Overview
Weight Loss through the Bariatric & Metabolic Institute
The Bariatric & Metabolic Institute and Section of Minimally Invasive Surgery at Cleveland Clinic in Florida treats patients who want to achieve weight loss through bariatric surgery, as well as patients with gastrointestinal conditions. The Bariatric & Metabolic Institute at Cleveland Clinic in Florida offers a variety of surgical and nonsurgical weight loss options. Because every weight loss journey is different, our team of specialists across southeast Florida, from Weston, Stuart, to Vero Beach, work closely with patients to determine the right weight management program for you.
There’s never been a better time to start working towards a healthier lifestyle. Weight-loss surgery options are more accessible than ever, with wider coverage by Medicare and commercial insurance providers. Self-paid options also available; please contact a local Cleveland Clinic in Florida insurance specialist to discuss your options.
Why Choose Cleveland Clinic in Florida?
We are committed to providing patients with a path to a healthier future. There are many reasons to choose Cleveland Clinic as a partner on your weight loss journey, including:
- Comprehensive team approach to your care, which includes a bariatric nurse and bariatric dietitian.
- Number of bariatric surgery options available (including Gastric Sleeve, Gastric Bypass, Complex reoperations, and possible care of LapBand).
- Experienced bariatric surgeons with advanced training.
- Support groups.
- Financing self-pay options available.
National Bariatric Surgery Accreditation
Accreditation of our bariatric surgery programs at Cleveland Clinic Weston Hospital and Cleveland Clinic Martin North Hospital by the Metabolic and Bariatric Surgery Accreditation and Quality Improvement Program (MBSAQIP®) acknowledges our commitment to quality improvement and safety efforts for patients undergoing metabolic and bariatric surgery. Our leadership and care teams continually work to improve outcomes and achieve additional accreditations across the region.
Industry Leadership in Research & Innovation
The bariatric surgeons at Cleveland Clinic in Florida have performed thousands of weight-loss surgeries making it one of the largest bariatric programs in Florida. They are internationally renowned for advancing surgical weight loss approaches through research -- from gastric sleeve surgery and lap band procedures to all forms of gastric bypass surgery. They are also innovators in the use of obesity surgery to treat type 2 diabetes and as a bridge to organ transplantation candidacy.
Our team includes current and past presidents of the American Society of Bariatric and Metabolic Surgeons (ASMBS) and the Florida Chapter of the ASMBS as well as editors of leading industry publications, such as Surgery for Obesity and Related Diseases (SOARD), the official journal of the ASMBS, Bariatric Times, and the peer-reviewed journal Obesity Surgery.
How Do I Get Started?
Creating a personalized weight loss plan for you.
The multidisciplinary team at the Bariatric & Metabolic Institute at Cleveland Clinic in Florida works with our patients and their families to develop a personalized weight loss plan that works for them. Our dedicated team of physicians, dietitians, nurses, coordinators, and insurance specialists evaluate our patients with a thorough physical exam, diagnostic tools like blood work and imaging, and medical history to develop a complete, comprehensive profile. Your evaluation will determine which weight loss plan is best for you. We offer both surgical and medical weight management programs.
With non-surgical weight loss plans, our registered dietitians offer patients personalized medical weight loss programs that include diet, exercise, lifestyle and behavior support. Our weight-loss specialists may also recommend medications to manage obesity and obesity-related conditions.
If you are a candidate for bariatric surgery, your weight loss plan also will be personalized and include one-on-one education, support groups, regular physician consultations, and pre- and post-surgery follow-up care.
The weight loss programs at Cleveland Clinic in Florida are comprehensive and revolve around your well-being and healthy lifestyle goals. Get information about the programs we offer throughout South Florida and the Treasure Coast and frequently asked questions.
Schedule a Bariatric Program Consultation
To schedule a consultation, call the Cleveland Clinic location in Florida nearest you:
Weston – 877.463.2010
Stuart – 772.223.2890
Vero Beach – 772.770.0323
About Obesity
What is Severe Obesity?
According to the Centers for Disease Control and Prevention (CDC), obesity is a label for ranges of weight that are greater than what is generally considered healthy for a given height. Severe obesity is a chronic disease, with symptoms that build slowly over an extended period of time. An estimated 42.4% of Americans are considered obese. Obesity becomes “morbid” when it reaches the point of significantly increasing the risk of one or more obesity-related health conditions or serious diseases (also known as co-morbidities) that can result either in significant physical disability or even death.
Related Links
- American Obesity Association
- American Diabetes Association
- American Society for Metabolic and Bariatric Surgery
Causes of Severe Obesity
The underlying causes of severe obesity are not known. There are many factors that contribute to the development of obesity including genetic, environmental, metabolic and psychological. There are also certain medical conditions that may result in obesity such as steroid use and hypothyroidism. That’s why it’s important that you work with your doctor to make sure you do not have a condition that should be treated with medication and counseling.
Treatments For Obesity
Non-Surgical
For anyone who has considered a weight loss program, there are a number of choices. In fact, to qualify for insurance coverage for bariatric surgery, many insurers require patients to have a history of medically-supervised weight loss efforts.
Most medical weight loss programs are based on some combination of diet/behavior modification, medications and regular exercise. The Bariatric & Metabolic Institute at Cleveland Clinic in Florida offers nutritional counseling and classes.
Surgical Weight-loss Options
Am I a Candidate for Bariatric Surgery?
If you're significantly overweight and want to make a lifestyle change, you may be a candidate for bariatric surgery. At Cleveland Clinic in Florida, we carefully evaluate all patients being considered for bariatric surgery. Nutritional and behavioral counseling are conducted, and patients are required to attend a support group session prior to weight-loss surgery. A consultation with a bariatric surgeon is a mandatory step prior to surgery, and will help you screen for eligibility.
Generally speaking, appropriate candidates for bariatric surgery:
- Have a BMI of 40 or greater or BMI of 35-39.9 with pre-existing co-morbidities such as diabetes, heart disease, sleep apnea, hypertension, GERD (heartburn), and others. BMI Calculator.
- Have been unable to achieve a healthy body weight for a sustained period of time, even through medically-supervised weight loss programs for at least one to two years prior to surgery.
- Have psychiatric clearance and be willing to commit to lifelong nutrition and behavior changes.
- Do not smoke.
If you are a woman of childbearing age and planning a pregnancy, it’s vital to know that you must not get pregnant within the first 18 months to two years following surgery. The rapid weight loss and nutritional deficiencies associated with bariatric surgery make pregnancy very dangerous for you and for a developing fetus.
Why should someone consider having bariatric surgery?
Obesity is harmful to a person’s health. Someone who is 40 percent overweight is twice more likely to die prematurely than an average-weight person. (This effect is seen after 10 to 30 years of being obese.) In this country alone, about 300,000 deaths per year can be blamed on obesity. Obesity is a risk factor for many conditions and life-threatening diseases, including:
- Cancer
- Chronic kidney disease
- Depression
- Diabetes
- Fatty liver disease
- GERD (Gastro Esophageal Reflux Disease)
- Heart disease
- High blood pressure (hypertension)
- High cholesterol
- Infertility
- Menstrual irregularities
- Obstructive sleep apnea
- Osteoarthritis of weight-bearing joints
- Osteoporosis
- Stroke
- Urinary stress incontinence
What are the Benefits of Weight-loss Surgery?
Studies show that you will see an improvement with comorbidities if you continue to follow post-surgery guidelines. Within the first six months of having weight-loss surgery, patients often no longer need to take medications for these conditions. In addition, women who struggle with infertility before surgery find that conception is possible after surgery. Other benefits include:
- Average of 50-75 percent of excess weight loss*
- Improved quality of life
- Increased energy
- Improved self-esteem and confidence
- Lower blood pressure
- Increased mobility, with less joint pain
- Improved blood glucose and cholesterol levels
- Improved overall health and life expectancy
*Estimated weight loss is based on national averages. Success after bariatric surgery is dependent on your ability to make positive lifestyle changes including following the behavioral and nutritional guidelines and exercising for at least an hour daily.
What bariatric surgical procedures are performed by surgeons at Cleveland Clinic?
The Bariatric & Metabolic Institute at Cleveland Clinic in Florida offers many options for patients who are interested in bariatric surgery. For more information on the weight-loss surgery options available, visit our Surgery Options page.
What makes our bariatric surgery program unique?
We have a team of physicians, registered nurses, registered dietitians and support staff to ensure that you are guided throughout the program to achieve your weight loss goal. Prior to surgery you will attend education classes and learn how to live a healthier life as a bariatric patient. Our program also offers support groups and individualized care. You will have someone by your side every step of the way. Our program doesn’t end after your surgery -- we are here for you for the rest of your life to keep you successful.
What is the recovery time following weight-loss surgery?
Cleveland Clinic Florida’s medical team has an immense wealth of experience in bariatric surgery. Combined with advances in the field of bariatric care, this means that most patients recover from surgery quickly and without complications. The average hospital stay for patients who undergo the Roux-en-Y gastric bypass is usually one to three days.
What is my ideal body weight?
Cleveland Clinic Florida’s Bariatric and Metabolic Institute follows the guidelines set out by the body mass index scale. This scale recommends a BMI of between 18.5 and 24.9. You can use the calculator to find your current BMI and ideal BMI.
Is there support from surgeons and staff following weight-loss surgery?
Cleveland Clinic in Florida’s bariatric surgery health care team board-certified dietitians and nutritionists, specialty-trained nurses, bariatric program coordinators and schedulers there to guide patients after each procedure. Regular follow-up visits are scheduled during the first year after weight-loss surgery to check overall physical and mental health, metabolism and nutritional status. Support groups are also available to help you through your weight loss journey.
How much weight loss can be expected?
Most patients will lose between 66 and 80 percent of their excess body weight, most of which is lost 18 to 24 months following bariatric surgery. Weight loss is dependent on several factors including the type of bariatric surgical procedure you choose and your metabolism. However, the greatest factor is your ability to make and maintain the lifestyle changes necessary for you to leverage surgery as a tool for success.
In addition to surgery, what other lifestyle changes must be made?
Successful treatment for morbid obesity also includes permanent lifestyle changes such as healthy food choices, reduced caloric intake, increased exercise and other behavior modifications. Counseling and support groups can help with these changes.
What are the restrictions following weight-loss surgery?
Following surgery, you will need to follow specific eating guidelines. Registered dietitians work directly with patients to help plan healthful, appropriate meals. Additionally, you will need to stop smoking and discontinue use of NSAIDS.
What can I eat after having bariatric surgery?
The first month following surgery your meals will consist of protein shakes and soft or pureed foods. Your caloric intake gradually increases over time to about 1,200 calories a day. Your diet must be carefully balanced to include high-protein, low-fat, low-sugar foods. Protein is especially important to ensure healing after surgery and to preserve muscle tissue. You will be able to eat regular food about four weeks after surgery, without concentrated sweets, in six small portions a day. You will have to eat only small amounts, chew your food well and eat very slowly. Our registered dietitian will review this information with you before and after surgery.
How will I make sure my body gets all the nutrients it needs after surgery?
You will need to take vitamin and mineral supplements for the rest of your life after surgery. The Roux-en-Y Gastric Bypass surgery bypasses most of your stomach and duodenum, where vitamins are absorbed so that your caloric intake of 1,200 calories a day cannot provide all the nutrients your body needs. The Sleeve Gastrectomy, also called a stomach sleeve, and Lap Band procedures do not have this malabsorptive factor, but it is required to have a good quality vitamin for optimal health.
What will keep me from losing too much weight?
Your body will slow down weight loss over time and until it stabilizes. We also will closely follow your weight loss to ensure you are maintaining adequate nutrition.
Is it possible to gain the weight back after surgery?
Bariatric surgery has an excellent long-term track record for helping individuals with morbid obesity lose weight. However, there are no guarantees with any method of weight loss, even surgery. Success is possible only if you are committed to making lifestyle and dietary changes for the rest of your life.
All surgical procedures have risks, particularly when the patient is morbidly obese. Different procedures involve different risks, and depending upon your individual circumstances, your risks may be higher or lower than average. It’s also important to know that bariatric surgeons with more experience performing weight-loss surgery report fewer complications. Potential risks of surgery should be discussed with your surgeon so you can make an informed choice.
What are the most serious risks of bariatric surgery?
Any major surgery can be life-threatening. Obesity increases the risk of complications from blood clots and breathing problems. Surgery may be complicated by leaking from the suture lines, but the incidence of this occurring is small. As with any surgery, complications such as bleeding and anesthetic problems may also occur.
Can bariatric surgery be reversed?
Depending on what type of procedure you have determines if the procedure is reversible. Weight-loss surgeries can be converted or revised to another surgical procedure. Any potential reversals require another operation with the same or greater risks.
I have a Lap Band from a different bariatric program. Can I see one of your physicians for my follow-up care?
After assessing the band, our physicians can make adjustments to your existing Lap Band. Also, if you are having issues or concerns with your Lap Band, our physicians are trained in revision surgeries to remove the band and convert you to a gastric sleeve or gastric bypass.
I’ve already had surgery elsewhere and have some concerns. Can I follow up with your program?
Yes, if you are a bariatric patient and have concerns you can see one of our physicians. Also, if you are struggling with weight regain you can make an appointment with our bariatric registered dietitian to help get you back on track.
What if I need revision surgery?
Bariatric surgery is not a magic bullet and, while most patients are successful after weight-loss surgery, there are instances where revision weight-loss surgery is required. Regardless of the reason for seeking revision weight-loss surgery -- inadequate weight loss, weight regain, unresolved co-morbidities, or medical complications -- a revision solution may be possible.
Revisional and Conversion Procedures Overview
Revisional and conversion bariatric surgery, regardless of the previous surgery, is always challenging. A Revision refers to a change to a current procedure to repair- or improve the existing bariatric anatomy, while a conversion is changing one past bariatric procedure to another type of procedure. They both require adequate expertise to achieve desired results. Centers accredited through the Metabolic and Bariatric Surgery Accreditation and Quality Improvement Program and Bariatric Centers of Excellence certified by the American Society for Bariatric Surgery provide a multidisciplinary team and facilities for managing patients requiring revision surgery. It is highly recommended that patients requiring any revisional or conversion surgery find a surgeon at a bariatric center that has much experience with those types of procedures.
Will insurance cover bariatric surgery?
Many insurance companies now recognize obesity as a substantial health risk and are paying for bariatric surgery. Contact your insurance provider to find out if bariatric surgery is a covered benefit under your insurance contract. Coverage for bariatric surgery is policy specific and needs to be verified by a Cleveland Clinic insurance specialist and is subject to multiple clearances. The insurance specialist can also help clarify what self-pay options may be available.
What do I need to know about pregnancy after gastric bypass surgery?
During the first 18 months after your gastric bypass surgery, your body is undergoing many changes. Weight loss is a major one. Your body also is experiencing hormonal changes, increasing your fertility. Please be cautious during this time and use a method of birth control to ensure that you do not become pregnant. If applicable, a pregnancy test will be conducted prior to your surgery.
However, after your surgery, pregnancy is possible if you manage it well with your Cleveland Clinic physician.
Much of the current research suggests that pregnancy in individuals with lower BMI is often safer than pregnancy with complications from obesity. If you have had weight-loss surgery and are considering pregnancy, consult your physician for safe family planning. It would also be beneficial to mention this to your doctors during the consult for your weight-loss surgery so they can provide guidance and resources.
During the first 18 months after your gastric bypass surgery, your body is undergoing many changes. Until your weight begins to stabilize, it’s not advisable to become pregnant until at least 18 months after surgery. Rapid weight loss immediately following surgery creates hormonal changes and might deprive a growing baby of important nutrients.
Insurance & Financial Eligibility
Insurance coverage varies for weight-loss surgery procedures. It is crucial that you call your insurance provider to determine if your policy covers surgical weight-loss. As an integral part of our team, a financial counselor can answer questions and give you guidance when working with your insurance company to acquire approval.
It is a team effort between you and our financial counselor to ensure we do everything possible to gain an approval for surgical weight-loss procedures such as laparoscopic gastric bypass surgery.
Our navigation team will verify your benefits and assist you in understanding insurance requirements. Once you are accepted into the program, you will be assigned a personal navigator to assist you in your pre-operative weight loss journey.
We understand the importance of surgical weight-loss procedures and will work with you every step of the way.
Cleveland Clinic Florida accepts most major insurance carriers, including Medicare and Medicaid. Cash pay and financing options are also available.
If you have any further insurance or financial questions regarding surgical weight-loss procedures, please call:
Weston – 954.659.6274
Stuart – 772.223.2890
Vero Beach – 772.770.0323
Surgery Options
Choosing Surgery
Although most patients enjoy an improvement in obesity-related health conditions (such as mobility, self-image and self-esteem) after the successful results of weight-loss surgery, these results should not be the overriding motivation for having the procedure. The goal is to live better, healthier and longer. Keep in mind that rapid weight loss will result in remission of most comorbidities such as diabetes, hypertension, sleep apnea, high cholesterol, and others.
That is why you should make the decision to have weight-loss surgery only after careful consideration and consultation with an experienced bariatric surgeon. A qualified surgeon should answer your questions clearly and explain the exact details of the procedure, the extent of the recovery period and the reality of the follow-up care that will be required.
They may, as part of routine evaluation for weight-loss surgery, require that you consult with a dietitian/nutritionist and a psychiatrist/therapist. This is to help establish a clear understanding of the post-operative changes in behavior that are essential for long-term success.
Weight-loss Surgery Options
The types of weight-loss surgeries available fit into two categories:
- Restrictive procedures that decrease food intake
- Hypoabsorptive procedures that alter digestion, thus causing food to be poorly digested, incompletely absorbed and eliminated in the stool
‘Gastric Sleeve’ – Laparoscopic Sleeve Gastrectomy
Gastric sleeve surgery involves removing a significant portion of an individual’s stomach and leaving about 25 percent to create a gastric “tube” or “sleeve” as the remainder for a new stomach. Surgical staples are used on the new stomach to keep it enclosed. The procedure results in a reduction of the stomach and removal of 80% of the appetite hormone (Ghrelin) producing cell mass, thus limiting the amount of ingested food and decreasing the appetite. Similar to the gastric bypass, it also results in a positive alteration of the gastrointestinal hormones.
Gastric Bypass
Gastric bypass surgery is a procedure in which a small pouch is connected to the lower segment of the small intestine, making the patient’s stomach smaller. The purpose of gastric bypass surgery is to restrict the intake of food and give the individual a feeling of being full with less food. Also, bypassing part of the intestine results in decreased absorption of nutrients and alteration of the gastrointestinal hormones. The latter changes determine weight loss and have a positive influence on several of the co-morbid conditions, such as diabetes and high blood pressure. Roux-en-Y procedure reroutes a variable length of the small intestine to connect to a newly created smaller stomach pouch, bypassing a portion of the digestive system. The procedure promotes weight loss not only by limiting food intake, but also by decreasing the absorption ability of the digestive system.
Intragastric Balloon
The Intragastric Balloon System is implanted in the stomach via a 30-minute minimally invasive endoscopic outpatient procedure while the patient is under mild sedation. Once in place, the balloon device is inflated with a sterile solution. The balloon partially fills the stomach to provide a feeling of satiety. The balloon is removed after six months, at which time patients remain in a structured dietary program to maintain weight loss.
Duodenal Switch
Duodenal Switch is a combination of the gastric sleeve and gastric bypass procedure. The procedure creates a smaller stomach that is connected to the farthest part of the small intestine. The duodenum, jejunum and part of the proximal ileum are bypassed and then connected to a point near the ileocecal valve. The surgery is effective, but also riskier than other procedures. It is generally only for people who have a BMI higher than 50.
Reoperative Bariatric Surgery
Bariatric surgery is considered successful if 50 percent of excess weight is lost and maintained for at least five years, resulting in improvement of obesity-related conditions and quality of life. Revisions often involve converting a failed procedure of some other type to Roux-en-Y (RNY) gastric bypass, but patients who have received the RNY sometimes require revision of the procedure to clear up complications or to achieve further weight loss.
We perform highly complex re-interventions in patients that have complications from previous bariatric procedures. For patients who have experienced complications following either VBG, Sleeve Gastrectomy, or LAP-BAND, our surgeons perform a surgical revision, converting to Roux-en-Y (RNY) gastric bypass. While RNY is a technically challenging procedure that requires surgical expertise, it has been proven to be safely integrated into a bariatric treatment program with good results.
Life After Surgery
The following identifies areas that will be important for patients to follow after weight-loss surgery.
- Nutrition
The modifications made to your gastrointestinal tract will require permanent changes in your eating habits that must be adhered to for successful weight loss. Post-surgery dietary guidelines will vary by surgeon. You may hear of other patients who are given different guidelines following their weight-loss surgery. It is important to remember that surgeons perform different types of weight-loss surgery and the dietary guidelines will vary by surgeon and procedure. What is most important is that you adhere strictly to your surgeon’s recommended guidelines.
The following are some of the generally accepted dietary guidelines associated with weight-loss surgery:
- When you start eating solid food it is essential that you chew thoroughly. You will need to start with small or shredded pieces of meat.
- Don’t drink fluids while eating. They will make you feel full before you have consumed enough food.
- Omit desserts and other items with sugar listed as one of the first three ingredients.
- Omit carbonated drinks, high-calorie nutritional supplements, high-fat foods and foods with high fiber content.
- Avoid alcohol for the first year.
- Limit snacking between meals.
- Have smaller or more frequent meals, and limit snacking between meals.
- Going Back to Work
Your ability to resume pre-surgery levels of activity will vary according to your physical condition, the nature of the activity, and the type of weight-loss surgery you have. Many patients return to full pre-surgery levels of activity within one to six weeks of their procedure. Patients who have a minimally invasive/robotic laparoscopic procedure may be able to return to these activities sooner. - Birth Control & Pregnancy
It is strongly advised that women of childbearing age use 2 forms of birth control during the first 12 to 18 months after weight-loss surgery. The added demands pregnancy places on your body and the potential for fetal damage make this a most important requirement - Long-Term Follow-Up
Although the short-term effects of weight-loss surgery are well understood, there are still questions to be answered about the long-term effects on nutrition and body systems. Nutritional deficiencies that occur over the course of many years will need to be studied. You will need annual checks for anemia (low red blood cell count) and Vitamin B12, folate and iron levels. Follow-up tests will initially be conducted every three to six months or as needed, and then every one to two years. For surgery to be successful, patients must be committed long-term.
Appointments & Locations
Cleveland Clinic Florida makes scheduling easy. Whether a doctor’s appointment or diagnostic test, we have locations throughout southeast Florida for your convenience.
Schedule a Bariatric Program Consultation
To schedule a consultation, call the Cleveland Clinic Florida location nearest you:
Weston Hospital – 877.463.2010
Martin North Hospital – 772.223.2890
Indian River Hospital – 772.770.0323
Virtual Visits
You can now stay connected to your healthcare team through virtual visits, using your smartphone, tablet or computer.
Why go virtual? It's an easy, convenient and secure way to see your provider face-to-face without having to leave home. This saves you travel time, parking fees, and time spent in the waiting room — and you can have a loved one or caregiver join you. If needed, you can also have a prescription sent to the pharmacy of your choice.
Many insurance companies cover the cost of virtual visits, so check with your insurer ahead of time. Interested in getting started? Call your provider to find out what virtual visit options are available.
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