Frequently Asked Questions

Candidacy is determined by looking together at body mass index (BMI), obesity-related comorbidities, weight history, eating habits, psychological readiness and surgical risk. The 2022 ASMBS/IFSO joint statement notes that metabolic-bariatric surgery may be offered to people with a BMI of 35 kg/m² or higher, with or without a comorbidity. A final decision is only made after a clinical examination, investigations and multidisciplinary assessment.

Under the current framework, surgical assessment may be offered to people with a BMI of 35 kg/m² or higher, with or without a comorbidity. In the 30–34.9 kg/m² range, surgical assessment may be considered when metabolic disease—especially type 2 diabetes—is present, or when non-surgical measures have not achieved adequate, durable weight loss. These thresholds do not automatically mean surgery will be performed; individual assessment is essential.

No. BMI does not distinguish muscle from fat mass and does not show how body fat is distributed. Waist circumference, body composition, blood glucose and lipid values, fatty liver, sleep apnoea and other comorbidities, along with weight history, are all considered together. In some ethnic groups, the same BMI value can carry a higher metabolic risk.

In sleeve gastrectomy, the stomach is reduced vertically and the intestinal connections are not altered. In gastric bypass, a small stomach pouch is created and the small intestine is rerouted, which also changes absorption. The choice is made considering factors such as BMI, history of reflux, type 2 diabetes status, eating habits and the patient's likely adherence to follow-up.

Mini gastric bypass (one-anastomosis bypass) may be considered in selected patients with coexisting type 2 diabetes who do not have a significant history of reflux. It differs technically from the classic Roux-en-Y bypass. Suitability is determined through examination, endoscopy and multidisciplinary assessment.

No. A gastric balloon is a non-surgical procedure in which a balloon is placed in the stomach endoscopically and typically remains for a defined period. It supports weight management by creating a feeling of fullness. If habits are not maintained after the balloon is removed, weight regain can occur; it is therefore regarded as a tool that supports the process rather than a permanent solution.

The procedures are largely the same; the emphasis differs. The term "metabolic surgery" highlights the effects of the operation beyond weight loss—particularly changes in type 2 diabetes, blood pressure and lipid profile. The decision is still made on an individual basis.

People outside a certain age range are assessed in more detail. In adolescent and older patients, the decision is made in a multidisciplinary way, taking into account growth and development status, comorbidities, anaesthetic risk and expected benefit. Age alone is neither a barrier nor a justification.

Typically, blood tests (full blood count, biochemistry, thyroid function, HbA1c, vitamin and mineral levels), upper gastrointestinal endoscopy, abdominal ultrasound, chest X-ray, ECG and an anaesthetic assessment are planned. Endocrinology, cardiology, respiratory medicine, psychiatry and nutrition consultations are added when needed.

Blood tests from the last 6 months, if available, along with thyroid function, HbA1c, lipid profile, vitamin and mineral levels, endoscopy and imaging reports are helpful. If you have previously had obesity surgery, the operative report and discharge summary are particularly important. Please also bring a list of all medications you are currently taking.

The decision is a shared one made by the team and the patient, not by a single person. Surgical, anaesthetic, nutritional and, where needed, psychiatric/endocrine assessments are brought together, and the benefits and risks are discussed with the patient in detail. Informed consent is an integral part of this process.

No. This is a patient-information site about obesity and metabolic surgery; it does not provide online diagnosis, a personal treatment plan or a second-opinion service. The information here does not replace clinical examination, investigations or a physician's assessment. For your individual situation, you need to speak with your physician at the healthcare institution you consult.

As with any surgical procedure, there are risks: bleeding, leak from the staple line or anastomosis, infection, thromboembolism (blood clots), anaesthesia-related complications and, in the long term, vitamin and mineral deficiencies. Efforts are made to reduce these risks through careful patient selection, preoperative preparation, an experienced team and regular follow-up. No operation is risk-free.

Duration varies with the procedure, the patient's anatomy, any previous abdominal surgery and coexisting conditions. In general, bypass-type operations take longer than sleeve gastrectomy. It would not be accurate to give a fixed number of minutes; duration varies by patient and centre.

Length of stay depends on the procedure performed, the patient's recovery course and the centre's protocol. During this time, transition to a liquid diet, pain management, mobilisation and discharge education are completed. The duration may be longer or shorter depending on the individual.

Obesity surgery today is largely performed using a laparoscopic (minimally invasive) approach. However, on rare occasions, conversion to open surgery may be required because of technical difficulties encountered during the operation or adhesions from previous surgery. This possibility is discussed before the operation.

Because small incisions are used in the laparoscopic approach, scars are generally small and tend to fade over time. Scar healing varies from person to person depending on skin type, age, nutrition and wound care. It cannot be said that scars will disappear completely.

A leak is a rare but serious complication in which fluid seeps from a suture or staple line. High fever, rapid heart rate, severe abdominal pain, shortness of breath and a general decline in condition can be warning signs. If any of these occur, you should contact the centre that performed your surgery without delay.

High fever, abdominal pain that does not resolve or that worsens, persistent vomiting, shortness of breath, chest pain, one-sided leg swelling and pain, bloody or black stools, and confusion all require urgent assessment. If any of these occur, seek medical care without waiting.

Vomiting that recurs or continues for days after surgery is not considered normal. Disruption of fluid and food intake can lead to thiamine (vitamin B1) deficiency within a short time, which can cause neurological symptoms such as loss of balance, abnormal eye movements, confusion, and numbness or weakness in the legs. If vomiting persists, seek same-day physician assessment rather than trying to take vitamins on your own; a stricture, obstruction or another surgical cause should also be investigated.

Detailed guide: vomiting, thiamine (B1) and red-flag symptoms after bariatric surgery

Yes. Smoking impairs wound healing, increases the risk of pulmonary complications and blood clots, and raises the risk of ulcers after bypass. Stopping well in advance of surgery is recommended. Alcohol can act faster and differently after surgery; its use should be discussed with your physician.

No. No medical intervention can be given a definite outcome or guarantee, and such claims would also be against health advertising regulations. Expected results vary from person to person depending on factors such as the procedure, starting weight, comorbidities, nutrition and adherence to follow-up.

Nutrition progresses in stages: starting with liquids, then puréed foods, followed by soft foods, and finally a return to normal-textured food. The length of each stage varies by patient and centre. Prioritising protein, eating small portions, eating slowly, chewing thoroughly and drinking enough fluid are basic principles. The plan is carried out together with a dietitian.

Yes, and this monitoring continues for life. Micronutrient levels—particularly B12, iron, folate, calcium and vitamin D—are checked regularly. Because absorption is altered, especially after bypass-type operations, the risk of deficiency is higher. Deficiencies are easier to manage when detected early.

Generally, a full blood count, iron and ferritin, vitamin B12, folate, 25-OH vitamin D, calcium, albumin, parathyroid hormone, liver and kidney function, electrolytes, HbA1c and lipid profile are monitored. Zinc, copper, magnesium and other vitamins may be added depending on the situation. Frequency is determined by your physician.

In most patients this is long-term, and after bypass-type operations it is usually lifelong. However, the dose and content are not standard; they are determined individually based on laboratory results. Do not follow ready-made protocols found online on your own.

Adequate protein intake is important for preserving muscle mass during the weight-loss period. The target amount is determined individually by a dietitian based on weight, height, age, sex, activity level and laboratory results. A personal plan should be followed rather than a general figure.

In the early period, caffeinated drinks are generally limited because of stomach sensitivity and fluid balance. As recovery progresses, they can be gradually reintroduced based on tolerance and your physician's advice. It would not be accurate to give a fixed day; the timing varies by patient and centre.

This can occur, particularly after bypass, when sugary or highly refined carbohydrate foods pass rapidly into the small intestine. Palpitations, sweating, weakness, nausea, abdominal cramping and diarrhoea can occur. It is usually controlled with dietary adjustments; let your physician know if it happens frequently.

Spreading fluid intake through the day, taking small sips, and drinking apart from meals generally makes it easier to tolerate. If you cannot take in enough fluid, notice reduced urine output, or feel dizzy, contact your team without delay.

Weight loss varies considerably from person to person depending on starting weight, the procedure used, eating habits, physical activity and adherence to follow-up. It would not be accurate to promise a specific figure. In general, weight loss is faster in the early period and gradually slows in the following months.

Short, frequent walks are generally recommended from the first days, which also helps reduce clot risk. The waiting period before weightlifting and more intense exercise varies by patient, type of surgery and recovery course. Plan your programme gradually together with your physician.

The time to return varies by occupation, type of surgery and speed of recovery. Return is generally earlier for desk-based work, while those doing physically demanding jobs may need a longer period. Your physician will determine the exact timing at your follow-up visit.

The general approach is to wait around 12–18 months, until weight loss has stabilised; during rapid weight loss it is harder to meet the increased nutritional needs of pregnancy. Effective contraception and continued vitamin and mineral monitoring are recommended during this period. The individual plan is decided together by the obstetric team, the surgical team and a nutritional assessment.

Detailed guide: planning pregnancy after bariatric surgery and the 12–18-month approach

Temporary hair loss can occur during the rapid weight-loss period. Adequate protein intake and checking iron, zinc and B12 levels are important. If hair loss is significant or prolonged, a laboratory assessment should be carried out.

Skin laxity can occur after significant weight loss; its extent varies with age, skin elasticity, and the speed and amount of weight lost. Once weight has stabilised, plastic surgery assessment may be considered in suitable patients.

They may. Doses of medications for type 2 diabetes, hypertension and reflux may need to be readjusted after surgery. Some medication forms (such as extended-release tablets) may also need to be changed, and care is needed when choosing pain relief. Do not stop your medications on your own; proceed in coordination with the relevant physicians.

It is helpful for many patients. Changes in eating behaviour, body image and daily routine can be challenging after surgery. In patients who need it, support from a psychiatrist or psychologist eases the process and contributes to long-term success.

Follow-up visits are scheduled more frequently during the first year; after that, most patients are recommended a comprehensive assessment once a year. The interval may be shorter for patients found to have deficiencies or who have undergone revision surgery. Clarify your follow-up schedule with the team that performed your surgery.

Some degree of weight regain can occur in the long term if eating habits and physical activity are not maintained; a certain amount of regain can be expected with any procedure. Regular follow-up, dietitian support, psychological support where needed, and a sustainable lifestyle help reduce this risk.

It is considered in situations such as insufficient weight loss, significant weight regain, persistent reflux unresponsive to medication, dilation of the sleeve, or anatomical problems after bypass. The decision is made in a multidisciplinary way, following endoscopy, imaging, laboratory testing and nutritional/psychological assessment.

The diagnosis is clarified first, with endoscopy and, if needed, pH testing and imaging. Lifestyle changes and medication are sufficient for most patients. In persistent reflux unresponsive to medication, or in the presence of a coexisting hiatal hernia, revision—usually conversion to gastric bypass—may be considered.

Revision operations can be technically more challenging because of adhesions from previous surgery and altered anatomy; the complication risk is higher than for a first operation. For this reason, the decision is made after a detailed discussion of the balance between expected benefit and risk.

The first step is assessment, not surgery. Nutrition, portions, liquid calories, snacking, sleep, stress and behavioural factors are reviewed; current medications and comorbidities are assessed; then the anatomy is examined with endoscopy or imaging. Based on that assessment, medical treatment (obesity medications), endoscopic options or revision surgery are discussed individually. Revision is not an automatic first choice.

Medication and surgery are not competitors but different treatment tools for the same chronic disease. For some people, medication may be sufficient; for others, the targeted metabolic improvement is not achieved. Which route is appropriate is determined by assessing BMI, comorbidities, previous treatment response, access and likely adherence to follow-up.

The effect of these medications continues only while they are being used. When the medication is stopped, appetite and satiety signals can return to their previous state, and weight regain is common. For this reason, the decision to stop should be made under physician supervision, together with a nutrition and activity plan.

Be sure to inform your surgical and anaesthesia team. Because these medicines can slow gastric emptying, the timing of use is planned separately for anaesthetic safety. There is no single universal stop interval that applies to everyone; the decision is individualised by the surgeon, the anaesthesia team and the prescribing physician. Do not stop or continue the medicine on your own.

In selected patients, medical treatment support may be considered in cases of inadequate response or significant weight regain. This is not routine practice; the decision is made individually by the surgical team together with endocrinology.

The process proceeds by scheduling an in-person consultation, arranging any required tests through the institution's secure channels, and coordinating a travel schedule. WhatsApp and email are for general contact and appointment logistics only; please do not send test results, reports, photographs or special-category health data through these channels. Medical assessment is carried out during examination.

The length of stay is planned taking into account the tests required, the type of operation, the recovery course and flight suitability. The period generally needs to cover the investigations, the operation, the hospital stay and a pre-departure follow-up visit. The exact number of days varies by individual and is clarified during the initial consultation.

Permission to fly is assessed at a follow-up visit based on your recovery course, clot risk and general condition. Because inactivity on long flights can increase clot risk, it is important to follow your physician's recommended precautions, such as moving regularly, staying hydrated and, if advised, wearing compression stockings or taking medication.

Long-term follow-up can be carried out in cooperation with your local physician and dietitian. You are given your operative report, discharge summary and follow-up plan. It is possible to have your follow-up tests done locally and share the results for remote assessment; however, situations that require a physical examination will need an in-person visit.

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No. Email and WhatsApp are for general communication and appointment logistics only. Please do not send test results, reports, photographs or other special-category health data through these channels. Medical assessment is carried out through clinical examination and the secure channel of the institution you are consulting.