• Kayla Landaeta

FAQs for Bariatric Surgery: Why is my pre-op program different from what I saw online?

I had, and went public with, my surgery over 4 years ago, and my pre-op process took 8 months. That means as of March 2020, I have 5 years of answering a lot of questions about the weight loss surgery process. I've decided to create a posting series with some of the most common questions I get from clients, followers, and anyone who finds out what I do for a living!

Being someone who is considering surgery, or has been thrown into the pre-op approval process, can be daunting. Not only is there the whole idea of choosing an elective surgery to completely change your life, but you also will be navigating your healthcare system - something that can already be confusing and overwhelming. Coupled with the fact that very few bariatric clinics and insurance companies are operated exactly the same can leave you feeling left high and dry.

That leads to my first most commonly asked question for today:

Why is my pre-op plan so different from what I saw online? This is especially prevalent in America, where we do not have any type of centralized healthcare system.

When you decide to have weight loss surgery, you have two major organizations that have to approve you: your doctor/clinic, and your insurance company (if that is how you intend to pay for care.) There will be some overlap for what you need to do for both organizations, but others may have their own stipulations as well to prove medical necessity and due diligence.

The biggest differences patients see when they talk to other pre-op patients include:

  • What testing is required before surgery

  • How long you have to wait for surgery

  • How frequently you need to see the clinic during your pre-op process

  • What kind of education you need to do, if any

  • How much weight you need to lose on your own, if any

  • What kind of a pre-op diet you need to follow, if any

Things that are the most common, although are not always the case, include:

  • Patients typically have a BMI over 40, or a BMI over 35 with comorbidities (conditions directly related to your weight or would benefit from your weight loss, such as sleep apnea, diabetes, high cholesterol, PCOS, etc.)

  • Patients typically will have to go through a psychological evaluation, to give initial clearance that they can handle weight loss surgery, mentally and emotionally.

  • Patients typically have to go to some kind of an educational meeting or class, to make sure they understand their programs' pre-op and post-op diets.

As for why these programs can differ so much, a lot of it boils down to the beliefs of your insurance company and your doctors' offices. If they see a certain test or appointment as redundant or not necessary, they may not make that an essential part of their program. If they do absolutely everything, it may be their belief that they are doing their due diligence for their patients to succeed.

For example, my program did not require me to lose a certain amount of weight pre-op, and they did not require a swallow test after surgery - two things I thought were expected for everyone going through the process. My plan did require me to meet with an exercise therapist and do bi-weekly phone calls with nutritionists and exercise therapists - something I have never heard other patients having to do outside of my insurance company and clinic. As for the swallow test, my team chooses to not do tests unless there are indications or symptoms that show a test is necessary.

This is the reason why I started coaching bariatric patients. I had a very in-depth and supportive clinic and insurance agency. I know I can call my nurse practitioner anytime, and I'll get a call back within a couple of days to talk about my surgery, regain, or any questions I may have. When I began talking to other patients around the world and realized that the level of care I received was not normal - I knew a person in a coaching capacity could be a huge help for others who want to have all of the resources and help to rock their new tool.

I have had clients ranging from self-pay patients with no guidance to patients who had a year-long process with classes, weigh-ins, and constant education and support.
All of these people have the capacity to succeed at weight loss surgery - but there is definitely a good reason to stack the deck with as many resources as possible.

If you think something is odd that you don't have to do it for your program, there is no shame in asking your doctor why you don't have to do it. Asking "why" is your control, especially where your health is related. Better understanding the process and the reasoning behind your medical choices is a powerful tool and only helps you be a better advocate for yourself.

I will encourage one bit of caution: Your doctor is the one in charge, and their goal is for you to succeed and thrive. If they have a test or a process they require you to follow - you need to follow their plan. If you disagree, you may always seek a second opinion, but don't just ignore your doctors' instructions. There is a reason they are asking you to follow these rules and procedures - trust them during this process.

Keep an eye out for future posts, and let me know if there is a particular question you want me to include in this series. Some questions coming up will include:

  • Fixing your relationship with food/understanding food funerals

  • How to set yourself up for success for surgery day

  • When can you go back to work/what to tell your employer

  • How to handle your fear about recovery/pain

Thank you all for your support!

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