What are the selection criteria for weight loss surgery?
What procedures are available at Methodist?
How does the LAP-BAND work?
How does the Roux-en-Y gastric bypass work?
What risks are involved in this type of surgery?
What should I expect after surgery?
What are the other benefits of surgery?
Does my diet after surgery need to change?
What is my protein requirement after surgery?
How will I drink fluids?
Will I need to take supplements?
Will my insurance cover surgery for weight loss?
How should I select a physician and hospital for weight loss surgery?
How do I set an appointment for the pre-surgery visit?
What occurs during the pre-surgery visit?
What if my insurance requires a pre-surgery diet program?
When do I come to the center after surgery?
To be a candidate for bariatric (weight loss) surgery, you must:
- Have a Body Mass Index (BMI) of 40 or greater (about 100 pounds over ideal body weight) or BMI of 35 to 39.9 with a significant obesity-related condition such as diabetes, high blood pressure, heart problems, sleep apnea, or reflux disease.
- Have made prior attempts at weight loss such as diets, exercise, behavior modification or medications.
- Have an understanding of the possible risks, benefits, and side effects of the procedure.
- Have no medical or psychiatric condition in which surgery would be contraindicated.
- Show commitment and motivation with realistic expectations after surgery.
- Be free of any other addictive behaviors such as smoking, drinking, and/or drug abuse.
- Undergo both psychological and nutritional evaluation prior to approval.
The Weight Management Center at Houston Methodist Hospital offers several different surgical weight loss treatments. Two of the best-known procedures, the LAP-BAND® and the Roux-en-Y Gastric Bypass (RYGB) are both performed at The Methodist Hospital. The LAP-BAND® is considered a restrictive surgery (meaning that weight loss occurs by strictly reducing daily food intake) and does not involve cutting or stapling of the stomach. The RYGB surgery both restricts the amount of food ingested and causes malabsorption (less absorption of calories and nutrients) by surgically bypassing a portion of the intestinal tract.
The LAP-BAND® is the least invasive weight loss surgery option. The LAP-BAND® procedure uses a silicone band that is fastened around the upper part of the stomach, greatly reducing the volume, or capacity of the stomach. The banded upper stomach or small “pouch” causes a feeling of fullness when consuming small amounts of food. The band is adjustable, so tightening the band further increases the sense of fullness, and over time, may continue to reduce daily caloric intake. To tighten the band, the inner surface can be inflated by injecting a saline solution into a self-sealing access port located just under the skin. This allows the surgeon to increase or reduce the size of the band to better promote successful weight loss. Though not an intended option, the LAP-BAND® is removable and completely reversible.
The Roux-en-Y gastric bypass (RYGB) is both malabsorptive and restrictive. This surgery involves creating a small stomach pouch by stapling across the top portion of the stomach, dividing it from the rest of the stomach. The new pouch is about the size of an adult’s thumb and holds about 1 ounce (2 tablespoons) which greatly reduces food volumes and portions able to be consumed at one time.
The intestine is surgically restructured so that the small pouch connects directly to the middle part of the intestine (the “Roux limb” of the jejunum), thereby bypassing the majority of the stomach and upper intestine (duodenum). Normal digestion and absorption of nutrients are reduced due to the small stomach size and altered, shortened intestine; this decreases absorption of calories and nutrients.
Failing to follow an appropriate diet soon after RYGB can cause a side effect called dumping syndrome. Dumping syndrome occurs when consuming foods or fluids (1) high in sugar and fat, (2) at the same time, or (3) in larger amounts that triggers “dumping” or faster emptying of foods or fluids from the stomach pouch directly into the intestine, causing symptoms such as abdominal cramping, diarrhea, lightheadedness, sweating, and heart palpitations.
Every surgical procedure has a certain degree of risk. While complications are extremely infrequent at Methodist, some risks include infection, gastric leaks, pneumonia, pulmonary embolism and in very rare cases, death. The surgical risks will be discussed with you at length when you meet with our surgeons prior to surgery so that you can weigh your own personal advantages against the risk of bariatric surgery.
What should I expect after surgery?
Weight loss varies from patient to patient, and also depends upon the procedure you are having.
Those who have the LAP-BAND® procedure can expect weight loss of 1-3 pounds per week in the first year after surgery. Though weight loss is gradual, maintaining a structured diet and exercise regimen will promote long-term weight loss.
Persons who have the RYGB generally experience rapid weight loss that mostly occurs in the first six months to one year after surgery. Long-term, a person may maintain a weight loss of 50 to 60 percent of excess weight.
Remember, eating behaviors must change permanently. There is a potential for eventual weight regain if a person does not adhere to diet and exercise regimen, eats more than recommended amounts, or increases frequency of meals.
Some patients may experience heightened anxiety or depression within the first years after surgery. This is usually not serious, and can be handled many times over the phone. Monthly TMH patient support groups are not mandatory, but highly recommended, and helpful in managing lifestyle changes and for ongoing social support.
After surgery, patients often report a number of health improvements. Many patients are able to reduce or eliminate their previous medications for diabetes, hypertension, reflux, and other conditions.
In addition to the weight loss and decrease or elimination of medication, many patients enjoy increased energy and a greater interest in physical activity, along with greater self-confidence.
The diet after surgery usually starts with clear liquids and progresses gradually to regular, low-fat diet. The diet progression promotes gastrointestinal tolerance, initial healing after surgery, and reduction of potential complications associated with surgery.
Immediately following surgery, you will be sipping on clear liquids (1 to 2 ounces every hour). Clear liquids include water, broth, sugar-free fluids (e.g., diet fruit-flavored drinks, Crystal Light®), and decaffeinated, non-carbonated beverages. Over the course of the first month, the diet will slowly progress to include initially low-fiber foods, semi-solid foods (blended), soft-textured foods, and finally a regular diet. Foods consumed should be low in fat and sugar.
The portions at each stage of diet will gradually increase, also. Long-term, the recommended average portion of food consumed at one setting is about 8 ounces (1 cup).
Food tolerances vary among individuals. For example, a person may react differently to a specific food that may have been tolerated before surgery or that is tolerated by someone else who had the surgery.
Prior to surgery, you will meet with a clinical dietitian for a comprehensive instruction with nutrition education handouts regarding diet and recommended behavior changes after surgery.
Due to the limited portions, it is important to maximize nutrition by choosing low-fat, higher protein foods. The general goal is at least 70 grams protein per day from foods and fluids. Immediately after surgery, protein intake may be limited due to the volume limitation of foods and fluids. Eventually, as more solid foods and fluids are tolerated, you will be able to consume more protein sources and achieve your protein goal.
Good sources of protein include: meat, poultry, fish, low-fat cheese, low-fat cottage cheese, low-fat tofu, light yogurt, and beans /legumes. Grains and vegetables contain protein in smaller amounts.
Many people supplement meals with protein powders (e.g., 100% whey protein isolate, soy protein isolate or protein drinks (e.g., Isopure®, No sugar added Carnation Instant Breakfast®). Ask your dietitian if you have questions regarding protein supplements.
Foods and fluids cannot be consumed at the same time. Fluids should be consumed on a consistent basis between meals. You should wait at least 30 to 60 minutes before and after meals to drink fluids. Also, drinking fluids right after meals may expand the stomach pouch or force foods through the intestine at a faster rate causing uncomfortable side effects (e.g., dumping, vomiting).
Fluids consist of water, broth, or sugar-free fluids (e.g., Crystal Light®), sugar-free gelatin, sugar-free popsicles (no fruit pieces), milk, and soy milk. Carrying a water bottle during the day is recommended, so that you always have fluids on hand. Take your time drinking fluids.
Avoid caffeinated and carbonated beverages. Caffeine is an appetite stimulant, causes increased urination that may promote dehydration, and can interfere with mineral absorption (e.g., calcium). Carbonated beverages can expand the pouch or cause discomfort, (e.g., belching).
Avoid alcohol. It is considered “empty” calories and may not be well tolerated after surgery.
Reduced calorie intake, poor digestion/absorption of nutrients, and changes in food tolerances may lead to protein or vitamin/mineral deficiencies and poor nutrition. Possible side effects of deficiencies include hair thinning, hair loss, muscle loss, bone loss (long-term osteoporosis), low body iron stores, and tiredness.
After bariatric surgery, you are at risk for malnutrition. Daily vitamin and mineral supplementation is required for life. The dietitian will recommend specific vitamin and mineral supplements which may include prescribed supplements by your physician.
Diet Tips at a glance
- Choose sugar-free or low sugar fluids. You may use sugar-substitutes (e.g., Sweet-n-Low®, Nutrasweet®, Splenda®).
- Avoid beverages containing caffeine, carbonation, or alcohol
- Choose low-fat, high protein foods for good nutrition
- Meats must be lean and low in fat. Try other healthy protein foods which include tofu or soy-based products, low fat yogurts/cheeses, beans
- Eat the meat or protein first at every meal
- Avoid high fat foods, sugary desserts and monitor portion sizes closely to decrease daily calories
- Practice taking small bites (pencil eraser size bites) and chew foods thoroughly– 30 chews per bite. Stop eating when you are full
- Make mealtime last up to 30 minutes
- Carry a water bottle during the day and sip on fluid on a consistent basis between meals
Most insurance companies provide some coverage for gastric bypass surgery. Our staff at the Weight Management Center can help you find out your benefits. Because we understand the medical importance of bariatric surgery as an often-lifesaving procedure, we are your advocates, and will work directly with your insurance company to ensure that you receive the coverage that is available.
The decision to have bariatric surgery is an important one, as is determining which physician and hospital is right for you. It is critical to select a center that provides a comprehensive multidisciplinary program. Our team of surgeons, physicians, nurses, dietitians, and psychologists will care for you from start to finish.
The Methodist Hospital's Weight Management Center is proud to be a Center of Excellence. This is your assurance that our surgeons are board-certified in general surgery and have significant abdominal and laparoscopic surgery experience. Our center has also been designated a Level-1 Bariatric Surgery Facility by the Bariatric Surgery Center Network (BCSN) Accreditation Program. The Methodist Hospital is licensed and Joint Commission on the Accreditation of Healthcare Organizations (JCAHO) accredited. We are equipped with an intensive care unit, strong diagnostic tools such as CT scanners, 24-hour physician staffing and a full range of medical specialists on staff to help you.
You may set up your comprehensive pre-surgical appointment by calling the Weight Management Center at 832-667-LOSE (5673). The appointment will take about two and a half to three hours. The required nutritional and psychological evaluations will be performed at this time. You will also meet with the bariatric nurse for anthropometrics (body measurements) and a laboratory test as explained below.
Attached below is important paperwork that must be completed and submitted at your appointment.
In addition to printing and completing the three documents above, please also go to forms for existing patients and follow the instructions to have access to the Patient Portal. This will help you, the surgeon’s office and the Weight Management Center track your information and progress.
There is one form that needs to be completed at the center, so please arrive 30 minutes prior to your appointment time. If you are unable to open the attached files or do not complete them prior to your appointment date, then please arrive one hour early to complete these forms. If you are unable to keep your appointment, please call at least 24 hours in advance to cancel or reschedule. Because of the center's schedule, we cannot guarantee that you will be serviced if you arrive more than 20 minutes late for your scheduled appointment.
We are located in the Neurosensory Building of The Methodist Hospital, located on the corner of Fannin and John Freeman Boulevard.
6501 Fannin St.
Houston, TX 77030 (map)
The psychological evaluation includes an interview with the psychotherapist, who will examine past psychiatric and psychosocial history along with assessment of coping skills – an important factor in dealing with lifestyle changes after bariatric surgery.
A nutritional evaluation will involve meeting with the clinical dietitian to discuss past nutritional history, current eating and lifestyle habits, and post-surgery expectations. You will receive a bariatric surgery guide with nutritional parameters, as well as information for your pre-surgery diet program if it is required by your insurance or physician. Also, you will be required to attend a 90-minute comprehensive nutrition class that covers diet after bariatric surgery. The class schedule will be given at the evaluation session.
The bariatric program nurse will check blood pressure and anthropometrics (e.g., weight, height). Also, an H. Pylori breath test, if requested by surgeon, will be performed. Helicobacter pylori are bacteria that can cause stomach and duodenal (small intestine) ulcers in some individuals; it has also been linked to certain stomach cancers. It is a critical test to perform prior to having gastric bypass surgery; once the stomach is stapled shut, H. pylori is difficult to treat. The breath test requires that you have nothing to eat or drink (including water and chewing gum) for one hour prior to the test. Please notify the nurse ahead of time of appointment if you have taken any of the following drugs:
- Prilosec OTC
- Pepto Bismol
A pre-surgery photograph will also be taken at this appointment.
As part of your insurance criteria, you may be required to complete a three to six month program with a registered dietitian to qualify for bariatric surgery. This program is designed to prepare you for bariatric surgery and the lifestyle changes which will follow. Throughout the program you will work toward established goals which focus on exercise, healthy meal planning and behavior modification.
Our pre-surgery diet program is meant to:
- Assess your diet history and develop a personalized plan to improve your nutrition/behavior prior to surgery
- Educate and prepare you for the nutrition and lifestyle changes required after bariatric surgery
- Encourage taking responsibility for your diet and lifestyle by closely monitoring your progress
- Require demonstrated nutrition and behavior changes at the end of the three or six month program
Your surgeon also may order a pre-surgery nutrition program if deemed necessary for a goal of weight loss prior to surgery. The time frame and/or weight loss goal will be determined by the surgeon based upon your particular situation.
You may call the Weight Management Center at 832-667-LOSE (5673) to schedule your pre-surgery diet program.
Long-term maintenance and adherence in both healthy diet and lifestyle is critical for success. In addition to follow-up with your surgeon after surgery, it is highly recommended that you come back to the Weight Management Center for nutritional consultation with your dietitian, emotional counseling with your psychotherapist, and cardiac rehabilitation with your exercise physiologist or staff to re-condition your body. General follow-up after surgery is recommended at one month, three months, six months, one year and annually thereafter.
The Methodist Hospital monthly patient support group meetings are held on the last Wednesday of every month from 7:00 p.m. to 8:30 p.m. in the Bluebird Auditorium, on the first floor of the Neurosensory Building at 6501 Fannin Street. Weight Management Center staff will be present to address any questions that you may have. These meetings are a great way to network and gain peer support for ongoing postoperative success.