Frequently Asked Questions

The diagnosis of overweight or obesity is based on a measurement called Body Mass Index (BMI). Generally, patients with BMI of 30 or greater are considered candidates for medical weight management, as are those with BMI 27 or above who also have weight-associated medical conditions such as diabetes, hypertension, high cholesterol, or sleep apnea. Patients who do not meet these criteria but have an increased abdominal circumference (>35 inches for females, >40 inches for males) are also candidates. 

BMI is a calculated number based on a patient’s height and weight that allows us to estimate their body fat content. It is not the most accurate measurement of overweight or obesity, but it is easy to calculate and is closely associated with body fat in most individuals. A normal BMI is between 18.5-24.9. Patients with a BMI of 25-29.9 are considered overweight, and patients with a BMI > 30 are considered to be in the obese range.

Higher BMI is associated with higher risk of medical complications (see below). The weight management treatments that we offer are generally based on a patient’s BMI. For patients who have a BMI in the overweight category without complications, we generally recommend nutritional counseling and exercise. Patients with a BMI of 27 or greater who also have weight-related medical issues (co-morbidities) are offered weight loss medications. Patients with even higher BMI may qualify for weight loss (bariatric) surgery.

There are numerous medical conditions that are associated with or perhaps even caused by obesity, known as weight-related comorbidities. Some of these diseases include high blood pressure, adult-onset diabetes mellitus, high cholesterol, obstructive sleep apnea, polycystic ovarian syndrome, several types of cancer, and heartburn. Many other medical problems are made worse when associated with obesity including cancer, fatty liver disease, osteoarthritis, and asthma. 

Metabolic syndrome is a cluster of diseases that occur in conjunction with obesity. Specifically, patients with increased blood pressure, increased blood sugar, abnormal cholesterol and/or lipid levels, and excess abdominal fat have metabolic syndrome. This disease process is associated with increased risk of heart attack, stroke, and diabetes. Weight loss is the most effective treatment for metabolic syndrome and can result in resolution of some or all medical conditions associated with this syndrome. 

Patients with a BMI 30 or greater are considered candidates for medication therapy, as are patients with a BMI 27 or greater who have obesity-related co-morbidities. 

Between weight loss medication and lifestyle changes, one can expect to lose on average between 5-20% of your total body weight. Studies show that weight loss of this amount can improve many obesity-related co-morbidities.

Obesity is defined as a chronic, progressive disease. Currently there is no cure of obesity. In the past few years, obesity has been recognized as a disease and has been studied intensively. There are currently several FDA-approved medications and several surgical options, as well as an improved understanding of the role of behavioral health, nutrition counseling, and physical activity in the management of obesity. The advice to "eat less and exercise more" was not helpful in the past and is still inadequate in the treatment of obesity. With the currently available treatment options, obesity treatment is more successful than ever. 

The diagnosis of overweight or obesity is based on a measurement called Body Mass Index (BMI). Generally, patients with BMI of 30 or greater are considered candidates for medical weight management, as are those with BMI 27 or above who also have weight-associated medical conditions such as diabetes, hypertension, high cholesterol, or sleep apnea. Patients who do not meet these criteria but have an increased abdominal circumference (>35 inches for females, >40 inches for males) are also candidates.

BMI is a calculated number based on a patient’s height and weight that allows us to estimate their body fat content. It is not the most accurate measurement of overweight or obesity, but it is easy to calculate and is closely associated with body fat in most individuals. A normal BMI is between 18.5-24.9. Patients with a BMI of 25-29.9 are considered overweight, and patients with a BMI > 30 are considered to be in the obese range.

Higher BMI is associated with higher risk of medical complications (see below). The weight management treatments that we offer are generally based on a patient’s BMI. For patients who have a BMI in the overweight category without complications, we generally recommend nutritional counseling and exercise. Patients with a BMI of 27 or greater who also have weight-related medical issues (co-morbidities) may be offered weight loss medications. Patients with a BMI of 35 with co-morbid conditions or a BMI of 40 or greater may qualify for surgery.

There are numerous medical conditions that are associated with or perhaps even caused by obesity, known as weight-related comorbidities. Some of these diseases include high blood pressure, adult-onset diabetes mellitus, high cholesterol, obstructive sleep apnea, polycystic ovarian syndrome, several types of cancer, and heartburn. Many other medical problems are made worse when associated with obesity including cancer, fatty liver disease, osteoarthritis, and asthma. 

Metabolic syndrome is a cluster of diseases that occur in conjunction with obesity. Specifically, patients with increased blood pressure, increased blood sugar, abnormal cholesterol and/or lipid levels, and excess abdominal fat have metabolic syndrome. This disease process is associated with increased risk of heart attack, stroke, and diabetes. Weight loss is the most effective treatment for metabolic syndrome and can result in resolution of some or all medical conditions associated with this syndrome. 

Patients with a BMI 30 or greater are considered candidates for medication therapy, as are patients with a BMI 27 or greater who have obesity-related co-morbidities.

Between weight loss medication and lifestyle changes, one can expect to lose on average between 5-20% of your total body weight. Studies show that weight loss of this amount can improve many obesity-related co-morbidities.

Obesity is defined as a chronic, progressive disease. Currently there is no cure of obesity. In the past few years, obesity has been recognized as a disease and has been studied intensively. There are currently several FDA-approved medications and several surgical options, as well as an improved understanding of the role of behavioral health, nutrition counseling, and physical activity in the management of obesity. The advice to "eat less and exercise more" was not helpful in the past and is still inadequate in the treatment of obesity. With the currently available treatment options, obesity treatment is more successful than ever. 

If you are concerned about your weight and feel that durable weight loss would improve the quality of your life, you should schedule a visit with one of our weight loss providers to discuss your options. There are nationally recognized guidelines that determine what type of weight loss treatment is recommended.

Patients who have a BMI greater than 40 are considered candidates for weight loss (bariatric) surgery if they meet a list of criteria listed below.  Similarly, patients with a BMI over 35 who have obesity related comorbidities are considered surgical candidates.  The other criteria for surgery include the following: Prior unsuccessful attempts at weight loss, psychologically stable condition, able to understand risks and benefits of surgery, physically capable of tolerating surgery, no tobacco or nicotine use, and commitment to ongoing weight management.  

BMI Calculator

Surgery is currently the most successful treatment for obesity, but not everyone wants or qualifies for surgery.  Studies have shown that weight loss of even 5% has many beneficial effects on a patient’s overall health.  If you are suffering from obesity but don’t want surgery, we still encourage you to participate in our medically supervised weight loss program.

Laparoscopic bariatric surgery has evolved into one of the safest surgical procedures currently performed.  The risk of major complications from surgery is between 1-2%.  Risks include bleeding, infections, blood clots, and leaking from the newly created stomach and small intestine incisions.  The risk of mortality from bariatric surgery is extremely low, around 0.1%. 

Obesity is defined as a chronic, progressive disease.  Currently there is no cure for obesity.  In the past few years, obesity has been recognized as a disease and has been studied intensively. With the current medical and surgical options available, obesity treatment is more successful than ever. 

Yes, you do!  There are many patients with obesity who are not ready for surgery for one reason or another.  Patients in this situation are encouraged to come in for an evaluation.  Often, we can develop a program in conjunction with our other medical specialists, nutritionists, and physical therapists to help get the ball rolling in the right direction.  With proper care and guidance, we can help people lose weight and improve their health enough that surgery becomes an option.    

Currently we offer bariatric surgery to patients aged 18-70.  Younger patients can participate in the medical weight loss program until they reach age 18 or can be referred to tertiary care pediatric centers if surgery is urgent.  Patients over age 70 are evaluated on a case-by-case basis, and sometimes will qualify for surgery.  As always, any patient who cannot have surgery is still a candidate for a medically supervised weight loss program.  

Yes. While we no longer place Laparoscopic Adjustable Bands for new patients, we are still able to provide care for patients who had the bands placed previously.  We offer band adjustments, band removals, and conversion procedures where the band is removed, and a gastric bypass performed.  

Yes, we can help.  Approximately 40% of patients who had a prior bariatric surgery will experience either inadequate weight loss or weight regain.  We have a standard treatment algorithm for patients in this situation.  Our top priority is to make sure that nothing has changed with your anatomy since the original surgery.  If there is a problem with your anatomy, then revision surgery is an option.  In most cases, the weight regain is not due to a problem with the initial surgery, but rather progression in the disease of obesity.  In those cases, we can offer counseling, support, and weight loss medication to help get you “back on track.”    

In New Hampshire, most insurance plans include coverage for bariatric surgery or other weight loss treatments. If you are unsure if your health insurance carrier will cover your surgery, consult your surgeon and your insurance provider. You can start now by exploring your insurance coverage eligibility by contacting your health insurance company. 

All surgery for patients in our program is performed at Southern New Hampshire Medical Center.  

The length of the program depends upon several factors.  Most patients can complete the program requirements in 6 months or less.  Some patients, particularly those with multiple medical problems, will take longer to complete the process.  Some insurance companies also have strict guidelines on the length of the program.  We will take all factors into account and then work to get you through the process as quickly as we can.    

The surgery for a sleeve gastrectomy takes about an hour and most patients are home by the end of the following day.  The surgery for a gastric bypass takes closer to two hours, and most patients can go home about mid-day on the second day after surgery.  

Using minimally invasive techniques and the latest processes to enhance recovery, most patients are home 1-2 days after surgery.  The most common complaint in the first week after surgery is fatigue, but patients will be able to get around their homes and climb stairs within a few days of surgery.  Most patients (excepting those with very strenuous jobs) can return to work within 2 weeks of surgery.  You will have several office visits in the first month after surgery where you will get instructions on advancing your diet and activity level.  Patients usually feel fully recovered within 4-6 weeks of their procedure.