WA Weight Loss Centre

Frequently Asked Questions

Frequently Asked Questions

Frequently Asked Questions2024-05-14T15:46:59+08:00

General FAQs

What is Bariatric surgery?

Bariatric or weight loss surgery is the most effective way of sustained weight loss. They are major surgery involving  key hole or laparoscopic access to the belly cavity making changes to the stomach or stomach and intestine. Rapid weight loss and long term maintenance is the result. Post bariatric surgery effects are due to physical effects like portion control, Caloric malabsorption and other gut hormone and neuronally mediated  changes like reduced hunger, early and sustained satiety after a meal and enhanced metabolism. Overall it leads to a correction of the physiological derangement that led to obesity in the first place . With these changes after surgery body now naturally wants to maintain a much less fat mass (lower fat mass set point) which makes getting into and maintaining a lot lower bodyweight much easier.

Weight loss surgery is major surgery with potential serious complications and side effects which are fortunately rare. They are not for everyone, certainly not for someone who wishes to simply lose a small amount of weight. On a risk benefit analysis they are indicated only if you fulfil certain criteria. General guidelines are as follows.

Age over 18 Yrs.

BMI over 40 with or without related medical co-morbidities.

BMI ≥ 35 and at least one or more obesity-related co-morbidities such as type II diabetes (T2DM), hypertension, sleep apnoea and other respiratory disorders, non-alcoholic fatty liver disease, osteoarthritis, lipid abnormalities, gastrointestinal disorders, or heart disease.

Inability to achieve a healthy weight loss sustained for a period of time with prior weight loss efforts by other means.

No psychiatric or drug dependency problems and have no contraindication for major abdominal surgery.

A capacity to understand the risks and commitment associated with the weight loss surgery

Weight loss surgical patients require detailed and extensive assessment, education and preparation and strict long-term follow up for successful results and to minimise complications. This process involves multiple visits for office consultations. Typically, you will see the Doctor at least three times prior to and three times in the first year after surgery and usually once a year after that. You will pay consultation fees up to $ 3500/- in total. For outpatient consultation visits associated fees, you will be eligible for a Medicare rebate. Please note that Private health Funds do not cover any outpatient consultation fees and regardless of the level of cover, you will be required to pay these fees.

With WA weight loss centre all your surgery associated costs are billed directly to the health fund with no GAP. This means that you will have the same out of pocket costs for gastric sleeve, any type of gastric bypass, primary or revision weight loss surgery. With us you will be free to make the appropriate choice of weight loss surgery without financial considerations getting on the way.

If you choose to have bariatric surgery in a private hospital as a self paying patient, the total cost would be close to $20,000/-. Major part of this is to cover operating theatre and hospital bed costs. Having an appropriate level of private health cover you will bring this cost down a minimum. You will need to have the top level Gold cover and should have completed a 12 month waiting period from joining the fund.
For more complete guide please see cost of bariatric surgery.

To book a consultation with Dr Werapitiya, you need to have a referral letter from your GP. Often a referral with recommendation to have bariatric surgery is helpful as your GP is the doctor who closely knows your medical history. Once we have received the referral you will be contacted from our office and generally you will be able to see Dr Werapitiya for the first consultation within 3 weeks.

Allowing time for education and pre surgery preparation, generally you can choose to have surgery 4 to 8 weeks after the first consultation. However after the first consultation you need to be prepared to spend as much time as necessary to make an informed choice and feel comfortable with your decision. You also need to time your surgery in such a way that you will have the much required time and space after surgery to comply and adjust to diet and lifestyle changes. Occasionally for people with complex medical history or extreme BMI, a longer preparation time may become necessary.

Individual experience of recovering from bariatric surgery can be variable. However most patients have a better recovering experience than anticipated mainly because of the minimally invasive laparoscopic surgery. Dealing with pain and nausea are the issues in the first few days. After discharge from the hospital maintaining adequate liquid intake and protein intake becomes priority. Over the next few weeks you will gradually get back eating a normal diet and normal level of activity. Most people will be able to return to a office job by the end of second week.
For more detailed account on recovery Please click the following link.

Bariatric operations are major surgeries involving division and joining of stomach and intestine. The human body is wired in such a way that injury to an internal organ is not readily felt. Most of the pain associated with abdominal operations come from the cut in the body wall used to gain access to the internal organs. Laparoscopic surgery removes the pain of a large body wall cut and allows patients to recover faster, giving them the impression of having had a less serious operation and a sense of safety.

Fortunately, the risk of serious complications after bariatric surgery is very rare.

You should go into any surgery confidently. Speak with your doctor about the known potential risks and complications of the weight loss surgery of your choice, as well as any surgical alternatives that are worth considering.  This is so you can make the most-informed choice for yourself.

A lot of my patients ask what type of bariatric surgery I would recommend for them. While myself and our multidisciplinary team are there to educate you and guide you so that at the end you will be able to make an informed decision with confidence. Your choice should not be based on the personal experience of someone else being successful or otherwise after a certain surgery but it should to be based on facts. Please be prepared to do your research and ask questions before you decide.

For more detailed account please click the following link.

Weight loss surgery is a very powerful tool and most people experience a lot more weight loss with much less effort compared to any previous attempts at weight loss on their own. You have to remember a tool is something used by someone to assist them in performing a task or function but the tool does not do all the work alone.
Weight loss after bariatric surgery is usually expressed as a percentage excess weight loss ( %EWL). This can also be expressed as expected percentage body weight loss. These figures are only an average and only an indication as to what you might lose rather than an accurate calculation of expected weight loss. If a particular surgery is offered 1000 people with the same body weight, individual response to surgery is different and quite unique. This variability in response is due to many factors like genetic makeup, age, gender, previous response to weight loss by other means, stress levels, sleep, medication, diet and exercise patterns, ability to make lifestyle changes etc. This is why it is important that you are prepared to make appropriate diet and lifestyle changes with surgery to expect the best outcome.

On an average you are expected to lose between 60% to 70% of the excess weight with sleeve gastrectomy. Do you lose more after a gastric bypass?. The short answer is yes, but the percentage difference between the average amount lost by patients who had gastric bypass vs gastric sleeve is only around 5%. Gastric bypass surgery will usually result in quicker weight loss but data show that at the 24-months point the numbers are pretty similar.

How to calculate % excess weight loss

Set point Theory is an idea that the human body has a specific predetermined weight that it wants to maintain. With weight gain and loss the main change is in the amount of fat mass we carry as energy store. Specific weight set point means a specific fat mass set point. Over the last 15 years there is a body of scientific evidence accumulating in favour of this theory.

It is thought that factors like your diet, exercise, stress level, sleep, day night pattern, medication etc. influence this through epigenetic phenomenon.

Selecting your surgery type

The first three months after surgery will be the time when weight is lost the fastest. Changes made to the digestive system restrict calorie intake and absorption, and the liquid diet perpetuates rapid weight loss. Patients can lose between 15 to 20 kg, which amounts to approximately 25-35% of their excess weight. The rate of weight loss will slow down after about 3 months but most patients continue to lose between 1 and 2 kg a week during this time. At the end of six months, most patients have lost approximately 45% of their excess weight. At the 12-month mark, some patients may be close to their target goal with between 50% and 700% of their excess weight eliminated. If you have not achieved these percentages at the end of a year, do not worry, stay focused, and continue to persevere, and you will get there. Weight loss results will vary by individual so do not be concerned if your progress is different as these are only averages.

You are going to have your first post-operative follow-up with Dr Werapitiya three weeks from surgery. Please make sure that you have a booked appointment to come back to, before your discharge from the hospital. If you are unable to attend in person for some reason, you will be able to make a telephone consultation appointment. It is also important that you recover well as expected in this period with no complications. During this period, if there is anything of concern please contact us directly for an earlier appointment. If you are suspecting a staple lines leak or anything serious of that magnitude please contact Dr Werapitiya directly using his mobile number. Around three week mark after surgery, you will have your first follow-up consultation with the bariatric Dietitian. You will have follow-up appointments with r Dr Werapitiya or one of his team members add three months, six months and one year after surgery and yearly thereafter after.

A weight loss journey does not end after weight loss surgery. It involves a commitment to a lifestyle change. It is not always going to be easy, but it will be rewarding. Be ready to jump into a healthy diet and strong exercise routine. The foundation of successful results is a healthy mindset. Know what to expect throughout your journey, set goals, and seek support.

All type of bariatric surgery is lead to portion control, meaning you will be eating small meals. It is important that you learn to provide everything the body needs in three small meals and two healthy snacks. Your bariatric dietician will be there to guide you through these changes. Basically you are required to eat healthy balanced diet assembled from basic ingredients to provide you enough protein, carbohydrate, healthy fats, fibre and other micro nutrients. Changing your diet does not have to be daunting, it can be fun! You can take this as an opportunity to try new things, search for new recipes, challenge your food horizons and create some delicious and nutritious meals which can have a positive impact on your whole family.
Weight loss can be a very freeing experience. Not just because you were able to shed the extra weight, but because it can open doors for so many new opportunities in life. Take on a new adventure in life that you always want to do but held back due to obesity. Cycling, running, netball or footy or even a more physically demanding career. That will be of value as a reminder for you of the value in maintaining lost weight and that will keep you motivated. A key to success is engaging in activities, behaviors and groups that remind you of your health goals and support your new lifestyle, so stay involved in your hobbies, favourite activities and social groups.
A weight loss journey does not end after weight loss surgery. It involves a commitment to a lifestyle change. It is not always going to be easy, but it will be rewarding. Be ready to jump into a healthy diet and strong exercise routine. The foundation of successful results is a healthy mindset. Know what to expect throughout your journey, set goals, and seek support.

With weight loss surgery, many patients start to lose weight quickly. Your friends, coworkers, or neighbors will likely start commenting on these changes. While the attention can be flattering and a great motivator to stay on track, you’ll also get questions about “how are you doing it?” It is completely up to you if you want to tell people you’ve had a bariatric procedure. Some of our patients tell everyone, and some just tell their close friends and family. If you don’t want to talk about your surgery, you can advise those asking that you’re losing weight with a focus on small meals with protein and plenty of vegetables, and by adding daily exercise to your routine. And that will be true! Just because you’ve also had surgery, this in no way diminishes the credit you should get for your hard work. Surgery is a tool that helps you make these changes, but your weight loss is ultimately a credit to your lifestyle changes and commitment.

Preparing for surgery

Bariatric surgery can change your life for the better and is a powerful tool that can provide sustained relief for overweight people. Prepare for surgery as best as you can.

Some think people go on for a period of feasting (last supper) before having bariatric surgery. There is no need of this as modern bariatric surgery still allows you to be able to eat most of your favorite meals and you are not going to miss out on dining experience. However it makes sense for you to start on a healthy diet before surgery as a preparation for what is required after. It is very important that you start having three meals and two snack diet pattern and avoiding all calorie rich beverages (carbonated beverages, fruit juice and alcohol) and soft calories (Lollys, chips, chocolate). Start eating slowly and avoid drinking while eating.

A minority of patients will be required to have a prescribed very low calorie diet (VLCD) as meal replacements for a short period to achieve a weight target before been considered suitable for safe laparoscopic surgery. This is commonly required if your starting BMI is over 45 kg/m2. Your surgeon will inform you if it is necessary in your case and your dietitian will guide you through the process.

If you smoke , you should give up – preferably for good. Start taking vitamin and mineral supplements as a way of establishing a routine. Try and adopt a more active lifestyle and engage in exercise like what you want to achieve after surgery.
Blood thinners can lead to higher chance of severe bleeding after surgery and hence need to be discontinued for a period under medical supervision prior to surgery.
Uncontrolled high blood pressure after surgery is another factor that increase risk of bleeding and it is important taking your blood pressure medication as usual.
Bariatric surgery can change your life for the better and is a powerful tool that can provide sustained relief for overweight people. Prepare for surgery as best as you can.

Some think people go on for a period of feasting (last supper) before having bariatric surgery. There is no need of this as modern bariatric surgery still allows you to be able to eat most of your favorite meals and you are not going to miss out on dining experience. However it makes sense for you to start on a healthy diet before surgery as a preparation for what is required after. It is very important that you start having three meals and two snack diet pattern and avoiding all calorie rich beverages (carbonated beverages, fruit juice and alcohol) and soft calories (Lollys, chips, chocolate). Start eating slowly and avoid drinking while eating.

A minority of patients will be required to have a prescribed very low calorie diet (VLCD) as meal replacements for a short period to achieve a weight target before been considered suitable for safe laparoscopic surgery. This is commonly required if your starting BMI is over 45 kg/m2. Your surgeon will inform you if it is necessary in your case and your dietitian will guide you through the process.

If you smoke , you should give up – preferably for good. Start taking vitamin and mineral supplements as a way of establishing a routine. Try and adopt a more active lifestyle and engage in exercise like what you want to achieve after surgery.
Blood thinners can lead to higher chance of severe bleeding after surgery and hence need to be discontinued for a period under medical supervision prior to surgery.
Uncontrolled high blood pressure after surgery is another factor that increase risk of bleeding and it is important taking your blood pressure medication as usual.

Post Surgery

You are going to be in the hospital for up to three days after surgery. Most of the acute complications that can happen occur during the first four weeks after surgery. If there is a concern from your side as to the possibility of an acute complication, you should make timely contact with your surgeon. If the situation demands urgent and prompt action, please contact Dr. Werapitiya on his mobile 0438967237.

Bleeding
Surgery involves incisions and cutting that can result in bleeding, which can vary from minor to major. Bleeding, if excessive, may require blood transfusion or emergency surgery and may even lead to death in extremely rare circumstances. Bleeding is most serious if it is within the abdominal cavity and the bleeding can also occur into the intestine from the bowel joint.

For patients on blood thinners and or blood pressure medication
Blood thinners can lead to a higher chance of bleeding after surgery and hence the need for stopping such medication under medical supervision, prior to surgery. Uncontrolled high blood pressure is another factor that increases the risk of bleeding, hence the importance of taking blood pressure medication on the day of surgery as usual.

Leak
Stapling and stitching is required during bariatric surgery in order to create a stomach tube and new connections between gut components. These staple and suture lines are meant to be watertight without any leakage of intestinal content into the abdominal cavity. There is a rare risk of leaking (1 – 2%), particularly in the first two weeks after the surgery. Leaking from the staple line/bowel join is a serious problem. The leak may allow stomach acid, bacteria, bile and digestive enzymes to escape into the abdominal cavity causing severe infection (peritonitis) that may even be potentially lethal.

If a leak is suspected, you may have to undergo further tests including x-rays and emergency surgery. Initial steps in emergency surgery are aimed at controlling infection and inflammatory reaction. We do this by cleaning out the leaked content with an abdominal cavity washout and diverting further leakage by placement of multiple drain tubes. Complete resolution of a leak can take a long period of time, usually requiring you to have in hospital care for a long period of time, sometimes weeks or even months. In the process, you may also require intensive care treatment or transfer to a different hospital for optimal care.

Leak after a sleeve is almost always at the upper end of the staple line. The sleeve tube has a high pressure build up within it compared to the stomach tube of a gastric bypass, which explains why a sleeve leak is generally more difficult to treat.

Blood Clot
Also called deep vein thrombosis (DVT) and pulmonary embolus (PE). Although this is an exceedingly rare complication, it can possibly lead to death. PE is still the most common cause of mortality after bariatric surgery, with most occurring in the first 3 weeks after the procedure. Blood thinning medications will be administered while you are in hospital to minimize the risk of blood clotting, and calf compression stockings will be used to prevent blood pooling in leg veins. From your part, it is important that you get out of bed as early as possible and move your feet and legs to try and help prevent blood clots. It is also very important keeping up with your fluids to prevent dehydration.

Reflux (GORD)
There is a valve or sphincter mechanism built into the lower end of the oesophagus to prevent stomach content flowing back. When the valve mechanism is not working properly the result is reflux. After bariatric surgery, reflux can be a troublesome problem in the long term, and it may be difficult to treat.

Acid reflux
The stomach lining secrets strong hydrochloric acid which can burn and injure the oesophagus when exposed. It is now known that acid reflux can be a common long-term problem after sleeve gastrectomy. The small stomach tube after sleeve gastrectomy has a high pressure within it that overcomes the resistance of the lower oesophageal valve, which leads to higher chance of reflux. Acid reflux usually manifests as heartburn and is treated with strong medications that suppress the acid production. After sleeve gastrectomy, it is more common to develop a hiatus hernia and distension of the thin-walled top end of the stomach tube. These factors together increase the chance of fluid reflux, commonly leading to throat and chest symptoms due to aspiration. It is now recognized that bile reflux can also be a common occurrence after sleeve gastrectomy, which explains why there is sometimes poor response to anti acid medication.

Long term reflux can also lead to changes on the surface of the lower oesophagus called Barrett’s change. This is a precancerous condition. There is some concern of chronic reflux increasing the chance of Barrett’s and hence, the very rare possibility of oesophageal cancer after sleeve gastrectomy.

Fixing the hiatus hernia, if there is one, and a great deal of technical precision at the sleeve operation, are important factors to prevent reflux.

It is observed that reflux after SADI-S operation is not as common compared to sleeve. Both OAGB and Roux-en-Y gastric bypass, have a lower pressure within the newly created stomach tube and have very low risk of acid reflux. While sleeve is expected to make the preexisting reflux symptoms worse, gastric bypass operation will generally make the reflux better.

Bile reflux
Bile reflux is a well-recognized but rare problem after OAGB. Due to loop configuration, bile can enter the stomach tube that can reflux into the oesophagus. It is expected around 1% of people with OAGB may end up having further surgery due to bile reflux.

With the introduction of OAGB, a major concern amongst the opponents was the possibility of bile reflux leading to an increased chance of oesophageal cancer in the long term. Over the last 20 years, no case of oesophageal cancer has been reported after OAGB. However, it remains a theoretical possibility.


Would weight loss surgery benefit you?


BMI is one of the leading ways of measuring obesity,
find out if you’re a candidate for surgery.

cm
kg
Your BMI is

  • UNDERWEIGHT
  • NORMAL
  • OVERWEIGHT
  • MORBIDLY OBESE
  • SUPER OBESE

YOUR CURRENT
WEIGHT

40kg

BMI 40.0

HEALTHY BMI
WEIGHT

88kg

BMI 24.9

WEIGHT LOSS NEEDED TO
ACHIEVE A HEALTHY BMI

24kg

or 28% of your overall body weight

Your Expected weight loss in 1 year

With the most common treatment options

3.5kg

or 3.2% of your overall body weight 1

Lifestyle Changes

3.2 - 6.7kg

or 5 - 10% of your overall body weight 2,3

Prescription Medication

22 - 37kg

or 20 - 33% of your overall body weight 4

Weight Loss Surgery


Percentages are based on the weight loss averages

1) Sumithran P and Proietto J. The defence of body weight: a physiological basis for weight regain after weight loss. Clin Sci 2103; 124: 231–41.RACGP. Obesity prevention and management position statement 2019. Available at https://www.racgp.org.au/FSDEDEV/media/documents/RACGP/Position%20statements/Obesity-prevention-and-management.pdf, accessed September 2022. 2) Pilitsi E, et al. Pharmacotherapy of obesity: Available medications and drugs under investigation. Metab Clin Exp 2019; 92: 170–92. 3) Lee PC, Dixon J. Pharmacotherapy for obesity.Aust Fam Phys. 2017; 46(7): 472–7. 4) NH&MRC (2013) Clinical practice guidelines for the management of overweight and obesity in adults, adolescents and children in Australia. Available at https://www.nhmrc.gov.au/about-us/publications/clinical-practice-guidelines-management-overweight-and-obesity, Accessed September 2022.

Your Expected weight loss in 1 year

With the most common treatment options


Percentages are based on the weight loss averages

1) Sumithran P and Proietto J. The defence of body weight: a physiological basis for weight regain after weight loss. Clin Sci 2103; 124: 231–41.RACGP. Obesity prevention and management position statement 2019. Available at https://www.racgp.org.au/FSDEDEV/media/documents/RACGP/Position%20statements/Obesity-prevention-and-management.pdf, accessed September 2022. 2) Pilitsi E, et al. Pharmacotherapy of obesity: Available medications and drugs under investigation. Metab Clin Exp 2019; 92: 170–92. 3) Lee PC, Dixon J. Pharmacotherapy for obesity.Aust Fam Phys. 2017; 46(7): 472–7. 4) NH&MRC (2013) Clinical practice guidelines for the management of overweight and obesity in adults, adolescents and children in Australia. Available at https://www.nhmrc.gov.au/about-us/publications/clinical-practice-guidelines-management-overweight-and-obesity, Accessed September 2022.

At your BMI, the Australian Obesity Guidelines(9) recommend my target weight loss should be:


No recommendation based on your BMI.

Answer the questions below, and we can contact you to discuss your treatment options

Tell us about any other health issues

If you do not meet the BMI or weight criteria, you still may be considered for surgery if your BMI is over 30 and you are suffering serious health problems related to obesity.

Do you have either of these serious health concerns?

Have you experienced any of the following Health Risks Associated with Obesity?

BMI is not the only criteria

Something here about lifestyle or how long you’ve been trying to lose weight and what you’ve tried.

Tell us if any of these apply to you

What is your outlook on weight loss?

Readiness to begin your weight loss journey is important.

How committed are you to your weight loss journey?

Fill in your details to have these results sent to you.

If you choose, we can share information about your health, medical history and lifestyle with our team who will determine whether you are a candidate for weight loss surgery.

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consultation

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Corner of Roberston Drive
and Bussell Highway,
Bunbury WA 6230

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