Steps Before Weight Loss Surgery

The process from inquiring about weight loss surgery to having surgery performed involves a number of steps.  It takes time to undergo the proper evaluations, testing, and behavioral changes necessary before surgery. Insurance approval for the procedure can also take time and require documentation, which must be collected. It is not unusual for a period of six to nine months to pass between the initial evaluation and surgery date. Our clinic understands and empathizes with our patients' desire to move forward as soon as possible after deciding to undergo bariatric surgery.  For more information, contact WellSpan Ephrata Community Hospital's Weight Loss Clinic at (717) 721-8795.

Financial Counseling & Insurance Approval Process

It is usually necessary to obtain approval from your health insurance carrier in order to have the surgery covered by the insurance company. Bariatric surgery is an area where there is a great deal of variability in regards to insurance coverage and requirements. Some policies may exclude weight loss surgery totally. Most companies require that you meet their list of criteria to consider approval. Our financial counselor will advise you about the requirements your particular insurance carrier may have.

Initial Evaluation

During the initial evaluation, you will meet with a medical provider. The evaluation will consist of reviewing medical information and weight history. Surgical options will be discussed including risks, complications, and weight loss expectations. If you are deemed an appropriate candidate and decide that you would like to proceed with surgery, you begin the process for surgery. This process involves many steps. The time from your initial evaluation to surgery can be six to nine months.

Nutritional Evaluation

An evaluation of your dietary habits is performed by a registered dietitian. The dietitian will assess your dietary habits and behaviors while providing education about post-surgical dietary and nutritional needs. Patients meet with a dietitian both pre- and post-operatively.

Consultation with Surgeon

The surgeon will discuss the surgical details with you and determine if there are any factors present that may affect the surgical course. Laparoscopic surgery becomes more difficult from a technical standpoint if your BMI is over 60. If your BMI is over 60, the surgeon may suggest weight reduction prior to surgery. After meeting with the surgeon, you will be scheduled for any tests prior to surgery.

Pre-operative Testing

Certain tests are required before surgery to lower the risks of complications. This allows the opportunity to correct problems that may affect your surgical outcome or to discover problems that might place  you at too great of a risk to undergo surgery.

Esophagogastroduodenoscopy (EGD)

Patients who are undergoing gastric bypass surgery have the lining of the esophagus, stomach, and upper duodenum evaluated by endoscopy. This is an outpatient procedure performed at the hospital. After patients are given IV sedation, the physician evaluates the stomach with a flexible scope. Biopsies may be obtained if there is significant inflammation. The doctor may prescribe medication to heal any abnormalities found from the EGD.

Gallbladder Ultrasound

Patients who are undergoing gastric bypass surgery also have their gallbladder evaluated by an ultrasound exam to determine if gallstones are present. If gallstones are present, the surgeon will discuss the possibility of removing the gallbladder at the time of the gastric bypass surgery.

Medical Clearance

Every operation places a patient at a certain level of risk of complications. Morbidly obese patients are considered to be at higher risk for any surgery. Patients must be evaluated and medically cleared for surgery. Sometimes, your primary care physician may do this. In some cases, you may need to be cleared by a specialist, such as a cardiologist or pulmonologist.

Psychological Evaluation

Most insurance companies require that patients undergo a psychological evaluation as part of the approval process. You will undergo psychological screening tests as part of the initial evaluation process.

Maintaining Current Weight

Bariatric surgery is a tool used to aid weight loss. It is not a cure. Successful results require a commitment to healthy eating habits and activity. If patients are unable to maintain their weight throughout the pre-operative process, they may have difficulty adhering to post-operative recommendations. Patients who gain a significant amount of weight during this process may be deemed poor candidates for surgery.

Pre-operative Counseling

At this point you have had all of the pre-operative testing completed and been approved for surgery by your insurance company. Before having surgery, patients are seen at the clinic for a pre-operative visit. During this visit, health history and medication will be reviewed. You will also receive counseling about the post-operative period after surgery. This includes a comprehensive nutritional program to get the most benefit from your surgery.

Support  Group

The American Society of Metabolic and Bariatric Surgeons states that every weight loss surgery program should include a support group. Our clinic has an active support group that meets twice a month. Patients are strongly encouraged to attend meetings both before and after surgery.


It is important to learn as much as you can about weight loss surgery and the lifestyle changes needed to be successful before you decide to have the surgery. The Weight Loss Clinic at WellSpan Ephrata Community Hospital is committed to helping you select the appropriate solution to meet your individual weight loss goals.

For more information, contact the Weight Loss Clinic at (717) 721-8795.

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