If you meet the established guidelines, your next step is to seek a weight-loss surgery program that has been certified as a Center of Excellence by the American Society of Metabolic and Bariatric Surgeons (ASMBS) or other credentialing board. This ensures a high level of experience and expertise of the surgeons and other medical/surgical personnel, comprehensive lifestyle programs and a hospital setting that is well equipped to manage the weight-loss surgery patient.

Most programs have an information session—a one-hour program designed to inform you about the whole surgical pathway and what you can expect. If, after that session, you still want to continue (many people change their minds since it’s much more than they expected!), you’ll meet with the surgeon and begin both your medical and lifestyle preparation.

You’ll also be introduced to the variety of services in the weight-loss surgery program, including support groups. It’s a great idea to attend these groups before your surgery to get an idea of what life is like afterward. Many friendships are formed during these first months, and they are of great support in the months and years following the surgery.

Depending on your individual health, your surgeon will provide a list of medical clearances you will need. It’s important for your primary care doctor to be involved in your surgical preparation as well. The lifestyle team will also be able to answer questions and help prepare you for life before and after the surgery.

The first step in preparing for surgery is research. This decision is a life-changing one and should only be undertaken with a full understanding of the risk and potential benefits. Prepare yourself:

• Research. Visit Web sites, go to seminars and orientations given by hospitals and surgeons in your area, read books and magazine articles.
  
  
• Talk to your doctor. Discuss the decision with your personal physician early in the process. He or she might point out specific medical issues that may make surgery more or less reasonable for you, and may help you determine which kind of weight-loss surgery would be best.
  
  
• Seek out people who’ve been through it. You or your friends may know people who’ve already had surgery, or who have lost weight without surgery.
  
  
• Get as fit as possible. Many programs like to see a 5 to 10 percent weight loss before surgery to demonstrate the patient's intent to change his or her life. Doing so may also improve diabetes control and shrink a fatty, swollen liver, which can make surgery more challenging. Starting slowly and putting those exercise and nutritional habits in place before surgery will help make your procedure more successful over the long term.

Like an athlete preparing to run a marathon, candidates for weight-loss surgery who decide to have surgery need to get themselves “in shape” for the operation. This includes physical, behavioral and social preparation.

Physically, you’ll need to do everything you can to improve your health, which will reduce the risks of the surgery. In our program, we require a modest weight loss (approximately 10 percent) prior to surgery. This reduces the size of the liver, which makes it easier for the surgeon to see and work during the operation.

You should also increase your physical activity and obtain a full medical clearance. If you smoke, quit several months before surgery to reduce respiratory complications and improve wound healing. If you have sleep apnea, get comfortable using a home breathing device while sleeping.

Prepare to change your lifestyle. This includes changing your eating habits, incorporating different techniques for dealing with stress and preparing for the changes in body image. Shop for foods and other supplies you’ll need after surgery, and remove sweets and junk food from your home. Attempt to make the necessary postsurgical adjustments before surgery so the transition will be smoother.

Socially, prepare yourself for issues that may arise after surgery related to family interactions, friendships, relationships, jealousies, intimacy and even sabotage. Working with a trained behavioral therapist can be invaluable.

The decision to have weight-loss surgery should not be made lightly. First, become well-informed about the nature of the surgery, including its risks and benefits, and the major changes you will have to make in your eating and lifestyle habits, both after the operation and long term. You need to be well-informed about the likelihood of experiencing vomiting, dumping and other related complications following the surgery and your new eating plan.

Meet with your program’s dietitian. Following the postsurgical diet for several months can also help prepare you for the dietary changes that will be required after the operation.

Join a support group. You can get much information about the surgery, its risks and the psychological and behavioral consequences of the surgery from people who have been through it.

Psychologically, assess your expectations, making sure that they are realistic. Most people lose about 30 percent of their initial weight after surgery—some more, some less. Instead of just focusing on weight loss, though, it is important to pay attention to other improvements in health and activities in daily living, like walking up a flight of stairs without being out of breath or playing on the floor with kids or grandkids. These improvements in quality of life are better measures than just weight loss alone.