Bariatric Treatment

• Is It Right for You?
• Bariatric Treatment Overview
• Types of Bariatric Surgery
• How to Choose the Right Bariatric Doctors
• Find a Bariatric Surgeon in My Area

Obesity Cause & Effect

• Causes of Obesity
• Obesity and Genetics
• Does Fast Food Cause Obesity?
• Obesity Virus
• Cause and Effect of Obesity
• Obesity Health Problems

Gastric Bypass

• Laparoscopic Gastric Bypass Surgery
• Cost of Gastric Bypass Surgery
• Complications of Gastric Bypass Surgery

Adjustable Gastric Banding

• Analysis & Cost of Lap Band Surgery
• Gastric Lap Band Procedure
• Lap Band Problems & Lap Band Complications

Diet Before & After Surgery

• Bariatric Diet
• Bariatric Eating Techniques
• Bariatric Vitamins

Financing & Insurance

• Financing Bariatric Surgery
• Bariatric Surgery Insurance
• Weight Loss Surgery Mexico & Abroad
• Cost of Bariatric Surgery

Other Effective Procedures

• Duodenal Switch
• Gastric Sleeve Surgery
• Vertical Banded Gastroplasty
• Mini Gastric Bypass Surgery

Life After Surgery

• Life after Weight Loss Surgery
• Weight Loss Surgery Support Groups
• Online Weight Loss Support
• Pregnancy After Weight Loss Surgery

Risks & Challenges

• Bariatric Surgery Complications
• Bariatric Surgery Risks
• Weight Gain after Bariatric Surgery
• Blood Clot Symptoms
• Dumping Syndrome

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The Bariatric Surgery Blog

Bariatric Doctors / Bariatric Weight Loss Center: 4 Essential Steps to
Finding the Surgeon That’s Right for You

Honing in on the best weight loss surgeon for you will require specific knowledge and proper guidance.

You will need to know exactly where to begin your search, how to verify surgeon credentials and when to apply your own personal impressions.

This page explains the 4 steps required to find the surgeon that’s right for you...

• Step 1: The necessary homework
• Step 2: Creating your initial list of potential surgeons
• Step 3: Narrowing your search
• Step 4: Interviewing the “best of the best” and choosing your surgeon

Step 1: The Necessary Homework Before Beginning Your Bariatric Doctors Search

Before beginning your search for the ideal surgeon, you should have a solid understanding of the individual components of bariatric surgery and all the ways they will effect you.  Click the following links to round out your research...

• Is bariatric treatment right for you?
• Compare the types of bariatric surgery and choose the procedures that best fit your situation (it’s okay if you can only boil it down to 2 or 3 procedures)
• Potential bariatric surgery complications
• Bariatric diet before and after surgery
• Life after weight loss surgery

If you don’t have a solid high level understanding of the above points, then you will not be able to effectively select the best surgical team.

Step 2: Creating Your Initial List of Potential Bariatric Doctors & Bariatric Weight Loss Centers

There are thousands of great bariatric doctors to choose from, some that may have convenient locations right down the street and others located literally on the other side of the world.

The goal of Step 2 is to find at least three surgeons that have the necessary qualifications, although finding four or five candidates during this step is preferable as you may remove a couple of them during Step 3.

To come up with your Step 2 list of at least three potential surgeons, consider and apply the following...

• How you pay for surgery
• Ask for referrals
• Conduct your own search
• Verify credentials

How you pay for surgery may influence your list of choices.

If you have weight loss surgery insurance, it is best to find a surgeon as close to home as possible. 

If you will be paying for surgery on your own, you may need to consider surgeons located farther away to make the surgery affordable.

For example, if a great surgeon in the next town over is willing to offer you interest-free financing and BLIS coverage while your local surgeon will provide neither, it may make sense to be treated outside of your home town (see Financing Bariatric Surgery for more about these and other financing options).

Similarly, if you are open to having surgery outside of the United States, you may be able to save as much as $16,000 or more while receiving treatment from a surgical team that is as good or better than what is available locally. Our Weight Loss Surgery Mexico & Abroad page provides a complete analysis of medical travel outside of the U.S and how to go about finding the right international surgeon.

Assuming you've decided to have surgery in the United States, begin your search by asking for referrals.

If at all possible, try to obtain at least one or two referrals from your primary care physician (PCP) or another trusted doctor.  Your PCP should be kept in the loop throughout your bariatric treatment and will be an integral part of your long-term follow-up care, so any referrals they provide should be strongly considered.

Unfortunately, not all primary care physicians support weight loss surgery. If this is the case with yours, don’t be discouraged. Your PCP may not be up to speed on the latest bariatric surgery techniques, lower risks and the positive impact on obesity health problems.

Before writing off an unsupportive primary care physician, present information and research to try to change his or her opinion. Continuing your relationship with your current PCP will be easier and smoother than getting a new one up to speed before surgery.

To convince your PCP, discuss your obesity health problems (many of which he or she should be familiar with) and how they impact your life. Include both medical problems as well as more private issues such as trouble sleeping, personal hygiene, infertility, sexual problems, obesity discrimination and mental health issues.

Talk about your previous weight loss attempts, both medically supervised and non-medically supervised. In addition, click the following links, print the studies and provide copies to your PCP for review...

• Pennington Biomedical Research Center – Weight Loss Surgery Extends Lifespan
• Journal of Occupational & Environmental Medicine - A Comprehensive Exam of Comorbidities in an Employed Population
• Cleveland Clinic Journal of Medicine – Risks and Benefits of Bariatric Surgery: Current Evidence
• Agency for Healthcare Research and Quality - Review this entire page and include studies that will support your case. There are many studies relating to specific populations – if it applies to you, include it. There are also several impactful general studies.

If your primary care physician cannot be persuaded, you may have to find another one who understands the necessity for your surgery. A supportive PCP will be important during your after-care.

On top of your referrals (or if you are not able to obtain any), conduct your own search for bariatric doctors.

If you have insurance that covers bariatric surgery, find additional surgeon and bariatric weight loss clinic candidates by searching your health insurance company’s directory of providers.

Search for additional doctors in your area using our directory of bariatric surgeons:

• Find a bariatric surgeon in my area:
  • United States
  • Canada (Bariatric Surgery Canada)

In addition to including all surgeons designated as Centers of Excellence (COE) by the American Society for Metabolic and Bariatric Surgery (ASMBS) and the College of Surgeons, our directory also includes referrals from other site visitors.

Your Step 2 goal should be to get your total list of referred and ASMBS bariatric doctors to at least three. For example, if you received one referral from your doctors, you need to find at least 2 additional surgeons near you in the ASMBS database.

After your list of 3 or more bariatric doctors is ready…

Verify that each of the weight loss surgeons on your list has the appropriate credentials.

To stay on your list past Step 2, your potential bariatric doctors should each:

• Have an up-to-date license from their state’s medical board.
  
  Click here to search the Administration in Medicine’s (AIM) DocFinder for your surgeon’s license status. Once on their site:
  1. First use the search box on the left under “Participating State Licensing Authorities”
  2. If you don’t find your surgeon, find your state’s link on the right side of the page under “States with links only”, then follow the doctor search instructions on your state’s website.
  3. The list of bariatric doctors that you find with the same last name should provide clickable links to more information about each doctor. Click on your doctor’s link to view his or her information.

In addition to confirming that each surgeon’s license is active, the doctor information provided should tell you their:

• License type – should be both Physician and Surgeon
• License status – should be renewed and current
• Primary practice area – should be surgery-related
• Public record actions – look for surgeons who have none against them
• Board certification – only work with surgeons who have been board certified

• Be board certified.

Board Certification gives you confidence in your potential surgeon’s focus on bariatric surgery because board-certified surgeons must, according to the American Board of Medical Specialties (ABMS)...

“Participate in an ongoing process of continuing education to keep current with the latest advances in medical science and technology in his or her specialty as well as best practices in patient safety, quality healthcare and creating a responsive patient-focused environment.”

To confirm that your surgeon has been board certified, you will need to register for a free account with the ABMS. If requested during sign up, choose the “State Medical Board or State Board of Medical Examiners” option. You can also leave the “Other Information” section blank that asks for your company name, address, etc.

See the American Board of Medical Specialties' website for more information about board certification.

Bariatric Centers of Excellence (COE)

While not absolutely necessary, finding bariatric doctors who have been designated as one of the Bariatric Centers of Excellence (COE) by the American Society for Metabolic and Bariatric Surgery and the American College of Surgeons is recommended. To receive COE designation, surgeons are required to perform at least 50 surgeries per year while COE hospitals/clinics must perform at least 125 per year. COE surgeons also have strict continuing education requirements and COE facilities must meet specific resource and care standards.

However, there are qualified, talented and experienced surgeons/clinics who have not obtained COE designation, many of which meet or exceed the COE standards.

 

In addition, the actual outcomes for patients receiving treatment at bariatric centers of excellence may2 or may not3 be any different than those receiving treatment from non-COE providers, depending on which studies are referenced.

 

Bottom line? All else being equal, choose the COE provider. Experience, minimum care standards and continuing education are important, and COE designation is an easy way to "check the boxes" for those requirements when interviewing your potiential surgeons.

 

But if you receive a strong referral outside of the Centers of Excellence circle, keep them on your list. Ask them why they chose not to apply for COE designation and how their practice stacks up against the COE requirements.

Search the Bariatric Centers of Excellence database to find out if your list of surgeons has obtained COE designation.

If any bariatric doctors on your list have an outdated license, have public record actions listed against them or are not board certified, remove them from your list.

Step 3: Narrowing your list to bariatric doctors with the highest likelihood of a successful outcome

During Step 2, you should have narrowed your list of potential bariatric doctors down to at least three well-qualified surgeons. Now it’s time to dig a little deeper...

Step 3 determines which bariatric doctors on your list are worthy of face-to-face interviews.

Print our Bariatric Surgeon Questionnaire (one for each surgeon on your list) and call each of your candidates’ offices. Let them know that you are considering an initial face-to-face consultation with the surgeon but that you have a few questions before scheduling the interview. Your goal is not to speak directly with the surgeon but to speak with someone knowledgeable enough to answer your questions.

Responses to the following questions (also provided on the questionnaire with blank spaces for your notes) will either remove a bariatric doctor from your list or give you a better idea of what to ask during them during face to face interviews in the 4th and final step.

The order of the questions is intentional - start with the higher level questions, and if at any time you receive an answer that is unacceptable to your situation, thank the person for their time, remove that surgeon from your list and move on to the next surgeon on your list...

• What percentage of your practice’s patients are bariatric surgery patients?

The answer you are going for is “100%” or very close to it. Bariatric surgery is a complicated procedure that demands complete attention. Finding a practice that is solely focused on bariatric medicine and related treatment ensures that their expertise is not spread too thin.

• What types of weight loss procedures does the surgeon perform?

Find out not only which procedures they focus on but whether they perform the majority of them open or laparoscopically. Laparoscopic surgery is generally preferable, although there are circumstances where open surgery may be necessary.

During your preliminary research, you should have honed in on one or two weight loss surgery procedures that you feel fit you best. If one of the bariatric doctors on your list focuses primarily on surgeries that you are not interested in, remove that surgeon from your list.

• How many bariatric procedures of each type does your practice AND the surgeon perform per year?

To meet the Surgical Review Corporation’s Bariatric Centers of Excellence criteria, each bariatric weight loss center must conduct at least 125 weight loss operations per year and have at least two credentialed and experienced bariatric surgeons who perform at least 50 weight loss operations per year.

What's more, it appears that the more cases a surgeon performs per year, the less likely the patient is to experience complications.

One study of over 3,400 patients and 31 surgeons found that for each additional 10 surgeries per year a surgeon performed, the risk of a serious complication decreased by 10%.⁴

In another study, a surgeon was evaluated over his first 300 patients. When comparing patients 201 to 300 with patients 1 to 200, the 201-300 group had 89% fewer reoperations (1 vs. 9), 50% fewer coversions to open surgery (1 vs. 2) and was in surgery for 69 fewer minutes on average.⁵

• What are the surgeon’s complication and mortality rates?

In general, the rates should be in the same range as the rates reviewed on our Bariatric Surgery Complications page. Keep in mind that some surgeons specialize in treating higher risk patients (i.e. patients with a body mass index over 50), and those specialists understandably have higher complication and mortality rates.

• How long will you have to wait for surgery after you get approved?

Depending on your level of urgency, a long wait time may be unacceptable. However, you might want to consider that a long wait time could be due to the surgeon’s good reputation and therefore a positive thing

• Are the professionals on the surgeon’s pre- and post-care team well-qualified?
  
  Following are the professionals you will be working with in addition to your weight loss surgeon:
• Bariatric program coordinator/director
• Bariatric nurses supporting the surgeon before, during and after surgery
• Anesthesiologist - how many years and how successfully has the anesthesiologist worked with obese patients? Get the anesthesiologist’s name and click here to confirm that they have been certified by the American Board of Anesthesiology (ABA).
• Psychologist – make sure there is one on staff or in close partnership with your surgeon and that they specialize in bariatrics. The psychologist will work with you before surgery and should be available for counseling afterwards.
• Dietician or nutritionist – ensure that your surgeon works closely with a registered dietician or nutritionist for pre- and post-surgical consultations. They are an extremely important resource for both helping you establish your short and long-term diet plans and overcoming any bariatric diet related obstacles.
• Fitness advisor – do they work directly with anyone who can help you establish an appropriate exercise program or, at a minimum, refer you to a personal trainer experienced in working with bariatric patients.
• Weight loss surgery support group – does their office have pre- and post-surgery support groups in place? If so, is there just one, or are there different groups for different needs (i.e. diet, exercise, recovery, procedure-specific, etc.).
  
  Patients who regularly attend support groups have been shown to have better long-term outcomes. While you can and should find additional offline and online weight loss support on your own, working with a surgeon or bariatric weight loss center that has their own programs will make finding and joining one near you much easier.
• Insurance coordinator (if you have insurance) – as reviewed on our Bariatric Surgery Insurance page, getting surgery approved is often a grueling process. Offices with a coordinator on staff can make the process a whole lot easier.

• Will another doctor be assisting the surgeon during surgery? If so, what are the assistant’s qualifications and how involved will he/she be in your treatment?

Make sure that the surgeon will be the one coordinating and performing the surgery. In addition, any staff or nurses assisting the surgeon should be primarily focused on assisting bariatric surgery patients (again, you don’t want the professionals operating on you to be spread between multiple areas of expertise) and be taking continuing education classes relating to the care of bariatric patients.

• Does the surgeon have a short and long-term follow up program to work with you after surgery?

There should be a detailed plan in place to help you transition to and maintain a healthy life after weight loss surgery with the involvement of many of the professionals listed above.

• Are your facilities equipped to handle obese patients?

Not only will things like bigger waiting room chairs and hospital beds along with a staff trained in obesity empathy make you feel more comfortable and relaxed, they also show you that you are dealing with a compassionate surgeon who has your best interests in mind.

• Do you offer seminars for potential patients?

Seminars are a good way to get to know the practice and surgeon. They are also a great resource for learning more about the surgery and your new life. In addition, they often answer many of the face-to-face questions discussed in Step 4 below.

The responses you receive during Step 3 should help you boil down your list to three well-qualified bariatric doctors who have the team, facilities and experience to maximize your likelihood of a long-term successful outcome. If your list is now smaller than three surgeons, go back through Steps 2 and 3 to find, verify and call additional surgeons.

During Step 4, you will interview each of these surgeons in person in order to choose the one that’s right for you.

Step 4: Interviewing the three (or more) bariatric doctors on your list and choosing your surgeon

In all likelihood, each of the surgeons that passed Steps 2 and 3 will be an excellent choice. Step 4 is all about:

1. Choosing the surgeon and bariatric weight loss center that “just feels right” and
2. Learning more about what to expect

To begin Step 4, review each remaining surgeon’s web site if they have one. A link to their site can be found:

• By searching for their information in the bariatric surgeon directory, although many listings there do not have links.
• By typing the bariatric doctor’s or bariatric weight loss center’s name in quotes into your favorite search engine.
• By calling and asking the surgeon’s office.

Ask your surgeon to test you for anemia

Over 50% of patients entering the hospital for any type of surgery are anemic.

Many surgeons are unaware that some patients do not respond to oral therapy for post-operative anemia, and using intravenous iron and intramuscular B12 instead may be more appropriate.

Ask your surgeon to test you for anemia and discuss both options. If he or she is unfamiliar with both treatments, refer them to this study. 

Next, call each surgeon’s office and find out when their next seminar takes place (if they offer them). Attend the seminar and take notes. Take the Bariatric Surgeon Questionnaire you printed in Step 3 and fill out answers to the questions listed in the Face-to-Face Interview section.

If you still feel confident in the surgeon’s program and experience after their seminar, find out if you can attend a bariatric surgery support group offered by the surgeon’s office. In addition to giving you a first hand account of what it was like for other patients to be treated by your surgeon, attending a support group meeting will give you a much better understanding of what’s to come.

After you attend the support group meeting, it’s time to schedule your face-to-face interview with each surgeon. The purpose of your interview is to get answers to your remaining questions and to get a better feel for the surgeon.

The questions in the Face-to-Face Interview section on the Bariatric Surgeon Questionnaire will get you started, but they are only a general guideline. Ask any and all questions that come to mind. Good bariatric doctors will be glad that you are doing your research and will be happy to provide answers.

Procedure-Specific Questions

Consider asking these additional questions depending on which procedures you are interested in...

Roux-en-Y gastric bypass surgery: What steps do you take to ensure that no leaks occur after surgery? In order to prevent leaks, your surgeon should check the surgical connections a number of different ways before completing the operation, including (1) blowing air into the connection and observing whether any gets through and (2) using a dye to check for a leak.

Lap band surgery: What technique do you use to place the band: pars flaccida or perigastric? Bariatric doctors performing the pars flaccida technique (PFT) when placing the band see up to 22% fewer lap band reoperations than doctors using the perigastric technique (PGT).1

Duodenal switch surgery: I’ve read that DS surgery can be especially appropriate and effective for the super-obese, but its higher complication rate coupled with a super-obese patient’s increased risk for complications demand careful consideration. What is your feeling about this? Also ask about leaks as indicated under gastric bypass above.

Gastric sleeve surgery: Since there is limited long-term research available for gastric sleeve surgery, can you help me understand why you think this procedure will continue to be effective over the long-term? What procedures are you familiar with for tightening a stretched stomach? Also ask about leaks as indicated under gastric bypass above.

Vertical banded gastroplasty: Other procedures appear to have similar or better outcomes than VBG with lower risks. What is your opinion? Also ask about leaks as indicated under Gastric bypass above. 

Mini gastric bypass surgery: Why would this procedure be recommended over Roux-en-Y gastric bypass? In what situations would you recommend Roux-en-Y instead? Also ask about leaks as indicated under gastric bypass above.

After interviewing each of the bariatric doctors, how do you decide which one to choose? It comes down to how personally comfortable you are with each surgeon.

Maybe one office was more relaxing and their staff more welcoming. Maybe one of their aftercare plans seemed more well-planned and thorough. Maybe one surgeon’s former patients seemed more pleased with their experience. Maybe one surgeon “just felt better.”

Regardless of which one you choose, if they passed the above 4-Step process, their support group had positive things to say and you felt good about them during their seminar and the interview, you should feel confident that you have chosen a great surgeon.

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