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Before surgery

Whether you are just exploring metabolic and bariatric surgery or preparing for surgery, Kaiser Permanente is here to support you. Learn more about important considerations and explore common questions before surgery.

The top 10 factors to consider before having metabolic and bariatric surgery

One of the most important goals of the Options program is to prepare you for a safe and effective surgery if you decide surgery is right for you. Surgery can change your life in a lot of ways, and it’s important to be aware of these up front. We asked Kaiser Permanente members who have had the surgery to share some of the most important decision-making factors when it comes to metabolic and bariatric surgery. Here are the top 10 considerations that came from those conversations.

1. Surgery is just a tool

Surgery is just a tool. Tools are only as effective as you allow them to be. On average, you will see the greatest effects within the first 18 months after surgery. After that, the ability to maintain weight loss will depend on long-term lifestyle changes (sleep, physical activity, healthy eating, and mental health).

2. Pre-surgery weight loss

To improve the safety and effectiveness of your surgery, surgeons ask you to lose some weight before surgery.

3. Lifelong changes to the way you eat and drink

Surgery changes your digestive system, making it necessary to change the way you eat and drink. You will only be able to eat small amounts at a time. You must also separate what you eat and drink by 30 minutes.

4. Vitamin and mineral supplements for the rest of your life

Surgery changes your digestive system, and some vitamins and minerals will no longer be absorbed as well. To stay healthy, you will have to take vitamin and mineral supplements every day for the rest of your life.

5. Relationship changes with self, food, and others

Surgery can lead to major lifestyle adjustments (for example, how and what you eat and drink) and body changes (for example, extreme weight loss and loose skin). This can also impact how you think about yourself, your relationship with food, and your relationship with other people. Taking care of your whole self, including both your mental and physical health, is an important part of the pre- and post-surgery experience.

6. Sleep

Sleep is key for overall health. Many people have sleep apnea before surgery. While it can improve with weight loss, it’s important to continue treatment for sleep apnea after surgery.

7. Fitness before and after surgery

Being able to walk for at least 15 minutes before surgery is aimed at making sure you’re able to move after surgery to reduce complications like blood clots and lung infections. Gradually increasing your fitness toward a goal of 150 minutes of moderate-intensity exercise a week will help keep your weight off long term. Finding a fitness routine that works for you after surgery is key to long-term success.

8. Tobacco

Smoking or chewing tobacco or using other nicotine products (vaping devices, e-cigarettes) harms every organ in the body and has been linked to ulcers, blood clots (the leading cause of death after metabolic and bariatric surgery), heart disease, stroke, lung disease, increased risk for hip fracture, cataracts, and certain cancers.

Need support quitting tobacco? Check out our Center for Healthy Living resources, including Freedom from Tobacco workshops and Wellness Coaching by Phone.

9. Alcohol

Alcohol is not recommended after surgery. Surgery changes the way your body absorbs and processes alcohol. Alcohol contains calories that will work against your weight loss goal, and it may cause ulcers. Alcohol is also more addictive after surgery. One in five patients develop alcohol-use disorder within 7 years after surgery.

Need support to lower your drinking risk? Check out our Center for Healthy Living resources on alcohol and your health.

10. Family planning/pregnancy

It’s recommended to avoid getting pregnant for 18 to 24 months after surgery. This allows you to have maximum weight loss and reach a stable weight. Your nutrient intake will also be very limited for quite some time after surgery, which can affect a baby’s development. Weight loss can improve fertility, and it may be easier to get pregnant after surgery.

Common questions before surgery

Why is it recommended to lose weight before surgery?

To improve the safety and effectiveness of metabolic and bariatric surgery, surgeons ask you to lose some weight before surgery. This does three things.

  1. Decreases the size of your liver. This makes it easier for the surgeon to operate.
  2. Makes laparoscopic surgery safer. It also makes it less likely to be converted to an open procedure. This is because the gas pumped into your abdomen not only holds up your skin so the surgeon can see but also pushes down on major blood vessels, which can reduce blood pressure. If this happens, the surgeon can’t pump in more gas, which reduces visibility. The less visibility, the higher the risk of complications. Therefore, people with a higher BMI may be asked to lose more weight before surgery.
  3. It can make it easier to lose weight after surgery. This varies for each person. In general, losing weight
    leads to a lower resting metabolic rate (the rate at which you burn calories at rest) and your body will burn fewer calories. Therefore, it can actually be easier to lose weight before surgery and use the surgery as a tool to help you lose and maintain more weight loss long term.

Overall, research has shown that weight loss before surgery may reduce complications after surgery.

Source: Anderin, C. (2017). Response to “Weight Loss Before Bariatric Surgery and Postoperative Complications”. Annals of surgery, 265(4), e55.

Is there a standard diet right before surgery?

This will depend on your surgeon. Follow your surgeon’s guidance for what to eat in the days right before surgery.

Why do I need to quit smoking before surgery?

Smoking or chewing tobacco or using other nicotine products (vaping devices, e-cigarettes) harms every organ in the body and has been linked to ulcers, blood clots (the leading cause of death after metabolic and bariatric surgery), heart disease, stroke, lung disease, increased risk for hip fracture, cataracts, and certain cancers. It can also increase the risk for wound infection and leaks after surgery.

What are important considerations for women of child-bearing age when thinking about metabolic and bariatric surgery?

It’s recommended to wait 18 to 24 months after surgery to get pregnant. This allows you to have maximum weight loss and reach a stable weight. You will also be able to build your nutrition back up to help make sure you have a safe pregnancy. Fertility improves with weight loss, and people often become more sexually active. Therefore, it’s important that women of child-bearing age (still menstruating) choose a birth control method before surgery.

Learn more about metabolic and bariatric surgery and family planning.

What if I decide not to have surgery right now?

At Kaiser Permanente Southern California, your referral to metabolic and bariatric surgery is good for 1 year after completing the Options pre-surgery workshops. After that, it is recommended that you retake the Options pre-surgery workshops to make sure you are prepared for a safe and effective surgery.

How much does metabolic and bariatric surgery cost?

Options is a covered benefit for Kaiser Permanente Southern California members. However, there are costs associated with hospitalization that will vary based on individual coverage. Please contact Member Services to discuss your individual coverage at 1-800-464-4000 24/7, except major holidays.

Can I use short-term disability and/or FMLA for time off work?

Yes, you can use short-term disability and/or FMLA for time off work.

Is the stomach removed during surgery?

This depends on which surgery you have.

Gastric sleeve (sleeve gastrectomy) surgery makes the stomach smaller by permanently removing most of it. Once you’re under anesthesia, the surgeon will place a small tube in your mouth and guide it down to your stomach. This tube is about the size and shape your stomach will be after surgery. The surgeon cuts the stomach around the tube’s outline. The part that’s left behind is closed with permanent staples. The tube is then carefully pulled back out. The portion of the stomach that was cut is then removed from the body.

With gastric bypass surgery, the stomach is separated into two parts. Each part is stapled shut. This leaves a small stomach pouch about the size of an egg. Like gastric sleeve, this small pouch limits (restricts) how much food you can comfortably eat. Next, the small intestine is cut and reattached to the stomach pouch. This is the “bypass.” The other part of the intestine is reattached to your new digestive system so digestive juices can flow easily. Food now moves from the new stomach pouch directly to the lower part of the small intestine. In gastric bypass surgery, nothing is removed.

Two women in yoga class

Mental health and wellness before surgery

There is no shame in getting support.

Your mental health is just as important as your physical health. If you had a broken leg, you would seek help to make sure it healed properly. Mental health is the same! Getting the right care is key to helping you heal.

Explore our resources

Physical activity before surgery

Starting a regular physical activity routine that you enjoy before surgery can help you lose weight (which makes your surgery safer), increase rates of good surgery outcomes, and improve overall well-being.

Explore our resources

Woman sleeping in bed

Sleep before surgery

Sleep has a major influence on your overall health, especially your weight. The amount of sleep you get can change the hormones in your body that drive you to eat more and/or choose less-healthy options. Treating sleep problems before surgery is very important. Starting and sticking with healthy sleep habits after surgery is important for long-term weight loss and overall health.

Explore our resources

Senior couple smiling

Life Care Planning

Because metabolic and bariatric surgery is a major procedure, it’s important to think about choosing someone to represent your health care wishes in case there is a time in the future when you can’t speak for yourself. At Kaiser Permanente, we have made this process simple and easy through our Life Care Planning program.

Learn more about Life Care Planning

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