Bariatric Surgery

If you’re thinking about bariatric surgery, you may be wondering how the whole process works. The Central Maine Healthcare Bariatric Surgery Program is here to provide the information you need, so you know just what to expect at every step. Start with this helpful FAQ.

View our informational video, which is presented by a board-certified surgeon at Central Maine Medical Center in Lewiston, that explores different types of weight loss surgery.

Who is a candidate for weight loss surgery?

For those considering surgery, you need to have a BMI (body mass index) between 35-40 with certain medical conditions associated with obesity, or a BMI greater than 40 with no medical problems.

In addition to the BMI requirement, you must realize that bariatric surgery is not the best weight loss option for all people and that this will be discussed at your consultation with a surgeon. You must remember that bariatric surgery is a TOOL and not cure, for weight loss. Your hard work, good eating habits, and good exercise and lifestyle habits are what will maintain weight loss and keep you healthy.

What are the benefits of bariatric surgery?

There are so many benefits to bariatric surgery! These are both physical and emotional. Bariatric surgery can improve your health and help you to get rid of medical problems and medications you had before surgery. You may have improvement in your energy and ability to do things in your day. You may suffer from less pain in your muscles and joints. Overall, you may see your quality of life has improved dramatically.

What are the risks of bariatric surgery?

All surgeries carry risk with them. Bariatric surgery overall is very safe, with a risk of death around 0.1%. In fact, weight loss surgery decreases the risk of dying from obesity and medical problems related to obesity. Some complications that can occur during or after surgery include things such as bleeding, leak, infections, blood clots, hernias and strictures. Your provider will review specific risks with you during your consultation.

Is weight loss surgery the ‘easy way out’? Should I just work at dieting and exercise?

No. Bariatric surgery is a big commitment and requires you to participate in a program that is several months and requires you to make changes to your diet and exercise habits. Most people who consider bariatric surgery have been struggling with their weight for years, and have tried many diet and exercise programs with variable success.

Most people who suffer from obesity find it hard to lose the weight they want and keep it off with diet and exercise alone. This is because obesity is a chronic disease that creates a vicious cycle leading to greater obesity. Weight gain can be related to many things, such as:

• Food addiction and poor eating habits
• Poor sleep habits
• Eating a diet high in sugar, fats, processed meats and grains
• Eating a diet low in fat fighting foods such as fruits, vegetables, lean proteins
• Mental health issues and stress
• Medications
• Genetics

Weight gain leads to many changes in the body which makes it harder to lose weight. Hormonal changes in the body alter functions that control appetite, feelings of hunger and fullness. Inflammation is heightened in the body’s cells, leading to fatigue and lack of energy. Studies have shown that diet and exercise alone lead to little long-term success. Weight loss surgery helps with long term weight loss because it creates biological changes in the body that help reduce food intake, change the hormonal signals to function properly, and reduce inflammation. It also restricts stomach size (you feel fuller with less) and with certain procedures also alters absorption.

Will my insurance pay for bariatric surgery?

Weight loss surgery is covered by a lot of insurances as long as certain criteria are met. Insurance coverage for program components will depend on your individual health plan. Some insurances will not cover all portions of a program and may require self pay.

We verify benefits with your insurance before your consultation, but it is always a good idea to contact your insurance provider to see if you are covered.

What are the differences between traditional and minimally invasive approaches for surgery?

Minimally invasive surgery (robotic or laparoscopic surgery) is surgery done through multiple small incisions rather than a large incision. Minimally invasive surgery usually means less pain after surgery, smaller scars, and quicker recovery.

How much weight can I expect to lose?

This number is dependent on the type of procedure you have as well as your success in making positive changes to your life regarding your diet and exercise habits. You will go through this more in depth during your consultation.

Will I be on a diet before surgery?

Yes, for 2-3 weeks before surgery you will be on a special diet. This diet is aimed at shrinking the liver and reducing fat inside the abdomen in order to make surgery safer. For certain individuals, it may be determined that they will need to lose a certain amount of weight before being able to have bariatric surgery. Furthermore, some insurance companies will require weight loss before approval.

All patients in the program are participating in medically supervised weight loss through dietician appointments. These visits are aimed more at teaching you about food, healthy habits and tools for long term success after surgery.

Will I be on a diet after surgery?

You will be on a graduated ‘diet’ from liquids to solids over six weeks. Afterwards it will be very important for you to choose healthy items for best results. In general, most patients describe a decrease in their appetite after surgery, and being satisfied with a smaller amount of food.

Are there certain medications I should avoid after surgery?

After surgery you may not take any medication in the NSAID category (NonSteroidal Anti-Inflammatory Drugs) as these may cause complications. You may have to hold certain medications before and after surgery, which you will discuss in your consultation. 

Will I have to take vitamins?

Yes. You will need to take multivitamins for life after bariatric surgery. You may also need higher doses of certain vitamins and minerals such as Iron, Calcium and Vitamin D. You will also need to have your vitamin levels checked every year.

Does weight loss surgery cause serious health problems from vitamin deficiency?

In general, as long as you take your vitamins, it is rare to have serious health problems from vitamin deficiency, but weight loss surgery can cause reduced vitamin levels because of changes in food habits and altered absorption. Vitamin deficiency can lead to fatigue, anemia, bone and muscle loss, impaired vision at night, altered senses, changes to mental function and altered immunity.

A healthy diet and the use of supplements will help prevent vitamin deficiency. The ones at biggest risk are those who don’t have a healthy diet, don’t take vitamins and don’t follow-up with their providers to get lab work. Make sure you stay in touch with your bariatric team every year or do your labs with your family provider!

Is exercise an important factor after bariatric surgery?

Yes absolutely! We encourage you to start being active as soon as possible. Remember, exercise is different for everyone and there is not a ‘one size fits all’ exercise plan. What’s most important is that you are participating in exercise that increases your heart rate and helps you build muscle. Exercise is a very important component of your successful weight loss journey, and is important to maintain your overall health as you age! If you are at a loss of what that looks like for you, we have resources to help.

How soon after surgery can I drive?

For your own safety, you shouldn’t drive until you have stopped taking narcotic medications and can move quickly and alertly to stop your car, especially in an emergency.

How long do I have to be off work?

This depends on what you do for work. You may take as little as 1-2 weeks off of work or you may require 4-6 weeks depending on your job.

Will I lose hair after weight loss surgery?

You may. Some patients do experience some hair loss or thinning in the first six months after surgery. This is usually due to hormonal changes during rapid weight loss. Hair loss is usually temporary. While we don’t fully understand hair loss, we do know that good nutrition and adequate protein intake, as well as taking vitamins, will help.

Will I have excess skin after my surgery?

You may have excess skin after surgery but this is dependent on many individual factors such as how much weight you have to lose, how quickly you lose it, your age and your exercise habits. Some patients choose to have surgery to remove skin after weight stabilization, either for cosmetic purposes or because of recurrent skin infections.

Can I become pregnant after weight loss surgery?

Yes, you can. In fact, most women are much more fertile after surgery and weight loss. In general, it is recommended that you wait at least one year after surgery to become pregnant and very strongly recommended that you use a form of birth control at all times. Your cycle may be very irregular and you may become pregnant when you least expect it.

What is dumping syndrome?

‘Dumping Syndrome’ is a side effect that can happen after gastric bypass when a patient eats something high in sugar or carbohydrates. Because of the altered way in which the body handles these things after gastric bypass, one may have feelings such as abdominal cramps, racing heart, cold sweats, light-headedness and diarrhea. This may last anywhere from 30 minutes to an hour. Treatment for dumping syndrome revolves around diet modification.ber is 207-795-2559.

After attending an information session, you’ll schedule an initial evaluation with a surgeon and the rest of the bariatric team. During this appointment, you will complete a full physical and record your medical and surgical history. If you are a candidate for weight loss surgery, you’ll undergo a series of medical screenings, attend a pre–operative nutrition screening and diet counseling and pre-operative behavioral health screening,

At this time, a letter will be sent to your insurance company to obtain approval for the operation. The approval process can take from a few weeks to a few months, depending on your insurance company.

Initial Evaluation for Bariatric Surgery

During your initial evaluation your surgeon will complete a full physical and record your medical and surgical history. The surgeon will also determine what tests and other medical clearance you will need to complete the program. These tests are evaluating your obesity related diseases and to make sure you are healthy enough to have surgery. Some medical problems may mean you are not a candidate for surgery.

Some of the pre-operative tests that may be required include:

• Abdominal Ultrasound
• A complete set of blood work
• Cardiac Clearance
• Chest x-ray
• Electrocardiogram (EKG)
• Echocardiogram (Echo)
• Medical Clearance
• Pulmonary Function Tests
• Sleep Study
• Endoscopy (EGD)
• Upper gastrointestinal (GI) evaluation
• Computerized Tomography (CT) scan 

Pre-operative Behavioral Health Screening for Bariatric Surgery

Surgical treatment for obesity changes a person’s relationship with food. Therefore, it is essential as part of the pre-operative assessment process that you undergo a psychological evaluation. This evaluation is performed by our licensed clinical social workers to determine if bariatric surgery is appropriate for you. Your assessment will be looking at:

• Psychiatric history
• Current psychological function
• Weight and dieting history
• Current eating behaviors
• Level of physical activity

During the evaluation, you are also educated on the behavioral changes necessary to ensure good post-operative results, as well as any psychological changes that can be anticipated after surgery. Your initial evaluation may determine that you will need further appointments before being ready for surgery.

Pre-operative Nutrition Screening and Diet Counseling for Bariatric Surgery

Our pre-operative nutrition screening is focused on changing your eating behaviors and food selection practices. This helps you more easily adjust to your post-operative diet and achieve the best results possible from bariatric surgery. During nutrition screening, a dietitian from our team will evaluate your weight loss history and current eating behaviors using a weight and diet history questionnaire. You will then have a series of appointments to complete dietician modules. You will need to make certain changes to your food behaviors in order to be ready for surgery.

Most insurance companies require six months of supervised weight loss, called Medical Weight Management. At each of these monthly visits, you will meet with a dietitian to work towards completing all the testing required before surgery and preparing for all the dietary and behavior changes that come with surgery.

Last Steps before Surgery

All of the testing you completed is sent to your insurance company for pre-authorization. You will work with our Insurance & Surgery Coordinator to then determine a surgery date and schedule pre-op and post-op visits.

Surgery

All bariatric surgeries require general anesthesia. Surgeries are performed using small incisions either laparoscopically or robotically. The hospital stay is usually one to two nights. Patients will start a liquid diet in the hospital and be walking in the halls.

Recovery

Patients should avoid lifting more than 10-25 pounds for four to six weeks after surgery and avoid abdominal exercises for six to eight weeks after surgery. Typical surgical follow up visits are at two weeks, six weeks and three months after surgery.

Long Term

Lifelong follow up is required. Usual follow up visits are at six months, one year, and annually after surgery. At these visits, you will meet with the physician assistant and a dietician. The goal of these visits is to help you stay on track with your weight loss and prevent weight regain, nutrition deficiencies or late complications from surgery.

New Patient Questionnaire Packet

Before you arrive at your initial consult visit with the surgeon, please print and fill out the New Patient Questionnaire Packet below.  You will need to bring the following items with you to the first appointment:

• The new patient questionnaire packet
• Your insurance card
• Copy of your medication list, including any over the counter medications you take
• Copayment if indicated

You must bring the below new patient questionnaire packet completed with you to your first appointment in order to be seen.

If you’re obese, you’re not alone: more than one-third of American adults are morbidly obese – increasing their risk for diabetes, heart disease, stroke and other serious conditions, while keeping them from the active and happy life they deserve.

Our Bariatric Surgery Program offers highly effective surgical options to put you on the path to success. Our board-certified weight-loss surgeons specialize in the latest minimally invasive techniques, giving you the best possible start on your journey. And with a caring team of dietitians, mental health providers, bariatric-trained nurses and other specialists, we’ll be with you every step of the way.

We offer: Vertical Sleeve Gastrectomy Surgery Roux-en-Y Gastric Bypass Surgery

Gastric Band Management Revisional Surgery

Bariatric Surgery Approaches

We are highly skilled and experienced in minimally invasive surgical techniques, including laparoscopic and robotic-assisted bariatric surgery.

Robotic-Assisted Surgery

Robotic-assisted surgery enables the surgeon to have increased precision and control, especially for more complex cases. To operate the FDA-approved da Vinci ® Surgical System , your surgeon makes tiny incisions in your body and inserts miniaturized instruments and a high-definition three-dimensional camera.  Then, from a nearby console, your surgeon manipulates those instruments to perform the operation.

During a robotic-assisted procedure, your surgeon uses master controls to manipulate the instruments, which translate your surgeon’s movements into precise movements inside your body. Your surgeon is in control the whole time; the surgical system responds to the direction he/she provides. Robotic-assisted bariatric surgery may offer many benefits including:

• Potential for fewer complications for certain individuals
• Less pain and scarring
• Small incisions
• Lower risk of infection rates
• A shorter hospital stay
• The ability to use small incisions for complex cases

Laparoscopic Surgery

As an alternative to open surgery, Laparoscopic Bariatric Surgery (minimally invasive surgery) allows your surgeon to use techniques that limit the size and number of incisions. It’s typically considered safer than open surgery. You’ll usually recover more quickly, spend less time in the hospital, and feel more comfortable while you heal. Other benefits include:

• Less post-operative pain
• Shorter hospital stays
• A reduced rate of infection
• Less blood loss
• Smaller scars

Vertical Sleeve Gastrectomy

The vertical sleeve gastrectomy, otherwise known as ‘the sleeve’, is a procedure that makes the size of the stomach smaller. This limits the amount of food you can eat, so you are fuller faster. It also affects certain hormones in the body that affect our hunger, so in general your appetite is suppressed. This surgery is non-reversible.

Advantages:

• Reduction in portion size
• Reduction in hunger
• Decreased chance of malabsorption and nutritional deficiency
• No dumping syndrome
• Improvement or resolution of medical problems related to obesity

Disadvantages:

• Gastro-esophageal reflux disease (GERD)
• Stricture or narrowing of the sleeve
• Ulcers, particularly from NSAID use or smoking

Roux-en-Y Gastric Bypass

With gastric bypass surgery, a small stomach pouch is created from your normal stomach. This ‘pouch’ is where your food will go once you swallow it. The pouch is connected to a segment of your intestines so that your food ‘bypasses’ the majority of your remaining stomach (‘remnant stomach’) and the first portion of your small intestines. This means that you will have some malabsorption of some vitamins and minerals. Gastric bypass helps with weight loss because of restriction (small stomach), hormone changes (changing your hunger) and malabsorption.

Advantages:

• Reduction in portion size
• Reduction in hunger
• Improvement or resolution of medical problems related to obesity

Disadvantages:

• Dumping syndrome
• Malabsorption can lead to poor absorption of iron, calcium and B vitamins
• Ulcers from smoking or NSAID use
• Strictures at the intestine connections
• Change in the absorption of certain medications

Gastric Band Management

The LAP-BAND is an adjustable silicone band placed on the top portion of the stomach that is attached to a port to restrict food intake. We do not insert gastric bands in patients, but we do manage them for patients who are happy with them. We also remove them for those patients having issues with them.

Revisional Surgery

Revisional surgeries are surgeries performed on patients who have had previous bariatric surgery. Common indications for revisional operations include complications such as ulcers, fistulas, hiatal hernias, uncontrolled reflux or issues with lap-bands. Revisional surgeries are more complex and carry increased risk compared to original bariatric surgeries. Your surgeon will carefully evaluate you and your history to determine if you need revisional surgery.

About the Program

Our surgeons are fellowship trained and have extensive training in bariatric surgery, gastrointestinal surgery, robotic and advanced laparoscopic techniques. Our hospital is prepared to take care of morbidly obese patients with specialized equipment. We have 24-hour in house surgeon coverage for all of our patients.

Our comprehensive program features:

1. Experienced board-certified surgeons affiliated with the American College of Surgeons and the American Society for Metabolic and Bariatric Surgery
2. A multi-disciplinary team, including specialty trained providers, skilled physician assistants, dietitians, nurses, and behavioral health specialists
3. Bariatric procedures using state-of-the-art robotic and laparoscopic techniques resulting in fewer complications and faster recovery

Our team is devoted to the practice of bariatric surgery and weight loss management, ensuring our focus on state-of-the-art service. Our dietitians, behavioral health specialists and bariatric nurse coordinator will support your personal efforts preparing you for surgery. Your program will be personalized to you from your first visit through post procedure follow-up care. You’ll have guidance through each step along the way by our dedicated bariatric nurse coordinator.

Our program works closely with you and your insurance payer to determine your bariatric surgery coverage. You will be required to participate in medically supervised weight loss with our dieticians. The program can take up to eight months before surgery depending on insurance requirements.

Accreditation

Central Maine Bariatric Surgery was established in 2007. Since 2012, our program has been accredited through The American College of Surgeons as a Metabolic and Bariatric Surgery Accreditation and Quality Improvement Program (MBSAQIP®). The American College of Surgeons (ACS) and the American Society for Metabolic and Bariatric Surgery (ASMBS) combined their respective national bariatric surgery accreditation programs into a single unified program to achieve one national accreditation standard for bariatric surgery centers, the Metabolic and Bariatric Surgery Accreditation and Quality Improvement Program (MBSAQIP®).

MBSAQIP works to advance safe, high-quality care for bariatric surgical patients through the accreditation of bariatric surgical centers. A bariatric surgical center achieves accreditation following a rigorous review process during which it proves that it can maintain certain physical resources, human resources, and standards of practice. All accredited centers report their outcomes to the MBSAQIP database.

The Centers for Medicare & Medicaid Services (CMS) has recognized Central Maine Medical Center and allows expanded Medicare coverage of bariatric weight loss surgery for beneficiaries of all ages who have been diagnosed with other health problems associated with obesity. Medicare coverage has been limited to procedures performed in facilities certified by the American College of Surgeons or the American Society of Bariatric Surgery.

Preferred Status with Insurance Payers

Central Maine Bariatric Surgery has a preferred status as a center of excellence with the following insurance payers:

• Harvard Pilgrim Health Care Center of Excellence
• Aetna Bariatric Institute of Quality
• Cigna Certified Hospital for Bariatric Surgery
• Blue Distinction Center for Bariatric Surgery and Blue Distinction Center for Bariatric Surgery by Anthem Blue Cross Blue Shield, an independent licensee of Blue Cross Blue Shield Association

Programs and Services

Central Maine Bariatric Surgery offers you the opportunity to participate in numerous meetings and support groups before and after surgery to help contribute to your successful outcome. Patient groups are particularly helpful as they can share their experiences and provide the encouragement and reinforcement you need to succeed in changing your lifestyle behaviors. We offer:

• Bariatric Surgery Information Seminar
• Bariatric Surgery Support Group
• Weight Loss Video
• Nutrition Resources
• Behavioral Health Resources

Central Maine Bariatric Surgery provides patients with ongoing support before, during and after surgery. This includes pre-operative nutrition, behavioral health counseling and post-operative support with our physician assistant and dieticians. Patients are seen in the clinic at 2 weeks, 6 weeks, 2 months, 3 months, 6 months, 1 year and annually thereafter. We highly encourage and desire patients to continue with life-long bariatric follow-up and support.

Bariatric Surgery Support Group

One of the most important keys to achieving success with bariatric surgery is having a strong support system. Individual patient experiences are invaluable resources that are beneficial for the whole group. We have created a private online support group through Facebook. This forum is facilitated by a licensed professional and moderated for appropriate content. Discussions include health goals, dietary requirements, exercise expectations, psychological preparation, role of family, short and long-term challenges, pre-op and post-op phases, etc. The Central Maine Bariatric Support group is open to patients who have undergone weight loss surgery, as well as those who are considering the procedure. For information on how to submit a request to join this private group, please contact the office and they will provide you steps for joining.

Weight Loss Video – Get Answers from the Experts

Considering a life-changing weight loss procedure? Have lots of questions or concerns? You owe it to yourself to learn more by viewing the weight loss video from Central Maine Bariatric Surgery. The video is presented by our board-certified and fellowship trained surgeon and offers the information (and inspiration!) you need to make the right decision for your life.

Topics Include:

• Different types of surgery we offer, including laparoscopic options for less pain and faster recovery
• Benefits, risks and expected results of each procedure
• Dietary and lifestyle changes needed for lasting success
• How we support you at every step, from pre-op to follow-up
• Qualifications for surgery to help determine if you’re a candidate

Have Questions?

Please contact us if you have questions or would like to schedule an appointment.

Nutrition Resources

The nutrition portion of the bariatric program is designed to help you get ready for the surgery by providing education on the dietary requirements and key lifestyle habits that lead to long-term success. In the first visit, be prepared to openly share your current eating and drinking routines, food restrictions and preferences, and the personal challenges you face when trying to eat healthier and lose weight. Future visits will focus on reviewing a few specific areas of lifestyle change at a time in each of the six modules, and reviewing your progress towards implementing these changes and problem-solving together around any barriers as needed. We will use food tracking and monthly weight checks as tools for accountability and feedback. Remember, the dietitian is on your side to help and support you! Ask for what you need! The ultimate goal by the end of your nutrition pre-surgery program is that you will be “walking the walk” of a bariatric surgery patient, making your post-surgery recovery and journey as successful as possible.

Pre-Operative Diet

All patients will start a pre-operative diet two to three weeks before surgery.
2 WK Pre-OP Diet
3WK Pre-Prep-Surgery Diet

Post-Operative Nutrition Guidelines 

Vitamin and Mineral Supplements list
Protein Meal Replacement

Welcome to Central Maine Bariatric Surgery

Our core team includes surgeons, physician assistants, behavioral health specialists, and registered dietitians. Other medical specialists provide imperative care for our patient’s medical problems as needed. This team helps patients through the bariatric surgery program, helping to make lifestyle changes that are important for long term success.

The bariatric surgery program provides safe, effective metabolic procedures that aide with weight loss which include Vertical Sleeve Gastrectomy, Roux-en-Y Gastric Bypass, Gastric Band removal and management, and Revisional surgery. We offer minimally invasive surgery options including laparoscopic and robotic-assisted procedures. We provide comprehensive care for our patients preoperatively and lifelong after surgery. Our nurse coordinator will help patients in making sure they are completing all necessary tests and appointments.

Patients who would like to have an initial evaluation with our surgeons are required to attend a bariatric surgery information seminar or watch an online information seminar video. You will then have your initial evaluation with a surgeon, where you will learn what you will need to do to complete the program.

Our center also offers monthly support groups, in which patients can learn from our dietitians, behavioral health specialists and physical therapists, as well as have a time for social interaction and community building.

Locations

Central Maine Medical Center
12 High Street, Suite 401, Lewiston, Maine 04240
Phone: 207-795-5710 Fax: 207-795-2559

Topsham Care Center
105 Topsham Fair Mall Road, Topsham, ME  04086
Phone: 207-798-6300

Office Hours:   Monday-Friday 8am-4:30pm, closed Saturday and Sunday

Your Bariatric Team

As you start your weight loss journey, our team will be here to support you every step of the way. Our surgeons, dieticians, behavioral health specialists and other healthcare team members offer compassionate care starting with your initial evaluation and continuing throughout the rest of your life.

Who is a Candidate for Bariatric and Metabolic Weight Loss Surgery?

If you’re considering bariatric surgery at Central Maine Medical Center, you must meet specific criteria before you can be considered for a consult. This criteria is based on universal standards established by the National Institutes of Health and includes:

1. Body Mass Index (BMI) greater than 40 or BMI greater than 35 with medical complications related to obesity, such as high blood pressure, type 2 diabetes or sleep apnea. Use the BMI calculator from the Centers for Disease Control and Prevention to check your BMI. Many other medical complications qualify.
2. A documented history of weight management and weight loss attempts with supervised diets and exercise programs.
3. No indication of active alcoholism, active drug addiction or a major psychiatric disorder.
4. Our surgeons will evaluate other criteria, such as your age and general health, to determine if bariatric surgery is appropriate for you.

You will be evaluated by our surgeons to determine if bariatric surgery is right for you. You will also be evaluated by our dietitians and behavioral health specialist to make sure you are ready. Further assessment may be needed by other medical specialists.

After the completion of your requirements, our team will meet to decide whether you are an appropriate candidate for surgery. This decision is based upon your physical and emotional state, as well as eating habits, food preferences, activity levels and other health problems. In some cases, the type of surgery you desire will not offer optimal outcomes, and a different type of bariatric surgery or an alternative treatment may be recommended.

You also may be required to meet certain criteria — such as losing weight, attending counseling or undergoing physical therapy — before your surgery is scheduled. This helps to ensure that you will have the best possible chance of recovering from the surgery and succeeding at weight loss. Once you successfully complete the screening process and obtain insurance approval, your surgery will be scheduled and pre-operative preparation will begin.

Referrals

If you have a Central Maine Healthcare provider, please have provider enter the referral into Cerner. If not, please have your provider mail or fax the following information:

• Referral for the evaluation and treatment of morbid obesity
• Referral authorization number from the insurance company, referral must be for 1 year
• Demographic Information on the patient (DOB, address, phone number, insurance info)
• Most recent history and physical including blood work and medications
• All related diagnoses and co-morbidities
• Weight history of the past 3 years
• Previous attempts/duration of unsuccessful weight loss

Referral Process

1. Your primary care provider sends us a completed referral form with above documentation.
2. Our staff will review your referral and contact your insurance to verify your bariatric criteria.
3. Once bariatric criteria has been confirmed, you will then be contacted to schedule an appointment.
4. Before your appointment, you will be mailed a packet of information including appointment information and forms that need to be completed prior to your visit.
5. Most insurance plans cover these visits. However, coverage can vary and we recommend that you check your health insurance benefits.

Central Maine Bariatric Surgery Fax Number is 207-795-2559.

Weight Loss Surgery FAQ

If you’re thinking about bariatric surgery, you may be wondering how the whole process works. The Central Maine Healthcare Bariatric Surgery Program is here to provide the information you need, so you know just what to expect at every step. Start with this helpful FAQ.

Who is a candidate for weight loss surgery? For those considering surgery, you need to have a BMI (body mass index) between 35-40 with certain medical conditions associated with obesity, or a BMI greater than 40 with no medical problems.
In addition to the BMI requirement, you must realize that bariatric surgery is not the best weight loss option for all people and that this will be discussed at your consultation with a surgeon. You must remember that bariatric surgery is a TOOL and not cure, for weight loss. Your hard work, good eating habits, and good exercise and lifestyle habits are what will maintain weight loss and keep you healthy.

What are the benefits of bariatric surgery? There are so many benefits to bariatric surgery! These are both physical and emotional. Bariatric surgery can improve your health and help you to get rid of medical problems and medications you had before surgery. You may have improvement in your energy and ability to do things in your day. You may suffer from less pain in your muscles and joints. Overall, you may see your quality of life has improved dramatically.

What are the risks of bariatric surgery? All surgeries carry risk with them. Bariatric surgery overall is very safe, with a risk of death around 0.1%. In fact, weight loss surgery decreases the risk of dying from obesity and medical problems related to obesity. Some complications that can occur during or after surgery include things such as bleeding, leak, infections, blood clots, hernias and strictures. Your provider will review specific risks with you during your consultation.

Is weight loss surgery the ‘easy way out’? Should I just work at dieting and exercise? No. Bariatric surgery is a big commitment and requires you to participate in a program that is several months and requires you to make changes to your diet and exercise habits. Most people who consider bariatric surgery have been struggling with their weight for years and have tried many diet and exercise programs with variable success.
Most people who suffer from obesity find it hard to lose the weight they want and keep it off with diet and exercise alone. This is because obesity is a chronic disease that creates a vicious cycle leading to greater obesity. Weight gain can be related to many things, such as:
– Food addiction and poor eating habits
– Poor sleep habits
– Eating a diet high in sugar, fats, processed meats and grains
– Eating a diet low in fat fighting foods such as fruits, vegetables, lean proteins
– Mental health issues and stress
– Medications
– Genetics

Weight gain leads to many changes in the body which makes it harder to lose weight. Hormonal changes in the body alter functions that control appetite, feelings of hunger and fullness. Inflammation is heightened in the body’s cells, leading to fatigue and lack of energy. Studies have shown that diet and exercise alone lead to little long-term success. Weight loss surgery helps with long term weight loss because it creates biological changes in the body that help reduce food intake, change the hormonal signals to function properly, and reduce inflammation. It also restricts stomach size (you feel fuller with less) and with certain procedures also alters absorption.

Will my insurance pay for bariatric surgery? Weight loss surgery is covered by a lot of insurances as long as certain criteria are met. Insurance coverage for program components will depend on your individual health plan. Some insurances will not cover all portions of a program and may require self-pay.
We verify benefits with your insurance before your consultation, but it is always a good idea to contact your insurance provider to see if you are covered.

What are the differences between traditional and minimally invasive approaches for surgery? Minimally invasive surgery (robotic or laparoscopic surgery) is surgery done through multiple small incisions rather than a large incision. Minimally invasive surgery usually means less pain after surgery, smaller scars, and quicker recovery.

How much weight can I expect to lose? This number is dependent on the type of procedure you have as well as your success in making positive changes to your life regarding your diet and exercise habits. You will go through this more in depth during your consultation.

Will I be on a diet before surgery? Yes, for 2-3 weeks before surgery you will be on a special diet. This diet is aimed at shrinking the liver and reducing fat inside the abdomen in order to make surgery safer. For certain individuals, it may be determined that they will need to lose a certain amount of weight before being able to have bariatric surgery. Furthermore, some insurance companies will require weight loss before approval.
All patients in the program are participating in medically supervised weight loss through dietician appointments. These visits are aimed more at teaching you about food, healthy habits and tools for long term success after surgery.

Will I be on a diet after surgery? You will be on a graduated ‘diet’ from liquids to solids over six weeks. Afterwards it will be very important for you to choose healthy items for best results. In general, most patients describe a decrease in their appetite after surgery, and being satisfied with a smaller amount of food.

Are there certain medications I should avoid after surgery? After surgery you may not take any medication in the NSAID category (Nonsteroidal Anti-Inflammatory Drugs) as these may cause complications. You may have to hold certain medications before and after surgery, which you will discuss in your consultation. 

Will I have to take vitamins? Yes. You will need to take multivitamins for life after bariatric surgery. You may also need higher doses of certain vitamins and minerals such as Iron, Calcium and Vitamin D. You will also need to have your vitamin levels checked every year.

Does weight loss surgery cause serious health problems from vitamin deficiency? In general, as long as you take your vitamins, it is rare to have serious health problems from vitamin deficiency, but weight loss surgery can cause reduced vitamin levels because of changes in food habits and altered absorption. Vitamin deficiency can lead to fatigue, anemia, bone and muscle loss, impaired vision at night, altered senses, changes to mental function and altered immunity.

A healthy diet and the use of supplements will help prevent vitamin deficiency. The ones at biggest risk are those who don’t have a healthy diet, don’t take vitamins and don’t follow-up with their providers to get lab work. Make sure you stay in touch with your bariatric team every year or do your labs with your family provider!

Is exercise an important factor after bariatric surgery? Yes absolutely! We encourage you to start being active as soon as possible. Remember, exercise is different for everyone and there is not a ‘one size fits all’ exercise plan. What’s most important is that you are participating in exercise that increases your heart rate and helps you build muscle. Exercise is a very important component of your successful weight loss journey, and it is important to maintain your overall health as you age! If you are at a loss of what that looks like for you, we have resources to help.

How soon after surgery can I drive? For your own safety, you shouldn’t drive until you have stopped taking narcotic medications and can move quickly and alertly to stop your car, especially in an emergency.

How long do I have to be off work? This depends on what you do for work. You may take as little as 1-2 weeks off of work or you may require 4-6 weeks depending on your job.

Will I lose hair after weight loss surgery? You may. Some patients do experience some hair loss or thinning in the first six months after surgery. This is usually due to hormonal changes during rapid weight loss. Hair loss is usually temporary. While we don’t fully understand hair loss, we do know that good nutrition and adequate protein intake, as well as taking vitamins, will help.

Will I have excess skin after my surgery? You may have excess skin after surgery but this is dependent on many individual factors such as how much weight you have to lose, how quickly you lose it, your age and your exercise habits. Some patients choose to have surgery to remove skin after weight stabilization, either for cosmetic purposes or because of recurrent skin infections.

Can I become pregnant after weight loss surgery? Yes, you can. In fact, most women are much more fertile after surgery and weight loss. In general, it is recommended that you wait at least one year after surgery to become pregnant and very strongly recommended that you use a form of birth control at all times. Your cycle may be very irregular and you may become pregnant when you least expect it.

What is dumping syndrome? ‘Dumping Syndrome’ is a side effect that can happen after gastric bypass when a patient eats something high in sugar or carbohydrates. Because of the altered way in which the body handles these things after gastric bypass, one may have feelings such as abdominal cramps, racing heart, cold sweats, light-headedness and diarrhea. This may last anywhere from 30 minutes to an hour. Treatment for dumping syndrome revolves around diet modification.