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Bariatrics and Weight Loss

Program Steps

Welcome to the Program and to our Weight Loss Family!

You’ve watched the on-line seminar, had your initial appointment and you’re ready to get started on the journey to a new you! 

Weight loss surgery is a personal journey for every individual. You must be committed and dedicated to this decision. At the Center for Surgical and Medical Weight Loss at Midtown, we have used our expertise in obesity medicine to ensure weight loss success, long-term health, and safety. It is important to remember as you make this journey, that you are not alone.

For more information

CALL (615) 284-2400

map girl 5bBy joining our program family you will be asked to complete a number of “program steps”, prior to surgery in order to help yourself to be as prepared as possible to undergo your procedure, and for life after surgery. Although some of these steps may not be required in order to be approved for surgery, all of these steps are important. The Center’s Patient Advocate will help you navigate through the steps.

Once you have completed the steps, an Insurance Specialist will obtain the pre-cert/authorization from your insurance company for your surgery. A pre-cert/authorization can take up to 30 days. Once it is obtained, the surgery scheduler will contact you to schedule your surgery during your projected surgery month.

Please note that you must be nicotine free for a minimum of two months prior to having surgery. Failure to meet this requirement will lead to canceling your surgery until you are compliant.

Step 1 – Psychological Test & Evaluation

Step 1Psychological testing is a routine part of preparing for surgery. Your pre-surgical care and aftercare will be provided to you by a team of professionals, who will need to become more familiar with you, your situation and needs. Most insurance companies understand the importance of this and require the test. Our program requires the test. Your care team wants you to maximize your success – to lose excess body weight, become a healthier person and improve the quality of your life.

The test’s purpose is not to find underlying problems and conflicts that might have caused you to become obese and/or to find a reason to exclude you from surgery. In fact, studies have shown that a very small number (perhaps four percent) of individuals are found to be poor candidates based on their psychological test results.

A one on one, evaluation with a psychologist can help identify your strengths, such as a strong motivation to exercise as your weight is coming off, a complete understanding of the effects of surgery or a supportive relationship. It can also help find areas where you might need support after surgery, such as depression or mood swings, lack of family support or triggers for past emotional eating. The psychological testing and evaluation must be completed within the first 30 days after your initial appointment at our Center. Patients cannot proceed to next steps in the Program until the psychological evaluation is completed.

Step 2 - Sleep Medicine Consult/Study

Step 3Step 2 is only applicable to patients that have been identified high risk at their initial appointment.  Obstructive sleep apnea (OSA) is a potentially serious sleep disorder. It causes breathing to repeatedly stop and start during sleep.  During your initial appointment at our Center, you will be administered a screening questionnaire called the STOP BANG Questionnaire to determine your risk for Obstructive Sleep Apnea (OSA).  If your score on the questionnaire reflects “high risk” for OSA, our physician assistant will refer you to one of our Sleep Medicine physicians for a consult.  Completion of the consult is required to continue through the program steps. At your sleep consult, the sleep physician will determine if you need further testing (i.e. sleep study). If a sleep study is ordered it must be completed within 30 days. If the sleep consult and/or study is not completed after the referral is made, the patient will not be able to proceed to next program steps, and will not be eligible for surgery. This step is important in helping patients who are at high risk for OSA start treatment pre-operatively, prior to surgery. Untreated Sleep Apnea can lead to complications during and after surgery.

Step 3 – Nutrition and Exercise Class

You will be scheduled to attend a group class that incorporates pre-operative and post-operative guidelines as it relates to your surgery and the nutrition and exercise expectations. Additionally, you will be given instructions on your pre-op diet with helpful resources to guide you along the way. You will gain an understanding about physical activity and the importance of incorporating an exercise plan into your daily routine. This is another opportunity for you to ask questions. A patient reference guide to your particular surgery will be distributed to you in a binder at the class. We encourage you to take notes, record your journey and keep important papers in your binder.

Step 4 – Pre-Operative Labs

You will be given a lab slip at the Nutrition and Exercise Class containing the lab values that you must have tested prior to your Nutrition Consult. This is so we can address any abnormalities you may have prior to surgery. Results will be uploaded to your patient portal and abnormal results will be reviewed.


Step 5 – Attend a Support Group

Step 5Support groups are a valuable resource to obtain information about surgery. Our Center offers a variety of support groups to attend. During group you will have the opportunity to learn new information, ask questions and meet patients going through the same process as you. Some of our most successful patients are those who participate in a support group, and we strongly encourage you to take advantage of these opportunities. For more information about support groups, please click on Support Groups located on Midtown’s home page. This program step may be completed at any time throughout your journey.

Step 6 – Nutrition Consult

This is a 60 minute, one on one evaluation with the Registered Dietitian that includes a complete nutrition assessment, vitamin regimen and further explanation regarding your pre-operative nutrition routine to help keep you on the right track. The dietitian also prepares you for your nutrition lifestyle after surgery and ensures you understand the lifestyle changes, and are ready for surgery in that regard.

Step 7 – Upper GI Study

Step 7An x-ray (radiographic) exam of your esophagus, stomach and duodenum will be performed to assess your anatomy and identify any abnormalities that might complicate your surgery.



Step 8 – Pre-operative Class

A comprehensive two-hour class that is both a refresher on what you have learned, and a final preparation shortly before your surgery. The Registered Dietitian presents dietary progression and the Registered Nurse educates you on “before surgery, day of surgery, and after surgery”. We strongly encourage the person that will be your caregiver after surgery to attend this class with you.

Step 9 – Pre-operative Appointment

You will have a pre-op appointment with your Surgeon approximately 2 weeks prior to your surgery. This is when you will meet your Surgeon (if you have not already), ask any remaining questions and discuss final decisions regarding your surgery and review surgical risks and complications again. You will start your pre-op diet at this time. Information about the day of your surgery, discharge information for incisions, and other relevant issues such as, what to bring to the hospital, what not to bring and medications will be reviewed.

Pre-admission testing may occur on the same day as your pre-op appointment. The surgery scheduler will set up your pre-op appointment and pre-admission testing.

Step 10 – Pre-admission Testing

Step 9

Approximately two weeks prior to your surgery, you will be required to complete pre-admission testing. These important tests help us determine if you are physically stable enough to undergo surgery. Based upon your medical history certain medical clearances may be required from your physician or specialty physician such as, cardiac clearance. You will also receive information about anesthesia at pre-admission testing which is located on the 1st floor of the hospital (Kidd building lobby – 20th Avenue entrance).


Step 11 – Day of Surgery

You will receive detailed information about the day of your surgery, discharge information, and other relevant issues at your pre-operative appointment with your Surgeon and during the pre-operative class. What to bring to the hospital, what not to bring and medications will be reviewed.

Depending on what type of surgery, you may remain in the hospital after surgery same day, overnight or for approximately two to three days. You need to ensure you have someone to drive you home following discharge. Depending on your type of surgery, you may have to have someone stay with you at home for the first few days after being discharged.


Step 12 – Post Care

You will receive our pdf Bariatric Tips Sheet to assist you with aftercare at home.

Within 72 hours after going home, you will receive your first phone call from our RN to check in with you and find out how you are progressing.

At 2 weeks and at 6 weeks, you will come back to the Center for your post-operative visit with your Surgeon. At 6 weeks, you will also see the dietitian.

We encourage you to join our monthly support and social groups, and to participate in an exercise program. Ask about our special rate for our patients at Saint Thomas West Wellness Center!

Please keep up with the schedule of bariatric follow-up visits that you will be given.