Article By: Whittany Gibson, RDN
Whittany is a Registered Dietitian Nutritionist who specializes in bariatric nutrition counseling, providing education and support prior to and following weight loss surgery.
Choosing the right bariatric surgery center can mean the difference between having a successful WLS experience and going through an extremely difficult journey. Many prospective bariatric surgery patients may choose the best deal when vetting a surgeon... But when it comes to bariatric surgery, price simply cannot be the priority. As a bariatric dietitian, I’ve heard nightmare stories from patients who took shortcuts, wanted the fastest track possible to get to surgery, and did not take the time to do their research. This is where patients risk getting under-qualified treatment in addition to a lack of support both before and after surgery. In my professional opinion, weight loss surgery is a life-altering decision that requires the utmost preparation and guidance. Following WLS, there's a completely new lifestyle to adopt. In order to use this new tool to the fullest, patients need adequate support and resources from their program. When it comes to choosing your bariatric surgeon and surgery center, you may not know where to start... It all begins with a surgery consultation. But what questions do you need to ask? Below you’ll find seven questions that will help you make the best decision possible so you can move forward confidently knowing you’re in good hands.
1) Is the surgeon board certified? To be "board certified" means the surgeon has passed a specialty-specific exam and has achieved a higher standard of care than industry peers. Board certification validates a surgeon's expertise as well as their desire to be among the best in their field. Holding a board certification demonstrates a surgeon can deliver the best quality care for their patients.
2) How many surgeries do they perform per year? You may want to ask the surgeon a few questions related to the volume of surgeries they perform. A low volume bariatric hospital (LVBH) could mean higher complication rates while high volume bariatric hospitals (HVBH) will have more familiarity with the management principles necessary to minimize postoperative risks and complications. What does this mean? Basically, there's a higher level of experience with the surgery itself and therefore improved patient outcomes. Ask these questions:
- “How many times have you performed this surgery?”
- “How many surgeries did you perform last month and last year?”
- “How long have you been performing this surgery?”
I asked a board certified surgeon whose center is accredited as a Bariatric Surgery Center of Excellence by ASMBS and performs surgeries at a HVBH... He said, “On average, you want to choose a surgeon performing at least 100 cases per year."
3) Is the surgery center accredited as a Bariatric Surgery Center of Excellence by the American Society for Metabolic and Bariatric Surgery (ASMBS)? When choosing your surgery center, you want to ensure it has been accredited as a Bariatric Surgery Center of Excellence. This means the program has undergone a rigorous review process as well as peer evaluation validating the center can operate to the highest standards of bariatric practice. Accredited centers report outcomes to what is called the MBSAQIP database, and this information is used to support continuous quality improvement. In other words, it’s safe to say that the facility is top-notch if it is accredited as a Bariatric Surgery Center of Excellence by the ASMBS.
4) What type of patient education is offered prior to surgery? Patient education is huge, folks! I can’t count the number of times a new patient coming from a subpar surgery center has told me, “I barely received any education or information prior to surgery,” or “I felt lost and didn’t know what to do or how to eat after surgery.” For whatever reason, these patients were clearly not prepared. It is obvious that WLS success starts well before surgery. It is up to the patient to prepare for the long journey ahead, but the bariatric program you choose should offer support along the way. Education prior to surgery is vital to post-op success. Patients need to be provided with adequate education on basic nutrition concepts and how to begin applying them, how to begin an exercise regimen, and how to begin practicing some of the necessary post-WLS eating behaviors. Patients should also learn and understand post-op diet progressions and guidelines including appropriate eating behaviors, proper multivitamin supplementation, and exercise expectations for long-term success. Without first educating the patient, they can be left in the dark, ultimately not losing weight as expected, regaining weight a year or two down the road, and/or suffering from malnutrition. The program should offer multidisciplinary support that includes both nutritional and behavioral support prior to surgery. With adequate resources and education, the patient should feel confident and secure with their decision to have surgery prior to the big day.
5) What does the program offer in terms of follow-up appointments and support following surgery? When choosing your surgery center, ensure your team has a concrete follow-up plan for post-op appointments. A good follow-up schedule typically includes a one week post-op surgical visit with your physician or physician assistant. After this follow-up, patients should be scheduled to see a provider every three months for the first year (then on an annual basis). If you need additional support, you should be able to make an appointment at any time. In addition to surgical follow-up, nutritional support should also be offered. Many programs may offer only one post-op appointment with the dietitian. It is actually recommended that bariatric patients continue nutrition counseling on the same schedule as surgical follow-ups. However, depending on insurance coverage, your visits may not be covered, but self pay rates are usually very affordable. Either way, it is highly encouraged to meet with your dietitian on a regular basis. After all, patients tend to have the most difficulty with nutrition and eating behaviors after surgery, especially within the first year. Other than following-up with your providers, a support group of some sort should be offered, either in-person, online, or both. Support groups are critical to a patient's success as they are able to identify with a common population and can share experiences.
6) Does the center offer an experienced dietitian that specializes in bariatric surgery? Too often, dietitians are put in positions they are not passionate about or are not specialized in. When these two things intersect, patients receive subpar coaching. When it comes to bariatric surgery, patients need much more than just education and information handed to them on paper. They need a cheerleader, motivator, and someone to give them the support system they need. Bariatric patients need someone who can educate them and help simplify concepts and guidelines to be successful. More than anything, patients need accountability. The dietitian should be qualified in motivational interviewing methods in addition to being proactive with other types of support. Optimally, you want a dietitian that is able to offer support outside of the office setting such as being involved in support groups, private forums, additional group classes, cooking classes, digital education in audio/visual formats, you name it. It’s all about the support!
7) Does the center have good reviews? Sure, all the boxes are checked, but are patients happy? A center might check all the boxes and look good on paper, but what are the patients saying? It might serve you well to do some digging and read reviews. Everyone will have bad experiences now and then, and you’ll have to take some of the reviews with a grain of salt... However, if reviews are overwhelmingly positive with compliments about the staff and providers, you likely have a good center on your hands. It’s paramount that patients feel supported, comfortable, and well taken care of.
As you’ve read, choosing a surgery center is much more than finding an affordable in-network provider. WLS certainly isn’t the type of surgery you want to be in a rush for. In order to be successful with your surgery, you need to have the best support system possible — a center that is qualified but also truly cares about your long-term success and is with you for the long haul!
BariMelts provides general recommendations, not to be construed as medical advice. Please consult your doctor.