Frequently Asked Questions

Are the injectable weight-loss medications the same as the diabetes drugs I've heard about?

They overlap. Semaglutide and tirzepatide were first developed for type 2 diabetes (Ozempic, Mounjaro) and later approved at weight-management doses under different brand names (Wegovy, Zepbound). The active medication is the same class, but the approved indication and dosing differ.

Will I have to take medication forever to keep the weight loss?

In short, yes. Obesity is a chronic condition, and these medications treat that condition as long as they are being taken. Most people regain weight after stopping, so they are designed for long-term use. Your physician will discuss a realistic long-term plan with you.

How do medications compare to a balloon, ESG, and surgery?

Newer medications can rival endoscopic procedures and approach some surgical results, but they require ongoing use and cost. Balloons and surgery are procedures with their own risks and benefits. The easiest path to goal weight sometimes combines both approaches. Dr. Fitzer will help you understand the options and the outlook.

Will my insurance cover Zepbound or Wegovy in Virginia?

It depends on two separate gates. First, does your plan cover weight-loss medications at all? Many Virginia employer plans, and all individual and small-group marketplace plans, exclude them outright. Second, if the category is covered, do you meet the plan's clinical prior-authorization criteria — usually a BMI of 30 or higher, or 27 or higher with a weight-related condition, plus documented lifestyle efforts. Ask your plan about the exclusion question first, because no documentation can overcome a benefit exclusion. See our Virginia weight-loss medication insurance guide for plan-by-plan details.

My plan excludes weight-loss drugs. Are there other ways to get covered?

Yes. Some patients have a backdoor available through alternate diagnoses such as type 2 diabetes, moderate-to-severe obstructive sleep apnea, established cardiovascular disease, or MASH with fibrosis. Coverage follows the diagnosis, not the molecule, so a drug like Mounjaro or Ozempic may be covered under a diabetes indication even when the same molecule sold as Zepbound or Wegovy is excluded for weight loss. See our Virginia weight-loss medication insurance guide for the full backdoor explanation.

Who should not take weight-loss medication?

Semaglutide and tirzepatide both carry a boxed warning regarding thyroid C-cell tumors, based on findings in rodents; whether that risk translates to humans is not known. They are contraindicated if you have a personal or family history of medullary thyroid carcinoma, Multiple Endocrine Neoplasia syndrome type 2, or a serious allergy to the drug. Tell us before starting if you are pregnant, breastfeeding, or planning pregnancy, or have a history of pancreatitis, gallbladder disease, severe gastroparesis, an eating disorder, diabetic retinopathy, or kidney problems. The most common side effects are gastrointestinal and are usually most noticeable during dose escalation.

What is bariatric surgery?

Bariatric surgery is a group of surgical procedures that help people lose weight by making changes to the digestive system. Depending on the procedure, surgery may reduce the size of the stomach, reroute the digestive tract, or both. It is typically recommended when diet, exercise, and medications have not produced sufficient results in patients with obesity-related health conditions.

What types of bariatric procedures do you offer?

The evidence-backed procedures we offer include:

• Roux-en-Y Gastric Bypass (RYGB): The stomach is divided into a small pouch and connected directly to the small intestine, bypassing most of the stomach and part of the intestine.
• Sleeve Gastrectomy: Approximately 75–80% of the stomach is removed, leaving a narrow, sleeve-shaped stomach. See our full guide to gastric sleeve surgery.
• Adjustable Gastric Band (Lap-Band): An inflatable band is placed around the upper stomach to create a small pouch and slow food passage.
• ESG (Endoscopic Sleeve Gastrectomy): A non-surgical, endoscopic procedure that reduces stomach volume from inside using sutures, with no external incisions.
• Orbera® Intragastric Balloon: A temporary, non-surgical weight loss balloon placed endoscopically in the stomach and filled with saline to promote earlier fullness.
• Transoral Outlet Reduction: An endoscopic revision procedure for patients who have regained weight after gastric bypass, reducing the size of the gastric outlet.
• Revisional Bariatric Surgery: Surgical correction or conversion of a previous bariatric procedure for patients experiencing complications or inadequate weight loss.

Which procedure is right for me?

The right procedure depends on your BMI, health conditions, eating habits, surgical history, and personal goals. Our team will review your full medical history and work with you to recommend the best option. There is no one-size-fits-all answer.

Who qualifies for bariatric surgery?

The current NIH criteria include:

• BMI of 35 or higher, OR
• BMI of 30–34.9 with at least one obesity-related condition (e.g., type 2 diabetes, sleep apnea, hypertension, or heart disease)
• History of failed attempts at non-surgical weight loss
• Commitment to long-term lifestyle changes

Read the full bariatric surgery qualifications for details on insurance, age, and BMI thresholds.

Are there reasons I might not qualify?

Yes. Factors that may disqualify a candidate include untreated severe psychiatric illness, active substance use disorder, certain medical conditions that make surgery too risky, an inability to commit to post-operative lifestyle requirements, or pregnancy.

Is there an age limit?

Bariatric surgery is most common in adults aged 18–70, but it is also appropriate for some older adults, who are evaluated on a case-by-case basis. Dr. Fitzer does not perform surgery on patients younger than 18, but a small number of centers do offer bariatric surgery to patients as young as 15.

What does the pre-surgical process look like?

The process typically includes:

• Initial consultation and evaluation
• Medical clearance by your own PCP and other specialists (e.g., cardiology) if indicated
• Testing (Labs, EKG, imaging, sleep study if indicated, etc.)
• Nutritional counseling and dietary education
• Psychological evaluation
• Insurance pre-authorization (if applicable)
• A pre-operative liquid diet (usually begins three days before surgery)

Why do I need a psychological evaluation?

The evaluation ensures you have realistic expectations, a stable mental health foundation, and the emotional readiness to commit to lifelong behavioral changes. It is a standard and supportive part of the process — not a barrier.

Do I have to follow a special diet before surgery?

In our practice, we have patients follow a special liquid diet for the three days preceding surgery. A three-day diet produces a reduction in liver size similar to two weeks of a low-calorie protein shake diet that some practices use. Our dietitian will review the specific plan with you.

Will I need to stop any medications before surgery?

Some medications — including blood thinners, NSAIDs, and certain diabetes drugs — do need to be stopped before surgery (bariatric or otherwise). Dr. Fitzer and/or his team will review your meds list and give you specific instructions for each med.

Is bariatric surgery performed laparoscopically?

Yes, in essentially all cases. We use minimally invasive laparoscopic or robotic-assisted techniques, which involve small incisions, a camera, and specialized instruments. This results in less pain, reduced scarring, and faster recovery compared to open surgery.

How long does the surgery take?

Dr. Fitzer performs most procedures in one hour or less. Revisional surgery takes a little longer. Individual factors (such as multiple prior operations or very extreme obesity) can impact the operative time.

Will I be under general anesthesia?

Yes. All bariatric procedures are performed under general anesthesia. You will be completely asleep and feel nothing during the operation.

How long will I be in the hospital?

Most patients stay one night for sleeve gastrectomy and gastric bypass. Lap-Band, TORe, and ESG patients usually go home the same day. Discharge dates sometimes vary based on Dr. Fitzer's assessment.

Does my health insurance cover bariatric surgery?

If you have government-provided health insurance (Medicare, Medicaid, Tricare, etc.), then congratulations! You do have bariatric surgery coverage.

If you have private health insurance (e.g., Cigna, United, Aetna, BCBS...), you may have coverage. All private insurers do offer bariatric surgery coverage, but not every policy includes it, unfortunately. (These days, it seems about 50-50.)

Give us a call. We can help you find out if your policy includes bariatric surgery coverage.

Are the qualifications for bariatric surgery different if you are using insurance?

Strangely, yes. Insurance companies adhere to the prior NIH guidelines on weight loss surgery. According to those guidelines, the BMI requirement is over 40 in the absence of comorbid medical disease, and over 35 with it.

Those guidelines are now more than thirty years old (published in 1991), and there is broad consensus in the medical community that they are too exclusive. (Insurance companies are the noteworthy exception to the consensus.)

What are the activity restrictions during recovery in the first few weeks?

There are two main restrictions: (1) no driving for five days, and (2) no lifting more than 25 pounds for the first four weeks. As far as return to work, people who work at a desk are usually off work for 1–2 weeks; people on their feet most of the workday (e.g., teachers) average 2–3 weeks off work; people who do heavy lifting at work (and for whom no light duty is available) must take four weeks off.

How much pain should I expect?

It is usually not too bad. Mild to moderate soreness is common for the first day or two after laparoscopic surgery. It usually subsides by post-op day two. Most patients manage well with oral pain medication.

What will I be able to eat after surgery?

Long-term, we prefer that patients eat small, balanced meals rich in protein — typically 3 small meals per day. If the meals are eaten with proper bariatric technique, odds are the patient will feel no desire to snack in between. Foods high in sugar and fat are discouraged and may cause "dumping syndrome" in bypass patients. We recommend that patients avoid foods or drinks containing sweeteners, whether sugar-containing or zero-calorie.

Do I need to take vitamins forever?

Yes, but you'd need to take the same ones if you lost similar weight just through dieting. Virginia Bariatric will give you a specific regimen in writing well in advance of surgery.

What is dumping syndrome?

Dumping syndrome is what we call the unpleasant symptoms that can occur after gastric bypass or sleeve surgery in response to foods really rich in refined sugar or liquid fat (grease). It is the result of abnormal gut hormone release provoked when food moves rapidly into the small intestine. Symptoms include nausea, cramping, sweating, dizziness, and sometimes diarrhea. It usually can be avoided by following dietary guidelines.

Will I ever be able to eat normally again?

It depends how we define "normally." If normally means eating as quickly as you could before surgery, the answer is a hard no. (You may rest assured that no bariatric patient will ever be in serious contention at a hotdog eating contest.) Your relationship with food will change, and you will settle into a new normal that is just as satisfying. You will learn to eat more slowly. You will learn to really consider how full you currently feel every time you contemplate taking an additional bite. Most patients are able to enjoy most of the foods they love once they relearn how to eat. Virginia Bariatric staff will help you develop an enjoyable and sustainable eating life.

Is any part of my stomach or intestine bypassed?

No. The sleeve removes part of the stomach but does not reroute the intestines. Food follows its normal path, which is one reason nutrient absorption is better preserved than with gastric bypass.

Sleeve or bypass — which is better?

Both are excellent operations with similar weight loss and diabetes remission. The sleeve is simpler with fewer complications; bypass is often preferred for patients with significant acid reflux or certain metabolic conditions. The best choice is individual — see our bypass vs. sleeve comparison.

Can the sleeve be reversed?

No. Because part of the stomach is permanently removed, the sleeve is not reversible — though it can be converted to another procedure if needed in the future.

How long is recovery after gastric sleeve surgery?

Most patients stay overnight in the hospital and return to normal activities within about four weeks. You will begin a liquid diet immediately and advance through pureed, soft, and regular foods over the following eight weeks.

Is gastric sleeve covered by insurance?

Many major insurers cover sleeve gastrectomy when medical criteria are met, such as a BMI of 35 or higher, or 30 or higher with an obesity-related condition. Our team verifies benefits and helps you through the authorization process.

What diet do I follow after sleeve gastrectomy?

Recovery eating progresses in stages: clear liquids, full liquids and protein shakes, pureed and soft foods, and finally regular solid foods. Daily vitamin supplementation begins right away, and our dietitian supports you through each stage.

Is ESG the same as gastric sleeve surgery?

No. Surgical gastric sleeve surgery laparoscopically removes about 80% of the stomach. ESG reshapes the stomach with internal sutures through the mouth—nothing is removed and there are no incisions. Surgery typically produces greater weight loss, while ESG offers a lower-risk, incisionless, potentially reversible alternative.

How does ESG compare to weight-loss medications?

Medications such as GLP-1 agonists can be highly effective but require ongoing use, and weight is often regained when they are stopped. One 2024 economic analysis found ESG to be more cost-effective than semaglutide over five years for class II obesity, with greater sustained weight loss. Many patients use these approaches in combination—this is best discussed individually.

Is the procedure reversible?

Because no tissue is removed, ESG is generally considered reversible or revisable, which preserves the option of other treatments in the future.

How long until I see results?

Weight loss typically begins within the first weeks and continues over 6 to 12 months, with results best sustained through ongoing nutrition and activity support.

How is the balloon different from gastric sleeve or ESG?

ORBERA® is a temporary, removable device placed without incisions and taken out after six months—nothing about your stomach is permanently changed. Sleeve gastrectomy surgically removes part of the stomach, and endoscopic sleeve gastroplasty reshapes it with internal sutures. Those procedures generally produce more weight loss; the balloon offers a lower-commitment, fully reversible starting point.

Does the balloon stay in permanently?

No. ORBERA® is designed to remain in the stomach for six months and is then removed endoscopically. Leaving it in longer than recommended increases the risk of deflation and is not advised.

Will I feel the balloon?

Most patients adjust within the first one to two weeks. Nausea and a sensation of fullness are common at first and typically settle as your stomach accommodates the balloon.

What happens after the balloon is removed?

The goal is that the habits built during the 12-month program carry your results forward. Continued nutrition support, activity, and follow-up are key to maintaining weight loss, and your team will help you plan for this from the start.