Dating after Bariatric Surgery: Volume 1

“Bob. Single, professional, 42 y.o., 5’9”, 227 pounds (down from 320 pounds since my VSG last year!), likes long walks on the beach and golden retrievers.”

Would you swipe yes or no? I suppose it depends on the circumstances.

Many of my patients have asked me when they should start dating after bariatric surgery. A subset of those patients have asked how and when to tell others that they have undergone a weight loss procedure. The answer is highly personal, and demands an in-depth discussion of the various approaches.

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Why is weight a casual topic of conversation?

“Did you stop working out?” a co-worker asked me last week in the hospital cafeteria. “You look way too skinny,” said a colleague in the O.R. to me a few months ago.  “You used to look a lot stronger,” a former co-resident said to me at a national meeting of Bariatric surgeons.

Sound familiar? Anyone ever come up to you at work and remark on your weight going up or down? Since when did our weight become an appropriate point of discussion with acquaintances? Okay, so I used to be a lot heavier, and my weight has fluctuated over the years, just like everyone else’s, but what the heck?

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We are a no judgement zone – come see us when you are struggling

I saw a woman in the office yesterday who has been struggling with major life stress, and, as a result, has been gaining weight over the past few years since her surgery. She wanted to come see me years ago, but was embarrassed by her weight gain. Please, do not be embarrassed to come see me. We are all in this fight together, and my Team has some great techniques to help folks get back on track. Stress causes increases in cortisol, which can lead to weight gain. Combined with time constraints limiting access to exercise, and stress eating, weight can begin to creep back. Come see me so we can help each other, and let’s get healthy together!

Why I do what I do

A little over a year ago, a gentleman in a wheelchair, with severe Parkinson’s disease, came into my office for a consult. He was over 500 lbs, and could barely care for himself, let alone for his family. He and I were both concerned that his weight-related medical problems were so severe that we would not be able to get him through surgery safely, but, without bariatric surgery, he was not likely to live much longer. We brought him into the hospital 3 days ahead of time to work on an aggressive medical plan to get him tuned up for surgery, and the procedure went very well. Some of the post op hurtles included needing his wheelchair to move around, high-dose Parkinson’s medications, and severe leg swelling. Additionally, several family members and staff were needed to help him with his daily activities. Today, just over 6 months after surgery, that man WALKED into my office. Yes, he walked. No wheelchair, no nursing staff, he walked, upright, into my office. He’s lost 135 lbs already, and has a new lease on life. That man (you know who you are) reminded me why I love what I do. I can’t thank you all enough for trusting my team and me with your lives, your loved ones, and for honoring me with your friendship. You all make it worthwhile. Thank you.

Medical Tourism Kills

Bariatric Surgeon Denver

I saw a patient in the office for a weight loss consultation the other day. For the sake of discussion, let’s call her “Kate.” Kate meets all of the criteria for bariatric surgery, being just over five feet tall, with a weight in the low 200 lb range. She also has a fairly large hiatal hernia and severe acid reflux, in addition to some other medical problems that put her at high risk for sleeve gastrectomy. On the other hand, she is a great candidate for a gastric bypass with hiatal hernia repair, a larger, more extensive operation, but one which I perform quite frequently.

Unfortunately, Kate’s insurance does not cover bariatric surgery.

I explained the self-pay system that we have built into our program, which includes contingencies for unforeseen complications, but this very well-educated, financially stable patient stated, “That’s okay, I’m going to go have it done in Mexico.”

Please don’t get me wrong, Mexico has some outstanding Bariatric Programs, with excellent surgeons. The problem is the lack of follow-up for American patients, and the need to return to Mexico should anything go awry. When I raised the aforementioned issues to Kate, she replied, “You can take care of me if anything happens.” Unfortunately, Kate, that puts me in a very difficult situation. Fixing another surgeon’s complications is fraught with danger. Each surgeon has a different way of doing a procedure; and suture material, stapling devices, and hernia mesh used in other countries may not meet the guidelines of the FDA, which can end up creating a huge and complicated mess inside the abdomen.

I have now repaired, revised, or performed what we refer to as “damage control” on over 40 cases that were performed in Mexico and other countries, and I was featured in a newspaper article about some of the problems from other countries that I have had to correct. Medical tourism is a prolific and lucrative industry, but it should be discouraged in the setting of procedures that can be performed safely and effectively by surgeons that have a vested interest in following their respective patients.

The Hippocratic Oath of “Do no harm,” is not a universally applied principle. Developing and maintaining a long-term relationship with patients is one of the reasons I chose bariatrics as my specialty. Weight loss surgery is one of the few surgical disciplines that enables a surgeon to follow patients forever after surgery. In fact, the Center of Excellence designation requires us to follow our patients long-term after surgery, and we are held accountable for lack of follow up and/or complications. Our data demonstrate that the more points of contact a patient has with a bariatric program (surgeon, dietitians, mental health, support group, nurse practitioners, physician assistants), the better he or she will do long term.

Going to another country to save some money might make sense if having a minor procedure, but a laparoscopic roux-en-y gastric bypass, with a simultaneous hiatal hernia repair, does not qualify as a minor procedure. Please folks, and especially “Kate”, think about the reasons you or your loved one is considering bariatric surgery. You want to get healthy. You want to be around for your family. You want to enjoy life, and get rid of a bunch of medications. Don’t throw everything away to save a few bucks, and then hope that someone back home can fix an unnecessary surgical disaster. Find a local, board certified, Center of Excellence Bariatric Program to take care of you. Do it right the first time, and let’s get healthy together.

Let’s get healthy together!

Dr. Matt Metz, MD, FACS
Medical Director
Bariatric and Aesthetic Surgery Associates