If you are struggling with obesity, you’re not alone. More than 25 percent of New Yorkers are overweight or obese, according to the Centers for Disease Control and Prevention. Obesity is related to a number of common medical conditions, including type 2 diabetes, high blood pressure, sleep apnea, and back pain.

If you’ve tried to lose weight and are still struggling, you may want to consider bariatric weight loss surgery. A popular and often ideal option for people who have not been successful losing weight on their own, bariatric surgery involves surgically altering the digestive system in ways that make weight loss easier.

However, the decision to undergo bariatric surgery should not be made lightly, and there is much to consider beforehand. In this Q&A, two of Mount Sinai’s leading bariatric surgeons answer some commonly asked questions about these surgeries.

Danny Sherwinter, MD, is Chief of Surgery at Mount Sinai Brooklyn and Assistant Professor of Surgery at the Icahn School of Medicine at Mount Sinai, and Patrick Dolan, MD, is Assistant Professor of Metabolic, Endocrine and Minimally Invasive Surgery.

What are the different bariatric surgery weight loss options?

There are three types of bariatric surgeries:

• Lap band surgery decreases the amount of food needed to feel full. It involves placing an adjustable band around the stomach, restricting the amount of food consumed.

• Sleeve gastrectomy is the most common bariatric surgery in the United States. It involves reducing the stomach to about 20 percent of its original size, significantly reducing the volume of food required to make you feel full.  It also has an effect on hunger hormones.

• Gastric bypass surgery (also referred to as Roux-en-Y for the way surgeons perform this) is a procedure in which the surgeon creates a small pouch from the stomach and connects it directly to the small intestines. As a result of the surgery, the amount of food a patient will be able to consume is reduced, and even the food and calories they do eat will not be fully absorbed. 

Do I need to try all non-surgical weight loss options first?

Surgery is never the first choice for weight loss. You should try to lose weight on your own with diet and exercise.  You should also consult with your primary health care provider for their support and input. However, if you find that you are unsuccessful in losing weight despite these best efforts, you are not alone, as most people are unable to lose enough weight to improve their medical conditions and their quality of life.  For those people, surgery is an excellent option.

Who qualifies for bariatric (weight loss) surgery?

In general, most insurance companies are willing to cover bariatric surgery of any kind when a person’s body mass index, or BMI, is over 40 and they’re otherwise healthy; or if their BMI is over 35 and they have medical comorbidities associated with obesity, such as high blood pressure or diabetes. You can determine your BMI using the CDC calculator.

What will my insurance company require in order to get approved?

Most insurance companies will require you to go through a lengthy process to document your need for bariatric surgery. You will need approvals from a nutritionist and a psychologist, and will be required to see a number of other medical practitioners based on your medical history. In many instances, this will require you to visit a gastroenterologist, pulmonologist, cardiologist, and your own doctor. You will need to visit your doctor on a regular basis to document ongoing diet efforts, which you will need to submit to the insurance company for approval. This process, in some instances, takes up to six months or longer. Your bariatric surgeon will be able to guide you through the process.

Will my lifestyle and eating habits change after I have this surgery?

Yes. If patients don’t expect to dramatically change their lifestyle after surgery, then these operations will not result in weight loss. To succeed in the long term, you must fundamentally change your lifestyle, food choices, and how you eat, in addition to the operation. Getting enough exercise will also be important.

What will my diet be like before and after surgery?

A week or two before surgery, patients typically go on a liquid diet so they can lose some weight to make the operation even safer. After the operation, patients continue a liquid diet for a couple of weeks, then switch to a soft puree diet for a few more weeks. Within a month or so after surgery, the patient is put back on a regular diet. When you switch back to a regular diet, there is a risk of vomiting. However, if you avoid eating too fast or swallowing food without chewing, you will reduce this risk. We always recommend that bariatric surgery patients take vitamins, and follow up with their doctor to have vitamin levels checked.

Are there any complications from weight loss surgery?

As with any surgery, bariatric surgeries have possible complications, which are different for each. However, they are extremely safe overall. According to statistics, the risks for all of these operations, even bypass—the most complicated—is about the same as gallbladder surgery, an extremely safe and common ambulatory operation.

Will I be able to get pregnant after weight loss surgery?

In our experience, patients are more likely to become pregnant after weight loss surgery, and their pregnancies are often healthier and safer. Obese patients who are unable to become pregnant before surgery may become more fertile after surgery due to hormonal changes (reduction in elevated testosterone levels); possible ovarian issues (e.g. polycystic ovarian syndrome); and often a reduction in abnormal periods. The weight loss makes the entire birthing process safer. There’s also a higher incidence of gestational diabetes in pregnant women who are obese. We usually recommend waiting about a year after surgery before getting pregnant. But the timing should always be something to discuss with your bariatric surgeon and your obstetrician.