Q. Who is a candidate for weight loss surgery in your program?A. Our program uses the NIH guidelines to determine whether a person is a potential candidate for surgery. We consider adult men and women with a body mass index (BMI) that exceeds 40, those with a BMI between 35 and 40 when the person also has at least one obesity related high-risk condition that requires medical treatment, or the person is about 100 pounds overweight as a potential surgical candidates. Potential patients must be able to understand the operation, as well as the lifestyle changes necessary for successful weight loss. Consideration is given to those who have tried traditional weight loss methods and failed to achieve long-term weight loss. Our surgeons may exclude patients with surgical risks that outweigh the potential surgical benefits including those that are unable to walk, cigarette smokers that are unwilling to quit, patients that require chronic steroid use, and some with prohibitively severe medical problems.
Q. What causes obesity?
A. The reasons for obesity aremany and complex. It is not simply a result of overeating. Studies have shown that in many cases a significant, underlying cause of morbid obesity is genetic. Research demonstrates that once the problem is established, efforts such as dieting and exercise programs have a limited success to provide effective long-term relief. Environmental factors, such as fast food, long days sitting at a desk, and suburban neighborhoods that require cars all magnify hereditary factors such as metabolism and efficient fat storage. Science continues to search for answers. But until the disease is better understood, the control of excess weight is something patients must work at for their entire lives.
Q. Why is being overweight so bad for your health?
A. Being overweight is not a cosmetic issue or just a social consideration. The extra pounds bring with them an extraordinary amount of disease and disability, as well as a shortened lifespan. Certainly being seriously overweight (100 pounds or more over the ideal body weight), markedly reduces a person's health even at a young age. Overweight and obesity lead to dramatic increases in diabetes, high blood pressure, high cholesterol, heart disease, sleep disturbance, degenerative joint disease, heart attacks and strokes. In addition, weight gain is associated with the cellular biochemical pathways that lead to cancer. So we see that the rates of many of the most common forms of cancer are substantially higher in overweight people when compared to normal weight people.
Q. Why do some people have weight loss surgery instead of using traditional weight loss measures of diet and exercise alone?
A. When obesity becomes so severe that it has negative effects on the person's health and quality of life, they may look to a proven method of weight loss such as surgery. While most morbidly obese people are able to lose weight in the short term, the percentage of people that successfully keep the weight off over two years is less than 5 percent. Bariatric surgery has been shown to produce lasting weight loss of significant amounts of weight, as well as improve or cure numerous health risks such as hypertension, diabetes, sleep apnea, and elevated lipid levels.
Q. Who does weight loss surgery at Lafayette General Medical Center?
A. Dr. Philip Gachassin and Dr. Dennis Eschete perform bariatric surgery at Lafayette General Medical Center. Dr. Gachassin also serves as the program Medical Director. To find out more about Dr. Gachassin and Dr. Eschete and their experience as a bariatric surgeons click here
Q. What are the different types of bariatric surgery performed at Lafayette General Medical Center?
A. Dr. Gachassin and Dr. Eschete perform three different laparoscopic bariatric surgeries; they include the roux-en-y gastric bypass, the adjustable gastric band, and the sleeve gastrectomy. For more detail about the procedures offered click here.
Q. How will I need to change the way I eat after surgery?
A. Because the size of the stomach pouch varies, the amount of food you can eat will depend upon the surgery you choose. However all three of the operations involve a drastic reduction in food intake and require adherence to a healthy diet afterword.
Q. Will my insurance cover the surgery?
A. The short answer is that some do and some don't. The best thing to do is to contact your benefits representative and ask if you have benefits for the surgical treatment of morbid obesity, if it is found to be medically necessary. The representative should be able to send you something in writing that explains your benefits and lists the criteria that must be met to access your benefit. Locate the information and print it out. If you find you do not have benefits, you should know that both the surgeons and the hospital offer competitive cash pricing for all procedures. The hospital and surgeons are in-network with most plans. For a list of contracted plans, contact our Financial Counselor Patti Navarre at 337-289-7282.
Q. Do I have to lose weight before I have weight loss surgery?
A. Yes, in most cases you do. We ask our patients to eat light meals with adequate protein and plenty of fluids for the last one to two weeks before surgery. This rapid weight loss helps to shrink the fatty stores in the liver, reducing strain on the heart and lungs, and creating some extra space within the abdomen to facilitate the operation being done efficiently and safely. Our dietician is available to assist with a weight loss plan tailored to your special needs.
Q. Do I have to exercise before and after surgery?
A. Yes. We ask you to begin a walking or pool exercise program prior to surgery. For those that are unable to walk long distances you can break the walks up in to multiple short walks. In some cases of extreme joint pain we recommend water exercise which is much gentler on the ankle, knee and hip joints. You will be given information on a variety of exercises that you will need to perform before and after surgery. Your success and overall health will be improved with regular exercise. You must always make sure that you are medically cleared before participating in any exercise program.
Q. Do I have to learn to read food labels or count calories?
A. Yes. Our dietician will work with you so that you can read and understand food labeling. You should know how much protein, fat, sugar, and carbohydrates your foods contain so that you can make informed choices to meet your specific dietary needs. The dietician will provide you with a protein goal and numerous suggestions for a high protein, low-fat, and low-sugar diet. You will eat measured amounts of foods until you become a good judge of the portions that are appropriate for you and to be sure you are consuming the required protein. Eating a nutritious low calorie diet is one of the ways you will lose the amount of weight you desire.
Q. Do I have to take vitamins forever?
A. Yes. You will need to take a multiple vitamin and calcium daily. You may also need to take additional supplements and vitamins depending upon the operation you have and any dietary deficiencies you may develop over time.
Q. Will my skin bounce back after I lose weight?
A. This varies with age, smoking history, etc., but most patients that lose 100 pounds or more will have significant loose folds of hanging skin. Many patients opt for plastic surgery to remove the excess skin. Insurance companies usually consider body contouring surgery as cosmetic, but some plans will pay for removal of loose skin when you have a history of skin infections and irritation.
Q. How long will I need to be out of work after weight loss surgery?
A. Most patients are well enough to return to work within two weeks of surgery, but you will discuss your job requirements with the surgeon and base your return to work date accordingly.
Q. How much weight loss can I expect to lose after weight loss surgery?
A. Average weight loss figures are available for each of the three types of surgery performed in our program; however, the amount and rate at which each person loses weight varies depending on the type of surgery, total caloric intake and exercise for the individual. Lap Band and Sleeve Gastrectomy patients typically lose 45-55% of excess body weight, while Roux-en-Y surgery offers 70-75% loss of excess body weight.
Q. Will I just keep losing weight and become too thin?
A. Most patient lose weight for a period of approximately 18 months. Weight loss tends to level off sometime between 12 and 24 months. It would be quite unusual for a weight loss surgery patient to lose too much weight. Your weight and laboratory values will be monitored on a regular basis to insure that you maintain a healthy weight after surgery.
Q. What are the risks involved in having bariatric surgery?
A. The risks involved in weight loss surgery are the same as with most other abdominal surgeries: Bleeding, leaks, blood clots, nutritional deficiencies, hernias, bowel obstruction, vomiting, gallstones, dumping syndrome, low blood sugar, stroke, heart problems, pneumonia, distension of stomach, ulcer formation, diarrhea, depression, infection, dehydration, and death among others. In the most recently ASMBS published studies, the mortality rate for bariatric surgery was ≤ .03-.05%. Those in the higher BMI ranges and those with significant obesity-related conditions are at highest risk of complications.
Q. What does your program do to lessen the chances of having a bad outcome?
A. Our bariatric program at LGMC believes that proper patient selection and patient education are the keys to success and good outcomes.
Q. Is there a Support Group that meets to discuss issues for weight loss surgery patients?
A. Yes, the support group meets on the second Thursday of each month. Click on the seminar and support groups link on the first page to view dates and times of our monthly meetings.
Q. What if I want to get pregnant after weight loss surgery?
A. We strongly suggest that you wait at least 18 months after surgery to have a child. And even after that, you must make sure that your obstetrician is aware that you had weight loss surgery. You should be closely monitored during the entire pregnancy. If you had the Lap Band procedure you may have the fluid in the band removed during your pregnancy. After delivery, the band can be readjusted.
Q. Is there an age limit for weight loss surgery?
A. The minimum age in our program is 18 years. However, there is no absolute upper limit. As long as you are physically able to withstand an operation and you fulfill the other criteria for surgery, you are a candidate.
Q. What is Laparoscopic surgery?
A. Laparoscopic surgery uses a small camera in a tube known as a laparoscope. A small incision is made above the navel, and then a special needle is inserted to inflate and distend the abdomen. The laparoscopic camera allows the surgeon to see inside the abdomen via a television monitor. Then, small-diameter surgical tools are inserted through other small incisions to allow the surgeon to perform the procedure. Patients enjoy smaller scars and slightly lower rates of post-op complications, than patients with open surgery. Patients typically have less post-op pain, require less pain medication and may recover faster.