Bariatric Surgery

Bariatric surgery is a safe and effective medical treatment for obesity, which reduces your overall body fat. It’s a long-term solution that gets to the root of what’s causing you to have trouble losing weight and keeping it off.

In addition to weight loss, bariatric surgery may help lower high blood pressure and reduce or eliminate, sleep apnea, joint pain, infertility (inability to get pregnant) and depression. Studies show that bariatric surgery can even cause long-term remission of Type 2 diabetes.

Bariatric surgery is considered an option if your body mass index (BMI) is 40 or more. If your BMI is 35 and you have any of these health conditions, you might also qualify for surgery:

• High blood pressure.
• High cholesterol.
• Coronary artery disease.
• Type 2 diabetes.
• Osteoarthritis of your weight-bearing joints.
• Sleep apnea.
• Non-alcohol-related fatty liver disease.
• Pseudotumor cerebri (PTC).
• Gastroesophageal reflux disease (GERD).
• Urinary stress incontinence.

You may also qualify for surgery if your BMI is over 30 and you have an unmanaged condition that’s related to obesity, like diabetes.

If you don’t meet the guidelines for surgery, choose not to have surgery or have gained weight even after surgery, there’s still hope. Your healthcare provider can recommend other types of weight management care, which combine diet, exercise and behavioral therapy. We’ll put together a weight loss plan that will help you meet your goals if surgery isn’t for you.

Bariatric endoscopy

Your provider may recommend minimally invasive bariatric endoscopy if you’re having problems after surgery or are gaining the weight back. There are several different types of bariatric endoscopic procedures. Your provider will go over which one they feel is the best option for you.

At Cleveland Clinic, we believe in using the skill and experience of many specialists for your care. When you and your healthcare provider have decided that bariatric surgery is right for you, your care team will include Cleveland Clinic experts who’ll help manage all parts of your weight loss journey. Your team may include:

• A surgeon.
• A physician or nurse practitioner specializing in obesity.
• A bariatric psychologist.
• A dietitian.
• An exercise physiologist.
• A patient navigator.

What is a patient navigator?

The patient navigator serves as your point of contact and helps guide you through your weight loss journey. Our navigators have over 75 years of experience getting people through the qualification process for bariatric surgery. They understand that the journey can be long and complicated, and they’ll be honest, caring, motivating and supportive throughout the process. They’ll also answer your questions and help with insurance requirements and medical, nutritional, psychological and surgical requirements.

Your surgeon will consider many things before recommending the surgery that’s best for you. These things include your BMI, eating and exercise habits, other health conditions, surgeries you’ve had before and the risks of each procedure. At Cleveland Clinic, our surgeons typically use minimally invasive surgery techniques, which mean smaller incisions (cuts), less pain and faster recoveries.

Types of bariatric surgery we offer

Roux-en-Y (roo-en-wy) gastric bypass: Your surgeon makes a small stomach pouch (enough to hold a cup of liquid) and connects it to the lower part of your small intestine. When you eat, the food bypasses (goes around) the rest of your stomach and empties directly into your intestine. You’ll feel full with less food.

Sleeve gastrectomy: Your surgeon removes about 75% of your stomach, leaving a narrow “tube” or “sleeve” about the size of a banana. Since this procedure makes your stomach a lot smaller, you won’t be able to eat a lot of food at one time.

Biliopancreatic diversion with duodenal switch: This procedure (sometimes just called a duodenal switch) combines a sleeve gastrectomy with an intestinal bypass. It limits how much food your stomach can hold and also how much nutrition your small intestine can absorb (take in) from your food. It also takes away some of your hunger hormones so you won’t feel as hungry. It’s especially helpful if you have extreme overweight or Type 2 diabetes.

Single Anastomosis Duodeno-Ileostomy Bypass with Sleeve Gastrectomy (SADI-S): This procedure is a modified version of the duodenal switch. It bypasses only about half of your small intestine, which leaves enough intestine to absorb more nutrients.

What to expect before surgery

Before any type of bariatric surgery, you’ll meet with your surgeon twice. At the first visit, you’ll:

• Talk about the procedure.
• Talk about financial and insurance requirements.
• Go over your medical history.
• See a bariatric psychologist.
• Have a thorough medical evaluation.

You’ll also learn what pre-surgery tests you might need, like:

• Chest X-ray.
• Electrocardiogram (EKG).
• Blood tests.
• Gastric exam (EGD or UGI).
• Sleep study.
• Physical exam.
• Abdominal ultrasound.
• Psychological and nutritional evaluations.
• Anesthesia consultation.

When your consultations and tests are completed, you’ll have your second visit before surgery. At this visit, you’ll:

• Meet with your surgeon again to go over your test results, talk about the surgery’s risks and benefits and ask questions.
• Meet with your anesthesia team.
• Get instructions for a liquid diet that you’ll start two weeks before surgery.

What to expect after surgery

Recovery from bariatric surgery is usually fast. Most people are back to work at a desk job within two to four weeks. You’ll need to eat slowly and drink less during meals so there’s more room for solid foods. A dietitian will provide you with dietary rules to follow. A big part of successful weight loss surgery is lifestyle change. At Cleveland Clinic, we want you to be successful. We have many support groups to help you with eating, exercising and staying motivated after surgery. You’ll also need to meet with your care team throughout the first year after surgery for follow-up visits.

Insurance coverage varies for weight loss surgeries. It’s important to call your insurance provider to see if your policy covers surgical weight loss. Your patient navigator will confirm your benefits and help guide discussions with your insurance company so you can get approval for surgery. We understand how important having bariatric surgery is for you, and we’ll work with you every step of the way to make it happen if at all possible.

Self-pay option

We have affordable self-pay options if you qualify medically for bariatric surgery but your insurance doesn’t cover the procedure. Our financial counselor can help you navigate the process if you choose to self-pay.

Taking the Next Step

Bariatric surgery is a powerful solution for weight loss, but it’s only the first step. Your dedication to a healthy lifestyle is important to changing your life for the better. If you’ve watched the seminar and you and your provider have decided that surgery is a good option, we’re ready to help guide you through each part of the process.