Stephanie:
What is the recovery time to resume normal activites?

Kathryn L. Burg MSN, CRNP:
Stephanie - Thank you for your question. Patients are able to return to normal activities within two to four weeks.

Sharon:
I need this, but my insurance won't pay for this. Can you help me?

Noel N. Williams, MD:
Sharon -- Thank you for your question. There are advocacy groups that you can get in touch with, from a legal standpoint, to help persuade the insurance company to pay for it. Please call 1-800-789-PENN for more information.

Stephanie:
I am a mother of 4 and when I had my first child in 1989, I had blood clots fron the c section. Am I considered high risk?

Noel N. Williams, MD:
No, your risk would be moderate because we are able to put a special filter in her main vein so that the blood clots would not get to your lungs. This would decrease the risk of serious complication of pulmonary embolus.

Naomi:
Isn't this surgery just a substitute for willpower? I have thought of having the surgery but I'm afraid that I still wouldn't be able to change the real cause of my obesity problems.

Rachel Griehs, MS, RD, LDN:
Good question. Will power is also necessary following surgery. However, long term success of surgery is significantly better then diet and exercise alone.

Theresa:
Is bariatric surgery covered by most medical insurances?

Noel N. Williams, MD:
Yes, bariatric surgery is covered by most medical insurance.

Stephanie:
What is the average weight loss in the first 3-6 months after surgery?

Kathryn L. Burg MSN, CRNP:
This varies significantly from patient to patient. On average individuals lose between 40-75 pounds between 3-6 months following surgery.

Stephanie:
I heard that having the method of surgery that was shown on tv is higher risk than the more invasive procedure. Can you please comment on that?

Noel N. Williams, MD:
Stephanie -- If you are going to have the laparoscopic approach, it is important to go to a bariatric program that has significant experience with this approach. If you do this, there is no difference in the risk.

Debbe:
If considering this type of surgery and not sure of adherence to the diet restrictions, would you give the patient a chance to follow the diet beforehand? Does this surgery have better success rate compared to Lap-Band?

Rachel Griehs, MS, RD, LDN:
Debbe - Thank you for your question. Yes, sometimes we encourage patients to try eating the types of foods on the post-op diet. It would be difficult to eat the portion size required after surgery. However, you would want to start making behavioral and diet changes.

Theresa:
After this type of surgery, is your diet restricted to certain types of foods or is the patient able to eat their usual diet but in much smaller portions? Thank you!

Rachel Griehs, MS, RD, LDN:
There will be some foods that you will be unable to tolerate after surgery. Sometimes this is temporary and in other cases it is permanent. Every person is different.

Katie:
I have a consult date for early June with Dr. Williams. The one thing concerning me at this time is that I had 2 abdominal surgeries in the past 2 years. Will the adhesions and scar tissue hinder surgery, Open RNY or Lap RNY?

Noel N. Williams, MD:
It would depend on what your previous surgery was, and where your incisions are, but we often operate on patients who have had previous abdominal surgeries.

Stephanie
What is the wait for the open surgery? Are there meetings to attend before?

Rachel Griehs, MS, RD, LDN:
Stephanie - Currently the wait period is four to six months. We have monthly support group meetings that you can attend before and after your surgery.

John:
Hi Katie, it's JR. I thought I'd stop in and say that the show is top-notch!

Kathryn L. Burg MSN, CRNP:
Thanks JR!!! You are the best!

Dottie:
How much does it cost and will health insurence pay for it? Is there a lot of pain after the operation?

Noel N. Williams, MD:
Most insurance companies will pay for it, therefore there is no out of pocket cost to the patient. There is some pain, but it is well controlled by post operative pain medication.

Linda:
Hello everyone! Guess what? I'm down 71 pounds since my surgery and I feel great. Thank you for everything.

Rachel Griehs, MS, RD, LDN:
Hi Linda - Thanks for your message. Dr. Williams and Katie say hi. Great job on your weight loss and the show. You are very inspirational.

Linda:
I'm learning a lot from this program. I had a VBG in 2000. I had none of the pre or post op support that was discussed tonight. Has this changed since my surgey? Or did the VBG not warrant this type of support?

Kathryn L. Burg MSN, CRNP:
Linda, Yes, support groups are necessary following VBG as well. It has been proven that long term support increases success longterm following any type of Bariatric Surgery.

Jacquie:
I have 2 aunts that had the surgery with your bariatric services, but when I met with my primary doctor, he told my I am not a candidate. I am 5'1" and 230 lbs. My weight is really causing alot of health risk and I'm in the precusor stage of type 2 diabetes. Why am I not a candidate? I am at least 100lbs overweight.

Rachel Griehs, MS, RD, LDN:
Hi Jacquie - If you are 100 lbs overweight, you are a candidate for the operation. Please call 1-800-789-PENN for an evaluation.

Christa:
How long of a wait is it to schedule surgery? Here in NJ I have to wait until October.

Kathryn L. Burg MSN, CRNP:
Christa, Currently the wait time for an initial appointment is 4-8 months. Once the initial appointment is complete, wait time to surgery is approximately 2 months.

Greg:
I know this was extremely risky a few years ago. What are the risks of complications and chances of success on average today?

Noel N. Williams, MD:
The chances of success with this operation are excellent. The complications are now to a minimum in hospitals where signficant numbers of these procedures are done.

Linda:
Do you also do the reversible technique? Is it an easier procedure for the patient?

Noel N. Williams, MD:
At this point in time, some insurance companies are beginning to cover the reversible technique. Yes, it is easier on the patient.

Tom:
I notice you did not mention the LAP Band as an option. Do you do that procedure? If not why?

Kathryn L. Burg MSN, CRNP:
Tom, Currently the insurance companies in Pennsylvania have not covered the Lap Band. Our surgeon is trained in the lap band and you are welcome to have an initial consultation. Due to the insurance issues, an appeal may be necessary if the procedure is denied.

Peggy:
I'm about 175 lbs. overweight. I have shortness of breath and edema in my feet and ankles. I'm really worried about the risks of bariatric surgery. What can you tell me?

Rachel Griehs, MS, RD, LDN:
Hi Peggy - Thank you for your question. It is important when considering the surgery that you look at the number of operations that the surgeon has performed. At the Hospital of the University of Pennsylvania, we have performed over 1,000 bariatric surgeries. To schedule an evaluation, call 1-800-789-PENN.

Greg:
As I am approaching 50, is there generally a need for cosmetic surgery due to the skin not being as elastic?

Noel N. Williams, MD:
The chances are, if you have surgery for morbid obesity at your age, you will need to have cosmetic surgery.

Feng:
My son is 17 years old and he weighs about 240 lbs. His height is about 5 foot 10. Do you think I should look into this procedure for him?

Kathryn L. Burg MSN, CRNP:
Feng, First of all it is necessary to look at your child's overall health. Surgery on Adolescents is a serious option. We take it very seriously and make sure adolescents need surgery. First of all you need to be sure he has exhausted all other weight loss options.

Dawn:
I got surgery at Pennsyvania Hospital back in February and I lost 61 pounds. I did hit a plateau for a month, though. I know carbs are a big factor in the diet. However, everything has carbs. Would it be wise to take the carb blocking pills to help and give an extra boost?

Rachel Griehs, MS, RD, LDN:
Hi Dawn - Carb blocking pills may initially help you lose weight. However, you will not permanently keep the weight off. It is important to adjust your diet. Protein is the key to successful weight maintenance and you should try to consume lean proteins at each meal or snack.

Robin:
This has been a real eye opener. Thank you. What's the most common side affect from surgery?

Noel N. Williams, MD:
The most common side effect after surgery is dehydration, and for that reason, we give our patients very clear guidelines on nutrition after surgery.

Sheila:
I will be 62 in October. Is my age an impediment to having the bariatric surgery?

Kathryn L. Burg MSN, CRNP:
Sheila, Age alone is not a limitation to surgery. We look at each individuals entire health history and current health condition prior to making a decision about proceeding with surgery.

Beverly:
Thank you Dr. Williams, Katie, Rachel and your entire team for what you did for my husband, Ken. He is a completely different person since surgery and a poster child for your total lifestyle change program. He is an inspiration to everyone, thanks to you.

Rachel Griehs, MS, RD, LDN:
Hi Beverly - Thank you for your message. We are so happy that Ken is doing well. He is a successful bariatric surgery patient and we are happty to see that.

Pam:
I have type I diabetes, and I've had a cardiac bypass. Could I be a candidate for bariatric surgery?

Noel N. Williams, MD:
Yes, you would be a candidate for surgery. However, you would need to be fully evaluated from a medical and cardiac standpoint prior to surgery.

Denise:
After having such surgery, is one able to be taken off of insulin and many medications for things such as high blood pressure, diabetes, cholesterol, etc?

Rachel Griehs, MS, RD, LDN:
Hi Denise - Weight loss greatly contributes to the improvement of many conditions. We see patients discontinuing their medications or greatly reducing the need for the medication.

Karen:
Can you tell me more about the after-effects of the surgery, namely the excess skin? Is plastic surgery covered by insurance down the road?

Kathryn L. Burg MSN, CRNP:
Karen, Currently most insurance companies cover excess skin surgery if it is medically necessary.

Mary:
Hi Katie & Dr. Williams,
The show was great. I am so excited I am having my surgery on May 20. See you all soon.

Tracey:
What is required for your insurance company to cover this surgery? What are the risk for a 50ish asthmatic female?

Noel N. Williams, MD:
Requirements vary with different insurance companies. You will need to receive guidelines from individual insurance companies. However, the majority of insurance companies cover the surgery. In relation to your second question, you would need to be fully evaluated by a pulmonary doctor, but your risk is acceptable.

Rufus:
I have tried every diet and program you can imagine and i still do not lose weight. Is the surgery available for everyone and what is the time frame before you get it?

Rachel Griehs, MS, RD, LDN:
Hi Rufus - The surgery is available to those who meet the criteria of 100 lbs overweight. Our timeframe for an appointment is four to eight months. With surgery approximately two months after that. We have support group meetings you can attend before your appointment.

Jackie:
I am very interested in the surgery, but I don't have any insurance to pay for it. I've tried everything imaginable to lose weight, with no success. I am mordily obese and need to lose the weight. Are there any doctors out there who are willing to peform this surgery for people in my situation. Thanks.

Noel N. Williams, MD:
Jackie -- Unfortunately, most institutions will not allow their physicians to operate on patients who do not have insurance.

Debbe:
Does this type of surgery have a better success rate over LapBand surgery?

Kathryn L. Burg MSN, CRNP:
Debbe, Yes it has a better success rate then the Lap Band surgery. The estimate for an excellent result from Gastric Bypass is weight loss of 70% of excess body weight. Estimates for the lap band vary from 40-60%.

Audrey:
Thank you so much for this program. This has helped my family have a better understanding of what I'm about to endure. How soon after my evaluation will I be scheduled with the psycologist and nutritionist.

Rachel Griehs, MS, RD, LDN:
Hi Audrey - Thank you for your question. At your initial consultation you will be scheduled for an appointment with a nutritionist and psychologist. These appointments are typically scheduled three weeks after your initial visit.

Peg:
Does the stomach grow depending on how much one eats (before surgery)? This is a question Weight Watchers would never answer and I am just curious!

Noel N. Williams, MD:
The stomach does not grow depending on how much you eat.

Robin:
I am a breast cancer survivor diagnosed in January of 2000. Since then, I have put on around 80 punds due to inactivity, depression and loss of thyroid function. I'm 4'11" and weigh 228 pounds. Am I a good candidate.

Kathryn L. Burg MSN, CRNP:
Robin, We would need to meet you and perform a thourough history and physical examination to determine if you are a good candidate for surgery.

Lynne:
Are there any studies or do you have any knowledge of people with Hepatitis C having problems with fatty liver and cirrohsis after bariatric surgery?

Noel N. Williams, MD:
Weight loss will improve fatty liver associated with this disease.

Dolores:
I was all set for this surgery, but the day before (8-7-2002) the surgeon called me to say another of his patients was having trouble and he would not do me because he did not want any more trouble. Since then I have gained even more weight. I have Keystone HPE. Could you help me. I am a teacher, age 59, and NEED this surgery soon to recover over the summer vacation from my job. Can you please help?

Rachel Griehs, MS, RD, LDN:
Hi Dolores - Thank you for your question. Currently there is a four to eight month wait period for an evaluation. Please call us at 1-800-789-PENN for an evaluation. Support group meetings are available prior to your evaluation and surgery.

Pat:
I'm 60 years old and have diabetes and had angioplasty in 1999. I don't take insulin, but do take other medication.

Kathryn L. Burg MSN, CRNP:
Pat, due to your significant health history, it is difficult to say if you are a candidate in this forum. We would need to perform a complete history and physical examination as well as obtain a cardiac evaluation in order to decide if you are a candidate for Bariatric Surgery.

Lona:
There is a procedure where a "band" is placed that can be tighten in the office. Is this procedure more risky than the procedure showned on tv? Quite frankly, I truly need the procedure for multiple health issues but I'm scared of the risks.

Noel N. Williams, MD:
No, this procedure is not more risky than that shown on TV. If you truly need this procedure, you should attend one of our support groups for more information. Call 1-800-789-PENN.

Bonnie:
I have also had previous surguries. Last year I was treated for stomach ulcers. I have hypertension, diabetes (oral medication) and colitis at times. I am 56 yrs old and at 5'3" I weigh 270 lbs. With my past medical issues would I even be considered. I have tried every commercial diet and would like to make a permanent change

Kathryn L. Burg MSN, CRNP:
Bonnie, Since you have a complex medical and surgical history, we would need to meet you and perform a complete history and physical examination, as well as pre operative tests to determine if you are a surgical candidate.

Denise:
I am scheduled to met with Dr. Williams in July. It is unclear to me if I am do anything prior to that intial meeting, or is my visit to establish a plan. I have waited over one year for this appointment.

Rachel Griehs, MS, RD, LDN:
Hi Denise - Thank you for your question. The initial visit is the first thing that you need to do. If you need a referral from your primary doctor, please bring that with you to your appointment. You may attend monthly support group meetings prior to your appointment. To learn more about support group meetings, please call 1-800-789-PENN.

Gerry:
After meeting Doctors, going to appointments, and meeting the staff team, how long will it be before I can have the surgery?

Noel N. Williams, MD:
Gerry -- Surgery will take place 6 to 8 weeks after meeting with doctors.

Emma:
Hello - If I move, is there support in other States?

Kathryn L. Burg MSN, CRNP:
We do not offer support group in other states, however our patients who have moved have joined support groups that are run by other Bariatric Programs.

Annemarie:
Wanted to thank Penn and Dr. Kirkland for giving my husband's his life back. He has already lost about 60+ lbs since Jan 21, 2004. He is a new person. THANK YOU!!!

Rachel Griehs, MS, RD, LDN:
Hi Annemarie - Thank you for your message. Congratulations to your husband.

Tanya:
I have high blood pressure. Would this pose an extra risk during the surgery?

Kathryn L. Burg MSN, CRNP:
Tanya, When patients have high blood pressure, we require cardiac clearance from a cardiologist to determine if it is safe to proceed with surgery.

James:
What factors determine whether the laproscopic procedure is used in WLS insted of the open procedure?

Noel N. Williams, MD:
95% of patients who come to our practice will get the laparoscopic approach. There are certain situations where this is not possible because of previous surgery.

Michelle:
I am 289 lbs and 5'9" is there a weight\height requirement before qulifing for this surgery?

Rachel Griehs, MS, RD, LDN:
Hi Michelle - Thank you for your question. There is a weight criteria of 100 pounds overweight or approximately 80 pounds with obesity related problems (i.e. diabetes, sleep apnea, or high blood pressure).

Patsy:
Hi, what is the BMI that justifies this surgery?

Rachel Griehs, MS, RD, LDN:
Hi Patsy - Thank you for your question. A BMI of 40 or 35 with obesity-related complications such as sleep apnea, high blood pressure or diabetes.

Dawn:
My mother is going for surgery soon. She had a screen put in for blood clots and is on cumadin (blood thinners). Which is a better option from your stand point for surger? This or shots in the stomache for a few days before called lomox. The heart doctor said to be in the hospital for a few days before and take heprin due to her size. She is 460 and 5'5"

Kathryn L. Burg MSN, CRNP:
Dawn, We also place IVC filters (screens) in patients who are at high risk for blood clots. Some physicians may also use blood thinners such as Coumadin, Heparin, or Lovenox as well.

Edna:
I have been interested in this surgery for a couple years, I have already learned much , but I was wondering how long does it take to get an appointment for an evaluation, then how long to the actual surgery? How long will I be out of work? I sit at a desk most of the day.

Noel N. Williams, MD:
For initial evaluation appointment, it will take 4 months from the first phone call. After this visit, surgery will be 6 to 8 weeks later. You would be out of work for approximately 3 weeks.

Michelle
I am 5'5 and weight about 250 lbs. I am open to learn more, but I am not sure if it's the right surgery for me. Are there classes or someone I can talk to?

Rachel Griehs, MS, RD, LDN:
Hi Michelle - We have monthly support group meetings that you can attend prior to making an appointment. This includes pre and post-operative patients. The meeting is run by the bariatric surgery team at Penn. Call 1-800-789-PENN for more information.

Audrey
I am actually scheduled to meet with Dr. Williams in July. My question is this: I had a blood clot years ago after gallbladder surgery. Does that make me less of a candidate for this surgery since a side effect are blood clots?

Kathryn L. Burg MSN, CRNP:
Audrey, We do pay special attention to patients with a history of blood clots. This does not however preclude you from proceeding with the operation. When we meet you we will discuss this with you in detail.

Paula:
I had a hysteritomy in September 2002 with complications due to extensive adhersions from past abdominal surgeries. Will this affect me qualifing for Bariatric surgery?

Noel N. Williams, MD:
Paula -- Each situation is individual and you would need to be evaluated in the office prior to making a decision on qualification for surgery.

Chipper
I know about eating protein first, but I've never heard you're to wait 30 minutes to drink fluids after eating.

Rachel Griehs, MS, RD, LDN:
Hi Chipper - Thank you for your question. Initially, the pouch is not equipped to handle foods and fluids at the same time. If you eat and drink too close together you likely will get sick. As you progress through your recovery, the time between eating and drinking will lessen.

Joan:
I am considering weight loss surgery and have read that there is a less drastic option called gastric banding. Do you offer this option and if not, why not?

Kathryn L. Burg MSN, CRNP:
Joan, Currently the gastric banding or Lap band is not covered by Pennsylvania insurance companies. We are trained in this procedure and patients are able to be evaluated for this procedure with the understanding that it may be difficult to obtain insurance coverage.

Peg:
I quit smoking one year ago and gained 50 pounds. I am now at 300 pounds (5'2"). I can't stand my weight. Do I need my family doctor to refer me to you for insurance purposes?

Noel N. Williams, MD:
Yes, you would need your family doctor to refer you. Please call 1-800-789-PENN to schedule an appointment.

Bernie:
Dr. Williams, I just wish to say the surgery you did for me 2 years ago has been excellent. I have gone to doing major remodeling and building re-construction for the Dragon House rest. in Wildwood,N.J. and now work full time. Please contact me at (609)425-2588. Thank you again. Bernie

Rachel Griehs, MS, RD, LDN:
Hi Bernie -- I am happy to know that you are doing well. Dr. Williams says that he will be there this summer!

Kathleen:
I had open bariatric surgery 2 and 1/2 years ago. It is unsuccessful in that I can (and do) eat just as much now as before the surgery and have had none of the behavior mod changes that I was told to expect. Could I be evaluated?

Kathryn L. Burg MSN, CRNP:
Kathleen Yes, you could be evaluated for surgery. We would have you meet with our entire team including the Psychologists to assist you with the behavior modification piece.

Jamey
I have a large surgial hernia. When i lay down it stick outs. Will Ibe a candiate for the surgery? Thank you.

Noel N. Williams, MD:
Jamey, we would need to see you in the office for an evaluation, but a hernia does not preclude you from surgery.

Lisa:
Are there procedures for someone who is overweight but not quite 100 lbs? I was told that I am not a good canidate because I'm about 80 lbs overweight .

Rachel Griehs, MS, RD, LDN:
Hi Lisa - Thank you for your question. At this time, surgery has only been approved for those are 100 pounds or more overweight. If you are 80 pounds overweight and have obesity related problems such as sleep apnea, high blood pressure, or diabetes you may be a candidate. To learn more about the program at Penn, call 1-800-789-PENN.

Michele:
I have Hepatitis C. Would I still be able to get this done?

Noel N. Williams, MD:
Michele - You will be able to have surgery, but would have to be fully evaluated from a liver function standpoint, prior to surgery.

Dave:
I am 400 lbs and have tried everything. I would like to attend the support meetings. Can you give me more information -- times, dates. Are there any meetings at night ?

Kathryn L. Burg MSN, CRNP:
Dave, The support group meeting meets the second saturday of each month. We meet at the Hospital of the University of Pennyslvania (34th and Spruce ) in the admissions center on Silverstein 1 from 10am to 12pm. The only exeption to this schedule is june. WE meet on June 5th instead.

Sandie:
Do you have to be 100 pounds are more before you are considered? I am 5 feet tall and weigh 198, and have sleep apnea which was determined from Penn. I have tried diets and have lost about 50 pounds in the last 9 years but can't get the rest off and now due to knee problems, I can't exercise.

Kathryn L. Burg MSN, CRNP:
Sandie, We actually look at patient BMI to determine if they are surgical candidates. You can find a BMI calculator online to determine what your BMI is. The criteria for surgery are a BMI of 40 or greater, or 35 or greater with obesity related health problems (such as sleep apnea).

Joanne:
Dr. Williams, I am one of your miracle patients. You did my surgery last March 5, 2003 and so far I have lost 100 pounds. My sister, Diane, had the surgery 3 months later and she has lost even more. I am jealous of her but thrilled for both of us! Anyone who asks me if I would do it again, I give them your number and say I wish I had known you 20 years ago. To you and your entire team, I want to say "Thank You" for your gifts, caring and for giving me the confidence to live my life again! I really enjoyed your show tonite and know that it took time and energy to put it together. It was fabulous and again, a gift to those who need this surgery to live. Hugs, Joanne Fay

Noel N. Williams, MD:
Joanne -- Many thanks.

Ange:
Congrats team, awesome show.

Rachel Griehs, MS, RD, LDN:
Hi Ange - Thanks for your message. You are an important part of the team!

Helen:
What is the leading cause of death after the surgery?

Noel N. Williams, MD:
Pulmonary embolism, or blood clots to the lungs, are the leading cause of death after the surgery.

Robin:
Since I have been cancer free for almost 5 years, would I be at any additional risk?

Kathryn L. Burg MSN, CRNP:
Robin, This depends on a variety of factors. We would need to perform a thourough history and physical exam as well as pre operative testing to determine the answer to this question.

Susan:
How are family members involved in the process?

Kathryn L. Burg MSN, CRNP:
Susan, Family members are encouraged to attend all aspects of the program. This includes the initial evaluation, nutrition class, psychology evaluation and support group meetings.

Lorraine:
With the laporoscopic surgery like Linda had, how soon could I go back to work? Also, what happens when you get to your goal weight with the extra skin, is there cosmetic reconstruction surgery too?

Noel N. Williams, MD:
Lorraine -- You could return to work in approximately 3 weeks. We work closely with the plastic surgeons at PENN, and refer patients to them who require cosmetic reconstruction.

Tanya:
I am 5'8" tall, and currently weigh 260 lbs. Would I be eligible for this surgery?

Kathryn L. Burg MSN, CRNP:
Tanya, Yes, by your BMI you are a candidate.

Sarah:
Do you have a special ward for bariatric patients? Also, how many doctors at HUP are performing this surgery?

Noel N. Williams, MD:
Sarah - yes, we do have a special ward for bariatric patients. In addition to myself, Dr. Steven Raper performs bariatric surgery at HUP.

Jeff:
I am from the Lehigh Valley. Do you get many patients from here and does Blue Cross from here cover the procedure if you are obese?

Kathryn L. Burg MSN, CRNP:
Jeff, We actually get patients from all over the Delaware Valley. You should contact Blue Cross to make sure that your plan covers the procedure (however, blue cross usually does).

Barbara:
Hi, I had my surgery 7/02 and I'm down 100 lbs and I feel great. I still want to lose at least 30 more. I go to a gym and I'm real anxious to lose this weight. Does it go slower now? Next, my doctor moved his practice up to the Newark area. Is there a support mtg in South Jersey or Philadelphia? Thanks the show was super and right on target!

Rachel Griehs, MS, RD, LDN:
Hi Barbara - The typical weight loss period is 12 to 18 months. At this point, the weight loss will be up to you by exercising and eating healthy. Support groups are for patients coming to Penn or who had their surgery at Penn. However, if you are unable to attend meetings where you had your surgery, please feel free to attend our meetings. Call 1-800-789-PENN for a schedule.

Linda:
If you are considering bariatric surgery, the most important thing you can do for yourself is to weigh all the factors and go to the best team, including the surgeon, nutritionist, program supervisor, surgical team and hospital. After considerable research I found the whole package at the University of Pennsylvania Health System.

Carol:
What are the financial costs to patients (initial consultation fees, etc). Also, how can interested people get information on the nutrition classes and support groups befor the surgery?

Kathryn L. Burg MSN, CRNP:
Carol, Some insurance companies do not cover the initial consultation (which costs about $200). You need to check with your insurance regarding this cost. Patients must also pay $200 for the nutrition class/counseling and $200 for the psychology evaluation. You can get information on the support group by calling the 1800789 PENN phone number.

Audrey:
Thank you for the program this evening. It has enabled my family to have a better understanding of what I am about to endure. How soon after my inital consult will I see the Psycologist and nutritionist.?

Rachel Griehs, MS, RD, LDN:
Hi Audrey - After the initial visit, you will see the psychologist and nutrionist within three weeks.

Pam:
Does insurance cover cosmetic surgery if needed after the weight loss to reduce excess skin?

Noel N. Williams, MD:
Pam -- It will only cover cosmetic surgery if it is deemed to be medically necessary. Otherwise, it will have to be paid by the patient.

Dianne:
My husband had the Lap Band surgery done I belive 4 years ago by Dr. Nole Williams and had 2 follow up visits with him. He was 320 lbs. The first year he lost 100 lbs. then he started gaining weight back. He is now back up to to 290. Is it possible the bands streched or broke? And it possible to have surgery re-done?

Noel N. Williams, MD:
Dianne -- It is possible that the pouch has expanded, which would explain his weight regain. Yes, it is possible to have this converted to a gastric bypass.

Sandie:
If you have had laproscopic surgery previously can you still be a candidate?

Kathryn L. Burg MSN, CRNP:
Sandie, We would need to meet you and perform a complete history and physical exam as well as pre operative testing to ensure that you would be a candidate. Usually previous laproscopic surgery does not cause a problem with this operation.

Audrey:
Once you have the surgery is there any chance to actually gain back all of the weight you may lose?

Rachel Griehs, MS, RD, LDN:
Hi Audrey - Yes it is possible. It is very important that you make behavioral and diet modifications to permanently maintain your weight loss.

Mary:
I had intestinal bypass surgery in 1976. It didn't work. I weight presently 378lbs. I am 57 can I get WLS.

Noel N. Williams, MD:
Mary -- You would have to be carefully evaluated prior to making this decision.

Mary:
I was glued to the t.v. during your show. In 1990 (February) I was diagnosed with endometrial cancer. I had radiation therapy and finished my last treatment in June 1990. I am 14 years out and have annual check ups. Am I a candidate for this type of surgery ?

Kathryn L. Burg MSN, CRNP:
Mary, This is difficult to answer without meeting you and reviewing your entire health history in detail. Cancer is not a contraindication to surgery if it has resolved.

Cathy:
I have had a double hernia repair as well as a total abdominal hysterectomy. Will this hinder WLS?

Noel N. Williams, MD:
Cathy - No, this will not hinder weight loss surgery.

Pauline:
My son tips the scale at 500 lbs. He's 6'5" tall. Ten yrs ago he was approx 250. He's not yet developed high blood pressure or diabetes, however, both run in our family. Might he be a candidate for bypass surgery?

Rachel Griehs, MS, RD, LDN:
Hi Pauline - Thank you for your question. Your son is 100 pounds overweight making him a candidate for obesity surgery. If you would like to schedule an evaluation at PENN, please call 1-800-789-PENN.

James Preston
Dr. Williams: I just receved a surgery date of 6-22-04. Please don't retire until seeing me. Thanks.

Rachel Griehs, MS, RD, LDN:
Hi James - Thanks for your message. We will see you in June.

Robin:
Is there any insight to any compications that may surface 15-20 years down the road?

Noel N. Williams, MD:
Robin -- Very good question. It is for this reason that careful post operative follow up is mandatory for patients who undergo this surgery.

Chipper:
I noticed in a question above for surgery the waiting period is 4-6 months. You said, had an appointment for mid december 2003. After waiting many months for it, it was cancelled 3 weeks before my appointment date. When they called they tried to reschedule it and I said no. I waited long enough to be evaluated. If I call and make another appointment, will it be within 6 months to surgery as stated in questions above from another person? Thanks.

Kathryn L. Burg MSN, CRNP:
Chipper, We have recently changed our clinic times to decrease the wait for an appointment. You are welcome to call and we will do our best to accommodate you sooner.

Karen:
I generally always vomit after anesthesia. Would this risk the newly stapled stomach?

Noel N. Williams, MD:
Karen -- Our anesthesiogists will make sure you do not vomit after surgery.

Pam:
What are the dietary resrictions after the procedure?

Rachel Griehs, MS, RD, LDN:
Hi Pam - Thank you for your question. There are several restrictions. There will be foods that you can no longer tolerate. You will also have to make changes in your eating behaviors.

Marie:
I'm going to have the surgery in June and am worried about blood clots. What cause's them and is there any thing I can do to help not get them?

Kathryn L. Burg MSN, CRNP:
Marie, Blood clots are a risk from surgery. They are caused by the fact that you are in bed during the operation and for a period of time afterwards. Obesity also increases the risk of blood clots. We use many modalities to prevent this risk in our patients.

Peg:
How long is the hospital stay for bariatric surgery?

Kathryn L. Burg MSN, CRNP:
Peg, The hospital stay is on average 4 days.

Helen:
What is the leading cause of death after the surery?

Lou:
Great show, You all did a great job.

Saunsiree:
I have hypothyroidism and I had the rt thyroid lobe removed. Since then my doctors are having a hard time regulating my medicine and I keep gaining weight. My primary suggested I look into this. My main question is will this help someone fighting with hypothyroidism?

Kathryn L. Burg MSN, CRNP:
Saunsiree, Hypothyroidism is not a contraindication to surgey.

Roe:
I have been dieting since I have been in grade school. I am 55 years old and definitely need to lose 150 lbs. When I do diet, I am focused, but once I slip, look out. It is great that there is a support group, but best of all the option that if you don't follow what you need to do, you will become ill. How long is recovery time? I have signed up to set up a date for an evaluation.

Noel N. Williams, MD:
Roe -- Recovery time after surgery is 3-4 weeks.

Dave:
I am a 67 year old type 2 diabetic male weighing 285 lbs and am 6'1" tall. Am I eligible for Bariatric Surgery?

Kathryn L. Burg MSN, CRNP:
Dave, Due to your variety of health problems you most likely are a candidate for surgery. Since you are 67 years old, we would need to evaluate you carefully to determine if this is a safe option for you.

Theresa:
Are there any guidelines regarding age in having this surgery? Should it not be performed after a certain age? Thank you!

Noel N. Williams, MD:
Theresa - Generally, the age range is 20-65, however, we have operated on patients 16-19 in certain situations.

Gerry:
If you are over 65 will there be a lot of lose skin from the weight lost? If so, can it be tighten through surgey?

Noel N. Williams, MD:
Hi Gerry - Thank you for your message. This will depend on your initial size, however if there is loose skin it can be tightened with surgery.

Bonnie:
I inquired about Bariatric surgery 2 years ago and at the time Aetna said that I would have to be on a doctor supervised diet for at least 6 months. Does that still hold true. Over the course of my last 20 years I have been on many diets with doctors and commercial brand diets. Does none of that count? I lost but always put back on the weight.

Kathryn L. Burg MSN, CRNP:
Bonnie, Yes, Aetna does require at least 6 months of supervised dieting in order to approve the surgery. Your previous dieting attempts count if you have documentation of physician supervision.

Barbara:
Way to go, team!!!! I enjoyed every minute.

Kathryn L. Burg MSN, CRNP:
Barbara, THANKS!!

Theresa:
Hello, I am super morbidly obese. My BMI is around 70. I currently weigh 480lbs. Am I too high risk to have the surgery or if I am a candidate are there more risks involved?

Kathryn L. Burg MSN, CRNP:
Theresa, We would need to meet you in person and perform a thourough pre operative evaluation to determine the severity of risk for the operation.

Lyn:
My medical doctor is too concerned about the 5% death rate that has been reported with this surgery. What are the adverse event statistics at Penn?

Noel N. Williams, MD:
Lyn -- the 5% death rate statistic is a nationally published figure based on all comers. We stratify risk based on the patient's medical complications prior to surgery. Patients are carefully evaluated to decrease the risk. Our mortality rates are well below the national average.

Toni:
I am over 90 lbs over weight I am not able to loss the weight. Would I be a canadate for this. Age 60 5'5" 225.

Kathryn L. Burg MSN, CRNP:
Toni, Criteria for surgery are a BMI of 40 or greater, or a BMI of 35 or greater with obesity related health problems. As for your age, we evaluate each patient on an individual basis to determine if it is safe to proceed with surgery.

Peg:
I noticed you congratulating some patients on their success....what happens to one's stomach and body if they are not "successful" after the surgery? Can they still gain weight with such a small stomach? Thanks for this forum. I am just full of questions!

Noel N. Williams, MD:
Peg - As long as patients follow the instructions post operatively, they will lose weight and the operation will be successful.

Audrey:
Is there anything that can be done after surgery to reduce the amount of excess skin. In other words will exercise take care of this or will there be some sort of excess skin if you are severely overweight.

Kathryn L. Burg MSN, CRNP:
Audrey, Exercise does help tone muscles and to some extent excess skin. In some individuals the elasticity of the skin does not improve with exercise.

Paula:
What is concern to be a normal amount of time after surgery that you can return to work?

Noel N. Williams, MD:
Paula -- You should be able to return to work in 3 weeks.

Toni:
I am over 90 lbs over weight I am not able to loss the weight. Would I be a canadate for this. Age 60 5'5" 225.

Noel N. Williams, MD:
Hi Toni - At 90 pounds overweight with obesity-related medical problems including sleep apnea, high blood pressure or diabetes, you would be a candidate for the surgery. If you have no medical problems, the criteria is 100 pounds overweight.

Molly:
Dr Williams,
I have already had a consult with you. My inusurance was willing to cover in network costs, however because you are out of network, they only will pay me if I was willing to have an affadavit drawn up to insure the hospital receive their money. Not good enough with the pre-admission certification. Seems to me this is all about money. I am not a charity case, nor do I have $6,000. to put out up front. Am willing to pay, however no provisions or considerations are made. This for the good of the patient? Or is the really about money as I stated above.

Noel N. Williams, MD:
Molly -- Please call my office on Monday to discuss. Thank you.

Annmarie:
Don't know if my first message got through, it said it did not. I had surgery on March 31. I had complications and was in the hospital for 7 days and was given 6 pints of blood. My incision was infected and is still draining, and on top of that I am sick as a dog. I am ,very, very nauseous. They tell me to drink iospure, that would make me sick to my stomach if I wasn't already, just about keep water down. Any ideas on what to do? I also tried suppositorys and they don't help. It's been 18 days. Am I ever going to feel better?

Noel N. Williams, MD:
Annmarie -- Please call 1-800-789-PENN for advice.

Kathy:
I've lost 75 lbs in 6 months since surgery (thanks to the HUP team). I'm getting discouraged though, that the weight loss is so much slower then many other people at the support groups. I exercise every day, and stick to the program, but I'm stuck on 75...any suggestions?

Noel N. Williams, MD:
Hi Kathy - Thank you for your message. Weight loss varies for each patient. People do hit p