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.
Today, people are more aware than ever of the risks of having a high blood cholesterol level.
High cholesterol levels can lead to clogged arteries, heart attack or stroke. So if you have high cholesterol, you should take steps to lower it. Simple dietary and lifestyle changes can reverse your course and set you back on the path of good health. For those who have coronary artery disease, or are at unusually high risk for it, lowering your lipid levels can reduce further coronary events and the possible need for interventions such as surgery or angioplasty.
What is cholesterol?
Cholesterol is a waxy substance produced by the liver that is also found in animal foods such as red meat and whole milk dairy products, which are usually high in fat as well. (Plant sources do not contain cholesterol.) Your body uses cholesterol to build cell walls and other necessary tissues. High-fat diets stimulate the liver to produce excessive cholesterol. As a result of the amount your body manufactures normally and in response to a fat-laden diet, you can accumulate too much cholesterol in your blood. That is when trouble occurs in the form of cardiovascular disease.
Cholesterol travels through the blood in packages called lipoproteins. Low-density lipoproteins (LDL), or bad cholesterol, have a tendency to cling to the inner walls of the arteries as plaque. This plaque restricts the flow of blood to the heart or brain, which can lead to heart attack or stroke. High-density lipoproteins (HDL), or good cholesterol, whisk surplus cholesterol from the blood and arterial walls, thus lowering the odds of developing cardiovascular disease.
What do my cholesterol numbers mean?
Total blood cholesterol is the number most people are familiar with. Doctors no longer measure just the total cholesterol level in your blood, because that only provides part of the picture. Your doctor should do a complete lipid profile, which includes measuring your levels of good (HDL) and bad (LDL) cholesterol and triglycerides. (Although completely different from cholesterol, triglycerides likewise are fats found in foods and manufactured in the body. Most of the fat we eat is in the form of triglyceride.) Other lipid tests are also available, if needed, to help your doctor and you define your risk level.
Ideally, your LDL cholesterol should be below 100; a desirable HDL level is 45 or higher. The lower the LDL and the higher the HDL, the more protected you are from cardiovascular disease. Most pre-menopausal women have high levels of HDL because of the female hormone estrogen, which offers added protection against heart disease. After menopause, though, a woman's risk for heart attack jumps until she is 65, by which time it is almost as great as a man's.
Triglyceride levels above 150 mg/dl are abnormally high. A high triglyceride level often accompanies a higher total cholesterol and LDL cholesterol level, and especially a lower HDL cholesterol. The combination of high triglycerides and low HDL levels in concert with disorders such as diabetes or high blood pressure is termed "metabolic syndrome." Metabolic syndrome is strongly associated with abdominal obesity, which itself has been shown to put you at risk for coronary artery disease. Whatever your cholesterol counts, keep in mind other important risk factors as well. Age, heredity, family history, high blood pressure, diabetes, smoking and lifestyle should all be considered when evaluating your risk of cardiovascular problems.
How can I lower my cholesterol level?
You can take control of your cholesterol by making lifestyle changes. Eating a heart-healthy diet is often an effective way to bring your blood cholesterol within a normal range. Limit saturated fat to no more than 7 percent of your daily calories and trans fat to no more than 1 percent, and substitute more whole-grain and high-fiber foods.
Load up on fish, fruit, vegetables, beans, rice and other whole grains in place of meat or baked goods. Switch to low-fat or skim milk dairy products. When you must cook with fat, choose the monounsaturated varieties, such as olive or canola oils. Don't overdo your use of even these oils, however, as they are still high-fat foods. Fat in the diet stimulates the liver to raise blood cholesterol levels; it is not just eggs that elevate blood cholesterol.
Additionally, since regular exercise has been shown to increase the level of good cholesterol, get active. Because smoking reduces the level of good cholesterol, smokers should quit. Everyone should maintain a normal body weight, as above-normal weight and obesity contribute to abnormal lipid levels, as well as diabetes, high blood pressure and other disorders. The rewards of changing your habits are well worth it; for every 1 percent drop in bad cholesterol, you get a 2 percent drop in cardiovascular risk.
Are foods labeled 'Cholesterol Free' safe bets?
Don't be fooled by food labels that say "cholesterol free." Foods bursting with saturated fat are sometimes disguised with these healthier-sounding labels. Likewise, products made with hydrogenated vegetable oils may seem good for you but are actually rich in fat. Current U.S. Food and Drug Administration regulations cut down the hype surrounding terms used on food labels, such as "cholesterol free." To prevent being misled, however, read nutrition labels to learn the amount of fat in a serving. A truly low-fat product contains three grams or less of fat for every 100 calories.
Should I consider cholesterol-lowering drugs?
Drugs that can help normalize blood cholesterol may be necessary for people at higher risk who can't control their levels through diet. Dietary changes should often be tried before medication, however. Within three months of following a low-fat diet, you should notice a reduction in your cholesterol count. If this self-care method doesn't lower your cholesterol to an acceptable level, you may need to add medication to your regimen, particularly if you have other risk factors for cardiovascular disease. Since drugs that lower cholesterol can have side effects, however, you should consult your physician before deciding if medication is appropriate.
Do I need to worry about my child's cholesterol levels?
Research indicates that one out of four children and teenagers has a high cholesterol level. Clearly, it's never too early to start thinking about your child's cholesterol. Although the American Academy of Pediatrics does not recommend universal screening of all children, it's wise to test children over two years of age who have a family history of early heart attacks or elevated cholesterol. Overweight children or those with high blood pressure, diabetes or other risk factors for heart disease should also be screened. An abnormal level warrants dietary modifications, but it is best to consult your doctor in individual cases.
Eating habits are established at a young age, and regardless of whether your child has a clean bill of health, you should set an example for a healthy future by serving low-fat meals to children over two years old. Remember, though, that children need some fat in their diets to help them grow.
How can I ensure an accurate cholesterol test?
It's usually better to get tested at your doctor's office rather than at a mass screening at a mall. To obtain a correct measurement of blood cholesterol, you need to fast for 12 hours prior to an HDL/LDL/triglyceride workup for a total profile.
How often should cholesterol be checked?
A high cholesterol level produces no warning symptoms, so it makes sense to test periodically. The American Heart Association recommends a lipid profile by age 20 or earlier in some cases. If your levels are acceptable, return to your doctor every five years for subsequent checks until age 45; after that, screenings should be scheduled every three years.
Before menopause, some degree of protection is afforded to most women, but they should still be tested. After menopause, all women should have their cholesterol measured every three to five years.
Can a cholesterol level ever be too low?
Usually, a low cholesterol level is a good health indicator. In other cases, it may point to a systemic disease that needs treatment. Ask your family physician to discuss your cholesterol measurement with you.
Why would I choose a minimally invasive procedure instead of a traditional surgery?
In many cases, minimally invasive procedures offer some significant advantages. Those advantages include less trauma during surgery and fewer complications after. With minimally invasive procedures, you typically enjoy a shorter hospital stay (or none at all), a faster recovery and less scarring. In fact, with many of these procedures, surgeons use Band-Aids® for dressings!
Why should I choose Thomas Jefferson University Hospital for my minimally invasive procedure?
Jefferson surgeons have been performing – and pioneering – minimally invasive procedures for over a decade. Today, we have many of our surgeons have extensive experience in minimally invasive diagnostic and treatment procedures covering a wide range of medical specialties. We have experts in advanced endoscopy in our Division of Gastroenterology and Hepatology. We have leading urologists who routinely use da Vinci® Surgery for prostatectomy. And our Jefferson Hospital for Neuroscience team includes surgeons who use minimally invasive techniques to treat hard-to-reach tumors of the brain and spine using stereotactic radiosurgery, cranial base surgery and endoscopic neurosurgery.
What is the difference between laparoscopic surgery and keyhole or Band-Aid® surgery?
The terms "laparoscopic surgery," "keyhole surgery" and "Band-Aid® surgery" are interchangeable. All refer to a family of minimally invasive procedures that use small incisions and some kind of laparoscope, or high-tech camera, to guide surgeons in performing the procedures through the tiny openings. These techniques can be used for a number of procedures, including common operations like removal of the gall bladder, removal of part of the colon and removal of the kidney.
How have Jefferson operating rooms been updated for minimally invasive procedures?
Jefferson has a range of surgical suites that have been outfitted with the tools and technologies needed for minimally invasive procedures. Jefferson Hospital for Neuroscience, for example, has state-of-the-art equipment for stereotactic radiosurgery. Similarly, the Jefferson Minimally Invasive Cranial Base Surgery and Endoscopic Neurosurgery Center uses the latest digital operating rooms – the first of their kind in the Delaware Valley.