HOOPS: Weight Loss Seminar

So I went to the required weight loss seminar yesterday.  I'm so lucky to have one of the best Bariatric Centers in the world right here.
The very first step in this process is to attend a weight loss seminar. I didn't get why but it's mostly because part of the insurance requirement to pay for surgery is to that you fully understand what weight loss surgery is (the person doing your psych eval has to sign off on this).  I signed up for the seminar online.  I waited for the one held by the surgeon I want (there are a few at the center but this guy is the director...and the best).  I'm glad I waited a few weeks because when I got there they told us that you have to go to the seminar of the person doing your surgery.
The day after I registered for the seminar online I got a call from the receptionist.  She asked me some questions to make sure I qualify for surgery. You either have to have a BMI of 40 or above....or a BMI of 35 or above with a co-morbidity (like diabetes). I have a BMI of 47 and diabetes and high blood pressure. So I was in like Flynn. The one time in my life that has worked to my advantage!  The receptionist also wanted to know about my health insurance. I don't have it yet but will next month so I'm good. 
The receptionist told me she would mail me a packet with info about the center.  As promised it arrived a few days later (in a descreet unlabeled envelope which was nice).  It had directions to the seminar and a thank you letter for signing up.  It also had this packet that my PCP is supposed to fill out so I can bring it with my to my consult with the surgeon.  It basically is a long long form saying what diets I have ever tried my entire life and how much weight I lost on them.  It also has a bunch of questions about my general health. The only question I'm scared of is where it asks if I am "generally compliant with treatment"....hmmm...not always. I forget or just don't take my diabetes and high blood pressure meds...and go off diet a lot. Like a lot a lot. So I have a month to get back on track.
The packet said that I could bring one support person with me. This is a free seminar so space was limited. I had Gander meet me there after work. He is such a good husband! He is so supportive through all of this.  We got there and got a folder full of info on WLS and their center. We also got a free pen! Which I was super excited about! Until I saw that it had "Bariatric Surgery Center" written on it...so I won't be using it ever.  We had to get there at 5:30pm to register and the seminar was supposed to start at 6pm.  I was sooo nervous so I got there at 5pm...then a lady got up front at 6:04 and explained what was in the packet...which I already knew because I had spent the last half hour sitting there reading the whole thing.  It was really helpful information. It outlined every step in the process including attending the seminar so we could all check that off our list. Then she said the surgeon would be there shortly...which turned into a half hour. Sigh.
When he did get there he had a slide show about the center. He showed us that the waiting room chairs and exam tables and scales and OR table are all extra big and sturdy and comfy for fat people...which I was oddly comforted by. Then he showed us a bunch of statistics about the center and why it's so great (which I already kinda knew).  Then he went on for way way way way tooooo long about the anatomy of the digestive system and how you get fat...you eat more calories then you burn. And how you lose weight....burn more calories than you eat. Seriously? Yeh...we know. We are considering weight loss surgery...its not usually the first thing you try. I think we all know how this stuff works.  So I spent a lot of this time yawning and looking at the clock.  But then it got good. Honestly the seminar could have started here and been just fine.
He went into the 3 different options in the order of most commonly performed there: Gastric Bypass, Sleeve Gastrectomy, Gastric Band.  The surgeon did a great great job explaining the differences in not only what happens to your insides (with slides!) but also the differences in hospital stay, average weight loss, upkeep, size of stomach, method (restriction vs malabsorbtion), operating time, time away from work, post surgery care, post surgery diet, and more.  He also went into the risks associated with the surgery.
At the end there was time to ask questions and he spent about an hour answering questions. We didn't leave til 9pm. But it was so worth it. I got all my questions answered and trust my surgeon 100%.  I was surprised that (despite my vorascious web browsing and blog stalking) I learned a lot about this process that I didn't know before.
I have really been wondering how long all the pre-approval and hoop jumping is going to take. Basically (as long as your insurance covers it) it really depends on your nutritionist.  You have to go to a bariatric nutritionist at the center and basically eat the way you would on maintenance after your surgery.  There are two visits that are mandatory (30days apart) and after that the nutritionist decides how many more monthly appointments you need. You have to keep a food journal and stuff like that. You don't have to lose weight during this time (unless your insurance requires it) but you can't gain weight. If you're gaining they take it as a sign that you aren't willing to make the lifestyle change required to make surgery successful.  Some one asked what would happen if some one has never dieted before.  The answer was that they would probably have to do 6 months of nutrition.  She also said the fastest some one would have the surgery is 3-4 months and the longest is a year. I get insurance in January...so best case scenario would be april...worst case would be January 2015. 
I asked if he oversews--he doesn't. He says there is no need and it slows healing. 
I asked how big he makes the sleeve. He said 11mm...about the size of a cigar....which is much smaller than "a small banana" which he described it as earlier. I asked if that's the same for every patient--it is.
I asked if he agrees that the sleeve truly isn't a "new" procedure.  He agreed that it has been done for years as part the first part of a two part procedure for very obese patients who would eventually get the duodenal switch.  But it is newer in the sense that it's being done as a stand alone procedure.  This cleared up a misunderstanding I had...I thought it was the first part of a gastric bypass...but it was the first part of the duodenal switch.
I asked why, if the sleeve is the second most common surgery done at the center, why was there so little information about it in their literature and none on their website. His anwer was that since it is newer, insurance companies just started approving it in 2007.  Ummmmmm seriously? You haven't updated your website and literature? That has been the only frustrating part of dealing with the center right now.  The website doesn't even mention the sleeve. I wouldn't have even known it was an option if I hadn't stumbled upon it in my internet searches.  Then I had to google my surgeon to see if he even did them.  Not good!
The most amazing thing I learned was about stretching out the stomach.  You can't. The new stomach does not stretch.  He said he has seen tons of patients who come to him who say they need another surgery because another surgeon did their WLS years ago and they have gained all their weight back and insist their pouch is stretched out. Every time he does xrays and it's the exact same size. They have just learned to get around it by grazing all day on calorie dense food.  All the surgery does is slow you down but you can still eat toooo much.
I also learned that the lower your BMI, the less difference there is between surgeries in the percentage of excess weight you're likely to lose.  If you are around 40 BMI or less you can expect 80% loss of excess weight. Great news!!!!
Another important thing is that your best way to minimize risks is to be in the best possible shape. My blood sugar and pressure has to be in control even if its by medication. Also if I exercise and eat right my heart and lungs will be in better shape.
Well I was all excited to have all my questions answered!