According to the Center for Disease Control and Prevention, 42% of Americans suffer from obesity as of 2018.

Early deaths are associated to obesity-related conditions. These conditions include heart disease, diabetes, cancer, sleep apnea, hypertension, and stroke. The gastric sleeve surgery reduces your stomach that restricts your food intake. Because of your reduced food intake, your ghrelin hormone production is significantly reduced to minimize your hunger.

The gastric sleeve permanently alters your body mentally and physically post-surgery. The gastric sleeve reduces your stomach size by 70 to 80 percent of its original size, just leaving a small thin tube for a stomach. By reducing your stomach size, you have a diet that is drastically altered to accommodate your lifestyle change. Because of the nature of this surgery, there are many necessary steps you need to qualify for surgery.  You must be able to handle the physical stress of surgery because there may be complications that stem from obesity itself.

Criteria for Gastric Sleeve Surgery

Body Mass Index (BMI) over 40 or BMI greater than 35 with another health problem such as:

• Sleep Apnea
• Hypertension
• High cholesterol
• Diabetes
• Joint Pain

Psychological Readiness:

• Attitude
• Motivations
• Follow through on recommendations made by your health care team
• Stress Level
• Most insurance requires a psychological consultation as part of the pre-op evaluation process

Nutrition and Weight History:

• Diet attempts
• Medically supervised diet for 3 to 7 months depending on the insurance company
• Eating Habits
• Exercise Regimen
• Weight Trends

Healthcare professionals may need to evaluate your overall health, including:

• Primary Doctor
• Psychologist
• Bariatrician
• Dietician

Reasons for Delay or Canceled Surgery

• Not psychologically or medically ready for surgery
• You haven’t made appropriate changes in your eating or exercise habits
• You gained weight during the evaluation process

Cannot Qualify for Gastric Sleeve Surgery

• BMI is not high enough
• You have limited previous diet attempts
• Specific physical or mental health conditions
• You are pregnant
• Current infection
• Operation risks including severe heart or lung disease
• Substance abuse/cirrhosis
• Unwilling to follow a long term diet, vitamin or exercise program
• Suicide attempt in the last 18 months or multiple efforts within the last 5 years

Considerations

There are many considerations the bariatric community uses when determining whether or not a patient is ready for surgery. Your medical condition is the primary consideration.

These include evaluating you for liver disease, heart problems, kidney function, and nutritional deficiencies.

Some health problems may arise due to the increased risks associated with having surgery. Your medical care team evaluates the medications you take, how much alcohol your drink, and whether or not you smoke. All of these lifestyle habits affect your ability to adequately prepare for surgery and have a successful life after surgery. You will also be evaluated for sleep apnea and receive an EKG exam of your heart.

Another major consideration your health care team has is evaluating your mental health. Your mental health is the next barrier that can prevent success pre and post weight loss surgery. Having the ability to confront your habits and negative thoughts are looking at your long term goals. At the same time, the physical exams identify your present, whereas the psychological exam identifies past, present, and future barriers to your success.

Some issues that are common amongst bariatric patients are disordered eating, substance abuse, anxiety disorders, major depression, severe bipolar disorder, schizophrenia, and childhood sexual trauma.

All of these are crucial in determining whether or not you have the mental stamina to endure weight loss surgery and its changes long term.

Pre-surgery requirements include mental and physical preparation before surgery. There are specific restrictions on eating and drinking before surgery. These lifestyle changes require counseling to help cope with the changes to your diet and exercise. Some necessary changes include quitting smoking, reducing alcohol consumption, starting a supervised physical or exercise program.

Quitting smoking is a requirement weeks before surgery because smoking slows down your healing time and may cause other health issues after surgery. You may also need to stop taking ibuprofen, aspirin, and blood-thinning drugs as well before surgery. All of these changes may be required by your health care team to allow for gastric sleeve surgery to be scheduled.    

My Gastric Sleeve Preparation

My first appointment with my bariatrician was in November of 2017. At this first appointment, I was given an outline of all of the requirements needed for my gastric sleeve surgery to be scheduled. I met the requirement of a BMI of over 40 and other health issues. I also tried many previous diets that were unsuccessful.

To obtain a surgery date, I had to attend weekly counseling sessions to determine whether or not I had an eating disorder. My counseling sessions were with both a food specialist and a therapist that specifically tackled bariatric patients.

Along with my counseling sessions to help improve my mental health, I had regular appointments with my bariatrician to help improve my diabetes. I also attended regular appointments with my dietician to develop a food and exercise plan.

The food plan consisted of a minimum protein intake of seventy grams and increasing my vegetables. With this food outline, my diet changed to a high protein, low carb diet to receive all of my nutritional needs.

I also began an exercise routine where I went to a local gym three to four times a week and walked on a treadmill for thirty minutes and used the elliptical for fifteen. Having a steady cardio routine created a great balance to my mental health and helped improve my coordination.

Other necessary tests performed before surgery was a sleep apnea test and an EKG exam. These were relatively easy to do, and there were no complications.

Due to all of these mental and physical changes, in March 2018, I was able to schedule my gastric sleeve surgery for August 2018.

For prep, before surgery, I had an all-liquid diet to clear out my system that lasted for fourteen days. The liquid diet was a new experience, which I found interesting to observe. Due to my overall health changes, I did not experience any cravings or withdrawals, which was a welcome surprise. By the day of surgery, I had lost over seventy pounds over nine months. I was proud of my progress and for following all of the guidelines.

I was adequately prepared for my gastric sleeve surgery due to all of the mental and physical preparation I had before surgery.

I am currently 20 months post-surgery, and I am happy with my progress and overall health. I maintain daily physical and mental goals, which I happily meet. There are moments where self-discipline can be a challenge, but I just start over, forgive myself, and move forward. Learning that life is full of ups and downs, but using my tool effectively is a daily choice I do not take for granted, considering all of the effort and work I have put into myself thus far.