Welcome to The Center for Surgical Weight Loss at Care New England. We understand that obesity can be a difficult disease to live with and a frustrating problem to treat. That's why we are committed to helping you along your journey to better health.
Review the following steps to determine if you're a
candidate for bariatric surgery.
Determine your Body Mass Index using our simple two-step BMI Calculator.
Watch the quick 10 minute Bariatric Webinar and learn everything you need to know about the surgical weight loss process.
After you watch the webinar, we will contact you to schedule a consultation.
Before making the decision to have bariatric surgery, you should first calculate your BMI to determine if you qualify. If your Body Mass Index exceeds 25 you might be eligible for this procedure. Here is a quick BMI reference guide:
Watch our free webinar and find the answers to your questions, all from the privacy of your own home. By participating in the free webinar, led by Dr. Jeannine Giovanni, director of bariatric surgery at Care New England, you’ll learn more about the considerations of surgical weight loss, get to know Care New England’s expert bariatric team, and take the first steps to start your journey to a healthier life.
You will learn about potential complications at the introductory seminar and from your doctor. It is important that you understand these risks so you can make an informed decision about surgery. We encourage you to learn as much as you can from us and through other resources. We invite and encourage questions from you.
The following is a list of potential complications:
For the Roux-En-Y Gastric Bypass and Sleeve Gastrectomy:
For the Lap Band, all of the above complications apply, plus these:
Any one of these problems may require another operation, removal, revision, or conversion of the band to a different weight-loss procedure.
You can help to reduce your risks of surgery with several measures:
Most women are much more fertile after surgery, even with moderate pre-op weight loss. Birth control pills do NOT work as well in heavy patients. Birth control pills are not very reliable during the time your weight is changing. For this reason, having an IUD or using condoms and spermicide with ALL intercourse is needed. Menstrual periods can be very irregular, and you can get pregnant when you least expect it! You should discuss a birth control plan with your gynecologist prior to surgery.
We recommend waiting 12-18 months after surgery before getting pregnant.
Many women who become pregnant after surgery are several years older than their friends were when having kids. Being older when pregnant does mean possible increased risks of certain problems. Down’s syndrome and spinal deformities are two examples. The good news is that, after surgery, there is much less risk of experiencing problems during pregnancy (gestational diabetes, eclampsia, macrosomia) and during childbirth. There are also fewer miscarriages and stillbirths than in heavy women who have not had surgery and weight loss.
Kids born after mom’s surgery are LESS at risk of being affected by obesity later, due to the activation of certain genes during fetal growth (look up “epigenetics” – for more information). There is also less risk of needing a C section.
Most patients have some loose or sagging skin, but it is often more temporary than expected. You will have a lot of change between six and 18 months after surgery. Your individual appearance depends upon several things, including how much weight you lose, your age, your genetics, and whether or not you exercise or smoke. Generally, loose skin is well-hidden by clothing. Many patients wear compression garments, which can be found online, to help with appearance.
Some patients will choose to have plastic surgery to remove excess skin. Most surgeons recommend waiting at least 18 months, but you can be evaluated before that. Plastic surgery for the removal of excess abdominal and breast skin is often covered by insurance for reasons of moisture, hygiene, and rash issues.
Arms and other areas may not be covered if they are considered “purely” cosmetic by your insurer. Some of these “less invasive” operations can be done in the clinic, however – so they can be much more affordable!
You will need to take a multivitamin for life. You may need higher doses of certain vitamins or minerals, especially Iron, Calcium, and Vitamin D. You will also need to have at least yearly lab checks. Insurance almost never pays for vitamin and mineral supplements but usually does pay for labs. You can pay for supplements out of a flex medical account. Generally, liquid or chewable vitamins are better absorbed. We do not recommend “gummy” vitamins.
Bariatric surgery will not be covered by your insurance carrier if you have an exclusion policy. This is true even if you medically qualify. Appeals are futile in this scenario.
There are loan programs available to cover the cost of health expenses such as metabolic and bariatric surgery. Appeals to insurance companies or directly to your employer may reverse a denial of coverage. Metabolic and Bariatric surgery is a health expense that you can deduct from your income tax.
If you are not able to qualify for a loan, the Obesity Action Coalition (OAC) produces a helpful guide titled “Working with Your Insurance Provider – A Guide to Seeking Weight-loss Surgery.” This guide can help you work with your provider and advocate for your surgery to be covered. You can view the OAC guide on their website.
Our staff can assist you with an out-of-pocket payment plan.
Yes. Most bariatric surgeons put their patients on a special pre-operative diet, usually 2 or 3 weeks just before surgery. The reason for the pre-operative diet is to shrink the liver and reduce fat in the abdomen. This helps during the procedure and makes it safer.
Some insurance companies require a physician-monitored diet three to six months prior to surgery as part of their coverage requirement. These diets are very different from short-term diets, and usually are more about food education and showing a willingness to complete appointments and to learn.
No and Yes.
Most people think of a “diet” as a plan that leaves you hungry. That is not the way people feel after surgery. Eventually, most patients get some form of appetite back six to 18 months after surgery. Your appetite is much weaker and easier to satisfy than before.
This does not mean that you can eat whatever and whenever you want. Healthier food choices are important for best results, but most patients still enjoy tasty food, and even “treats.”
Most patients also think of exercise as something that must be intense and painful (like “boot camp”). Regular, modest activity is far more useful in the long term. Even elite athletes can’t stay at a “peak” every week of the year. Sometimes exercise is work, but if it becomes a punishing, never-ending battle, you will not keep going. Instead, work with your surgeon’s program to find a variety of activities that can work for you. There is no “one-size-fits-all” plan. Expect to learn and change as you go!
For many patients (and normal-weight people, too) exercise is more important for regular stress control, and for appetite control, than simply burning off calories. As we age, inactivity can lead to being frail or fragile, which is quite dangerous to overall health. Healthy bones and avoiding muscle loss partly depends on doing weekly weight-bearing (including walking) or muscle resistance (weights or similar) exercise.
For those who struggle with obesity, there probably isn’t a diet or exercise they haven’t tried. Yet despite the effort brought forth, the desired results are rarely obtained.
Meet Frankie and Jess, a local couple who for years struggled with their weight until they decided to do something about it.
Everyone knows how difficult it is to find a routine when you are trying to lose weight. The road to a healthy life is long and arduous and there will be many pitfalls along the way.
Jeannine Giovanni, MD, is the director of bariatric surgery for CNE. She is a board-certified general surgeon with advanced training in bariatric surgery. She did her surgery training at Boston Medical Center and completed a fellowship in bariatric surgery at Saint Francis Hospital in Hartford, CT. She has been practicing since 2005 and has performed more than 3,000 laparoscopic bariatric procedures including the lap band, roux-en-Y gastric bypass, and sleeve gastrectomy.
Dr. Hebert is the Medical Director of Robotic Surgery at Kent Hospital. Dr. Jordan Hebert, DO, is a board-certified, fellowship-trained minimally invasive surgeon with specialized clinical expertise in bariatric surgery, hernia repair, abdominal wall reconstruction, colon surgery, and anti-reflux procedures. His extensive robotic surgery experience provides Rhode Islanders with advanced treatment options targeted to maximize outcomes.
Robotic weight loss surgery is a procedure to help patients struggling with being overweight or obese. The methods are less invasive, ensuring patients recover quicker compared to conventional laparoscopic procedures. Compared to conventional laparoscopic medical weight loss surgery, bariatric robotic surgery will likely offer you more potential benefits. You are likely to enjoy quicker recovery, lower infection rates, a shorter period in the hospital bed, reduced scarring and pain, and a lower risk of attached follow-up after surgery. Even more, you are likely to return to your routine sooner.
This device was approved for use in the U.S. by the Food and Drug Administration (FDA) in 2001. The band is made of solid silicone, like a belt, and is wrapped around the upper part of the stomach. The belt has an inner inflatable balloon that is adjusted by adding sterile water to the port. The port is placed under the skin. When the band is inflated, it squeezes the stomach, making it harder for food to pass from the small upper stomach pouch through to the rest of the stomach. Food is forced to slow down and, therefore, the small pouch stretches. This makes you feel full after eating very small portions. If the band is too tight, food will get stuck and cause vomiting. In that case, the fluid can be removed by the doctor to relax the band and allow food to pass easier. Digestion is normal and your anatomy is kept intact, which makes the procedure reversible.
The "sleeve" is a procedure in which the majority of the stomach is stapled off and removed. This results in a long, slender stomach tube that doesn't stretch much. This procedure helps you eat small portions (4-8 ounces). It also has the added benefit of reducing hunger, partly due to the dramatic decrease in the hormone ghrelin which is primarily made in the part of the stomach that is removed. There may be other hormone changes that occur to help improve diabetes.
This is still the most popular weight loss surgery in the U.S. With the bypass, nothing is removed but the anatomy is rearranged. First, a small one-ounce stomach pouch is created. This is stapled and divided from the rest of the stomach and can only hold a few ounces of food. The remaining 95 percent of the stomach remains in place but no longer is able to receive food. This "bypassed" leftover stomach does not shrink, rot, or cause any problems. It still makes digestive juices.
Next, the small intestine is "rearranged." About two feet of the small intestine is divided into three sections: the duodenum, jejunum, and ileum. The duodenum, where the majority of digestive juice is produced and nutrients are absorbed, is cut and connected to the jejunum three feet (100cm) downstream. The "free" or "cut" end is pulled up and connected to the pouch with a very small opening.
Now food enters the stomach pouch and squeezes through a small, button-sized opening to get into the intestine. The food travels three feet before it encounters the digestive juices produced by the bypassed stomach and duodenum. The overall effect is that patients eat small portions and calories do not absorb well (restriction plus malabsorption). In addition, because food bypasses the old stomach, 90 percent of diabetics are cured almost immediately after the operation.
We are glad you have chosen to have surgery with us. You can rest assured that we will provide the highest quality of care in a respectful, dignified manner. Your comfort and safety are our priority.
Surgery usually takes between one to three hours. You will meet the surgical team before going under anesthesia but will be completely asleep and continually monitored throughout your surgery. You will wake up from surgery in the recovery room where staff will monitor you carefully and make sure you are as comfortable as possible.
You will be allowed to drink water immediately. Most patients spend just a few hours in the recovery room. Your family and friends cannot come into the recovery area, but we will keep them updated about your condition. They may visit you when you arrive on the surgical floor. You will be up and walking within hours of your surgery. This helps you feel better, recover faster, and prevents life-threatening complications such as blood clots.
Lap band patients generally go home the day of their surgery. Sleeve and bypass patients spend one to three nights in the hospital. Everyone is followed closely by the surgical team made up of your surgeon, physician assistants, nurses, pharmacists, nutritionists, physical therapists, and medical specialists. All of these professionals have undergone training to understand your needs as a bariatric patient.
When you leave to go home, we will give you instructions about the diet plan, medications, and follow-up. We will also review the signs and symptoms of potential complications. Know that you can always call your surgeon with any problem no matter how trivial it may seem.
Recovery is different for everyone. You can expect some discomfort and we will give you medication to take as needed for pain and nausea. You may feel more tired than usual. It’s important to maintain a positive attitude and to keep your surgeon informed if there are any problems.
Lap band patients tend to recover quickly. Most patients take one to two weeks out of work. It is usually easier to eat and drink, but patients are advised to adhere to the strict dietary guidelines. These recommendations are crucial to avoid problems such as food getting stuck, retching, and vomiting. These actions can cause the band to slip or the sleeve/bypass to leak.
Bypass and sleeve patients tend to recover a little slower and usually need four weeks out of work.
Weight loss is rapid after the bypass and sleeve. The majority of patients lose most of their weight in the first six to 12 months. The band has to be adjusted often so weight loss tends to be slower (about one to two pounds per week). It’s important to remember that this process is a marathon, not a sprint!
You will need to see the surgeon two weeks after your operation. Band patients will then be seen monthly to adjust the band. Sleeve and bypass patients will need to be seen in the office every three months for the first year, every six months the second year, and then every year for life. We will check your blood work at each visit to make sure you are not developing any vitamin deficiencies. We also suggest that you see the dietitian regularly. These visits are important to monitor your weight loss, medical conditions, and potential problems. They are also important to help you stay on track to achieve your weight loss goals.
Remember that this is the beginning of your journey to a healthier you. We know you can do it and are here to help before, during, and after your surgery. Your success is our goal. Attend one of our free informational seminars.
“When we heard how excited the staff in Kent’s Center of Surgical Weight Loss office was about the Walk from Obesity, we knew we had to be a part of it. From our very first appointment and throughout our journey, everyone has made us feel like we are part of the Care New England family. We don’t want to miss out on the opportunity to meet other members of our ‘family’ and learn about new ways to stay healthy.
We love to share our success stories as we want people to know that having weight loss surgery is nothing to be ashamed of. For us, it was one of the most positive, life-changing decisions we made. We want to inspire others to walk their way to better health. Walking gives us the opportunity to spend time with each other and stay fit. It also helps us to be good role models for our kids, whom we encourage to adopt a healthy lifestyle.”
“Having bariatric surgery has changed my outlook on life altogether. I not only look different, but I feel healthier. I feel more energized and more importantly, people always say to me how happy I look. I lose my mother in March, who was my biggest supporter, and I didn’t think I could finish this journey without her. But I found it in myself to do it and move closer to my goal.
What did I do once I hit my goal? I went to Disney World with my best friend. I rode a roller coaster and was not afraid if I would fit in the ride. I rode on an airplane and did not worry if I would have to ask for a seat belt extender.
This surgery has changed my life in so many ways and I could not have asked for a better surgeon or a better medical office than The Center for Surgical Weight Loss at Care New England.”
“An outline for the stages I went through during the process with the hopes of motivating others:
SHAME. EMBARRASSMENT. DARKNESS.
SKEPTICISM. UNCERTAINTY. DILEMA
THANKFUL. ACCOMPLISHED. ACHIEVEMENT.
Thank you to Dr. Giovanni and Jocelynn Cobb for saving my life.”
“All my life, I have never been lean, slim, or thin. Being naturally built bigger, I knew I would never be skinny. I felt I could lead an active lifestyle but – having surpassed 400 lbs. – the reality was that my weight prevented me from doing the many things my heart desired. Things like skydiving, riding a roller coaster, etc. were physically out of reach.
Since having gastric bypass surgery my life has improved dramatically in so many ways. When I get on an airplane I can put the table down in front of me and use only 1 seatbelt! I’ve checked off several of my lifelong goals. I have been indoor rock climbing, skydived, surfed, and I even summited Mount Kilimanjaro in Africa, which was a major bucket list item.
I am days away from my 2-year surgical anniversary (as of 2017) and I am the healthiest I have ever been in my adult life. I have very few food limitations and, while my portions are small, they are no longer freakishly small; for the most part, I can eat just like anyone else. I am a happier person all around.
I now enjoy a much better quality of life and will forever be grateful. Thank you to Dr. Giovanni and her team for the expert care that to me back to what I deem to be a very full life!”
We are happy to announce the return of support groups, via Zoom, as of next month. Please click the link below and follow the instructions to receive the Zoom meeting information. Tune in at the following dates/times:
January 11, 2023|6 pm: Food Addiction with Jane Sylvestre, RD
February 8, 2023|6 pm: Post Holiday Check-in and Toolbox for Success with Margaret Furtado, MD, RD
March 8, 2023|6 pm: Nutrition Month- Vitamin Guidelines with Linda Carro, RD, LDN, CDOE
April 12, 2023|6 pm: The Right Mindset to Reach Your Goals with Michelle Ristuccia, PA-C
June 14, 2023| 6 pm: Review of Protein Sources and Goals with Kathy Shilko, RD, LDN