Considering weight loss surgery - what to expect

Information for patients

Weight loss surgery, also called bariatric or metabolic surgery, is sometimes used as a treatment for people who have a Body Mass Index (BMI) 35 and over who are classed as clinically obese.

It is a major operation and in most cases should only be considered after trying to lose weight through a healthy diet and exercise.

It can lead to significant weight loss and can help improve many obesity-related conditions, such as Type 2 Diabetes.

It is important to remember that whatever weight loss treatment you have, it is only a tool to aid weight loss. The success in the  long-term depends on your commitment to change the way that you eat, what you eat and to follow a healthy lifestyle.

This starts right now as part of the assessment process before you can be considered and accepted for weight loss surgery.

The assessment process

The Consultant surgeon will assess your suitability for surgery. Following your consultation you will be referred to:

• The dietitian
• The consultant anaesthetist
• The consultant diabetologist
• The Bariatric Support Group
• Any other healthcare professionals as recommended by the Metabolic Surgery team; this might include psychologist, psychatrist, respiratory

Dietetic assessment

The dietitian will complete a dietary assessment with you and advise you about diet and lifestyle changes that you will need to make to promote weight loss, as well as demonstrate your ability to adapt and maintain a healthier lifestyle. You will need to maintain these changes to ensure your suitability for surgery.

• You will be expected to lose 0.5kg-1kg or 1-2lbs per week over a three month period.
• You will be expected to attend the dietitian at least monthly initially for three months to monitor your progress
• If you are successful in losing weight during this three month period, you will continue to be reviewed on a monthly basis by the dietitian while you await your assessment from the other members of the team
• If you fail to reach the required weight loss over the three month period, you will be discharged from the service.
• If you gain weight on two consecutive occasions you will be discharged from the service.

Anaesthetic assessment

The anaesthetist will assess your anaesthetic suitability for surgery. Further tests may be needed, this may include:

• blood tests
• exercise tests
• breathing tests
• ECG – heart trace

You may be referred to a see a Respiratoy Consultant for sleep studies to be assessed for Obstructive Sleep Apnoea (OSA) which is a relatively common condition where the walls of the throat relax and narrow during sleep which interrupts normal breathing. This may lead to regularly interrupted sleep, which can have a big impact on quality of life and increases the risk of developing certain conditions.

Diabetes assessment

The diabetologist will asses your diabetes control and review of your medications. They will also ensure there is no other hormonal cause for your high BMI.

Bariatric Support Group

You will  meet people who have already undergone weight loss surgery. This is your opportunity to get feedback from people who have been through the process and undergone surgery. This is a vital part of your journey as it helps provide an  understanding of which surgical procedure is right for you and of the ongoing requirement to maintain lifestyle changes following surgery.

How do I get accepted on the Metabolic Surgery programme?

The Metabolic Surgery team will make a decision following completion of your assessment and after a period of monitoring the effects of lifestyle changes you make and sustain.

Once you have been accepted for surgery you will meet with the surgeon who will then discuss weight loss surgical options and agree the surgery that you will have.

NHS Lanarkshire Metabolic Surgery Service performs the following procedures:

• Intra Gastric Balloon
• Gastric Band
• Mini Bypass.
• Sleeve gastrectomy

If you are not accepted for surgery you will be referred back to your Diabetes team and GP.

What happens if I’m accepted for surgery?

You will be expected to continue to build on your positive lifestyle changes and weight loss while you are waiting for your date for your weight loss surgery. 

You will continue to see the dieteitian on a monthly basis to monitor your progress until you get a date for your surgery.

How much weight do I have to lose prior to surgery?

You should lose 0.5-1kg or 1-2lbs per week.

If you fail to demonstrate any weight loss over a two month period you will be discharged from the service.

Do I have to follow a special diet before my surgery?

Yes, you will have to go on a special diet two weeks prior to surgery. This is to shrink the liver and reduce the risks associated with surgery. You should lose 5kg (11lbs) in weight during this time.

If you do not lose this weight your surgery will be cancelled as the risks are felt to be too high to proceed

After surgery

You will be expected to take vitamin and mineral supplements for the rest of your life, regardless of the surgery you had.

You will need to attend follow-up appointments with the dietitian and the nurse once a month.

You will need to have an annual blood test to check that your nutrtion levels are normal.

What if I fail to attend any of my appointments?

Failure to attend any of your appointments will result in you being removed from the service.

If you wish to be re-referred to the service, your GP will have to wait one year before that referral can be made.

Useful information

For further weight loss advice you may wish to visit the following websites:

• www.wlsinfo.org.uk for information about the different types of surgery
• www.eatbetterfeelbetter.co.uk for information on healthy eating and weight loss
• www.bda.uk.com for information about food facts
• www.nlleisure.co.uk for specialised-health-classes/weight-management in North Lanarkshire
• www.slleisureandculture.co.uk for specialised-health-classes/weight-management in South Lanarkshire

Further Information

You should be referred to see the diabetes dietitian for further information and individual advice.

If you need this information in another language or format, please e-mail:

Translation.Services@lanarkshire.scot.nhs.uk