Weight Loss Surgery Consultation Overview

Weight loss surgery consultation is an important aspect before preparation for the surgery. Patients and surgeons must make it is as productive as possible

Patients should start the preparations for the bariatric surgery as soon as they make a decision to undergo it. It generally concerns dietary and exercising habits such as regular small meals, drinking at least 1,5 litres of water, making healthy choices as for products, quitting smoking, mental readiness for lifestyle changes.

Regarding the consultation, the more prepared is a patient, the more effective and informative is the visit. It is highly probable that a patient is informed how to prepare for a consultation by a surgeon or a clinic manager, however, we present some general guidelines that patients may find useful before the consultation:

• Getting to know how to qualify for weight loss surgery
  Patients should realize what qualifies for weight loss surgery type that they consider. This knowledge allows for self-evaluation and self-qualification (patients know which weight loss surgeries to consider and which are not for them). Most importantly, patients should know their BMI and what BMI for weight loss surgery is accepted.
• Preparing medical history
  The current health condition, as well as the family history, any past health issues, medication (including prescribed meds and any supplements), all the medical records from the doctors and hospitals, are vital. Of course, patients are examined thoroughly just before the surgery, however, sometimes it happens that patients medical records show that some weight loss surgery types cannot be performed. It is of uttermost importance not to keep any past or present health problems from the surgeon because it may result in serious complications afterward
• Noting down the history of weight and diet.
  Such notes are very informative and helpful not only for a surgeon but also for a psychologist and dietician. We recommend that patients try to recall any significant weight loss and weight gain periods, types of diets they went on, any events or experiences that made them ate more, moments when they realized they had weight problems, situations that made they start eating. Such notes allow specialists to get to know patients better and choose the right and individual approach.
• Getting mentally prepared for life-long changes
  Changing the approach towards eating and exercising, including the long term goals for weight loss and other life goals is very important and is the main determinant of weight loss surgery effects. Patients should change their thinking about food, namely, start making conscious choices about food quality and balance their meals. Food cannot be an award, punishment, stress reductor, etc. and if patients cannot eliminate this perception, they should inform the surgeon about it. Any eating disorders may preclude the weight loss of personal goals. Also, we need to mention that patients usually have a visit with a psychologist before the surgery, and being not aware of lifelong changes or being mentally unprepared for a diet can disqualify from surgery. Besides, patients should treat a bariatric surgery and post-op diet as the beginning of a new life, not a period of dieting after which they can overeat again.
• Checking the disorders related to obesity
  There are some health issues caused by the excess weight (e.g. acid reflux, hypertension, sleep apnea, type 2 diabetes) and each patient is asked about such diseases. The conditions related to obesity are easily accessible on the Internet, so we advise patients to take a look at them and check if they suffer from any. It would make the assessment during the consultation quicker.
• Preparing a question list
  Any questions and concerns that a patient comes up with should be noted down. It is totally normal that a patient who considers a weight loss surgery starts to read many articles and do the wide research, and obviously there are more and more questions that arise. Even if they seem to be obvious, patients shouldn’t hesitate about asking the surgeon about them.
• Following individual guidelines from the surgeon
  Usually, surgeons ask patients to follow a low-calorie and high-protein diet to lose some weight before the surgery (to minimize the risk of the complications) or attend some informative and support meetings organised by the clinic.

During the consultation, the doctor will check the BMI, analyse the diagnostic test, blood test, a patient’s medical history

Just before the consultation, patients weight and height is measured to check the BMI, then the doctor analyses the diagnostic test, blood test, a patient’s medical history, and other medical tests that have been performed and make the final decision about the qualification for the weight loss surgery (sometimes also a psychologist and dietician qualification takes place at this stage). The doctor suggests the surgery that would work most effectively for a patient and presents a detailed description of a procedure course, possible side effects, realistic results, and recovery period. After that, a patient may ask any bothering questions and discuss all the concerns with the surgeon. Patients should not hesitate to ask any questions, even these not related to the surgery, but rather concerning a diet, lifestyle changes, and exercises.

The bariatric consultation time is not set. The length of the visit depends on the patient. The first part of the visit is similar for everyone – a surgeon analyses the medical tests, interviews a patient, does necessary measurements and explains all the surgery aspects. The second part is just a discussion. Its length depends on the number of questions and concerns that a patient has. We often advise patients to ask any question they come up with, even if it seems obvious. The consultation is the best time to resolve all the doubts concerning the surgery, recovery, effects, diet plan, and any problems that may arise.

Patients usually have many questions to ask a doctor before surgery. It is a good idea to prepare a list with any concerns and bothering aspects because consultation is a unique opportunity to talk with the surgeon face to face. Below, we present the questions that patients may find useful during their consultation with a bariatric surgeon.

Questions to the surgeon

1. What are the different types of weight loss surgery available and which weight loss surgery is best for me?
   Patients should be informed about the bariatric surgery types and the reasons why or why not they are candidates for certain procedures. Knowing which weight loss surgery is most effective, safe and right for me gives a feeling of comfort and motivation.
2. How to prepare for surgery?
   Preparations for the surgery play a key role in weight loss, so patients should know what BMI qualifies for weight loss surgery (if their BMI is too high, they must lose weight before having a surgery), how to prepare for surgery diet, what are other instructions for patients which may help achieve greater results afterwards.
3. Are there any medications that I should avoid prior to the surgery?
   There are some medications that are recommended to take before the surgery as well as those which are forbidden before the procedure. Patients should inform the surgeon about any taken medications before surgery.
4. How long does bariatric surgery take?
   Some weight-loss surgeries last less than an hour, while some take a longer time. The surgeon will inform patients about the average time for a specific type of weight loss surgery.
5. How long recovery will last?
   Recovery is an important stage of losing weight after the surgery, so the more informed is a patient, the better for the results. Recovery aspects include e.g. stitches healing stages, the time before going back to normal, how long does a cut take to heal, how long to recover from general anaesthetic.
6. What complications I can meet during and after the surgery?
   A surgeon should clearly explain all possible surgical complications, postoperative complications, symptoms and signs of infection after surgery, and any long term side effects of general anaesthesia after surgery that may occur. This knowledge allows a patient to react fast when something worrying happens.
7. How long should I expect to be in the hospital?
   The weight loss surgery hospital stay depends on the surgery type, clinic policy, and a patient condition after the surgery. This information is important for a patient who needs to organise the family and work life, children/pets care, do the shopping and pack necessities to the hospital.
8. What can I eat after the surgery and will I have a diet plan prepared?
   The individual diet plan and allowed diet foods should be presented to the patient before the surgery. Patients should make sure what are the best foods to eat after surgery and what food to eat at different stages of a diet because a post-op diet plays a key role in weight loss after a weight loss surgery.
9. How much weight can I expect to lose and how quickly will I lose it?
   Patients should know how much they will lose weight in the first weeks, months, within a year, etc – it makes that they have realistic expectations towards the procedure effects. Patients may also ask the surgeon how to lose more weight after gastric bypass or gastric sleeve.
10. What about pregnancy?
    Getting pregnant after bariatric surgery may cause some concerns, hence a surgeon should explain the relation between weight loss surgery and pregnancy to patients, especially women.
11. When can I fly after the surgery?
    Flying after surgery is an important aspect especially for patients who travel abroad for the surgery. So, it is normal to ask how soon can you fly after surgery and how long do you have to wait to fly after surgery.
12. Will I need special care when I arrive home?
    The surgeon ought to describe how the first days and weeks will look like and what might change in a daily life including the need for post-operative care.
13. When can I start driving after the surgery?
    Question about driving after surgery should be asked always if a patient is going to drive back home from the hospital.
14. When can I return to work after surgery?
    A surgeon will inform a patient about weight loss surgery how long off work is required once patients admit where they work and what are their duties.
15. What if the bariatric surgery doesn’t work for me?- bariatric revision surgery
    There is a possibility that a weight loss surgery will fail and a patient should realise that and discuss with the surgeon the reasons why weight loss surgery fails, what weight loss surgery is reversible bariatric revision surgery. The surgeon should also give the guidelines for a patient what to do to achieve significant results and make a weight loss surgery a great success.

Bariatric surgery can be scheduled even a week after the consultation Some clinics offer the primary consultations when patients do the research among clinics – such consultation is mainly informative and explanatory

A patient who opt for a treatment in a private clinic should know in advance how long after a pre-assessment is the operation and how long after consultation is surgery. Usually, the consultation takes place not earlier than a week before the surgery (sometimes, it is scheduled after a patient is admissioned for the hospital). However, some clinics offer the primary consultations when patients do the research among clinics – the role of such a consultation is mainly informative and explanatory (it may take place in the surgeon’s office or via video chat as well). The proper consultation is the one where a patient is already qualified for the weight loss surgery (or is qualified during this consultation) – and the waiting time between this consultation and the surgery is rather short for private clinics. Of course, it is always on the clinic’s side to inform a patient about the procedure date as soon as they schedule it.

A weight loss surgery is a major, life-changing, and often life-saving procedure, hence patients should make an effort to be well-prepared for both the surgery itself and life afterwards. However, there are many sources, mainly on the Internet, giving answers to many questions, we advise patients seriously preparing for the surgery to use is as an alternative, and first and foremost treat the surgeon as a primary, authoritative and reliable source of any weight loss surgery knowledge they need. The bariatric consultation is the time when patients are educated, prepared, motivated, and instructed as for the surgery, recovery, diet and exercising. We strongly advise everyone to ask the surgeon questions because the weight loss surgery only starts the ball rolling and finally it is a patient who determines the final effects. 

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John M. Rabkin, MD. “Preparing for Weight Loss Surgery: Your Essential Checklists.” Bariatric Surgery Source, Bariatric Surgery Source, LLC, 3 Oct. 2018, www.bariatric-surgery-source.com/preparing-for-weight-loss-surgery.html.

Khatri, Minesh. “Truths About Weight Loss Surgery.” WebMD, WebMD, 30 July 2019, www.webmd.com/diet/obesity/preparing-for-weight-loss-surgery.

“Preparation for Bariatric Surgery.” Community Health Network, www.ecommunity.com/services/community-bariatric-and-medical-weight-loss-services/faq/preparation-for-surgery.