3 precautions to take if you choose to travel for weight loss surgery

It’s difficult to pin down the exact number of people who travel abroad to access medical services, but the Centers for Disease Control and Prevention (CDC) estimates that thousands of U.S. residents do so each year. And Patients Beyond Borders, a consumer source of information about medical tourism, says weight loss surgery is among the most-sought specialties, along with cosmetic surgery, dental work and cancer and heart treatments.

There are a number of reasons people travel to get these procedures, but two of the most common are:

  • Lower costs: Surgical procedures in some countries can cost up to 80 percent less than in the U.S.
  • Broader eligibility criteria than in the United States: We follow National Institutes for Health guidelines to determine who is eligible for bariatric surgery. It’s not done purely for cosmetic reasons. This isn’t the case in some countries, so people who might not qualify in the U.S. may be eligible elsewhere.

Not everyone who travels for medical care crosses the U.S. border. When a procedure or treatment isn’t available locally, some patients may need to go to a distant city or state to get it.

I’ve never had a patient ask me for advice before going abroad for bariatric surgery, but I have seen patients over the years seeking follow-up care or treatment for complications. Before you travel to get a procedure, such as gastric bypass or sleeve gastrectomy take these precautions.

1. Thoroughly research the doctor and facility

Each country has its own standards that healthcare providers and facilities must meet, and these can be very different from the United States. Check the qualifications of your doctor and facility and learn how they compare to those in the U.S.

You also can check with international accrediting organizations, which require facilities to meet a list of standards to be certified. The CDC recommends ensuring your facility is accredited by the Joint Commission International,  DNV GL - International Healthcare Accreditation or the International Society for Quality in Health Care.

Ask about your doctor’s experience. How many surgeries have they performed and what are their success rates?

Get in writing the specific treatment, supplies and care covered in the costs. You don’t want to be surprised when you arrive or get the bill.

2. Arrange for before- and after-care close to home

Bariatric surgery doesn’t start and end in the operating room. It’s not just an anatomical change; it changes how you’ll live the rest of your life. This type of change requires support–before and after surgery.

Procedures, such as gastric bypass, change how your body processes and absorbs food. They require major lifestyle and dietary changes. If you don’t understand what you can eat, when you can eat it, and how much of it you can eat, you can suffer from digestive problems or vitamin deficiencies.

Pre-surgery education and long-term follow-up care are essential components to a successful bariatric surgery outcome. Weight loss surgery patients in the United States go through, on average, six months of preparation and education by dietitians and other healthcare providers. After surgery, we recommend ongoing dietary supervision and regular appointments the first year and then yearly afterward, to monitor for nutritional deficiencies and other complications.

If you travel for surgery, it’s likely not feasible—or even an option—to spend months before and after surgery in that destination for education and follow-up care.

Form a relationship with a local bariatric surgery program to receive pre- and post-surgery education and care. Remember to check with your insurance company. If you’re having surgery outside the country, this care may not be covered by your plan. But as I said, this support is crucial to achieving your goal of long-term weight loss.

"If you must travel to get bariatric surgery, establish a plan for before- and after-care close to home." via @MedStarWHC

3. Plan for language barriers and potential complications

If you receive care in a country where you do not speak the language fluently, determine how you will communicate with your doctor and care team. While foreign language interpreters may be commonplace in U.S. healthcare facilities, don’t expect every place to have them. It’s vital that you are able to effectively communicate with your team, so there are no misunderstandings about your care.

Complications can arise, and you must be prepared for them. For instance, you may need to stay longer than anticipated to recover. If the problem is severe, you may need to return to the U.S. for more advanced care.

If you or a loved one has to be transferred from one hospital to another, you know how involved that move can be–even within the same city. Now think about the difficulty involved in transferring a patient to another country.

Keep in mind that flying after surgery has its own risks, including deep venous thrombosis (blood clots) and pulmonary embolism (blockage of an artery in the lung). To help prevent these complications during your flight:

  • Get up and walk around every two hours
  • Move your legs while sitting
  • Stay hydrated
  • Wear compression stockings

Bariatric surgery can be a lifesaver for people who struggle with severe obesity and the complications that can accompany it, such as diabetes and hypertension. But it’s more than surgery; it’s a set of lifestyle changes that requires education and continuous support. When possible, it’s best to get this care close to home. But if you must travel, whether to the next town or overseas, make the preparations necessary to optimize for a successful outcome.

 

Schedule an appointment to talk with our bariatric surgery team about pre- or post-surgery support.

6 frequently asked questions about bariatric surgery

Medical Intel Podcast: Dr. Timothy Shope Discusses Bariatric Surgery Methods

Bariatric surgery has been available in the U.S. for more than 50 years, and surgeons are doing more every year. In fact, our team performed 336 of these procedures in 2016, compared with 257 in 2013.

Still, bariatric surgery is still not well understood, and many people have questions about it.

I’ve heard many. Two of the most frequent ones I get are, “Is bariatric surgery safe?” and “Will I be left with a lot of flabby skin?”

Bariatric surgery, such as gastric bypass or sleeve gastrectomy, can be a lifesaver for people struggling with obesity and its side effects. So let’s get to the truth of some of the most common questions.

Is bariatric surgery dangerous?

Patients often tell me that friends and family worry they will die during bariatric surgery and try to discourage them from getting a procedure. I suspect this fear is a holdover from when the surgery was new.

As with any surgical procedure, the risks from bariatric surgery were much greater when it was first developed. But with the advent of minimally invasive techniques, such as laparoscopic and robotic surgery, which come with fewer complications, the procedures’ safety has dramatically improved.

In fact, the latest data show that bariatric surgery is safer than having your gallbladder removed. The mortality rate for bariatric surgery is 0.25 percent compared with 0.7 percent for gallbladder removal.

And don’t forget that obesity also is dangerous, increasing the risk of life-threatening conditions, such as diabetes and hypertension, and even decreasing lifespan.

"The latest data shows that bariatric surgery is safer than having your gallbladder removed."

Will I be left with a lot of excess skin after bariatric surgery?

This is a complex issue and it’s specific to every individual. The bigger you are and the more weight you lose, the more excess skin you’ll have. But most patients find they have less excess skin than they expected.

The best advice I can give to avoid excess skin is to maintain and increase muscle mass, giving the skin lean tissue to contract over. I’m not saying you need to become a body builder or look like a star athlete. But developing a fitness routine that promotes healthy muscle tone will help reduce excess skin.

If you do have sagging skin that bothers you, you can explore body contouring, which is an umbrella term for procedures, such as tummy tucks and lifts to the upper arms, midsection, back, thighs, buttocks and hips.

Will I just regain  the weight after weight loss surgery? 

Everyone seems to knows someone who had bariatric surgery and gained all the weight back. But in reality, that’s pretty rare. A 2016 study found that only 3 percent of study participants who had gastric bypass regained most or all of the weight they lost after 10 years.

Weight loss after bariatric surgery occurs on a curve. Weight drops rapidly right after surgery and continues for 18 months to two years. A little weight gain is expected after that, but then it should plateau. This is normal, and we’re talking about a few pounds, not a massive amount of weight (usually about 5 percent).

When a patient does regain a considerable amount of weight, we first try to determine whether there was a problem with the surgery. For example, in gastric bypass, the surgeon reduces the size of the stomach and reconnects the small intestine to the new stomach, bypassing the original stomach and several feet of the small intestine. One rare complication of this surgery is gastrogastric fistula, in which food goes into the old stomach instead of the new stomach pouch, causing weight gain.

Most weight gain can be traced back to dietary habits. People don’t come back for after-care appointments or follow diet recommendations, or they simply fall back into old habits. And while someone might go through all the pre-surgery education, their psychological relationship with food may not change post-surgery.

Regaining all the weight can happen, but it’s rare. We’ll work with you and a dietitian to help you get back on track before you regain too much of the weight you worked so hard to lose.

Is having weight loss surgery the easy way out?

I’m amazed that in this day and age some people still think of surgery as the easy way out. There is nothing easy about bariatric surgery. People who have these procedures prepare for six months on average and then must change their lifestyle and diet after surgery. It’s a lot of work.

Attend our free information sessions to see if bariatric surgery is right for you.

The National Institutes of Health recognizes bariatric surgery as the only effective way to treat severe obesity and maintain long-term weight loss.

Losing weight through diet and exercise can be extremely difficult. Many people experience the yo-yo effect, in which they lose and gain weight multiple times. This can wreak havoc with a person’s metabolism, making losing weight even more difficult. In fact, less than 5 percent of people who lose weight by diet and exercise are able to maintain long-term weight loss.

And weight loss medications come with their own problems. Along with potential side effects, they only work as long as you take them. There’s no long-term weight loss effect.

Will I develop a vitamin deficiency after weight loss surgery?  

Vitamin deficiencies are a real concern after bariatric surgery. Your body will not be able to absorb them, as well as it used to. However, taking a daily multivitamin and following your dietary recommendations should ward off potential problems.

Severe vitamin deficiencies don’t develop overnight, and we have processes in place to catch them early. We check your vitamin levels six months after surgery, at a year, then yearly after that. If your levels are low, we’ll work on it before it becomes a problem.

Will I still be able to eat dessert or drink alcohol after bariatric surgery?  

Yes. Because your body will process and absorb foods differently after surgery, we recommend that you not eat foods high in sugar and fat immediately after surgery or drink alcohol for two years. But after a while, you can have a piece of cake at a wedding or a glass of wine for your anniversary. You’ll need to eat and drink these items in moderation, but you can have them for special occasions. This is also a good guideline for people who just want to live a healthier lifestyle.

If you have heard something fishy about bariatric surgery, don’t hesitate to ask your doctor. We’ve heard it all, and we won’t think your question is silly. If you’re considering bariatric surgery, it’s your right—and our job—to make sure you understand the ins and outs before you commit to preparing for and maintaining a healthier weight.

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Springing Back from Obesity

Susan, 48, of Prince Frederick, Md., spent the last 25 years morbidly obese, reaching 360 pounds. After gastric sleeve surgery in March 2014 and excess skin removal 18 months later, she’s now at 170 pounds and still losing. But gaining so much more.

“I don’t hide anymore,” she says. “I’m not depressed. I can spend time with the five grandchildren I just inherited when my son got married.”

Susan says she was a closet eater as a child, hiding food under her bed, but was never overweight. Once she became pregnant in her 20s, everything changed. “I gained 150 pounds with my first son,” she says, and another 60 pounds with her second.

Sleep apnea and high blood pressure followed, as did depression. “I was so ashamed,” she recalls. “If I needed to go shopping, I waited in the car until no one was standing in front of the store, so I could slip in without being seen.”

Two things gave Susan the will to turn her life around. First, she needed knee replacements because of the arthritis, but the surgeon refused until she lost weight. And, her mother-in-law’s reply to Susan, when Susan offered to help with her declining health, was “How can you take care of me, when you can’t take care of yourself?” Susan says, “I knew I had to do something.”

The pivotal moment: “I was sitting in my car in the grocery store parking lot,” she recalls, “and I heard a radio ad for bariatric surgery. I said to myself ‘I have to call right now or I won’t do it.’” From her car, she made the appointment with MedStar Washington Hospital Center’s bariatric surgery program.

At the bariatric surgery orientation, Susan learned she’d need to lose some weight first, attend nutrition classes and undergo diagnostic tests. Her husband and sons were very supportive. Five months later, in March 2014, having dropped about 90 pounds after following the program’s diet, Timothy Shope, MD, performed gastric sleeve surgery, a minimally invasive procedure that reduces the size of the stomach.

After surgery, she lost another 100 pounds. But excess skin was a problem.

“I was hoping that five nights a week at the gym would allow me to avoid plastic surgery,” she says. “But I didn’t like what I saw.”

Praful Ramineni, MD, a Hospital Center body contouring plastic surgeon, said Susan was a great candidate for surgery. She had to wait another six months to ensure her weight had stabilized before he removed excess skin from her belly, arms, back and thighs. Two months later, her scars are fading. “I am so happy,” she says. “On vacation, I got the first tan ever on my stomach! But the best part? I can do things with my family. Now I can go to my grandchildren’s football games, instead of hiding. I’ve even  been horseback riding with my niece.”

Susan’s advice to others: “If you are considering surgery, please do it. My whole life is evolving in a good way. My relationships, my mental health, everything.”

Considering weight-loss surgery? There are several options to help you learn more:

Alternative Bariatric Surgery Option

A New Approach to Weight-Loss: vBloc®

Pacemakers have long been used to regulate heart function. Now, a similar approach called vBloc® is a bariatric surgery option that may help patients with obesity and weight control problems regulate their appetites, and it is now available at MedStar Washington Hospital Center.

Recently approved for clinical use by the Food and Drug Administration, the therapy uses a small device with electrodes implanted along the esophagus and the stomach. This device manages signals from the brain to the vagus nerve, which regulates many of the body’s digestive functions, including the sensations of hunger and fullness. By intermittently blocking these signals, the device helps patients better regulate their appetites, allowing them to eat more appropriate portion sizes and avoid snacking between meals.

A Minimally Invasive Option

Unlike more complex bariatric surgery procedures such as gastric bypass, sleeve gastrectomy and adjustable gastric banding, the vBloc device can be implanted on an outpatient basis. It can alsoe  be adjusted by your docotor as needed using wireless communication technology. This allows for you and your physician to work together in developing a weight-loss plan that is tailored to you individually. Another benefit vBloc therapy patients may have is fewer meal and lifestyle restrictions compared to those who opt for other weight-loss procedures.

Are you a candidate?

While vBloc is a promising alternative bariatric surgery therapy for weight loss, it’s not for everyone. “vBloc opens up possibilities for weight-loss surgery patients who have a lower body mass index,” says Timothy Shope, MD, a bariatric surgeon at MedStar Washington Hospital Center. “Patients still need to first come through our weight loss program and be evaluated to see if they are eligible for the therapy.”

You may be a candidate for vBloc Therapy if you meet these criteria:

  • Have tried to lose weight by diet and exercise in a supervised program within the last 5 years
  • Are at least 18 years of age
  • Have a BMI of 35 to 39.9 with a health-related condition such as: Type 2 diabetes, high blood pressure, sleep apnea, high cholesterol
Have Any Questions?

We're here to help! Contact us for more information about this and other bariatric surgery options. Call us at 202-877-3627.

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Why Choose Us – Bariatric Surgery

Bariatric Surgery
MedStar Washington Hospital Center - Why Choose Our Bariatric and Weight Management Department

Thinking about weight loss surgery? At the top of your “to do” list is choosing the very best hospital—and an experienced medical team. At MedStar Washington Hospital Center we’ve been successfully performing weight loss surgery—also called bariatric surgery—for decades. Our team’s experience and expertise translates into your positive outcome—and improved quality of life.

We put you at the center of our care and provide all the information you need to better understand your treatment options and make a full recovery.

Washington Hospital Center - The Best Choice for Bariatric Surgery:

  • Our program is an American Society for Metabolic and Bariatric Surgery (ASMBS) Center of Excellence and is fully accredited by the Metabolic and Bariatric Surgery Accreditation and Quality Improvement Program (MBSAQIP).
  • Our board-certified surgeons have extensive experience in minimally invasive and robotic bariatric surgical procedures, which translate into shorter hospital stays, less pain and a faster recovery.
  • You will be cared for by a multi-disciplinary bariatric team that includes a bariatric surgeon, gastroenterologist, nurse program coordinator, dietician and exercise physiologist.
  • All of the comprehensive resources of the MedStar Washington Hospital Center are available if you need them.
  • A free educational program before surgery helps prepare you for the procedure and your recovery.
  • Extensive follow-up care, including a support group of your peers, provides all you need to stay healthy long after your procedure.

 

Patient Success Stories

As Tyrone Harrison gained weight, his diabetes spiraled out of control. He was afraid he would lose a leg or go blind. Bariatric Surgery saved Tyrone's life. View his story below.

See other MedStar Washington Hospital Center Bariatric Surgery patient success stories.

Location Information

To find a bariatrics specialist, call 
844-333-DOCS (3627).

MedStar Washington Hospital Center POB
106 Irving St NW,
Physician Office Building, Suite 301 South
Washington DC 20010

 

Information Sessions and Support Groups

This is your first step in the bariatric surgical process. Come join us and you will:

  • Meet the bariatric surgeons and patient care team
  • Learn about surgical options
  • Learn about the process
  • Learn about insurance requirements and the authorization process 

Alternative Online Seminar: Click here to learn more about the Bariatric Information Session offered online. 

Supporting Documentation: If you choose to register for our online session, please download the following information: 

Meet Our Team

  • Dr. Timothy Shope: Bariatric and General surgeon
  • Dr. John Brebbia: Bariatric and General surgeon
  • Dr. Timothy Koch: Gastroenterologist
  • Dr. Elizabeth Zubowicz: General surgeon
  • Dr. Ivanesa Pardo: Bariatric and General surgeon
  • Marsha Brown, RN: Clinical Nurse
  • Catherine Hite, CRNP: Nurse Practitioner
  • Anyea Lovette MS, RD, LD: Bariatric Program Coordinator 
  • Andrea Goergen, MHS, RD, LD, Clinical Dietitian
  • Kristen McGill RD, LD, Clinical Dietitian
  • Administrative team:
    • Lenique Hammond, MA
    • Natalie Bryant, MA
    • Catina Wood, MOA
    • Janice Abrahams, MOA