Frequently Asked Questions

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.
• 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

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.