What You Need To Do Before Bariatric Surgery?




What You need to Know


In order to proceed with weight loss surgery, you will have to complete a number of requirements. In this post, I will give you most of the information that you need to do before bariatric surgery. 

If you prefer, you can also watch the video that I made about everything in this post. See the link below. You can also find that video and many other bariatric surgery videos on my YouTube Channel. 

Do You Qualify For Bariatric Surgery?

The first thing you need to know is if you qualify for weight loss surgery. If you already know this then skip to the next section. If not you can find more detailed information in the link below. I also made a nice video explaining this to you. 

I have explained this in more detail here.

You can also watch the short video below explaining if you qualify for surgery base on your Body Mass Index (BMI) and comorbidities.


Can You Afford Weight Loss Surgery?

Most health insurances cover weight loss surgery in the United States. If you don’t have health insurance or you have no bariatric surgery coverage then you need to figure out how you can afford the surgery. Watch the video below were I go over several options that you can use to pay for weight loss surgery.

Also, remember that you will need studies or other evaluations prior to surgery that you will need to self-pay or pay the copay.

Again, you can read more details about affording surgery here. You can also watch the video below.

If you have questions about your insurance coverage the best option is to call your insurance company and ask if you have weight loss surgery coverage and what are the requirements.


What You Need To Do Before Bariatric Surgery?

1. Psychological Evaluation

The psychological evaluation can be completed by a psychologist or a psychiatrist. Most of the time this is a single visit or consultation. In some cases, the provider might require a follow up depending on his or her findings.

Most patients get cleared by the psychologist or the psychiatrist without any problems, but I have seen several cases where they will not clear a patient for surgery.

The main purpose of the psych evaluation is to identify psychological issues that can be contributing to your weight gain. Many times if you don’t correct those prior to weight loss surgery then your success will be compromised.

If you have ever seen one of the weight loss television shows then you have seen the trainers testing the contestant psychology. They usually try to identify problems during childhood or adulthood that precipitated the weight gain. Self-esteem issues are very common culprits. Also, victims of mental or physical abuse can develop depression and weight gain.

What about death in the family?

I saw an episode of the biggest loser where the contestant was in a car accident with her family. Her husband and three kids died during the accident. She woke up from a coma and found out that life as she knew it was gone.

Talk about going crazy and eating your life away. I will probably gain 500 pounds after something like this.

In order to get that patient back on track and help her lose weight, she needs to heal from this episode. The psych evaluation could significantly help this patient.

Keep a very open mind during this evaluation and take full advantage of the opportunity to talk to someone about your struggles with your weight and any other personal issues.


2. Dietician Evaluation

The next thing you need to do before bariatric surgery is an evaluation with a certified dietician. Try your best to find a dietician with bariatric surgery experience. 

If you live remotely and you don’t have easy access to a dietician then try to find one that will do a phone or a video conference consultation. Bigger cities usually have several dieticians to pick from. 

Remember that diet modification is crucial, if not the most important part of weight loss surgery. If you want to succeed after bariatric surgery, or if you want to maintain your weight loss then diet changes are imperative. 

What You Need To Do Before Bariatric Surgery?

3. Medically Supervised Weight Loss Program

Most insurance companies have a requirement that needs you to complete 3-6 months of a medically supervised weight loss program. These months have to be completed consecutively. They also need to be recent, If you did them several years ago you will have to do them again. 

They also need to be visits specifically for weight loss. If you went to see your primary care provider for an asthma attack or any other issue then that visit will not count. It needs to be specific for your weight loss program. Other things can be addressed at the time but the main purpose of the visit has to be your weight loss attempts. 

You can complete this with your primary care provider. Most primary care providers are willing to help you with this portion of the process. You could also do this in a weight loss clinic like the Recharge Clinic in Ocala, Fl.  A dietician could also do this for you. Some bariatric programs have the manpower available to do this. Unfortunately, I do not have the time needed to help you with this portion. Maybe in the near future, my office will be able to accommodate patients for this but as of this writing, I cannot do this. 

Most insurance companies don’t require that you actually lose weight while doing the medially supervise program. They just want you to at least try. Of course the more weight you lose the better.  The thinner you are the easier your surgery will be. The faster you will recover and the sooner you will get to your goal weight. 

4. Quit Smoking

The next thing you need to do before bariatric surgery is to quit smoking. Obviously, if you don’t smoke this doesn’t apply to you. Haven’t said that, you should not start smoking after weight loss surgery.  

I did a full video about smoking and bariatric surgery. In the video, I explained why you need to quit and what complications you can develop secondary to cigarette smoking

In short, smoking is not good for you. This is particularly true before or after bariatric surgery. 

You need to quit for at least 3 months before surgery. We will do a laboratory test to confirmed that you in fact quit smoking. 

5. Upper GI Series or Upper Endoscopy

An Upper GI Series is a radiographic test that evaluates your esophagus and stomach. The patient is giving oral contrast and multiple Xrays are done to evaluate the patient’s anatomy or to ruled out ulcers, masses, Hiatal hernias or any other pathology that can interfere with your surgery.

Another alternative is an upper endoscopy (see image below). This procedure requires the placement of a camera through your mouth to look inside your esophagus, stomach and the first portion of the small bowel. This procedure is more invasive but could be used for some therapeutic interventions like biopsies.

Most patients only need one or the other. A very small group of patients will need both tests.

If you recently had one of these tests done, then most likely that will be adequate. Every case is different so make sure you discuss this with your surgeon.

6. Routine Blood Tests

Another thing you need to do before bariatric surgery is routine blood tests.  When you come to our office for the first visit you will receive an order for regular labs. The labs include hormones, vitamins, lipids, and other routine tests. 

If you recently had some of this done then you might not need to repeat them. This are baseline preoperative blood tests. 

7. Pre-op Class 

In our program, we offer free pre-op and post-op educational classes to help you succeed after weight loss surgery. One of the things that you need to do before bariatric surgery is the pre-op class. This class is mandatory.

The class is given by the Ocala Health Bariatric Coordinator. Kelli Potenza has been the bariatric coordinator for over 15 years. She can answer any of your questions. The dietician also comes to the class. In the class, you will be given the booklet that explained the post-op diet and you will get a tour to the hospital that way you know where to go and what to do the day of the surgery.

The post-op classes are not mandatory but they can be very valuable to you. They are free of cost and you can participate as many times as you will like. We also have the bariatric support group that meets the third Thursday of every month. The meeting is on the second floor of the medical office building next to West Marion Community Hospital. 

What You Need To Do Before Bariatric Surgery?

8. Do Not Gain Weight

When you come to my office for the first visit you will be weight. That is your initial weight with us. My expectation is that you do not gain any more weight from that initial weight. You can lose as much weight as you want but you cannot gain weight. 

I normally don’t ask the patient to lose weight prior to surgery but I do mandate that you either maintain the weight or lose weight. 

I don’t think is fair to me or to you to continue to gain weight when you are trying to change your life and lose weight. I had patients in the past that will go on a cruise and gain 3o pounds because the leisurely eat everything on-site because after surgery they will not be able to do that. That is the wrong attitude. If you are thinking that way then weight loss surgery is not for you. 

If you gain weight you will have to lose that weight before the surgery. I have postponed surgeries due to weight gain. Consider yourself notified about this issue. It will be you if you gain weight before your surgery. 

Just to give you one more example. I recently had a young patient that gained close to 30 pounds. When she came for her preop appointment 2 weeks before her surgery I told her she needed to lose that weight and her surgery got postponed. She cried and acted up in the office. I told her that I was going to do her surgery as soon as she loses the weight. 

She went home DEFEATED. 

She came back 2 months later for her new preop appointment. She was now down 35 pounds but the best part was her attitude. She was a different person. The main reason why was because she accomplished something on her own. She accomplished something that she thought was impossible.  She is now doing great and is killing it in life. That change in attitude completely changed her life. 

9. Sleep Study

The next thing that you need before bariatric surgery is a Sleep Study. This step is not for everybody. When you come to the office for your initial consultation you will answer a questionnaire. Base on those answers we will decide if you need a sleep study or not.

The reason to get the sleep study is to see if you have sleep apnea. If that is the case then you will need a CPAP to help you breathe at night. Sleep apnea is a common condition in overweight patients that affects your breathing while you sleep. Patients with sleep apnea stop breathing several times throughout the night. Sleep apnea can be fatal especially after surgery when the patient is under pain medications and sedation from the anesthesia.

If you already had a sleep study and you use a CPAP then you don’t need another sleep study. You do need to bring your CPAP machine with you to the hospital on the day of the surgery.

10. Letter Of Recommendation

You will need a letter of recommendation from your primary care provider. The letter just has to point out why you are a good candidate for weight loss surgery and how you can benefit from it. 

Many primary care providers’ office confuses the letter of recommendation with the referral paperwork to the surgeon’s office. They are two completely different things. 

We have a template that we provide to the patients when they come to our office for a consultation. Your doctor can use the template to prepare you the letter of recommendation.

Easy step to complete. 

11. Pre-op Liquid diet

Let us not forget about the next thing you need to do before bariatric surgery. The two weeks of liquid diet. That dreaded step that nobody wants to go through.

This is one of the most important things to do before your surgery. It has multiple benefits for you. once your surgery is approved by the medical insurance and you have a surgery date then you will have to start the liquid diet two weeks before the surgery. We will give you all the information you need on how to survive these two weeks.

Trust me, it is not as hard as it sounds.

I did a full video explaining the benefits of the liquid diet before bariatric surgery.


12. Other Referrals

In some special circumstances, referrals to a certain specialist might be needed. Evaluation by a cardiologist, pulmonologist, endocrinologist or gastroenterologist might be in order.

Those referrals are done only base on your clinical situation. Our office will coordinate those for you to facilitate the process.



I hope this post answered some of your questions. Perhaps it created some more questions. Feel free to call our office or to ask your questions in the comments below. 

You can also visit my YouTube Channel for more information. I will be doing more videos answering some of the questions. 

I want to thank you for your time and please feel free to contact us with any questions.