Significant weight loss may lead to excessive skin in areas such as the neck, abdomen, arms and thighs. For some patients, the excessive skin may cause problems with skin irritation and rashes. For others, it may be bothersome from a cosmetic perspective. A plastic surgeon will be able to determine the type of procedure that is needed and if there is a medical necessity. It is recommended that you wait until you have lost most of your weight loss goal before considering plastic surgery.

This is a common question. A multivitamin is recommended for all patients who have had bariatric surgery. Additional supplementation of vitamin B-12, calcium, iron and thiamine may be necessary depending on the surgical procedure. Your surgeon and the dietitian will discuss this with you before surgery.

Patients are generally seen at one week, one month, three months, six months and one year postoperatively and then annually. It is imperative that you continue to follow up with your bariatric surgeon and/or the support staff including the nurses and dietitian.

Morbidly obese women may often have problems with fertility and the ability to become pregnant. Obesity may also increase the risk of complications during pregnancy.

Pregnancy is not advised during the first year when the most rapid weight loss is occurring as it may deprive the fetus of essential nutrients that it needs to grow. Because weight loss may improve fertility, it is imperative that a reliable form of birth control be used following surgery. Women who are contemplating bariatric surgery and future pregnancy should discuss this with their obstetrician/gynecologist.

Weight loss varies from patient to patient, as a number of factors can influence weight loss including age, pre-operative weight, gender and compliance with follow-up, dietary guidelines and lifestyle changes including exercise. Patients who have regularly scheduled follow-ups with the surgeon and program team tend to achieve maximum success.

It is important that you have realistic expectations regarding your weight loss goals when considering bariatric surgery. For people who have been obese, a healthy target BMI is often higher than the "normal" BMI of 18.5-24.9 and may be closer to the range of 20-28, depending on the person. The majority of weight is lost in the first year but continues over a period of 2-3 years.

The following is an average weight loss of excess body weight for each procedure:

• Sleeve Gastrectomy: 60 - 70 percent of excess weight
• Roux-en-Y Gastric Bypass: 70-75 percent of excess weight
• Single Anastomosis "Loop" Switch: 75 - 90 percent of excess weight

The amount of weight you lose is affected by the procedure you choose, but more importantly your commitment to a healthy diet, exercise, and lifestyle changes. We have found that patients who are successful in losing weight and keeping it off long term,

• Change their eating habits and follow dietary guidelines
• Are physically active and exercise daily
• Attend scheduled follow up appointments
• Take advantage of program resources

Patients who aren't successful, revert to old eating habits, don't exercise, don't follow up with their surgeon or program team and don't follow dietary guidelines.

The MyNewSelf Surgical Weight Loss Program will communicate with your insurance company to determine if you have benefits for bariatric surgery.

Unfortunately, some insurance companies do not cover bariatric surgery due to an exclusion in the plan. Below are some options to consider in the event you do not have benefits for weight loss surgery.

• Your employer may offer more than one insurance plan at open enrollment time. If so, find out if any of those plans provide coverage.
• You may have the opportunity to purchase benefits on a spouse's plan. If your primary plan has an exclusion for weight loss surgery, your secondary plan may cover your surgery.
• You may pay for the surgery without insurance coverage. Call us at 314-966-9640 for cash pay pricing information.

For most patients the average return to work is two weeks. Time off work may vary depending on the type of work you do. Your bariatric surgeon will discuss your individual situation with you.

Generally, patients will spend one to two nights in the hospital.

There are risks associated with bariatric surgery and other potential complications, including death, associated with all surgical procedures. Morbid obesity may increase your surgical risks. It is important that your surgeon has as much information as possible about your medical and surgical history so that he can discuss your risks, benefits and alternative treatments with you, and thus allow you to make an informed decision about bariatric surgery.

Risks of bariatric surgery include but are not limited to bleeding, infection, pulmonary embolism, gastrointestinal leak (for RYGB, duodenal switch and sleeve gastrectomy), band slippage (for LAGB) and injury to surrounding organs.

The surgeon will discuss the benefits and risks of surgery at the educational seminars and again at your office consultation.

Bariatric surgery serves as a tool to assist you in weight loss. Many of the benefits of bariatric surgery are related to improvement in other medical conditions as a result of the weight loss. Conditions such as diabetes, high blood pressure, sleep apnea and high cholesterol may be resolved or improved after surgery.

Our patients also describe to us an improved quality of life and the ability to participate in activities that were too difficult before their weight loss.

The National Institutes of Health have studied morbid obesity and determined that bariatric surgery is considered medically necessary in patients who have a body mass index (BMI) (hyperlink) of 40 kg/m2. This is the equivalent of being about 100 pounds above your ideal body weight. Patients are also considered a candidate if they have a BMI between 35 and 40 kg/m2, if they suffer from a serious medical condition such as Type 2 diabetes and if they have high blood pressure or sleep apnea.

If you are considering weight loss surgery, you should understand and be willing to make the lifestyle changes needed for successful weight loss and to improve your overall health.

Certain medical conditions may prevent you from having bariatric or weight loss surgery, and our surgeons evaluate each patient to determine if bariatric surgery is an option. We are happy to discuss your individual situation with you. Please call us at 314-966-9640 for more information.