Frequently Asked Questions (FAQs) About Weight Loss Surgery

Who benefits from bariatric surgery?

Bariatric surgery helps people with obesity lose weight and keep it off. Typically, patients who have bariatric surgery have tried to lose weight with diet and exercise. Often, they have been successful in losing weight but then have gained most or all of it back. Patients who have bariatric surgery are often motivated by a desire to improve their overall health.

The National Institutes of Health recommends offering bariatric surgery to people with 1) a Body Mass Index (BMI) of 40 or higher or 2) a BMI of 35 to 40 and an obesity-related health condition such as high blood pressure, diabetes, or sleep apnea.

National Institutes of Health Consensus Development Conference Statement

How do I know what my Body Mass Index (BMI) is?

All you need to calculate your BMI is your height and weight. Calculate your BMI.

Why should I have bariatric surgery?

You may wish to have bariatric surgery if you have obesity. Obesity is defined as a BMI greater than 40 or a BMI of 35 to 40 with any associated medical conditions such as high blood pressure and diabetes. If you meet those criteria and would like to lose weight and improve your overall health, you should consider bariatric surgery.

What are the expected benefits of bariatric surgery?

After bariatric surgery you can expect to lose weight. The amount you lose and how fast you lose it will depend on the type of procedure you have. With some procedures your overall health improves as you lose weight. With some procedures medical problems such as diabetes are cured or significantly improved on the day of surgery. Most of our patients describe having more energy and zest for life. Read testimonials from our patients.

What are the risks of having bariatric surgery?

Like all surgeries, bariatric surgery is not without risk. However, bariatric surgery is actually safer than having your gallbladder taken out. Some of the risks include more common problems such as small wound infections and hernias, which are not life-threatening and easily treated. Some of the risks include less common problems such as a leak or bleeding, which may require a second operation.

Can I lose weight with diet and exercise?

Many people are successful at losing weight with diet and exercise. Unfortunately, most people are not able to keep that weight off. Fewer than 5% of individuals who lose a significant amount of weight with diet and exercise are able to keep that weight off.

Who are the bariatric surgeons at Washington University in St. Louis?

We are proud to have Drs. J. Christopher Eagon, Shaina R. Eckhouse, and Arghavan Salles performing bariatric surgery at Washington University in St. Louis. Learn more about our team.

Why should I have bariatric surgery at Washington University in St. Louis?

Our bariatric surgery program is accredited by the American Society for Metabolic and Bariatric Surgery, the leading surgical society for bariatric surgery. Our surgeons are leaders in American bariatric surgery. All three of them are members of leadership committees within the American Society for Metabolic and Bariatric Surgery. Our hospital is consistently ranked as one of the best hospitals in the United States, as is Washington University School of Medicine among medical schools. We are at the leading edge of research with ongoing studies including:

  • The evaluation of the impact of endoscopy on bariatric surgery procedure choice
  • Prediction of challenges after bariatric surgery using manometry and endoscopy data
  • Impact of biliopancreatic switch on glucose management
  • Impact of transversus abdominis block on post-operative pain after bariatric surgery
  • Improving clinical outcomes following bariatric surgery

What kind of food can I eat after bariatric surgery?

After the gastric bypass, sleeve gastrectomy, and duodenal switch, your diet will be restricted over the first month. The first week you will be on a liquid diet. Then you will be on a pureed diet for two weeks, and then a soft diet for two weeks. After that you will be able to eat whatever you feel like. You will also need to focus specifically on eating foods with high protein so you can improve weight loss and prevent muscle loss. Many people find that their tastes change after surgery, so you may no longer like what you used to eat. In particular, people have less interest in sweet foods after surgery.

Will I have a lot of pain after surgery?

Everyone’s experience with pain is different. Many people do not have a lot of pain after surgery, but some people do. We will work with you to try to make that pain tolerable. People who are taking narcotic pain medications before surgery may experience more pain after surgery.

How long does surgery take?

The duration of surgery depends on what procedure you are having. The gastric band and the sleeve gastrectomy take 1 to 1 ½ hours. The gastric bypass takes 2-4 hours. The duodenal switch takes 4-6 hours.

What types of bariatric procedures are offered at Washington University in St. Louis?

Our weight loss surgery group offers the laparoscopic gastric band, gastric bypass, sleeve gastrectomy, and duodenal switch.

How long will I stay in the hospital after surgery?

After the gastric band, you will either be discharged the same day or go home the next day. After the sleeve gastrectomy or the gastric bypass, you will stay in the hospitals two nights, typically. After the duodenal switch, you should plan to stay in the hospital 4-5 days.

How much weight can I expect to lose after bariatric surgery?

How much weight you lose depends on what procedure you have. We typically discuss weight loss in terms of excess body weight. The difference between your current weight and your ideal body weight is considered your excess weight.

  • With the gastric band, you can expect to lose 30-40% of your excess weight.
  • With the sleeve gastrectomy, you can expect to lose 50-60% of your excess weight.
  • With the gastric bypass, you can expect to lose 60-70% of your excess weight.
  • With the duodenal switch, you can expect to lose 70-80% of your excess weight.

I smoke. How does that affect my surgery?

Unfortunately, it is not safe to have bariatric surgery if you are smoking. The risks of having problems after bariatric surgery (including leaks and ulcers) are much higher if you are smoking. For this reason, we require that you permanently quit smoking prior to having surgery. We will likely test your urine prior to surgery just to make sure the harmful nicotine is out of your system prior to surgery.

Is bariatric surgery covered by insurance?

Although bariatric surgery is the only effective method to lose weight and keep it off, not all insurance policies cover bariatric surgery.  Prior to entering a bariatric surgery program, you may wish to check with your insurance. If they ask for a procedure code, you can give them (43644: laparoscopic gastric bypass, 43775: laparoscopic sleeve gastrectomy, 43770: laparoscopic adjustable gastric band, 43845: duodenal switch).

How can I decide which procedure is right for me?

This is a personal decision for many people. You may know people who have had one procedure or another and had a good (or bad) experience. It is helpful to talk to these folks and get their thoughts. It is also important to know what your goal is. Is it to lose the most weight possible? Is it to improve your overall health? Is it specifically to treat high blood pressure or diabetes?

What kind of testing do I need before having bariatric surgery?

What you need to have done before surgery will depend on which procedure you want to have done and what your medical problems are. Everyone will need to:

  • Have some blood drawn for basic labs and vitamin levels
  • Have a basic heart test called an EKG
  • Have a breath test to check for the bacteria, H. pylori, which can cause ulcers in the stomach
  • Patients who want a sleeve gastrectomy will be asked to have an upper endoscopy to make sure that there is no reason to not have the sleeve gastrectomy.
  • One common consideration is reflux or heartburn because this can get worse after certain procedures.

Depending on what your symptoms are, you may be asked to do something called esophageal manometry or a pH probe. The manometry evaluates your esophageal muscles which helps to push food from your throat down into your stomach. The pH probe allows us to make sure you do not have acid in your esophagus, which could be a problem if you were going to have a sleeve gastrectomy.

Why do I need to see a psychologist before having surgery?

When the National Institutes of Health examined bariatric surgery, they recommended every patient be evaluated by a psychologist to make sure people are successful after surgery.

Why do I need to see a dietitian before having surgery?

If you decide to have bariatric surgery, the way you eat will change significantly. Meeting with our dietitians helps you to understand what your restrictions will be and how you can manage to eat enough protein to optimize your weight loss after surgery.

Why do I need to see a physical therapist prior to having surgery?

Physical exercise is an important part of any lifestyle change. Our physical therapists will help you find exercises you can do to help you on your weight loss journey.

Do I need to have an upper endoscopy before having surgery?

If you are interested in the sleeve gastrectomy, we will request that you have an upper endoscopy done to make sure that you do not have any problems that will make you struggle after the surgery. The main thing we are looking for is whether you have any heartburn or reflux that might get worse after surgery.

If your H. pylori breath test in the office is positive (meaning you have the bacteria), we will request an endoscopy to make sure the infection is gone.

Do I need to have manometry or a pH probe prior to having surgery?

Depending on what your symptoms are, you may be asked to do something called esophageal manometry or a pH probe. The manometry evaluates your esophageal muscles, which help push food from your throat down into your stomach. The pH probe allows us to make sure you do not have acid in your esophagus, which could be a problem if you were going to have a sleeve gastrectomy.

How do I sign up for bariatric surgery at Washington University in St. Louis?

All you need to do to sign up with us is to enter some basic information on our scheduling platform.

What is a leak?

A leak can occur any time we divide any part of your gastrointestinal tract. This happens with the sleeve gastrectomy, gastric bypass and duodenal switch. We use surgical staples for all of these, and if for some reason the staples don’t heal properly, you can have enzymes and food that are meant to be inside your stomach leak outside. The consequences of this are variable, and it is treated on a case-by-case basis when it occurs.

I went to an information session. Now what?

The next step after the information session is to have a visit with our nurse practitioner, Jayme Sparkman, ANP-BC. She will go through your complete medical history and perform a physical exam. She will also order laboratory studies and help you get set up to see our psychologist, dietitian, and physical therapist. Once you have completed all your requirements you will call the office and schedule an appointment to see one of our surgeons. After that you will be scheduled for surgery.

How do I reach your office?

You can call us anytime at (314) 454-7224. If you do not reach us, we will call you back within 1-2 days.

See ASMBS questions