The qualifications for having bariatric surgery are fairly universal but always check with your practitioner to see if they have additional criteria that are not included in this guide.

These are the most common criteria considered for bariatric surgery:

• Inability to lose weight, maintain weight loss and remain at a healthy weight after attempts to do so through diet and exercise.
• Extreme obesity often referred to as morbid obesity. This is considered a Body Mass Index (or BMI) of 40 or higher, or a
• Body Mass Index of 35-39.9 and at least one other serious medical issue (called a co-morbidity) such as diabetes, sleep apnea or high blood pressure.
• A willingness to make major lifestyle changes after surgery such as a healthy diet and regular exercise. Changing any unhealthy lifestyle habits that contributed to your obesity is required.
• You are psychologically and mentally prepared for surgery and any complications that may occur.

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Bariatric surgery is a major surgical operation. As with all surgeries there are risks involved. Ultimately, your doctor is the best person to discuss these risks with. Fortunately, most people recover without any significant complications:

About 10% of patients will experience minor complications after surgery such as:

• Superficial wound infection
• Minor bleeding
• Abdominal hernia

Approximately 1-3% will have more serious, potentially life-threatening complications including:

• Blood clots (pulmonary emboli/DVT)
• Major wound infections
• Leaks in the "new connections"

Between 0.2%-0. 5% suffer fatal complications within the first month after bariatric surgery [1,1].

Patients who have obstructive sleep apnea (OSA), which is often caused by obesity, need to be aware of special risks. Sleep apnea increases sensitivity to certain pain medications and all central respiratory depressants, including general anesthesia. Careful administration of general anesthesia and close prolonged monitoring after recovery is an essential.

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• Gallstones: Up to 50% of people will develop gallstones after gastric bypass surgery. Gallstones can cause nausea, vomiting and abdominal pain. About 15-25% of people with gallstone symptoms will require surgery [1,1].
• Dumping syndrome: Occurs when food rushes through the stomach causing vomiting, nausea and weakness. This usually happens after consuming foods or liquids high in sugar.
• Vitamin and nutritional deficiencies: Can occur due to changes in the way the body absorbs food after surgery. Absorption difficulties can occur with: B12, iron, folate, vitamin D and calcium.
• Stomach or intestinal ulcers
• Obstructions: Caused from scarring and adhesions. These may require additional surgery to correct.

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Many bariatric surgeries are done as minimally invasive surgery, also called laparoscopic surgery. This type of surgery uses an endoscope, or small tube-like instrument that is inserted through small incisions in the abdomen. This means less pain, fewer complications and a shorter hospital stay. A typical stay after laparoscopic surgery is 2-3 days. If your surgery is an ìopen procedureî(a larger incision that directly exposes the area to the surgeon) or you have complications your stay will be longer.

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One of your best resources for finding a highly qualified surgeon is through your primary care physician, but you should be sure your surgeon has met the following criteria:

• Experience in the area of bariatric surgery, having done a significant number of cases each year. More experience equals fewer complications.
• Membership in (not just affiliate member) the ASBS, or American Society for Bariatric Surgeons.
• Board certification. You can go to the The American College of Surgeons web site (www.absurgery.org) to check for board certification. Board certification ensures that your surgeon has undergone rigorous training and testing.
• A policy of follow-up care and monitoring that lasts at least a year after surgery.
• Performs surgery at an accredited hospital with experienced staff that are experts in bariatric surgery (2).

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Following your surgeon's guidelines is very important to the success of the surgery and will help minimize complications, speed the healing process and prevent stress on the surgical area. Here is an example of what your post-surgical diet might be:

• Immediately after surgery you will not be allowed to eat. This usually lasts for one to two days. You are then required to follow a very specific progression in diet.
• Liquid diet: foods and fluids are liquid or semi-liquid at room temperature and consist mainly of water. Examples are broth, juice, milk, and clear soup.
• Pureed foods: foods with a consistency of smooth paste or thick liquid. There are no distinct pieces of food. This diet is usually maintained for 3-4 weeks.
• Soft foods: foods that are tender and easy to swallow, such as soft cooked vegetables and fruit. The soft diet lasts for about 8 weeks.
• Regular foods: foods with a regular consistency.

Additional requirements are:

• Initially consuming many small meals a day, up to six per day.
• Drinking small amounts of fluids throughout the day.

You will probably feel full after just a few bites and sips right after surgery. Eating too much too quickly can case nausea and vomiting.

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Weight loss does not occur immediately, but is usually gradual and continual.

The good news is that statistics demonstrate that between 70-80% of bariatric patients show significant weight loss. Data differs, but on average can expect to lose between 30-50% of your extra weight within 6 months after surgery. Overall, you can expect to lose nearly 60% of your excess weight over the course of the first year to few years after surgery.

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• Replacing large meals or binge eating with smaller, more frequent ones. Your stomach will not tolerate the same volume as before surgery.
• Being committed to a nutritious diet. This will help prevent complications and deficiencies in vitamins and minerals. Consider consulting with a Registered Dietician or Nutritionist for help in planning your dietary goals.
• Exercise: it is proven that people who have a consistent exercise program are more successful in maintaining the weight loss experienced after surgery. Even a simple walking routine can take you a long way to living a successful post-surgical life.
• Consider group or behavioral counseling to support you with your major lifestyle changes.

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Within 2-3 weeks you can resume most normal activity. Exercise will be a crucial part of your weight-loss success. Besides helping you lose weight, it will speed up the recovery process and reduce post-operative complications. Start with small goals. If you havenít been exercising at all, consider it a success to take a walk around the block. The objective is consistency. You can continue to increase your distance as you get stronger. Setting both long and short-term goals will help you keep track of your progress. Try to work toward getting at least 30 minutes a day 5 times a week of.

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Statistics show that, on average, 15% of post-surgical bariatric patients will need a revision. Failure in initial or long-term weight loss can be caused for reasons such as a mechanical problem (band slippage or pouch stretching) or because of patient behaviors, such as reverting back to poor eating habits. Prior to consideration of a revision your doctor should carefully evaluate your entire medical picture including any necessary testing to determine the causes of failure to lose weight.

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