to breathe more fully and get out of bed the night of their surgery. They’re also able to do more activities at home more quickly. And laparoscopic patients experience fewer hernias and wound infections, too.
How long will I have to stay in the hospital?
Because we perform surgery laparoscopically, your hospital stay is likely to be shorter than with traditional open methods. If you have a gastric bypass or sleeve, you should be able to go home two days after surgery.
How quickly will I lose weight?
Many patients will lose a lot of weight in the first weeks following surgery. This is usually a combination of the low-calorie liquid diet and the surgery. However, the most important thing we look at is how well you are healing. Early weight loss is not an indicator of long-term weight loss. However, when you lose weight early, it is very encouraging. Most of your weight loss will be over the first 18 months, with about half of the total occurring in the first five months.
Is the postoperative diet difficult to follow?
Most patients do fine following the postoperative diet plan. It is very different from your preoperative diet. But the surgery will help you adhere to the small portions and consume less sweet and fatty foods.
Can I get pregnant after this surgery?
Yes, but there are some caveats. First, it will be essential to ensure that you’re nutritionally sound prior to doing so. Second, you should not get pregnant during the phase of rapid weight loss. Therefore, we recommend not getting pregnant for the first two to three years after your surgery. We also need your obstetrician to be comfortable treating you even though you've had a gastric bypass.
Can I regain the weight?
If you don't follow the postoperative diet plan, you can regain some or all of the weight you've lost. Most patients are able to follow the plan and maintain their healthy weight.
About 75 percent of Americans have foot problems at some point during their lives. A complex structure of 26 bones, 40 joints, and an intricate maze of tendons, muscles, and ligaments, the average foot endures remarkable stresses throughout a lifetime. Yet, as much as we use our feet, we often take them for granted.
Although most foot problems are not life threatening, their presence can spoil many of life's enjoyable activities.
What are the common foot problems?
Many foot problems can be corrected by modifying shoes, by medication, or through a simple procedure to relieve pain and suffering. Some common foot problems are listed below.
Bunions are swellings or enlargements that develop at the joint of the big toe where it meets the foot. Women develop bunions about 10 times as often as men, and the prevalence of bunions increases with age. Left untreated, bunions may lead to bursitis (inflammation of the sac that cushions the joint), pressure and foot pain. Changing the type of shoe to accommodate the bunion will usually reduce pain. If this doesn't work, surgery may help.
- Corns and calluses
Thickened and hardened patches of dead skin cells, these cause pain as they transmit pressure to the bones of the feet. Corns usually develop on the toes, while calluses are more likely to occur on the soles.
People with diabetes are particularly prone to foot problems because of nerve damage associated with the disease. Pressure sores or infections often occur in people with diabetes. Because diabetes may impair the sense of feeling in the feet, people with this illness need to be particularly vigilant about foot care. Sores and infections may take much longer to heal, so any cuts should receive immediate medical attention.
- Fallen arches (flat feet)
This is a condition in which the arch of the foot has dropped, causing muscle fatigue and aching, pain or stiffness in the feet, legs and lower back. Custom-designed orthotics may be prescribed to alleviate the problem. Sometimes, surgery is indicated.
- Fungal and bacterial conditions
Athlete's foot and similar conditions can cause redness, peeling, blisters and itching of the skin. If not treated promptly, these can become chronic and difficult to cure.
A hammertoe is a painful deformation of the toe joint in which the toe curls downward, resembling a claw. Pain occurs on the top of the middle joint of the toe. Roomier shoes, splints, exercises and orthotic devices can alleviate pain. In more severe cases, surgery can provide relief.
- Heel pain
Pain occurring around the heel can often be attributed to nerve compression or inflammation of the tissues attached to the heel bone. Wearing well-fitted shoes, using orthotic devices or casts, stretching exercises, prescribed medications and, in severe cases, surgery, are all methods used to correct this problem.
- Ingrown toenails
The result of poor trimming of the nails or pressure from a nail deformity, ingrown toenails can cause infection and disabling pain. Once infected, they require medical attention.
- Morton's neuroma
This condition is the inflammation of a nerve in the ball of the foot. Pain sometimes extends toward the tip of the toe or to the ankle and lower leg. Your doctor may suggest roomier shoes, shoe pads, or cortisone injections. If these treatments don't work, surgery may be recommended.
- Ankle sprains
Patients can frequently injure the ligaments of their ankles with simple twisting injuries. About 23,000 ankle sprains occur daily in the United States. Most of these improve by themselves when treated with rest, ice compression and elevation. Some patients will need to see their physician for additional treatment, bracing or a physical therapy prescription. Sometimes, patients with chronic ankle sprains, or pain which does not improve with physical therapy or conservative treatment, may require operative intervention. This may incorporate arthroscopic procedures
or open procedures.
- Arthritis of the foot and ankle
Arthritis can affect any joint of the foot and ankle just as it affects the larger joints throughout the body. Forms of arthritis include inherited, traumatic, overuse and inflammatory. These can be treated with medication, modified shoe wear and physical therapy. Arthritic conditions of the foot and ankle may require operative intervention involving arthrodesis, also known as fusion, in which joints are screwed together. Arthrodesis is often performed to relieve pain and improve function. Ankle replacement surgery is a new and potentially promising form of therapy for patients with ankle arthritis.
- Plantar warts
These are viral skin infections found on the soles of the feet. Plantar warts require medical attention.
Who treats foot problems?
Orthopaedic surgeons are medical doctors who have received additional, specialized training to treat the bony structures of the body. You should see an orthopaedic surgeon to treat more complex foot and ankle problems. Orthopaedic surgeons specialize in Foot and Ankle Surgery. Doctors of podiatric medicine, or podiatrists, are medically trained specialists who diagnose and treat problems and diseases of the foot, ankle and lower extremities. They are recognized legally and professionally as full members of the health care team. Podiatrists can correct most minor foot and ankle problems.
What is high blood pressure?
High blood pressure, also known as hypertension, is the most prevalent cardiovascular condition. Sixty million men and women have blood pressure that's too high, and up to one third of them are unaware of it. Doctors call hypertension “the silent killer” because it usually causes no physical symptoms and people feel perfectly fine, even when their blood pressure is elevated. But damage to their bodies is occurring nonetheless.
If there are no symptoms, how can I tell if I have high blood pressure?
You can't, only your doctor can. Checking your blood pressure regularly, at least once a year, is the only way to determine if you have this condition. Even if you have a healthy blood pressure reading now, you can't necessarily count on it staying low forever.
What's a normal blood pressure?
A blood pressure reading consists of two numbers. The first and upper number (systolic pressure) represents the pressure in your arteries as the heart contracts to pump blood through the circulatory system. The second and lower number (diastolic pressure) is the pressure in your arteries between beats, when the heart is resting. Either the systolic or diastolic measurement, or both, can be elevated when your blood pressure is too high. High readings mean your heart is working unnaturally hard to circulate blood.
For adults, a blood pressure reading less than 120/80 mmHg, read as “120 over 80,” is considered normal blood pressure. Both numbers must be in the normal range for your blood pressure to be considered normal. Stage 1 hypertension is defined as a pressure between 140 and 159 systolic or 90 and 99 diastolic. People with Stage 2 hypertension have a systolic reading of 160 or higher or a diastolic of 100 or higher.
A new category of pre-hypertension has been recognized with blood pressure between 120 and 139 systolic or 80 and 89 diastolic. These patients need to be followed closely. Therapeutic lifestyle changes (diet, exercise) are recommended prior to antihypertensive medication.
If your doctor tells you your blood pressure is a little high, don't panic and assume this permanently places you into the category of hypertensive. Your doctor may do several blood pressure checks over a few months and in a variety of circumstances to get a true reading. Your doctor may also ask you to measure your pressure at home as well. You and your doctor should begin treatment when measurements indicate that your blood pressure is consistently elevated; more severe elevations may require immediate treatment, though.
How serious is high blood pressure?
High blood pressure should not be taken lightly. It's a risk factor for deadly conditions such as coronary heart disease, heart attack, stroke and kidney disease. High blood pressure contributes to atherosclerosis, the build-up of sticky plaque on the artery walls, making it difficult for blood to flow freely. When arteries in the brain or heart become clogged, you can suffer a stroke or heart attack. Impaired vision occurs when tiny blood vessels in the back of the eye rupture or become blocked. Kidney impairment results when vessels in the kidneys are narrowed.
What causes high blood pressure?
It's rare to pinpoint a specific cause of high blood pressure. Doctors do know that hypertension runs in families, and that lack of exercise, stress, being overweight, smoking and drinking heavily contribute to and even worsen hypertension. African Americans have a higher rate of hypertension and tend to have more severe hypertension than whites, but it's not yet known why this occurs. It's suspected that genes and diet play some role, though. Certain medical problems, such as sleep apnea and chronic kidney disease, may cause blood pressure to rise, and some medicines can raise your blood pressure.
Does sodium cause high blood pressure?
Although salt restriction may reduce the blood pressure of some hypertensive people, sodium itself does not cause hypertension. However, most Americans consume way too much salt. Excess sodium can lead to fluid retention. More fluid in the body raises the total volume of blood flowing through your system; the higher the volume, the higher your blood pressure.
Cardiologists typically recommend low-sodium diets for those with hypertension or with a family history of the disease because, in many people, blood pressure falls significantly if salt intake is restricted. These people are "salt sensitive," meaning their blood pressure rises when they ingest large amounts of sodium, and drops when they reduce sodium intake.
How is high blood pressure treated?
In general, the best approach to prevent and control high blood pressure is one that involves small, easy lifestyle fixes. Exercising regularly, giving up cigarettes, reducing stress and limiting sodium and alcohol intake can bring blood pressure down to safer levels. In fact, for many people with hypertension, losing 10 or 20 pounds can lower their pressure to a more normal range. Making physical activity a regular part of your everyday life, along with a reduced-fat diet, can help you shed excess pounds. Studies show that the DASH diet, which is low in salt, fat and cholesterol and rich in low-fat or non-fat dairy products, fish, poultry, nuts, nutrients, protein and fiber, reduces blood pressure.
These lifestyle improvements are the first step to controlling high blood pressure, no matter your age or risk status. The exception is if your blood pressure is so alarmingly high that immediate antihypertensive medication is needed.
What medications are used to treat high blood pressure?
Adopting a healthier lifestyle is often the only measure many people with high blood pressure need to take to bring their reading down. Others, however, need to combine medication with a healthy lifestyle to make their pressure respond in a more favorable way. Diuretics rid the body of excess salt and water. This reduces the volume and, therefore, the pressure of your blood. Beta-blockers keep your heart from pumping too hard and too fast, thus reducing blood pressure.
Calcium blockers, alpha blockers, ACE (angiotensin-converting enzyme) inhibitors and ARBs (angiotensin receptor blockers) all relax blood vessels, lowering resistance and, therefore, blood pressure. Calcium channel blockers relax the muscles in the blood vessel walls, alpha blockers interfere with impulses from the brain and nerves that constrict vessels, and ACE inhibitors and ARBs block the action of an enzyme that causes arteries to narrow.
Are there any drawbacks to medications?
When trying to bring blood pressure down to normal levels with medication, some people complain of fatigue, depression and a general sense of "not feeling right." Since high blood pressure rarely has symptoms, the treatment sometimes seems worse than the disease, and some patients stop taking medication, which isn't a wise idea. Hypertension is a lifelong disease that requires lifelong treatment.
Yet, there's no reason to tolerate unpleasant side effects if you're on medication. There are many factors that figure into the choice of antihypertensive medication. With advances in drug therapy, sometimes all that's needed to get rid of undesirable complications is a minor reworking of the type of medication, the dosage, how frequently you take it or how it's delivered to your body.
What is the goal of treatment?
The treatment goal for most adults is to get and keep blood pressure below 140/90 mmHg. For adults who have diabetes or chronic kidney disease, the goal is to get and keep blood pressure below 130/80 mmHg.
People with diabetes are nearly three times as likely to have a stroke than someone who does not have the disease. This increased risk may be due to some of the same complications that result from diabetes are also associated with stroke.
What is a stroke?
Stroke is a medical emergency, just like a heart attack. That's why experts in the field now refer to it as a "brain attack." Strokes result from a sudden decrease in the flow of blood to parts of the brain. When blood can't reach the brain, its cells are deprived of oxygen and die, so functions normally controlled by the damaged brain areas are impaired. Among the possible effects are temporary or permanent paralysis of various parts of the body or impaired speech or vision.
What is diabetes?
Diabetes is a disease which affects a person's ability to move blood sugar (or glucose) out of the blood and into the cells – where it is used as the body's primary source of fuel.
There are two types of diabetes:
- Insulin dependent (Type 1) – found in childhood and is characterized by the body's inability to produce enough insulin, which is a hormone that permits the body to metabolize blood sugar (glucose).
- Non-Insulin dependent (Type 2) – more common type of diabetes that makes up over 90 percent of all diabetes cases. It usually develops in adulthood and may go unnoticed for some time. The body is able to produce insulin, but tissues develop a resistance to its actions and blood sugar levels rise above normal.
Why is there a link between stroke and diabetes?
There are a number of risk factors that increase the chance of vascular complications in individuals with diabetes. At the top of this list is high blood pressure.
Hypertension is twice as likely among patients with diabetes. This contributes to a higher stroke risk, and can lead to a stroke from a blood clot or hemorrhage.
Heart disease is another common problem that can result in higher stroke risk among patients with diabetes. Myocardial infarction (heart attack) and atrial fibrillation (irregular beating pattern) are common and increase stroke risk.
Brain damage may be more severe and extensive if blood sugar is high when a stroke happens. Careful regulation of blood sugar, either with insulin or oral blood sugar-lowering drugs, can reduce vascular complications.
What is the treatment for diabetes?
Both types of diabetes can be controlled, reducing the risk of long-term health complications such as stroke. Type I is treated closely by monitoring blood sugar and taking daily insulin injections. Type II, which is worsened by obesity, can frequently be controlled through weight loss, dietary changes and exercise. Daily insulin injections are not usually necessary and are reserved as a last resort.
For an appointment with a Jefferson physician, more information or health information and education programs, please call 1-800-JEFF-NOW (1-800-533-3669).
Speech- or hearing-impaired callers can access JEFF NOW® by calling 1-800-654-5984.
Am I eligible for the liquid fast portion of the Comprehensive Weight Management Program?
The Jefferson Comprehensive Weight Management program is designed for people with a body mass index (BMI) of 30 or more, who have or are at risk of serious medical conditions. The Program also accepts people whose BMI is between 25 and 30 if they have health risks such as hypertension, diabetes, high cholesterol and sleep apnea. To determine whether you are eligible, please call us at 215-955-5732 or use our e-mail form.
How long will the liquid fast portion of the Comprehensive Program take?
The liquid fast and transition to food can take up to 24 weeks. However, maintenance lasts a lifetime. Maintenance sessions are available one to two times per week and many participants continue to attend them long after losing weight. Some also continue to use OPTIFAST® products after the fast period. Our Program is one the largest maintenance programs in the country because we emphasize maintenance.
I've tried every diet out there, losing weight each time, only to gain it back. What makes this Program any different than all the others?
Our Weight Management Program is unique from most others because it is medically as well as behaviorally oriented. After your informational session, you will schedule an appointment with our medical staff for a physical assessment. During this appointment, we take a complete medical history, which includes blood work and a review of current medical conditions and medications. We also give you the tools to become personally responsible for your weight management and offer ongoing education programs.
How often do I have to attend meetings?
During the initial phase of the Program, you will attend meetings once a week. Please consider your schedule before committing to the program. Attendance at these sessions is very important. If you are chronically unable to attend the sessions, we may ask you to discontinue until you have more free time. If you expect to miss a session, we ask that you contact us and arrange a make-up time.
As you transition out of the initial phase, you will attend six education sessions throughout the six-week transitional phase. Even if you have been extensively educated about food in the past, we find that most people learn new information and approaches to old topics. For that reason, attendance at all six sessions is mandatory.
Maintenance groups are offered one to two times per week.
What are my options if I want to lose weight but don't want something as drastic as the Comprehensive Program?
We have two additional programs:
- One-session weight loss class
- Six-session weight loss class