After you have completed your information session and your paperwork has been screened, you will be scheduled for a consultation with the doctor.  You will begin your appointments with the dietitian and also have a psychological evaluation.  A decision to proceed with further medical evaluations will also be made at that time (see list below), and you will also go to the laboratory for your blood work.

Blood Work

Blood drawn during this visit will include:  Comprehensive Chemistry, Complete Blood Count, Vitamin B₁₂ and Folate, Ferritin, Thyroid Levels, Cholesterol Levels, Zinc, Parathyroid Hormone Level, Hemoglobin A1c, Helicobacter pylori Antibody, Thiamine, Pre-albumin, Magnesium, Vitamin D, and Methylmalonic Acid Levels.

Information Release

You may be asked to sign a form agreeing to allow us to use information from your medical chart regarding your treatment anonymously for future medical reports about our center’s results with weight reduction surgery. This information will be in the form of a confidential computer database for tracking outcomes.

Program Fee

All patients are required to pay a non-refundable program fee of $600 at the time of the Nutrition Group class. This fee is in addition to surgical costs and is not covered by insurance. These services include but are not limited to post-operative nutritional education and counseling, pre and post-operative phone support, pre-operative nutritional class and an individual dietician consultation, review of your medical history by the physician before your visit, pre-operative education and support, all printed educational materials, lifetime monthly support group, verification of bariatric benefits, comprehensive letter and documentation packet submitted on your behalf to the insurance provider, maintaining outcomes database, access to our bariatric websites, pre-operative dietary prep, and access to exercise program discounts. Please note that most other bariatric programs charge a program fee for weight loss surgery.

Additional Tests

ENDOSCOPY (EGD)

If you have significant heartburn and take medications for indigestion or have a history of gastric pathology, you may be scheduled for an EGD. This is an exam where the doctor uses a flexible camera to look at the inside of your stomach.  You will be asked to refrain from eating or drinking after midnight on the day of your scheduled study. You will be sedated for this procedure.  If you have had a recent EGD, please bring your report to the office.

GALLBLADDER ULTRASOUND

If you have not had gallbladder surgery and have significant right upper quadrant (RUQ) abdominal pain consistent with gallbladder disease, you may be scheduled to have an ultrasound in Imaging before your surgery.  This exam does not cause discomfort, but it is very important that you do not eat or drink anything six hours prior to this exam. If you have had a recent RUQ Ultrasound, you should bring the report with you to your appointment.

SLEEP STUDIES

If you are not currently being treated for sleep apnea or have not recently been ruled out for sleep apnea with a sleep study, you may be referred to the Sleep Laboratory for a sleep study due to the high incidence of sleep apnea in the obese.

Cardiac Evaluation

Given the high incidence of cardiac disease in the obese patient population, we may recommend a cardiac evaluation to assure that you do not have heart disease.  Some patients are referred for a Dobutamine Stress Echocardiogram (DSE).  To perform a DSE, you will be given a medication to increase your heart rate while the cardiologist or technician looks at your heart with an ultrasound machine. If you had a recent cardiac evaluation, please bring this documentation with you to your first visit.

Nutrition Evaluation

Your bariatric coordinator will refer you to our dietitian. It is required that you attend a group class and a one-on-one nutrition evaluation. This is a required step in the approval and screening process and an important opportunity for you to receive some valuable nutritional education and instruction.  Your journey to improved health will be most effective if you learn how to make wise food choices and use your operation effectively.  You will also see our dietitian at your scheduled doctor’s follow-up appointments.

Remember, no method, including surgery, is certain to produce and maintain weight loss.  Success is only achieved with each patient’s full cooperation and commitment to dietary and lifestyle changes and medical follow-up.  Surgery provides you with a very effective tool that makes wise food choices more easily attainable.

Exercise Physiology

Surgery alone is not a cure for obesity, and you will need to be involved in a structured exercise program to achieve the results you desire.  We recognize that exercise can be more difficult for obese patients. Your bariatric coordinator can help you arrange a consultation visit with an exercise physiologist or trainer who will advise you on various flexibility and strengthening exercises that have been specifically designed for the bariatric patient.  If you are not involved in an organized exercise program during rapid weight loss, you will lose about 12 percent of your lean body mass (the good weight). If you are involved in a structured program, you will only lose about 4 percent of your lean body mass.

Psychological Evaluation

If the doctor has determined that a psychological evaluation is required. Please mention you are a Harbin Clinic bariatric surgery patient and need an evaluation for surgery. This evaluation will take approximately three to four hours.  Weight reduction surgery is often more stressful than people expect. Not only are there the physical changes associated with your surgery there are also social and emotional changes as well. People are at the highest risk for these problems when they are not psychologically prepared for the lifestyle changes they have to make.  The psychologist will discuss their recommendations with you after the evaluation. Our goal is to make sure you are ready to cope with the many changes that go along with weight loss surgery.