Step by Step Guide to Metabolic & Weight Loss Surgery

We only operate on individuals 18 years or older. Most insurance companies cover surgery for individuals with:

• A BMI of 40 or greater, or at least 100 pounds overweight.
• A BMI of 35 or greater accompanied by one or more obesity-related diseases, such as diabetes, hypertension or sleep apnea.

In 2022, several metabolic and bariatric surgery organizations updated the indications for bariatric surgery to give more patients access. This change was based on years of research showing excellent improvements in health that outweigh the possible risks associated with surgery.

Individuals now qualify for surgery if they have:

• A BMI of 35 or higher, with or without health conditions.
• A BMI of 30 or higher and have diabetes.

Coverage for surgery with these new criteria is still dependent on individual insurance policies, but we are hopeful that these policies will soon change. Learn your BMI with this interactive calculator.

It is important to check your insurance policy to ensure that your benefits cover bariatric surgery, your insurance will cover surgery at Lahey, and you know your out-of-pocket responsibilities. You can check by calling the member services number on the back of your insurance card.

Hear from our team members about obesity, benefits of surgery, and surgical options at our centers and our program’s support resources to guide your success, by watching or attending one of our information sessions. You can watch this information session online at your convenience or register for an in-person information session at one of our locations by clicking this link:

Attend one of our consults, which includes one-hour visits with an advanced practice provider (APP), dietitian and psychologist. The APP will provide you with a plan that outlines future appointments and any requirements that need to be met prior to surgery. We individualize your plan to best support your success. Consults are available in person or via telehealth, depending on the location of the visit.

You will be asked to start an exercise program before starting surgery. We recommend at least 30 minutes of exercise five days per week or more. We understand that some individuals may have health conditions that make it hard to complete exercise. We’ll provide some ideas to help you integrate exercise despite these limitations.

We will also discuss pre-surgery weight loss to improve your chances of a safe and successful procedure. Many patients do not require specific weight-loss targets, but if you carry excess weight around your abdomen, we may ask you to meet a certain weight loss goal to ensure your safety.

Losing weight before surgery creates space inside of your abdomen, allowing your surgeon to more easily navigate their surgical instruments, reducing your risk of complications. It’s possible we will postpone surgery if you gain weight prior to your operation.

Our APPs are trained to determine whether a medication should be prescribed to support your pre-surgery weight loss goals. If needed, we can also refer you to resources available through our robust Lifestyle Health program or Weight Management Program.

These resources give you access to our team of Bariatricians who can provide additional specialty support. Through some of these programs, our patients also have access to group cooking classes, behavioral change classes and more.

You will likely have one or more visits with the advanced practice provider before your operation. At these visits, we will make sure that you are completing the appropriate preoperative tests, that your health is stable, that you’re exercising and that you have a good understanding of surgical procedures.

You will need to meet with the dietitian one or more times before surgery to assess progress on your healthy eating behaviors. At these visits you will focus on improvements that will help you meet weight loss goals and review the pre-surgery nutrition and exercise recommendations. Surgery is just one tool of many, and it’s our job to make sure we’re all committed to long-term lifestyle changes.

At your initial consultation, the APP will determine if you need any particular testing before surgery. Some individuals may have to undergo testing for sleep apnea based on the initial evaluation by the nurse practitioner. Others may need a few heart tests, such as an EKG or stress test.

In some circumstances we may ask that you be evaluated by a heart or lung specialist to make sure that you are healthy enough to have surgery. If you have any medical conditions (such as heart disease, high blood pressure, depression or diabetes) that aren’t properly controlled, we will hold off on surgery.

At this visit, your surgeon will evaluate any pre-surgery testing that could impact your operation plan. You will further discuss your surgical options and decide which surgery is best for you. In most cases, you will have the freedom to choose your procedure, but a surgeon may recommend one or another operation based on your medical history or testing results.

Once this consult is completed, our nurse or advanced practice providers will review your plan and if all requirements have been completed, they will place an order for surgery.

Please note that a surgical date is not provided to you on the day that you meet with the surgeon. You will receive a call from our surgical scheduler a few weeks after this appointment. Surgeries usually take place two months after your visit.

All patients must attend three classes led by one of our psychologists before surgery. Held virtually, these classes focus on eating mindfully, establishing coping mechanisms, and identifying eating triggers. You will also learn how to recognize hunger and satiety and how these could change after surgery.

You may also wish to attend a monthly support group meeting prior to your surgery. Support groups are attended by other pre- and post-surgery patients. These are sometimes open discussion groups, but some focus on a single topic.

Support group sessions may be in person or virtual. At your consultation, we will share a link to our patient education website where you can find group session schedules and access links.

We will ask you to quit smoking if you haven’t already. You will need to pass a urine screen that is negative for nicotine prior to meeting your surgeon. If you continue to smoke or restart smoking, surgery will not be performed. Smoking can greatly increase the risks associated with surgery. You can also develop serious complications if you start smoking again after surgery. On average you will need to be smoke-free for about three months prior to surgery and continue to be so after your operation.

Other resources to help you quit smoking include:

• Your primary care provider
• Smoking cessation specialists at Lahey
• Support visits with our psychologists
• MA Tobacco Cessation and Prevention

Thirty days before your surgery, you will return for a series of pre-operation appointments. These will include a history and physical exam completed by one of our advanced practice providers or your surgeon.

We will ensure that you are still healthy enough for surgery. You may meet with members of the anesthesia team in the preoperative center if needed. You will also attend a two-hour teaching class with a nurse and dietitian.

We will talk about how to prepare for surgery, what will happen during your surgery and hospital stay, and review postoperative recommendations. The dietitian will review your diet after surgery and recommend protein and vitamin/mineral supplements.

The time between your initial consult and your surgery will depend on several factors, including health status, healthy lifestyle changes and insurance requirements. The fastest progression to surgery is typically three months.

Depending on the procedure you and your surgeon have selected, and whether there are any circumstances that affect the speed of your operation, your surgery should last between two and three hours. Most patients will stay in the hospital for one to two nights after surgery.

Long-term weight loss is a lifetime commitment. After your surgery, you will see members of the surgical weight loss team several times in the first month, and then once every three to six months for a year or two. You will meet with them once a year after that. We can make these visits more frequent in the long term if you feel that you need extra support to stay on track.

Research shows that if you are consistent with your follow-up appointments, you are more likely to keep the weight off. It’s also important that you have blood work done annually to check for vitamin and mineral deficiencies. This can be completed by your primary care doctor, but our tests typically provide more information.

There will always be somebody from the weight loss surgery team there to support you. Being an accredited center through the MBSAQIP Accreditation program supported by the American College of Surgeons and the American Society of Metabolic and Bariatric Surgery, our staff is trained to help you with any question or concerns you might have. We offer 24-hour coverage to each of our patients.

To help you stay on track, we also offer additional post-operation resources. These include:

• Monthly in-person or virtual support groups
• Individual visits with a bariatric psychologist
• Access to weight loss medication
• Group classes run by one of our psychologists
• Various group classes, including cooking classes offered through our Lifestyle Health center

We can customize your schedule of visits with our advanced practice providers and dietitians to best support your needs.