Bariatric Services - Barrington, Illinois

YOUR PATH TO A HEALTHIER LIFESTYLE! Barrington Bariatric Center is here to help you CHANGE YOUR LIFE!

Barrington Bariatric Center provides patients suffering from obesity and Type II Diabetes the treatment and support they need to lead healthier lives.

A weight problem is more than just appearance.  Being obese can increase your risk of comorbidities such as high blood pressure, high cholesterol, diabetes, heart disease, stroke, sleep apnea, arthritis, respiratory difficulties, and certain cancers. 

As the second leading cause of preventable death in the United States, obesity is a major health issue.  According to the Centers for Disease Control, the number of Americans dying each year from comorbidities directly related to obesity and a sedentary lifestyle will soon surpass tobacco related deaths.  We at the Barrington Bariatric Center are here to help you fight the battle against morbid obesity and reduce your risk of comorbidities, thus improving overall health and extending life expectancy. 

Whether you are thinking about gastric bypass, lap band, or sleeve gastrectomy surgery, our expert bariatric surgeon offers the most advanced minimally invasive laparoscopic skills available today.  Come inside the Barrington Bariatric Center and learn more about our excellent program and compassionate care.

Obesity and Related Health Conditions

What is obesity?

Obesity is a term that is used to refer to having so much body fat that your health is in danger. The measurement, Body Mass Index is a means for determining how much body fat you have. Having too much body fat can lead to serious health comorbidities such as the following: type 2 diabetes, heart disease, high blood pressure, arthritis, sleep apnea, and stroke. The location of where you carry your body fat may be as important as how many extra pounds you have. People who carry too much fat around the middle, rather than around the hips, are more likely to have health problems. Consequently, measurement of your Waist-to-hip ratio is important. An increased waist-to-hip ratio or waist circumference is associated with increased risk for obesity-related health conditions. If the ratio in males is greater than 1, and in females is greater than .8 that qualifies as a risk factor. Or, if the waist circumference for males is greater than 40 inches and for females greater than 35 inches, it's a risk factor.

What causes obesity?

When you take in more calories than you use/burn, you gain weight. How you eat, how active you are, and other things affect how your body uses calories and whether you gain weight. Obesity also has a genetic predisposition for some people.  If your family members are obese, you may have inherited a tendency to gain weight.  In addition, there is an environmental and social element to obesity.  Today we have fast food restaurants at our disposal in addition to serving large portions that tend to help us overeat, thus leading to high calorie intake.  Our busy lives make it harder to plan and cook healthy meals, because our work schedules, long commutes, and other commitments cut into the time we have for exercise.  Moreover, the friends and family that we socialize with also helps to form our eating and lifestyle habits, which can lead to obesity.

What are comorbidities?

Overweight and obesity are known risk factors for many health problems (comorbidities). These include:

  • High Blood Pressure / Hypertension
  • High Blood Cholesterol
  • Heart Disease
  • Type II Diabetes
  • Respiratory Disease, Asthma, and Bronchitis
  • Gallbladder Disease
  • Heart Burn and Reflux Disease
  • Sleep Apnea
  • Osteoarthritis and Joint disease
  • Cancers (breast, colorectal, kidney, gallbladder, uterine)
  • Pregnancy Complications
  • Menstrual irregularities
  • Stress incontinence
  • Venous Status disease
  • Depression
  • Psychological Disorders

Weight loss surgery dramatically improves your life by helping to eliminate or lessen the effects of multiple comobidities that frequently occur with obesity.  Evidence reveals that over 90% of comorbidities are improved or resolved with weight loss surgery.

Evidence reveals that over 90% of comorbidities are improved or resolved with weight loss surgery.  

N=104
1 year post-op

Number Prior to Surgery

% Worse

% No Change

% Improved

% Resolved

Osteoarthritis

64

2

10

47

41

Hypercholesterimia

62

0

4

33

63

GERD

58

0

4

24

72

Hypertension

57

0

12

18

70

Sleep Apnea

44

2

5

19

74

Hypertriglyceridemia

43

0

14

29

57

Peripheral Edema

31

0

4

55

41

Stress Incontinence

18

6

11

39

44

Asthma

18

6

12

69

13

Diabetes

18

0

0

18

82

  Average

 

1.6%

7.8%

35.1%

55.7%

CO-MORBIDITIES REDUCED BY GASTRIC BY-PASS SURGERY

90.8%
Improved or Resolved

Schauer, P.R. et al. Outcomes After Laparoscopic Roux-en-Y Gastric Bypass for Morbid Obesity. Annals of Surgery. 232: 4 (515-529); 2000.

In relationship to Type II Diabetes, the evidence in support of bariatric surgery for Type II Diabetes continues to mount. Various studies have shown:

  • Diabetes completely disappears or treatment (medicines, insulin) is no longer needed. In studies measuring for “resolution or improvement,” the number rose to 86% of patients.
  • For some patients, diabetes disappears almost immediately, within days of surgery. Others saw blood sugar levels begin to fall soon after surgery, becoming completely normal within a year.
  • 92% reduction in deaths from diabetes-related causes.

Other Research

  • 86% of diabetes resolved or improved
  • 70% of hyperlipidemia improved
  • 78.5% of hypertension resolved improved
  • 83.6% of sleep apnea resolved or improved
  • 400% Reduced incidence of cancer (2.03% vs. 8.49%)

Buchwald H, Avidor Y, Braunwald E, et al. Bariatric Surgery – A Systematic Review of the Literature and Meta-analysis. Journal of the American Medical Association, October 13, 2004 – Vol. 292, No. 14.

Economic Impacts of Obesity

In addition to health impacts of obesity, there are economic impacts of obesity as well.  Obesity and their associated health problems have a significant economic impact on the U.S. health care system (USDHHS, 2001). Medical costs associated with overweight and obesity may involve direct and indirect costs (Wolf and Colditz, 1998; Wolf, 1998). Direct medical costs may include preventive, diagnostic, and treatment services related to obesity. Indirect costs relate to morbidity and mortality costs. Morbidity costs are defined as the value of income lost from decreased productivity, restricted activity, absenteeism, and bed days. Mortality costs are the value of future income lost by premature death.  More and more employers today are providing coverage for bariatric surgery because the return on investment for weight loss surgery exceeds the cost of caring for their employees with multiple, complex comorbidities.    

As you can see, Barrington Bariatric Center is here to help you achieve a healthier, long lasting life! Call us today to help you CHANGE YOUR LIFE!  For other questions about obesity and comorbidities, please contact us today.

This information was obtained from the NIH, CDC, and Weight Control Information Network.

Is Surgery Right for Me?

At Barrington Bariatric Center, we understand that bariatric surgery is a life-changing event.  Consequently, our program follows specific guidelines from the National Institute of Health to ensure that you are an appropriate candidate for surgery.  Patients who meet the following requirements listed below are an appropriate candidate for surgery.  Our team will do its best in ensuring that you are able to meet these criteria:

  • BMI > 40 (80 - 100 lbs. or more overweight)
  • BMI between 35 and 40 with at least 1 significant co-morbidity
  • Patients have failed other medically managed weight-loss programs
  • Able to undergo a major operation
  • Understands surgery and risks
  • Absence of drug and alcohol problems
  • No uncontrolled psychological conditions
  • Consensus by our multi-disciplinary team
  • Committed to life-style change and lifetime follow-ups

What is Body Mass Index?

Body Mass Index is an indicator utilized by healthcare providers in the selection of treatment and therapy for people who are overweight or morbidly obese.  A person who is clinically severely obese (morbidly obese), when he or she is so heavy that the fat tissue load creates other medical problems such as hypertension, sleep apnea, joint disease, type II diabetes, and other conditions.  Individuals who are morbidly obese are typically 100 lbs in excess of ideal body weight.  Body Mass Index is calculated by weight (kg) / height (meters squared).

Frequently Asked Questions

Why Bariatric Surgery?

  • Diet and exercise only works for 1 in 20 people who are morbidly obese.
  • Bariatric Surgery is safe and effective.
  • For a growing number of morbidly obese people, the benefits of surgery outweigh the risks or SURGERY and STAYING MORBIDLY OBESE.
  • Bariatric Surgery improves co-morbidities for a longer, healthier life.
  • Bariatric Surgery improves the social and emotional benefits of Health.

The National Institutes for Health (NIH) has long endorsed bariatric surgery for the treatment of morbid obesity.  They stated in their 1991 Consensus:

  • “Only surgery has proven effective over the long term for most patients with clinically severe obesity.” 
  • “Dietary regimens (Medical Treatment) fail to provide long term weight control in severely obese patients.  Bariatric Surgery is recognized as an effective treatment to provide significant weight loss and long term weight control.
  • “Weight loss surgery for the morbidly obese, when combined with behavior modification, is currently the most reliable and only choice for long term maintenance of excess weight loss.” 

Surgery for the treatment of clinically severe obesity is also endorsed by the following health experts:

  • The American Medical Association
  • The National Institute of Diabetes and Digestive and Kidney Diseases
  • American Association of Family Practitioners

 The adverse health effects of obesity and severe obesity are many, including an increased risk of diabetes to an increased risk of various cancers. The risk of death has also been shown to be higher in obese people. The risk of death in a person with a BMI of 40 is estimated to be 10 times greater than the mortality risk in a person with a BMI of 20-25. The prevalence of obesity has been rising steadily in the United States, and the CDC estimated that in the year 2000 poor diet and inactivity caused 400,000 US deaths, making obesity the second leading cause of preventable deaths, close behind tobacco (435,000).

What are the surgical options to treat Morbid Obesity?

There are two surgical procedures currently offered at Barrington Bariatric Center: the Roux Y Gastric Bypass and Laparoscopic Adjustable Gastric Banding.

The Roux Y Gastric Bypass works by reducing food intake and the feeling of hunger. The result is an early sense of fullness, followed by a sense of satisfaction. Even though the portion size is small, patients have a feeling of being satisfied. The Roux Y Gastric Bypass also works by providing negative feedback when foods high in sugar are eaten. Consuming foods high in simple sugars can cause a condition called “dumping syndrome”, which may include light headedness, sweating, rapid heart rate, crampy abdominal pain, nausea, and diarrhea.

In the Roux Y Gastric Bypass procedure, the stomach is divided and separated with a stapler to create a small stomach pouch. The new stomach is approximately one half ounce in size. The small intestine is then cut about two feet below the stomach and is reconnected to the new stomach pouch. A small opening between the stomach and the intestine (about the size of a dime) is made to allow food to empty slowly from the pouch. Food no longer reaches the lower part of the stomach, but the digestive juices, bile, and stomach acid flows normally into the small bowel to digest the food you eat.

The Roux Y Gastric Bypass can be performed using either a laparoscopic or open approach. The laparoscopic procedure uses a telescope with instruments placed through 5 or 6 small abdominal incisions. The open procedure involves an incision extending from below the breastbone to the belly button.

The Laparoscopic Adjustable Gastric Band is purely a restrictive procedure. A band is placed around the upper portion of the stomach, and an access port is placed underneath the skin in the abdomen. Through this port, a balloon can be adjusted to limit both the size of the pouch and how quickly food can empty from the pouch. Patients typically describe a decrease in the sensation of hunger and earlier satiety during a meal. The band, however, cannot limit the passage of liquid calories, and may not be the optimal choice for patients with a weakness for ice cream, mile shakes, or non-diet soda. Because the band needs adjustment, patients must commit to frequent office follow up visits in order to optimize their weight loss with this tool.

What are the Risks and Complications of Surgery?

The risks associated with Gastric Bypass are similar to the risks associated with having any abdominal operation where the bowel is cut. The Adjustable Gastric Band has a lower early complication rate because no bowel is cut in this procedure. However, gastric banding patients may develop long term complications.

Lung Problems

Atelectasis is a partial collapse of small air passages in the lung. This commonly happens after surgery because patients breathe more shallowly due to pain. The best treatment for atelectasis is to prevent collapse of these small airways. This can be accomplished by walking, performing cough and deep breathing exercises, and using your CPAP machine if you have sleep apnea.

Pneumonia is an infection of the lungs that can occur when respiratory secretions are not cleared. It is important to cough up any secretions you may have after surgery.

Blood clots can form in the veins in the legs. Surgery increases the risk of developing blood clots in the legs, but simply being obese also increases the risk of blood clots. In addition, because patients are less active after surgery, blood can tend to pool in the leg veins. When blood flow slows down, clots have a tendency to form.

If a clot breaks off and floats through the veins to the lungs, it is called a pulmonary embolism. A pulmonary embolism affects the ability of the lungs and heart to get oxygen to the rest of the body. This complication can be fatal.

Thinning the blood can decrease, but does not eliminate, the risk for a pulmonary embolism. Patients receive medication just before and also after surgery which makes the blood less likely to clot. Special compression stockings are also used to keep the blood flowing through the veins. Finally, it is important to begin walking early after surgery and to continue to be mobile after surgery to decrease the risk of clots.

Infections

Wound infections are one of the most common postoperative complications, occurring in 5 to 20 percent of patients. Obese patients have a thicker layer of fat under the skin, which can become infected after surgery. Opening a portion or the entire wound treats most infections. The wound is then packed and allowed to heal from the inside out. While inconvenient, wound infections are usually not a serious problem. More serious infections sometimes require the use of antibiotics.

If the port site from a lap band becomes infected, the port will usually need to be removed or replaced, and the band itself may need to be removed. If the band is removed, weight loss will be affected.

An abscess is a collection of infected fluid (pus) that collects somewhere in the body. After an abdominal operation, a pocket of fluid may develop. If bacteria are present, the fluid becomes infected and can develop into an abscess. The treatment of any abscess is to drain away the infected fluid. Sometimes antibiotics are used.

If there is concern that a fluid collection may occur, a drain may be placed during the surgery. If an abscess does develop and no drain is in place, one can be placed through the skin by the interventional radiologists.

When bowel is cut and attached to another portion of bowel, or to the stomach, the connection is called an anastomosis. If the connection does not form a complete seal, fluid can leak out of the bowel and into the abdominal cavity. This is called an anastomotic leak. This may cause a serious infection and possibly the formation of an abscess. This is always a very serious complication.

Depending on the size of the leak, a second operation may be necessary. If the leak is small, it may be treated by the placement of a drain. Until the leak seals, the patient will be unable to eat or drink. Anastomotic leaks almost always result in a longer hospital stay. There may be discomfort from the drain and repeated X-ray studies are necessary.

Again, because no bowel is cut during the lap band procedure, there is no risk of an anastomotic leak with lap banding. However, there is dissection and manipulation around the stomach during a lap band procedure, and there is a slight risk of creating a hole in the stomach that may become a leak.

All patients having a gastric bypass procedure will have a urinary catheter placed during surgery that is left in place for the first night. Urinary catheters can predispose a patient to a bladder infection. Bladder infections are usually easily treated with antibiotics and do not increase hospital stay.

Heart attack (Myocardial infarction)

Bariatric patients are at increased risk of myocardial infarction because of their obesity and high prevalence of cardiac risk factors. You will need some evaluation of your heart prior to surgery, either an EKG or possibly a stress test.

Bleeding

When surgery is performed, blood vessels are cut. Bleeding is stopped by tying vessels, stitching them, or sealing the vessel with heat or other energy source. Sometimes a blood vessel may begin to bleed again either inside the abdomen or under the skin. The blood thinners that are given to decrease the risk of a blood clot may increase the risk of bleeding during and after surgery.

Obstruction

Scars and adhesions can form after any abdominal operation. At any time after surgery, even years after surgery, the intestines may become kinked by an adhesion, causing a blockage of the bowel. Sometimes an operation is needed to relieve the obstruction.

In performing the gastric bypass the opening which allows food to exit the stomach is deliberately made small, about 0.25 inches in diameter. This slows the flow of food out of the small stomach pouch. All healing occurs by scar formation. Scars have a tendency to contract or become smaller. This may cause the opening between the stomach and bowel to become so small that food cannot get through. This type of problem occurs in 5 to 10% of cases. Treatment to correct the problem can be done as an outpatient procedure.

Obstructions can occur after gastric banding as well. This can occur immediately after surgery, or after a band adjustment. If obstruction occurs after a band adjustment, then the balloon in the band can be deflated. If the obstruction occurs immediately after surgery it may be because the band is too small and needs to be replaced, which would require a second surgery, or may be because of swelling in the tissues around the band, which may resolve with time. If the band slips, or if some stomach herniates through the band, this may also cause obstruction and would require surgery to fix the problem.

Other complications

Esophageal dilation may occur after placement of the lap band. This may result in pain with eating or vomiting. This is usually reversible with deflation of the band balloon, but this may negatively affect weight loss.

Band slippage may occur after placement of the lap band. This occurs when the stomach slips through the band, and can cause severe vomiting. This can occur months to years after band placement, and occurs in 2-4% of patients. A reoperation is necessary to correct his complication.

Band erosion occurs when the friction of the band against the stomach creates a hole in the stomach. This may cause pain and can stop weight loss. The band can often be removed with a scope placed through the mouth and into the stomach, but occasionally requires surgery. This complication can occur years after the initial band placement, and occurs in 1-2% of patients.

Ulcers can occur at the site of the anastomosis in up to 15% of patients. Using aspirin or ibuprofen can increase the risk for ulcer formation. Ulcers can usually be treated with anti-acid medications.

Incisional hernias occur when there is a defect in the abdominal wall. This is more common after open surgery, where there is a larger abdominal incision, and is rare with laparoscopic gastric bypass and lap banding. Hernias usually require surgical repair, but often it is possible to wait until the patient has lost weight before repairing the hernia, to decrease the risk of a recurrent hernia.

Gallstones are more likely to from when patients have rapid weight loss. Gallstones can cause infection or pain in the gallbladder, which would require removal of the gallbladder. You will be started on a medication after surgery to decrease the risk of forming gallstones

Nutritional problems

A significant number of bariatric patients have nutritional deficiencies even before surgery, and gastric bypass may worsen these problems. Most nutritional problems can be avoided by using vitamin and mineral supplements, and by eating a healthy diet.

Because the lap band does not affect absorption, there are fewer vitamin and mineral deficiencies. Protein intake must still be emphasized with the lap band in the early post operative period.

Protein deficiency

Our bodies require a constant supply of protein to repair and replace tissues that become worn out or damaged. Our body does not store protein. Therefore, each day we need to replace the body’s protein needs. Most people need about 60 grams of protein every day. The gastric bypass and lap band procedures reduce the amount a patient is able to eat. Protein rich foods must be eaten with each meal to make sure the body gets the amount of protein it needs to preserve lean muscle mass. Using protein powders is not advised, and liquid calories, like those found in protein supplements, will defeat the surgery. Weight gain occurs because the pouch does not restrict liquids as well as it can restrict solids. Therefore, it is possible to take a large number of calories when they are in liquid form.

Vitamin and mineral deficiency

After weight loss surgery you will not be able to eat the amount of foods and the variety of foods needed to meet recommended vitamin and mineral requirements through diet alone. A multivitamin/mineral supplement with iron must be taken daily. Calcium and vitamin B12 supplements are also recommended to maintain adequate vitamin and mineral stores and prevent anemia and osteoporosis. Some patients may require additional iron supplements after surgery.

Eating Problems

Nausea and vomiting- After surgery, you will vomit if you continue to eat after noting a full feeling, eat too quickly, or if you do not chew your food well enough. A band that is too tight will also cause vomiting. Most patients have this happen several times. This can be avoided by eating slowly, chewing food well, and avoiding that last bite when you begin to feel full. Usually a feeling of satisfaction will occur in a few minutes, and the desire to eat more is lost.

Food intolerance

Red meats are not well tolerated and may cause vomiting. Red meats are much harder to digest than chicken or fish. Enzymes that help to digest red meats are not present in the pouch as they were in the intact stomach. Therefore, patients are advised to avoid red meats until at least 3-4 months after surgery, when their stomach function is improved. Some patients never eat red meat again because it makes them feel uncomfortable.

Dumping Syndrome

After gastric bypass surgery a condition called ‘dumping syndrome’ will occur if you eat foods containing sugar. While simple sugars reach the small intestine, a large amount of fluid is drawn into the small bowel. Light-headedness, profuse sweating, a rapid heart rate, crampy abdominal pain, nausea, and diarrhea are symptoms of dumping syndrome. Not eating foods or drinking liquids with high sugar content avoids the problem of dumping. Sweets, candies, fruit juice, certain dressings, barbecue sauce, tomato sauce, and mayonnaise may all cause problems. Sugar content must be less than 10 grams of sugar per serving. Sorbitol and sugar alcohol are other names for sugar and also need to be avoided.

To digest milk sugar (lactose), our bodies need an enzyme called lactase. This enzyme is often in short supply in the lower small intestine. After gastric bypass, milk and milk products may not be fully digested because part of the upper intestine is bypassed. When milk and milk sugars are not fully digested, bacteria in the small bowel ferment them. This results in gas, cramping, and diarrhea. Milk intolerance can be treated with Lactaid.

Dumping syndrome and milk intolerance do not occur with lap banding.

Changed bowel habits

After gastric bypass and banding surgery, the amount of food consumed is greatly reduced. Patients consume very little roughage. As a result, the number of bowel movements will be less. It may be normal after surgery to have a bowel movement only every 2 or 3 days. Constipation may become a problem. Constipation can be avoided through the use of a stool softener, fiber, regular exercise, and by drinking adequate water. The following regimens can be incorporated into your day if needed.

Sodium docusate (surfak, colace) - a stool softener
Take 1-3 tablets daily. Adjust the number of tablets to achieve the desired effect.
You should have a soft, formed stool every 1-3 days.

Fiber (Benefiber)
1-2 doses daily, to desired effect.
Mix with water.
Fiber is effective in preventing constipation, but may cause some bloating or gas.
Make sure you are drinking enough fluid. You should be drinking at least 64 ounces every day.

Exercise will also help to control constipation.

If you do not have a bowel movement after three days, you should use 2 tablespoons of milk of magnesia. Take this in the evening before you go to bed. You should have a bowel movement within 6-12 hours. Milk of magnesia may produce a soft or semi-liquid stool.

Hair loss

During the phase of rapid weight loss when calorie and protein intake is marginal, temporary hair loss may occur. In some persons, 30-40% (rather than the usual 10%) of hair follicles become inactive, causing noticeable amounts of hair to fall out. Hair loss resolves when nutrition and weight loss stabilize. Patients are advised to avoid hair treatments and permanents. Protein intake needs to be optimized. Remember 60 grams of protein per day is the minimum required amount. No other product, mineral, or vitamin will take the place of eating adequate protein to minimize hair loss. Zinc supplement, biotin, or gelatin may help.

Muscle loss

During rapid weight loss the body prefers to burn muscle mass rather than fat. Loss of muscle mass is preventable by exercising and eating adequate protein. We recommend at least 60 minutes of daily aerobic activity. It is also important to improve body strength. Fairly vigorous exercise for more than 30 minutes a day can greatly enhance fat burning and hasten weight loss. Exercise also improves mood and gives a feeling of well-being.

Pregnancy

Many severely overweight women are also infertile. As weight loss occurs, this situation may change quickly. We believe it is important to avoid pregnancy during the phase of rapid weight loss. This requires special attention to contraception during the first year after surgery. Patients are asked to use two forms of birth control during this time. One form of birth control should be a barrier method. It is unclear if oral, depot, or patch hormones are as effective during rapid weight loss.

What are the expected results?

Most patients who undergo a gastric bypass can expect to lose between 60% and 80% of their excess body weight. Approximately 2/3 of that weight is lost within the first year. Most patients continue to lose weight up to 2 years after surgery, and after the first 2 years most patients will have a rebound weight gain of approximately 20% between years 2 and 5 after surgery. The long term results for weight loss can also be excellent. The average person can maintain a weight loss of 50-60% of excess body weight up to 15 years after surgery.

Weight loss after adjustable gastric banding follows a slightly different course. Weight loss after banding occurs at a slower pace than after gastric bypass, peaking after about 3 years. Weight loss after banding averages about 50% after 3 years. Some weight regain can also be expected with banding.  Consequently, diet and exercise will remain an important component for the rest of your life to ensure you maintain your weight loss goals.  Patients undergoing sleeve gastrectomy may expect to see a 50 – 70% excess weight loss.

How do I prepare for surgery?

Most insurance plans cover bariatric surgery.  Our expert Insurance Specialist will help guide you through the insurance process in order to obtain insurance approval for surgery (you will meet with her at your consultation appointment to review your benefits).  Since many insurance policies differ from one another, we will assist you in understanding your benefits and requirements for bariatric surgery.  Commitment is necessary during this process to help achieve obtain an approval to have bariatric surgery by your insurance company.  Also, you may want to take the additional steps of informing yourself on your insurance benefits.  Here are some questions that you can ask your employer’s HR Department and/or Insurance Company:

  • Do I have benefits available for gastric bypass surgery?
  • Do I need a referral to see the doctor or for any of the tests that may be ordered?
  • Will I be responsible for any portion of the cost of the surgery, office visits, and/or tests?
  • Will my follow up visits be covered?
  • Is my insurance policy sponsored as a self insured plan or a fully insured plan by my employer?

If your employer plan is fully-insured, the insurance company is ultimately responsible for the healthcare costs. The employer typically purchases a standardized package of coverage from an insurance company.  In a self insured plan, your employer is ultimately responsible for the healthcare costs, and therefore can customize the plan to include and exclude specific coverage such as bariatric surgery coverage.  A key difference is that fully-insured policies are governed by your state insurance commission, while an employer’s plan (self-insured) is governed by the Federal Government through the Employee Retirement Income Security Act (ERISA) laws and regulations.  If your self-insured employer does not cover bariatric surgery, you may want to write them a letter explaining how this disease has affected your life in order to obtain support for bariatric surgery.  These differences affect how we will obtain insurance approval for surgery.  Our Insurance Specialist will assist you in navigating the insurance process and policy requirements and options for pursing surgery. 

Does my insurance policy cover Weight Loss Surgery for Morbid Obesity?

Request a copy of your insurance policy. These documents can either be provided from your employer or insurance company, (Many large employers have Benefits Websites where all of the plan documents can be found.) These documents explain your enrollment with the provider, such as whether you are enrolled in an HMO, PPO or indemnity plan. In regards to morbid obesity exclusions, request that your insurance provider highlight the sections in your plan that discuss the exclusions and mail/fax you a copy.  Please provide a copy to our Insurance Specialist at your consultation appointment. 

Does my insurance plan require a Medically Supervised Weight Loss Trial?

Many times the answer to this question is YES.  The following are common requirements by insurance companies in order to have weight loss surgery:

  • BMI greater than 35 with one or two comorbidities (hypertension, osteoarthritis, sleep apnea, Type II Diabetes, etc.)
  • Or BMI greater than 40.
  • 3 – 6 months of CONSECUTIVE medically supervised weight loss trial/documentation (either by Primary Care Physician or Surgeon)
  • Evaluation by a Dietitian and Exercise Specialist
  • Evaluation by a Psychologist for well-being
  • Evaluation by a Cardiologist or Pulmonologist
  • Sleep Study evaluation and other diagnostic tests

Insurance review boards determine the medical necessity of procedures and hospital stays prior to authorizing payment. They all have similar review processes. Many insurance companies are also asking for documentation that you have been on a medically supervised diet/trial for a period of 3 – 6 months before surgery. The length of the review process will vary between insurance companies. It may take 4 weeks or longer before a final decision is made. Your insurance plan or review board will send a letter stating their decision to both you and your doctor.

For many people, weight loss surgeryis an affordable health option because it is covered by many health insurance plans.  For patients whom do not have access to this option, Barrington Bariatric Center offers a unique program to allow you to achieve your goals.  We have created a Fast Track to Bariatric Surgery Financial Program to assist patients whom:

  • May want to self pay for bariatric surgery (i.e. may not want to wait 3 - 6 months to complete their insurance plan’s medically supervised diet plan)
  • Do not have bariatric insurance benefits (i.e. employer excludes the benefit or does not offer health insurance)
  • Are not able to meet their insurance policy’s requirements (i.e. documented 5 year history of morbid obesity)

We offer this comprehensive Fast Track to Bariatric Surgery Financial Plan with our expert surgeon, superior support staff, and the most advanced surgical options - all at a very competitive price.   Please contact our Insurance Specialist for more details.  Cleary, we feel it is important to understand the value of asking - WHAT IS THE COST OF NOT HAVING SURGERY? 

If the average morbidly obese patient dies at age 55 and surgery can extend life by 20 years, then the cost per day for bariatric surgery priced at $24,000 (hypothetical) is $3.28 per day for those remaining 20 years.

What does approximately $3.28 equate to?

  • pack of Diet Coke
  • Bag of Chips
  • Starbucks Coffee
  • Happy Meal at McDonald’s

In addition, Barrington Bariatric Center is pleased to offer patient financing options.  We have established relationships with both commercial lenders and medical specialty lenders specializing in bariatric surgery.  Please ask our Insurance Specialist about rates and details at your consult appointment.

Though there will be many changes after surgery, it is important to start making some lifestyle changes before surgery. The changes you make will have an impact on how well the surgery goes, and how well your final outcome will be.  It may seem like a daunting task, but keep a positive attitude!

  • If you smoke, you will need to quit smoking. This will be verified with a blood test.
  • All patients are asked to lose weight prior to surgery. Losing weight demonstrates commitment and your willingness and ability to follow the program objectives. Pre-operative weight loss also greatly improves the chances that your surgery can be done laparoscopically.
  • There are some specific changes you will be asked to make with your diet. You will need to begin eating 3 regular meals a day, to stop drinking soda, and stop eating fast foods.
  • If indicated by your history, you may have a sleep study or other consults with medical specialists to make sure you are healthy enough for surgery. Screening tests will be done before surgery to assist in planning your surgical care.

Dietitian consult

Before surgery all patients will meet with a dietitian. The dietitian will help you develop appropriate eating habits. You will also learn about making good food choices. The dietitian can be available for consultation after your surgery as well. There are specific changes you will have to make after surgery in your eating patterns to prevent pain, vomiting, and to promote safe weight loss. The dietitian will give you information about the changes that you will need to make.

Psychologist Consult

The purpose of the psychological evaluation is to ensure that patients thoroughly understand all aspects of the surgical procedure and are emotionally prepared to manage the post-surgical life-style and dietary changes, as well as potential complications. Your meeting with the psychologist will focus on the following:

  • Previous weight loss efforts and the results of those efforts
  • Current diet considerations that influence eating behavior
  • Factors that have contributed to previous success and failure in weight control

Your meeting with the psychologist is also intended as an opportunity for you to obtain information about the emotional and psychological impact the dietary and behavioral adjustments will have on your life after surgery. We anticipate that this consult will be a positive experience for you. The psychologist will also be available for consults after surgery if needed.

Cardiology Consult

Many patients require a non-invasive stress test of the heart to ensure that your heart is capable to undergo the stress of surgery. If this test is positive, or if your doctor has any concerns about your heart you may be asked to see a cardiologist or heart doctor who will examine you and clear you for your surgery. Sometimes additional heart tests are needed.

Sleep Study

If your doctor is concerned that you may be at risk for sleep apnea you will be asked to undergo a sleep study prior to scheduling your surgery. Your need for a sleep study will be determined by your history, symptoms, and related health problems. Sleep studies require an overnight visit to a sleep laboratory.

Abdominal Ultrasound

If you have symptoms that suggest you may suffer from pain from gallstones you will be scheduled for an abdominal ultrasound to determine if you have gallstones. If you have already had your gallbladder removed, you will not need to complete this test.

Bone Densitometry

All patients are scheduled for a bone density test prior to surgery and at 1, 2, and 5 years after surgery to evaluate for osteoporosis.

Two Weeks (14 days) Before Surgery

You will be asked to begin a specific pre-operative diet 14 days before the date of your surgery. The purpose of this diet is to decrease the size of your liver and familiarize you with the diet you will be on after your surgery. The diet you will be following is higher in protein and lower in carbohydrates. While on this diet, the glycogen stored in your liver will be used for energy. This will decrease the size of your liver. A smaller liver allows for better access and visualization of your stomach during the operation. An enlarged liver may be a reason for converting to an open surgery.

The Night Before Surgery

The night before surgery it is important that you do not eat or drink after midnight. Most often you will take your regular medications the morning of surgery with a sip of water. Some medications should NOT be taken before surgery.  Medications such as aspirin, ibuprofen, or Motrin can affect the clotting ability of the blood, and you should stop using these medications one week (7 days) before surgery.

What kind of diet should I expect for Gastric Bypass?

Normal Stomach Function

The job of the stomach is to receive all types of foods and liquids in many different quantities and consistencies. The stomach is a muscular organ, which can stretch, squeeze, and churn food. It reduces solid food to a nearly liquid form and empties it into the small intestine at a regular rate. The stomach produces acid and enzymes that help in the digestion process. Further digestion and absorption of nutrients and calories occurs in the small bowel wit the help of bile from the liver and secretions from the pancreas.

Weight loss after gastric bypass

After gastric bypass surgery, weight loss is the result of three mechanisms:

  • The pouch limits the amount of food that can be eaten, which decreases calorie intake.
  • The narrow outlet delays emptying of solid food from the pouch, which results in a sense of satisfaction after meals. You will feel full with less food.
  • The roux-y limb causes sugar and fatty foods to make you uncomfortable.

Because the small pouch is no longer able to grind food, all swallowed food must be well chewed so that it can empty through the narrow outlet. Three meals per day are eaten. The size of meals at first will limit caloric intake to between 300-500 calories per day. Energy needs are met by burning calories stored in the fat tissue. Success with weight loss will depend on your adherence to nutritious food choices and not snacking or grazing between meals. The pouch is a tool that you will need to learn how to use so that you can lose weight and keep it off.

Purpose of the gastric bypass diet:

  • To emphasizes lower calorie foods high in essential nutrients and protein and low in fat and sugar.
  • Minimize nausea, vomiting, and discomfort with eating and drinking.
  • Safely maximize your weight loss.
  • Help you make healthy food choices.
  • Provide you with the dietary tools you need for long-term success for maintaining your weight loss.

After surgery you will have to relearn how to eat and drink. During the first 3 months after surgery the consistency of the foods you eat will gradually change. The diet is formulated into three distinct stages, each reflecting a change in consistency. Once you are tolerating one stage without problems, you will transition to the next stage. You will find that as you increase the consistency of the food, you will not be able to eat the same volume or amount. For example, if you ate 3 ounces of pureed chicken on the Stage 1 diet to feel full, when you transition to the Stage 2 diet you may only be able to eat on 2 ounces of ground chicken breast. In the beginning there is very little variety, and food may become boring, but patients typically have very little appetite. You eat because meals are scheduled, and because you need to meet protein requirements.

Three Stages of Diet

  • Stage 1: To be followed for approximately two weeks post-operatively. The stage 1 diet consists mostly of pureed food.
  • Stage 2: Usually begins two weeks post-operatively, once you are tolerating Stage 1 without difficulty. Stage 2 diet consists of soft, easy to chew foods. These foods have passed the fork test; they can be easily mashed with a fork.
  • Stage 3: Final stage of the diet, and consists of solid food which is low in fat and sugar.

Important Guidelines

  • Eat only when you are completely relaxed. If possible, lie down and relax for 10-15 minutes before eating.
  • You should be sitting straight up when eating, as gravity will help food pass through your pouch.
  • Eat slowly. Set aside 30-45 minutes to eat for each meal.
  • Chew your food thoroughly.
  • Sufficient protein is important. You need to eat at least 60 grams of protein each day. At mealtime, eat the protein portion first. Then, if you are not full, eat the vegetables and fruit. Eat starches last. Stop eating when you are pleasantly full. In the beginning, you will not have room for any foods aside from protein.
  • Do not drink liquids for 30-45 minutes before or after eating solid foods in order to eat more solids in one setting. Do not drink liquids during your meals.
  • The amount of sugar in your food must be less than 10 grams per serving. The amount of fat per serving also needs to be 10 grams or less. You must learn to read food labels!. Eating foods high in sugar or fat will cause nausea, pain and/or diarrhea. It may also cause sweatiness and lightheadedness.
  • Avoid high calorie liquids at all times (alcohol, fruit juices, regular sodas, sports drinks, and protein shakes or supplements). These calories leave your stomach quickly and are absorbed quickly. This may slow your weight loss or cause weight regain.
  • Eat three meals per day, with no snacking. Snacks promote old eating habits and result in an intake of excess calories. Snacking will slow weight loss initially and lead to weight regain in the future. Snacking is the number one way to defeat the surgery.

Vomiting after Gastric Bypass

Vomiting can be caused by:

  • Eating too fast and not chewing properly
  • Eating too much at a meal
  • Drinking liquids right after eating
  • Lying flat right after a meal
  • Eating foods high in fat or sugar

If regular vomiting continues for more than 24 hours contact your doctor. Most vomiting episodes can be prevented. If you experience an episode of vomiting you should take the following precautions:

  • Do not eat or drink anything until your discomfort (pain or nausea) has subsided.
  • Once any nausea or pain has stopped, start with sips of liquids, ice chips, or sugar free popsicles. Preventing dehydration is the first priority.
  • Once liquids are tolerated, you may begin eating food again. Start with a Stage 1 diet for 24 hours, then you may slowly advance to Stage 2 and 3 foods.

Food Tolerance

Certain foods are known to be more difficult to tolerate after gastric bypass surgery. The tolerance for these foods varies from person to person. Use your own discretion when selecting from the following groups:

  • Red meats
  • Membranes of oranges or grapefruit.
  • Cores, seeds, or skins of fruits and vegetables.
  • Fibrous vegetables such as corn, celery, or sweet potatoes.
  • Chili or other highly spiced foods.
  • Doughy bread products.
  • Rice
  • Instant mashed potatoes.

Milk is an important part of your diet and supplies much needed protein and calcium. If you are unable to tolerate it as a beverage, it should be incorporated into the diet through other foods.

After the gastric bypass a condition called ‘dumping syndrome’ may occur. When simple sugars reach the small intestine a large amount of fluid is drawn into the small bowel. Feeling light headed, sweating, a rapid heart rate, crampy abdominal pain, nausea, and diarrhea are symptoms of dumping syndrome. Not eating foods or drinking liquids with high sugar content avoids the problem of dumping. Sweets, candy, fruit juice, certain dressings, barbecue sauce, tomato sauces, and mayonnaise may all cause problems. Sugar content must be less than 10 grams of sugar per serving. Sorbitol and sugar alcohol are also forms of sugar and need to be avoided.

Water

Why is drinking water important?

Drinking water prevents dehydration. After gastric bypass surgery, you are at risk for dehydration for two reasons. First, you are not able to drink large volumes of liquids rapidly. Because of this you will need to constantly sip liquids, pacing yourself throughout the day. Secondly, your metabolism has changed and your body needs more water in order to burn the fat. If you do not drink enough liquid, your metabolic rate decreases and your weight loss slows.  Drinking water helps the body to eliminate waste products. All the burned or metabolized fat needs to be flushed out of your system.
Water helps to prevent constipation. Drinking enough water helps to promote normal bowel function.

What kinds of liquids should you drink after surgery to prevent dehydration?
Any liquid that is low or no calorie, decaffeinated, and not carbonated.

  • Water
  • Crystal light
  • Sugar free kool aid
  • Fruit2O
  • Propel
  • Milk- skim or 1%

What are the symptoms of dehydration?

  • Constant nausea- if you start to feel nauseated it is a signal to you to start drink more.
  • Thirst
  • Constipation
  • Dark, concentrated urine
  • Dizziness
  • A bad taste in your mouth
  • Fatigue

How much liquid do you need to drink each day?

The minimum amount of liquid you will need to drink is 64 ounces. Some people will need to drink more to stay hydrated.

What should you do if you think you might be dehydrated?

Continue to focus on drinking your liquids. You need to drink through the nausea. If your symptoms persist, call the office as early in the day as possible. You may need to be seen in the clinic and given intravenous fluids.

Do I need to exercise after surgery?

Regular participation in an exercise program is a very important part of your new routine.  You will need to exercise in order to lose weight and maintain your weight loss. There are 1440 minutes in every day; schedule 60 of them for physical activity!  Running errands or household chores do not count.  You need to dedicate 60 minutes of time each day for exercise alone.

Exercise is important for the following reasons:

  • Increases strength and muscle tone.
  • Improves endurance.
  • Improves your ability to complete activities in daily life.
  • Improves circulation and helps heart and lungs to function more efficiently.
  • Decreases bone loss that could lead to osteoporosis.
  • Maximize total weight loss.
  • Improved energy levels.
  • Improved sense of well being.
  • Decreases stress.
  • Increases high density lipoprotiens (good cholesterol).

Getting Started

Be sensible and start out slowly. If you have been inactive for a while, begin by choosing a moderate intensity activity.  Although you should spend 60 minutes each day exercising, this time can be broken into 15, 20, or 30 minutes intervals during the day if you are not able to do 60 minutes all at once, especially when you first start out. Gradually increase either the length of time or the intensity of the activity as you become more conditioned.

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