Are you a candidate?

Know your:

  1. body mass index (BMI)
  2. waist circumference
  3. risk factors associated with obesity

Medical Weight Loss

It’s the most effective treatment for the disease of morbid obesity.

Diet & Exercise

After bariatric surgery, if you follow diet and exercise recommendations, you can keep most of the weight off permanently.


To ensure that you get enough vitamins and minerals and keep your weight-loss goals on track.

Sergey Lyass, MD, FACS, FASMBS

Metabolic & Bariatric Medical Weight Loss

Sergey Lyass, MD is a bariatric surgeon, weight loss specialist, and da Vinci® robotic surgery provider serving patients in Los Angeles, Glendale,  Marina del Rey, and soon San Pedro California. Dr. Lyass received his medical degree from the 2nd Moscow Medical Institute (now Moscow Medical University) in 1985.

He was trained in general surgery in Israel at the Hebrew University-Hadassah Medical Center in Jerusalem and did his internship at Mount Sinai Medical Center in New York City. Dr. Lyass completed both his surgical residency and his fellowship in minimally invasive and bariatric surgery at Cedars-Sinai Medical Center in Los Angeles.

Elainne Sher, FNP, NP-C

Nurse Practitioner with a passion for Aesthetic Medicine & Medical Weight Loss

Elainne brings a comprehensive perspective to health care as a clinician that blends clinical expertise in diagnosing and treating health conditions with an added emphasis on disease prevention and health management. For individuals who are ready to take charge of their health, Elainne can help with m
edication therapy assisted weight loss. Along with age and health appropriate diet and exercise, many health conditions, such as hypertension (increased blood pressure), hyperlipidemia (increased cholesterol), sleep apnea, and diabetes mellitus may be managed successfully.

Let us put together a long-lasting behavior modification plan to create and sustain your healthy lifestyle and to assist your loss of excess weight.

What We Do

Medical Weight Loss Options

Before we look at the most common procedures, it is important to understand the two basic methods of promoting weight loss through surgery and the modern tools used to perform weight loss surgery. In addition, consideration should be given to how your life as well as your body will change as a result of weight loss surgery.

Restrictive Procedures

Gastric banding and the sleeve gastrectomy are considered restrictive methods (decreasing food intake). The term restrictive sound negative but there is very little interference with normal absorption of food – weight loss surgery works by reducing food intake, and by reducing the feeling of hunger. The result is a very early sense of fullness, followed by a very profound sense of satisfaction. Even though the portion size may be small, there is no hunger, and no feeling of having been deprived: when truly satisfied, you feel indifferent to even the choicest of foods.

Restrictive and Malabsorptive Procedure

The gastric bypass surgery combines the creation of a small stomach pouch to restrict food intake and construction of bypasses of the duodenum and other segments of the small intestine to cause malabsorption (decreased ability to absorb calories and nutrients from food). This results in a faster weight loss than the purely restrictive methods but requires monitoring what you eat to ensure your body is properly nourished.

Laparoscopic Surgery

Laparoscopy is an operation performed in the abdomen or pelvis through small incisions with the aid of a camera. The benefits of the laparoscopic approach come from the very small incisions for slender tools which results in much less pain, quicker recovery time and very little scarring. Patients are able to get up and walk within hours after surgery, can breathe easier, and move without discomfort. Bowel activity usually is not affected, as it is with an open incision. Laparoscopic surgery is often referred to as “minimally invasive” surgery.


Weight Loss Options

Bariatric surgery is an ongoing process toward weight loss through lifestyle changes. The surgery makes it physically easier to adjust your eating and lifestyle habits but the changes require permanent changes in your eating habits that must be followed for successful long term weight loss.

Laparoscopic Sleeve Gastrectomy

Gastric SleeveThe sleeve gastrectomy generates weight loss by restricting the amount of food that can be eaten without any bypass of the intestines or malabsorption. The gastric sleeve shrinks the size of the stomach in order to make patients feel full off of smaller amounts of food. These smaller portions in combination with exercise and lifestyle changes help the person lose weight. Traditionally, the procedure performed as a laparoscopic surgery which employs cameras and long, thin instruments inserted through small incisions and will remove a portion of the stomach itself.

Weight loss operations, such as gastric sleeve surgery, are meant for patients who are severely overweight and have not been successful using traditional methods such as healthy eating and exercising. Surgery is traditionally considered an option when the person’s BMI, is at least 40.

Laparoscopic Adjustable Gastric Banding

This surgical procedure is a tool used to assist patients with losing weight and is placed during a minimally-invasive, laparoscopic procedure. In Gastric Banding a band is placed around the outside of the upper stomach, to create a small pouch with a narrow outlet. The special device used to accomplish this is made of implantable silicone rubber and contains an adjustable balloon, which allows us to adjust the function of the band, without re-operation. The most common type of this surgery is known as the Lap-Band® system. The system shrinks a patient’s stomach volume, which in turn lessens the amount of food a patient is able to consume in a single meal. This makes patients feel fuller faster and remain full for a greater duration of time. The system was created to help patients slowly lose weight over time and maintain the weight loss once it is achieved.  Gastric Banding is an option for those who have a BMI of 40 or higher or if it is 30 and you have an obesity-related concern.

Laparoscopic Gastric Bypass

A laparoscopic gastric bypass is a type of surgical procedure which helps patients to lose weight by changing how the stomach and small intestine accommodate food. The objective of Gastric Bypass, Roux en-Y surgery is to make a very small pouch (thumb-sized) out of the upper stomach, to restrict the amount of food which can be eaten.  That pouch is separated from the rest of the stomach, which is bypassed, by creating a new pathway into the intestines. The surgery shrinks the stomach which causes the patient to feel full when eating smaller portions of food. The passage of the food is also restricted and it no longer travels to specific parts of the stomach and small intestine. This restriction keeps the body from absorbing all of the calories from the consumed food. People that have a BMI around 40 and who have a threatening or chronic disorder related to their weight, such as type 2 diabetes or high blood pressure, are good candidates for the procedure. Gastric bypass is meant to work in conjunction with healthy dieting and exercise. The patient must learn to control food portions and increase activity levels to truly benefit from the procedure.

Laparoscopic Revision Surgery

Revision bariatric surgery refers to a weight loss treatment that follows a previous weight loss surgery that did not lead to the desired level of success. Often when someone chooses to have bariatric surgery and follows the after-surgery plan, they lose a significant amount of weight and they maintain this weight loss.  Sometimes a weight loss procedure will not lead to as much weight loss as the surgeon and patient hope for. In other situations, a patient will lose the weight but later regains some or all of that weight. This happens when the smaller stomach pouch becomes stretched, allowing more food to enter the stomach comfortably at one time. To accommodate for this, revisionary operations are available to reduce the stomach back to the appropriate post-operative size. If this has happened to you, you should not feel ashamed or consider this a personal failure. On the contrary, this is the time to contact an expert in revisional treatment.

GERD - Linx System

The LINX System is intended for patients diagnosed with Gastroesophageal Reflux Disease (GERD) which is often a progressive disease resulting from a weak Lower Esophageal Sphincter (LES). The system is placed laparoscopically and is meant for those who are seeking an alternative to continuous acid suppression therapy. The LINX System is a small flexible band of interlinked beads with magnetic cores. The magnetic attraction between the beads is intended to help the LES resist opening to gastric pressures, preventing reflux from the stomach into the esophagus. Patients have noticed changes after the first day. Designed to last a lifetime, the Linx device is constructed of titanium and the permanent magnets are designed to move so if your esophagus needs to stretch it can.

da Vinci Robotic Surgery

For patients needing surgery for a gastric condition, Dr. Lyass offers the innovative da Vinci Robotic Surgery system. This system utilizes a robotic aid to complete a laparoscopic procedure which is minimally invasive. With the da Vinci Surgical System, Dr. Lyass operates through just a few small incisions. The system features a magnified 3D high-definition vision system and tiny wristed instruments that bend and rotate far greater than the human hand. As a result, da Vinci enables Dr. Lyass to operate with enhanced vision, precision, and control. Dr. Lyass is 100% in control of the robotic system at all times translating his hand movements into smaller, precise movements of tiny instruments inside your body.


Weight Loss Options

Gastric Balloon

The Obalon® Balloon System is a swallowable intragastric balloon system indicated for temporary use to facilitate weight loss in adults with obesity (BMI of 30 – 40 kg/m2) who have failed to lose weight through diet and exercise. The System is intended to be used as an adjunct to a moderate intensity diet and behavior modification program. The Obalon® Balloon System helps facilitate weight loss by taking up space in your stomach so you eat less. Three balloons are placed for a six month non-surgical treatment, combined with a professionally supervised nutrition and exercise program for optimal weight loss.


Body Contouring & Skin Tightening

A non-invasive treatment for tightening skin, reducing cellulite, and improving wrinkles is called the Venus Legacy™. This treatment uses a hand-held device that sends a combination of energies below the surface of the skin. These energies heat the underlying tissue and stimulate the body’s natural collagen production which tightens sagging skin, helps smoothes out cellulite, and makes the body look slimmer, sculpted, and more toned. In most cases, multiple treatments are needed to achieve desired results.

And Much More

Don't put off your new life any longer, please contact us today!

In our Center we perform a variety of revisional procedures such as revisionary laparoscopic gastric pouch resizing, converting Gastric Banding to Sleeve Gastrectomy or to Gastric Bypass, adding Gastric Band to Gastric Bypass procedure and many more.

FAQs - Frequently Asked Questions

This Q & A is designed to give you answers to common questions people have about weight loss surgery.

What is the difference between overweight and obese?

An adult is considered “overweight” when he/she is above a healthy weight, which varies according to a person’s height. An individual is overweight when their BMI is between 25–29.9. The standard used by researchers to define a person’s weight according to their height is “body mass index” (BMI).

An adult with a BMI of 30 or more is considered obese. For example, for a 5’4″ woman, this means that she is 30 or more pounds over her healthy weight. If your BMI = 35.0 – 40 you are severely obese (with risk factors morbidly). If your BMI = 40.0 and up you are morbidly obese.

How do I know if I am a candidate for weight loss surgery?

According to the National Heart Lung and Blood Institute guidelines, assessment of overweight involves using three key measures:

  • body mass index (BMI)
  • waist circumference
  • risk factors for diseases and conditions associated with obesity

The BMI is a measure of your weight relative to your height and waist circumference measures abdominal fat. Combining your BMI and your waist circumference with information about your additional risk factors yields your risk for developing obesity-associated diseases and determines whether you are a candidate for weight loss surgeries such as gastric bypass surgery, the gastric band or other weight loss procedures. So your BMI is a good number to begin identifying your risk due to your weight. Generally, if your BMI is greater than 40, surgery should be considered.  If it is greater than 35-39.9 and is accompanied by a serious comorbidity (see list below), surgery may be medically necessary.  For patients with a BMI of 30-34.9, weight loss surgery is usually purely cosmetic meaning insurance will not cover it.

Have you been diagnosed as having any of the following comorbidities from being overweight? We look for health effects that are known to be caused by or aggravated by serious obesity such as:

  • Type 2 Diabetes
  • High Blood Pressure
  • High Cholesterol
  • Obstructive Sleep Apnea
  • Depression
  • Osteoarthritis
  • Acid Reflux / GERD
  • Stress Urinary Incontinence
  • Polycystic Ovarian Syndrome (PCOS) or Infertility

These problems alone or in combination contribute to a “quality of life” factor. Not being able to go out and play with the kids because your knees have worn out, or not getting enough sleep because the apnea wakes you up during the night. And if nothing is done about your obesity the list of co-morbidities you’re experiencing will grow eventually leading you down the path to very poor health.

FAQs by Category Tabs

Does Bariatric surgery make you thin?

Weight loss surgical procedures can help patients lose up to 40 to 80 percent of excess body mass depending on the type of surgery. Patients who are 150 pounds overweight are likely to remain at least 50 pounds overweight at the end of the process. Gastric Bypass and Sleeve Gastrectomy usually produce in average better weight loss (50-80% of excess weight), while Gastric Banding 40-60%. Excess weight is a difference between actual and ideal weight.

Will I be happy after surgery?

Losing weight does not guarantee happiness. That said, you will find many rewards — both physical and emotional — when you reach a normal weight. You’ll have a stronger sense of self-esteem, and your health problems will be much more under control. But weight loss surgery won’t solve all your problems, and you don’t want to go into it thinking it will.

Is it possible to regain weight after having undergone a weight loss procedure?

Weight loss surgery procedures are tools to help patients achieve a healthier life. Surgery isn’t a cure by itself. It’s possible to not lose significant weight or to regain weight after any type of weight loss procedure or surgery, even if the procedure itself works correctly. This weight gain can happen if you don’t follow the recommended lifestyle changes. Permanent healthy changes in your diet, along with regular physical activity and exercise, are necessary to avoid regaining weight.

Are you ready for weight loss surgery?

Chances are you are looking into weight loss surgery on your own without having discussed this consideration with your family or friends and that is fine. Obesity surgery is a very personal decision to make but at the same time, you won’t be going through this alone. With the help of your practitioner, you together with your loved ones should agree that weight loss surgery is the best choice for you but getting to that point can be difficult.

Deciding to undergo a bariatric surgical procedure will change your life in a dramatic and permanent way; your goals should be in the right order, first, to be healthier, next, to live happier, and lastly, to look great.

For all these reasons and more, you should make the decision to have weight-loss surgery only after careful consideration and consultation with an experienced bariatric surgeon and a knowledgeable family physician. A qualified surgeon should answer your questions clearly and explain the exact details of the procedure, the extent of the recovery period and the reality of the follow-up care that will be required. As part of routine evaluation for weight-loss surgery, they may require you to consult with a dietitian/nutritionist and a psychiatrist/therapist. This is to help establish a clear understanding of the post-operative changes in behavior that are essential for long-term success. Weight-loss surgery will only succeed when the patient makes a lifelong commitment. Some of the challenges facing a person after weight-loss surgery can be unexpected. Lifestyle changes can strain relationships within families and between married couples.

You know what you have to deal with but those close to you may not know the problems related to obesity so it is up to you to educate them. Let them know that this is a treatment of last resort; you repeatedly tried — and failed — to lower your BMI using diets, exercise and behavior modification and you still have serious health-risk factors associated with being seriously overweight, and that the primary reason for considering bariatric surgery is one of health and not appearance. Many of your friends may think you are doing this in vain instead of purely health reasons. So, it is important for family, friends, and coworkers to understand your condition so they may better understand the path you are on and your plan to change that path permanently. The sooner you do this, the sooner you can make the commitment to taking your life back from obesity.

Ultimately, the decision to have the procedure is up to you. After having heard all the information, you must decide if the benefits outweigh the risks. Remember, this surgery is only a tool. Your ultimate success depends on strict adherence to the recommended dietary, exercise and lifestyle changes.

What is the oldest patient you can operate upon?

Patients over 65 require very strong indications for surgery, and must also meet MediCARE criteria, which are stringent. The risk of surgery in this age group is increased, and the benefits, in terms of reduced risk of mortality, are reduced. In many instances, this argues against the surgery.

What is the youngest patient that can undergo gastric bypass surgery?

For Gastric Bypass surgery, patients as young as 16 years of age have been treated. In this age group, the concern is that the patient makes the decision for surgery him or herself and that there be a full understanding and commitment to the lifelong altered eating pattern which will be necessary for success.

Can weight loss surgery help with Type 2 Diabetes?

In general, all the available weight loss procedures that cause actual weight loss for the patient can result in partial or complete remission of Type 2 Diabetes.

  • The gastric bypass procedure can result in the rapid remission of Type 2 Diabetes independent of actual weight loss although the exact mechanisms of this remission are unclear.
  • The sleeve gastrectomy procedure also appears to have some weight loss independent effects (similar to results seen after gastric bypass) in Type 2 Diabetes remission.
  • In the gastric banding or gastric balloon procedures, the improvement of Type 2 Diabetes can occur only after weight loss is achieved which is primarily attributed to caloric restriction. There is no remission independent of weight loss. Gastric banding for the control of diabetes is better than intensive lifestyle treatment but is not as effective as gastric bypass or the sleeve gastrectomy.

Type 2 Diabetes is a major contributor to morbidity and mortality from stroke, kidney failure, and heart disease.  While bariatric surgery has some risks, the long-term risk of continued diabetes (which is often inadequately treated with medication) typically outweighs the risk of a surgical procedure for most patients. Each patient’s individual risks for surgery should be evaluated in the context of the duration and severity of their diabetes as well as their other obesity-related health problems.

What if I don't have health insurance?

If you do not have insurance, don’t give up! You still may have an option available in obtaining treatment. Simply become a cash patient. Pay for the surgery yourself. Some doctors can work with you on their pricing or payment plans. The benefit of paying for the surgery yourself is that you don’t have to wait for insurance approval and can usually have the surgery within 1-2 weeks of seeing the surgeon.

You may have to pay for your own weight loss surgery, but weight loss surgery is often covered by insurance. Even though in recent years, insurance companies have become more demanding in their screening of patients, the vast majority of surgeries are covered. If anyone, where you work, has had weight loss surgery, check with them about what experience he had with insurance coverage. You’ll get a sense of what, if anything, you may be up against. If you have the same insurance company as one of your friends but you aren’t on the same plan, your insurance could be entirely different. One company may list the surgery as an exclusion for its employees, while another company that uses the same insurance company may not. Just be sure to talk with your insurance company beforehand so you know what costs, if any, will be involved.

Why does it take so long to get insurance approval?

After your consultations are completed, and we get all reports it usually takes your doctor 1-2 days to send a letter to your insurance carrier to start the approval process. The time it takes to get an answer can vary from about 3-4 weeks or longer if you are not persistent in your follow-up. Most treatment centers have insurance analysts who will follow up regularly on approval requests. It may be helpful for you to call the claims service of your insurance company about a week after your letter is submitted and ask about the status of your request.

How can they deny insurance payment for a life-threatening disease?

Payment may be denied because there may be a specific exclusion in your policy for obesity surgery or “treatment of obesity.” Such an exclusion can often be appealed when the surgical treatment is recommended by your surgeon or referring physician as the best therapy to relieve life-threatening obesity-related health conditions, which usually are covered.

Insurance payment may also be denied for lack of “medical necessity.” A therapy is deemed to be medically necessary when it is needed to treat a serious or life-threatening condition. In the case of morbid obesity, alternative treatments – such as dieting, exercise, behavior modification, and some medications – are considered to be available. Medical necessity denials usually hinge on the insurance company’s request for some form of documentation, such as 1 to 5 years of physician-supervised dieting or a psychiatric evaluation, illustrating that you have tried unsuccessfully to lose weight by other methods.

What can I do to help the process?

First, help us to get all the information (diet records, medical records, medical tests) together in your case, so the carrier cannot deny for failure to provide “necessary” information. Letters from your personal physician and consultants, attesting to the “medical necessity” of treatment, are particularly valuable – when one or several physicians corroborate the necessity of treatment, it will be hard for the carrier to contradict them.

When the letter is submitted, call your carrier regularly (about once a week), to ask about your status. You may also be able to protest unreasonable delays through your employer or human relations/personnel office.

What are the routine tests before surgery?

Certain basic tests are done prior to surgery: a Complete Blood Count (CBC), Urinalysis, and a Chemistry Panel, which gives a readout of about 20 blood chemistry values. Often a Glucose Tolerance Test is done to evaluate for diabetes, which is very common in overweight persons. All patients but the very young get a chest X-ray and an electrocardiogram. Women may have a vaginal ultrasound to look for abnormalities of the ovaries or uterus. Many surgeons ask for a gallbladder ultrasound to look for gallstones. Other tests, such as pulmonary function testing, echocardiogram, sleep studies, GI evaluation, cardiology evaluation, or psychiatric evaluation, may be requested when indicated.

What is the purpose of all these tests?

An accurate assessment of your health is needed before surgery. The best way to avoid complications is to never have them in the first place. It is important to know if your thyroid function is adequate since hypothyroidism can lead to sudden death post-operative. If you are diabetic, special steps must be taken to control your blood sugar. Because surgery increases cardiac stress, your heart will be thoroughly evaluated. These tests will determine if you have liver malfunction, breathing difficulties, excess fluid in the tissues, abnormalities of the salts or minerals in body fluids, or abnormal blood fat levels.

Why do I have to have a GI Evaluation?

Patients who have significant gastrointestinal symptoms such as upper abdominal pain, heartburn, belching sour fluid, etc., may have underlying problems such as a hiatal hernia, gastroesophageal reflux or peptic ulcer. For example, many patients have symptoms of reflux. Up to 15% of these patients may show early changes in the lining of the esophagus, which could predispose them to cancer of the esophagus. It is important to identify these changes so a suitable surveillance or treatment program can be planned.

Why do I have to have a Sleep Study?

The sleep study detects abnormal stopping of breathing, usually associated with airway blockage when the muscles relax during sleep. This condition is associated with a high mortality rate. After surgery, you will be sedated and will receive narcotics for pain, which further depress normal breathing and reflexes. Airway blockage becomes more dangerous at this time. It is important to have a clear picture of what to expect and how to handle it.

Why do I have to have a Psychiatric Evaluation?

The most common reason a psychiatric evaluation is ordered is that your insurance company may require it. Most psychiatrists will evaluate your understanding and knowledge of the risks and complications associated with weight loss surgery and your ability to follow the basic recovery plan.

What impact do my medical problems have on the decision for surgery, and how do the medical problems affect risk?

Medical problems, such as serious heart or lung problems, can increase the risk of any surgery. On the other hand, if they are problems that are related to the patient’s weight, they also increase the need for surgery. Severe medical problems may not dissuade the surgeon from recommending gastric bypass surgery if it is otherwise appropriate, but those conditions will make a patient’s risk higher than average.

If I want to undergo a gastric bypass, how long do I have to wait?

New evaluation appointments are usually booked 4-8 months in advance. Once a patient is seen, if the surgeon and patient agree it is appropriate, the operation can usually be scheduled within 8 weeks. When the number of patient waiting for weight loss surgery is greater than the amount of available qualified bariatric surgeons, there will be a scheduling delay.

What can I do before the appointment to speed up the process of getting ready for surgery?

  • Select a primary care physician if you don’t already have one, and establish a relationship with him or her. Work with your physician to ensure that your routine health maintenance testing is current. For example, women may have a pap smear, and if over 40 years of age, a breast exam. And for men, this may include a prostate-specific antigen test (PSA).
  • Make a list of all the diets you have tried (a diet history) and bring it to your doctor.
  • Bring any pertinent medical data to your appointment with the surgeon – this would include reports of special tests (echocardiogram, sleep study, etc.) or hospital discharge summary if you have been in the hospital.
  • Bring a list of your medications with dose and schedule.
  • Stop smoking. Surgical patients who use tobacco products are at a higher surgical risk.

Does Laparoscopic Surgery decrease the risk?

No.  Laparoscopic operations carry the same risk as the similar procedure, performed as an open operation.  The benefits of laparoscopy are usually, less discomfort, shorter hospital stay, earlier return to work, and much-reduced scarring.

What do I need to do to be successful after surgery?

The basic rules are simple and easy to follow:

  • Immediately after surgery, your doctor will provide you with special dietary guidelines. You will need to follow these guidelines closely. Many surgeons begin patients with liquid diets, moving to semi-solid foods and later, sometimes weeks or months later, solid foods can be tolerated without risk to the surgical procedure performed. Allowing time for proper healing of your new stomach pouch is necessary and important.
  • When able to eat solids, eat 2-3 meals per day, no more. Protein in the form of lean meats (chicken, turkey, fish) and other low-fat sources should be eaten first. These should comprise at least half the volume of the meal eaten. Foods should be cooked without fat and seasoned to taste. Avoid sauces, gravies, butter, margarine, mayonnaise and junk foods.
  • Never eat between meals. Do not drink flavored beverages, even diet soda, between meals.
  • Drink 2-3 quarts or more of water each day. Water must be consumed slowly, 1-2 mouthfuls at a time, due to the restrictive effect of the operation.
  • Exercise aerobically every day for at least 20 minutes (one-mile brisk walk, bike riding, stair climbing, etc.). Weight/resistance exercise can be added 3-4 days per week, as instructed by your doctor.

What’s so important about exercise?

When you have a weight loss surgery procedure, you lose weight because the amount of food energy (calories) you are able to eat is much less than your body needs to operate. It has to make up the difference by burning reserves or unused tissues. Your body will tend to burn any unused muscle before it begins to burn the fat it has saved up. If you do not exercise daily, your body will consume your unused muscle, and you will lose muscle mass and strength. Daily aerobic exercise for 20 minutes will communicate to your body that you want to use your muscles and force it to burn the fat instead.

What is the right amount of exercise after weight loss surgery?

Many patients are hesitant about exercising after surgery, but exercise is an essential component of success after surgery. Exercise actually begins on the afternoon of surgery – the patient must be out of bed and be walking. The goal is to walk further on the next day, and progressively further every day after that, including the first few weeks at home. Patients are often released from medical restrictions and encouraged to begin exercising about two weeks after surgery, limited only by the level of wound discomfort. The type of exercise is dictated by the patient’s overall condition. Some patients who have severe knee problems can’t walk well, but may be able to swim or bicycle. Many patients begin with low-stress forms of exercise and are encouraged to progress to more vigorous activity when they are able.

Can I get pregnant after weight loss surgery?

It is strongly recommended that women wait at least one year after the surgery before a pregnancy. Approximately one year post-operatively, your body will be fairly stable (from a weight and nutrition standpoint) and you should be able to carry a normally nourished fetus. You should consult your surgeon as you plan for pregnancy.

What if I have had a previous weight loss surgical procedure and I’m now having problems?

Contact your original surgeon – he or she is most familiar with your medical history and can make recommendations based on knowledge of your surgical procedure and body.

What happens to the lower part of the stomach that is bypassed?

In some surgical procedures, the stomach is left in place with intact blood supply. In some cases, it may shrink a bit and its lining (the mucosa) may atrophy, but for the most part, it remains unchanged. The lower stomach still contributes to the function of the intestines even though it does not receive or process food – it makes intrinsic factor, necessary to absorb Vitamin B12 and contributes to hormone balance and motility of the intestines in ways that are not entirely known. In the BPD procedures, some portion of the stomach is completely removed.

How big will my stomach pouch really be in the long run?

This can vary by surgical procedure and surgeon. In the Roux-en-Y gastric bypass, the stomach pouch is created at one ounce or less in size (15-20cc). In the first few months, it is rather stiff due to natural surgical inflammation. About 6-12 months after surgery, the stomach pouch can expand and will become more expandable as swelling subsides. Many patients end up with a meal capacity of 3-7 ounces.

What will the staples do inside my abdomen? Is it okay in the future to have an MRI test? Will I set off metal detectors in airports?

The staples used on the stomach and the intestines are very tiny in comparison to the staples you will have in your skin or staples you use in the office. Each staple is a tiny piece of stainless steel or titanium so small it is hard to see other than as a tiny bright spot. Because the metals used (titanium or stainless steel) are inert in the body, most people are not allergic to staples and they usually do not cause any problems in the long run. The staple materials are also non-magnetic, which means that they will not be affected by MRI. The staples will not set off airport metal detectors.

What if I’m not hungry after surgery?

It’s normal not to have an appetite for the first month or two after weight loss surgery. If you are able to consume liquids reasonably well, there is a level of confidence that your appetite will increase with time.

Is there any difficulty in taking medications?

Most pills or capsules are small enough to pass through the new stomach pouch. Initially, your doctor may suggest that medications be taken in liquid form or crushed.

Will I be able to take oral contraception after surgery?

Most patients have no difficulty in swallowing these pills.

Is sexual activity restricted?

Patients can return to normal sexual intimacy when wound healing and discomfort permit. Many patients experience a drop in desire for about 6 weeks.

Is there a difference in the outcome of surgery between men and women?

Both men and women generally respond well to this surgery. In general, men lose weight slightly faster than women do.

Will I be asked to stop smoking?

Patients are encouraged to stop smoking at least one month before surgery. Smoking increases the risk of lung problems after surgery, can reduce the rate of healing, increases the rates of infection, and interferes with blood supply to the healing tissues.

How can I know that I won’t just keep losing weight until I waste away to nothing?

Patients may begin to wonder about this early after the surgery when they are steadily losing a significant amount of weight per month, or maybe once they’ve reached their goal weight and they’re still losing weight. Two things happen to allow their weight to stabilize. First, a patient’s ongoing metabolic needs (calories burned) decrease as the body sheds excess pounds. Second, there is a natural progressive increase in calorie and nutrient intake over the months following weight loss surgery. The stomach pouch and attached small intestine learn to work together better, and there is some expansion in pouch size over a period of months. The bottom line is that, in the absence of a surgical complication, patients are very unlikely to lose weight to the point of malnutrition.

What can I do to prevent lots of excess hanging skin?

Many people heavy enough to meet the surgical criteria for weight loss surgery have stretched their skin beyond the point from which it can “snap back.” Some patients will choose to have plastic surgery to remove loose or excess skin after they have lost their excess weight. Insurance generally does not pay for this type of surgery (often seen as elective surgery). However, some do pay for certain types of surgery to remove excess skin when complications arise from these excess skin folds. Ask your surgeon about your need for a skin removal procedure.

What do I do to use the Gastric Bypass "tool" successfully?

In general, the basic rules for gastric bypass patients are as follows:

  • Eat 2 -3 meals per day, no more.  Protein, in the form of lean meats (chicken, turkey, fish), and other low-fat sources, should be eaten first and should comprise at least half the volume of the meal eaten.  Foods should be cooked without fat, seasoned to taste.  Avoid sauces, gravies, butter, margarine, mayonnaise, and junk foods.
  • Never eat between meals – nothing.  Do not drink flavored beverages, even diet soda, between meals.
  • Drink 2 -3 quarts, or more, of water each day.  Water must be consumed slowly, 1 -2 mouthfuls at a time, due to the restrictive effect of the operation.
  • Exercise aerobically every day, for 20 minutes at least (one-mile brisk walk, bike riding, stair climbing, etc.).  We encourage weight/resistance exercise 3 – 4 days per week.

When each meal is satisfying, this is not a diet, but a style which you can easily achieve, and which will result in rapid weight loss followed by weight maintenance.

Do I meet with a nutritionist before and after surgery?

Nutritional counseling will take place before and after surgery as required by Dr. Lyass. He provides patients with materials that clearly outline his expectations regarding diet and compliance with guidelines for the best outcome based on your surgical procedure. After surgery, health and weight loss are highly dependent on patient compliance with these guidelines. You must do your part by restricting high-calorie foods, by avoiding sugar, snacks, and fats, and by strictly following the guidelines set by Dr. Lyass.

What vitamins will I need to take after surgery?

Generally speaking, taking supplements after surgery is important for three reasons:

  • To make sure you get adequate vitamins and minerals even though you are eating less food
  • To help prevent deficiencies that you are at greater risk for because of your procedure (especially for malabsorptive procedures)
  • In some cases, to treat a nutritional deficiency

The most common types of supplements taken after surgery are multivitamins, calcium, vitamin B12 and iron.

B12 injections are sometimes suggested once a month for the first year and every six months thereafter. B12 may also be taken orally or sublingually (under the tongue) by many patients. Most surgeons recommend a daily multivitamin for the rest of your life.

How long will I be off of solid foods after surgery?

Dependant upon the procedure, your surgeon might recommend a liquid diet followed by semi-solid foods or pureed foods, for a period of time until adequate healing has occurred. Your surgeon will provide you with specific dietary guidelines for the best post-surgical outcome.

Will I be able to eat “spicy” foods or seasoned foods?

Most patients are able to enjoy spices after the initial 6 months following surgery.

Can I drink carbonated beverages such as soda after surgery?

Many patients do find carbonated beverages or sodas uncomfortable and it is recommended that you avoid any flavored drinks between meals, such as diet soda, coffee, and tea for the following reasons:

  • They can cause gas and bloat. Carbonated beverages like sodas contain gas, which can cause bloating, discomfort and abdominal distension. Carbonation can also place added stress on your incision, which can interfere with the healing process. You will need to avoid carbonated drinks of all kinds for a minimum of three months after weight loss surgery.
  • They can cause dumping syndrome. If you’ve had gastric bypass, eating or drinking anything with high sugar content can lead to dumping syndrome. The result is a very unpleasant feeling, as you break out in a cold clammy sweat, turn pale white, feel butterflies in your stomach and a pounding pulse. This may be followed by cramps and diarrhea. This state can last for 30 – 60 minutes, and is quite uncomfortable – most have to lie down until it goes away.
  • They can slow down weight loss. Non-diet sodas and other sugary beverages are full of empty calories, which can slow down your weight loss efforts.
  • They can activate your hunger mechanism.  This can lead to snacking which will slow down your weight loss and can lead to regaining of weight.

What is the problem with milk products?

Milk contains a special sugar, called lactose, or milk sugar, which is not well digested. This sugar passes through undigested, until bacteria in the lower bowel act on it, producing irritating byproducts, as well as gas. Depending on individual tolerance, some persons find even the smallest amount of milk or milk sugar will cause cramps, gas, and diarrhea.

Why can’t I eat red meat after surgery?

Solid foods such as red meats contain a high level of meat fibers (gristle) which hold the piece of meat together, preventing you from separating it into small parts when you chew. The gristle can plug the outlet of your stomach pouch and prevent anything from passing through, a condition that is very uncomfortable.

After about eight weeks (on the gastric bypass diet), you can gradually return to eating firmer foods. But foods must still be chopped or diced. Start slowly with regular foods to see what foods you can tolerate. You may find that you still have difficulty eating spicier foods or foods with crunchy textures.

Other foods you should avoid because they may cause gastrointestinal symptoms, such as nausea, pain or vomiting:

  • fried foods
  • nuts and seeds
  • bread
  • popcorn
  • dried fruits
  • carbonated beverages
  • granola
  • stringy or fibrous vegetables, such as broccoli, celery, cabbage or corn

Over time, you may be able to try some of these foods again, with the guidance of your doctor.

Why should I drink so much water?

When you are losing weight, there is a heavy load of waste products to eliminate, mostly in the urine. Some of these substances tend to form crystals, which can cause kidney stones. A high water intake protects you and helps your body to rid itself of waste products efficiently, promoting better weight loss.

Water will also fill your stomach and will help to prolong and intensify your sense of satisfaction with food. If you feel a desire to eat between meals, it is because you did not drink enough water in the hour before.

Will I be allowed to drink alcohol?

You will find that even small amounts of alcohol will affect you quickly and most alcohol is considered liquid calories which contradicts the purpose of undergoing weight loss surgery in the first place. It is suggested that you drink no alcohol for the first year. Thereafter, with your physician’s approval, you may have a glass of wine or a small cocktail. It is important to note that according to research published in 2017 in an online issue of the journal of the American Society for Metabolic and Bariatric Surgery (ASMBS) that weight loss surgery increases the risk of alcohol use disorder (AUD) and that alcohol abuse can happen even years after surgery.  Given the research, people who’ve had bypass surgery might want to stay away from alcohol altogether.

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