Before bariatric surgery

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The decision to have weight loss surgery isn’t easy. Not everyone considering it is a good candidate for it. And the long-term lifestyle changes required to make surgery successful can be challenging.

At Atrium Health Floyd and Harbin Clinic, our bariatric surgery team meets you wherever you are in your weight loss journey. We guide you through key steps in the months leading up to possible surgery to make sure you’re ready to undergo this life-changing treatment safely.

Who is a candidate for bariatric surgery?

To qualify for bariatric surgery, you must meet certain requirements. Typically, we consider patients good candidates for weight loss surgery if they are either:

100 pounds or more over their ideal body weight
75 pounds over their ideal body weight with life-threatening obesity-related conditions (such as diabetes, high blood pressure, high cholesterol or sleep apnea)

A good candidate for bariatric surgery must also be motivated. Surgery isn’t a quick fix. You need to commit to lifelong lifestyle changes, including following a restrictive diet and exercising regularly.

Before your first appointment

Every person must attend either an in-person or virtual information session before they can have an evaluation for weight loss surgery. At this session, a doctor explains the risks and benefits of weight loss surgery as well as the lifestyle and dietary changes required.

After the session, you need to complete a patient information packet. We can begin the process of arranging the required screenings, education and consultations after we review your information.

This is also the time to contact your insurance company. They’ll have a list of documentation they require before approving coverage for the surgery. You’ll need a letter from your doctor documenting your supervised weight loss efforts. The letter should say they’re referring you for evaluation for bariatric surgery because other medical weight loss efforts have been unsuccessful.

Bariatric testing needed before surgery

We require certain steps as part of a routine evaluation for weight loss surgery. You’ll have an initial consult with one of our bariatric specialists. They will go over your medical history and discuss the next steps.

You’ll get blood tests, meet with a dietitian and psychologist, and follow a structured exercise program. You may also need imaging tests and sleep or heart (cardiac) studies.

After your provider consultation, we’ll take a blood sample. We test for:

Comprehensive panels
Complete blood count
Comprehensive metabolic panel

Vitamins and minerals

B1 (thiamine)
B9 (folate)
B12 (cobalamin)
B9 (folate)
D (calciferol)
Iron
Magnesium
Zinc

Proteins, hormones and other markers

Cholesterol
Ferritin
Helicobacter pylori antibody
Hemoglobin A1c
Methylmalonic acid
Parathyroid hormone
Prealbumin
Thyroid-related hormones

You’ll have a one-on-one evaluation with a dietitian. You will also attend a group class for weight loss surgery candidates.

Your nutrition evaluation is one of the most important tests to support successful treatment. It provides valuable nutrition instruction and education that you can use long-term.

A psychological evaluation helps ensure you’re ready for the changes that come with weight loss surgery. The treatment process can be stressful. Surgery can lead to emotional and social changes in addition to physical changes.

The psychologist evaluates your readiness and helps you mentally prepare for the road ahead. You’ll discuss ways to cope with physical, emotional, social and lifestyle changes. The evaluation takes about three to four hours.

You participate in a structured exercise program to help you prepare for weight loss surgery and achieve your desired results. An exercise physiologist or trainer can advise you on flexibility and strength exercises specifically for people undergoing bariatric surgery.

You’ll lose about 12% of your lean body mass if you don’t follow an organized exercise program during rapid weight loss. Lean body mass includes everything that is not fat weight, such as muscle and bone mass, and is important for your long-term health. However, you will only lose about 4% of your lean body mass if you are involved in a structured exercise program.

Your provider may order other tests to evaluate your eligibility for bariatric surgery and help them prepare for a safe procedure. Depending on your health history, you may need:

Gallbladder ultrasound, an imaging test to check for gallbladder disease
Heart and vascular screening, which involves several tests to assess heart health and check for signs of heart disease
Sleep study, an analysis of your sleep quality to check for obstructive sleep apnea
Upper endoscopy, a minimally invasive procedure to examine your food pipe (esophagus), stomach and part of your small intestine for stomach-related disease

Preparing for successful bariatric surgery

Your bariatric care team will give you detailed information on how to prepare after you get approval for surgery. After approval and before surgery, you may need to take steps such as:

Eating a very low-calorie diet that includes small portions of nutrient-rich foods
Cutting down (or eliminating) sugary foods and drinks
Quitting smoking
Starting a structured exercise program that you can continue after you’ve physically recovered from surgery

Your doctor will give you instructions to prepare for the day of surgery. They’ll cover diet, medications and supportive care for when you return home.