Your first visit to one of our Duke Center for Metabolic and Weight Loss Surgery clinics may include necessary laboratory studies, a medical examination, a psychological interview, and a nutritional evaluation. This visit will take about two to three hours.

Medical Evaluation

You will meet with one of our surgeons, physician assistants, or nurse practitioners who have special knowledge and experience in the diagnosis and treatment of morbid obesity. They will perform an examination and evaluate any medical problems that have resulted from your obesity.

Psychological Consultation

As part of the application for metabolic and weight loss surgery, you will have a psychological consultation. We invite patients of the Duke Center for Metabolic and Weight Loss Surgery to have this consultation done with one of our licensed clinical psychologists who specialize in the psychology of eating behavior, weight loss, and bariatric surgery.

Prior to the consultation with our psychologist, you will complete a packet of questionnaires about eating behaviors, mood, and relationships. Please make sure to thoroughly complete this packet in advance and bring it along to the consultation. During the consultation, the psychologist will review questions about eating patterns, psychological functioning and history, motivation and support for having weight loss surgery, goals, and health behaviors (i.e. exercise, beverage choices, smoking habits, etc.).

After the consultation, the psychologist will provide you with an individualized treatment plan to assist in best preparing for weight loss surgery from a lifestyle and behavioral perspective. You will also be given educational materials and recommendations that can further assist in their preparation for weight loss surgery.

Once scheduled for surgery, patients at Durham Regional Hospital will be encouraged to attend the behavioral group component of the program. This includes one preoperative group session and four post-operative group sessions during the first post-operative year (e.g. three weeks post-op, three months post-op, six months post-op, and one year post-op).

The groups introduce common behavioral changes among weight loss surgery patients and strategies for addressing these issues. Topics include:

• Relaxation training
• Exercise motivation
• Behavioral pain management
• Replacement activities for eating
• Managing social responses to weight loss
• Communicating with friends and family about weight loss
• General information about staying on track with weight loss

Additionally, the group sessions provide patients an excellent opportunity to meet other bariatric patients and receive support and encouragement through the experience.

Consultation fee: Currently, Durham Regional Hospital has enrolled our psychologists in-network for Medicare only. For patients with other insurance companies, our psychologists will be considered out-of-network.

At the time of service, a co-pay may be collected if required by your insurance company. The bill for the consultation ($300) minus any co-pay will be sent to yourinsurance company for possible reimbursement. Any remaining money owed will be billed to the patient directly by Duke. You can pay this fee over time or in one payment.

Duke Raleigh Hospital's psychological services are outsourced and fees will vary.

Psychological group fee: The fee for the five-session behavioral and lifestyle counseling program at Durham Regional Hospital is $50 per group session.

The process for possible insurance coverage for the behavioral groups is the same as for the initial psychological consultation. Thus, co-pays are collected if required, the insurance company is billed, and the patient is billed any residual fee by the hospital. Although this may represent an additional expense, our program believes that behavioral and lifestyle counseling in the first year can enhance success with weight loss surgery.

Nutritional Evaluation

You will meet with one of our dietitians to assess your current diet patterns and health behaviors. At the conclusion of the evaluation, they will share the findings and discuss recommended dietary changes to prepare for surgery. Keep in mind that measurements to determine your body mass index and total body fat will be taken using bioelectric impedence (please do not apply body cream or oils to your feet before this first visit as it will interfere with this test).

In addition, the number of calories you are burning each day may be measured from collection of the air you breathe out. Finally, they will evaluate your baseline respiratory and skeletal muscle function. At the conclusion of the evaluation, they will share the findings and discuss recommended dietary changes to prepare for surgery. They will advise you on a low sugar, low fat, small portion meal program that you will need to follow until surgery.

Laboratory Studies

As part of the medical evaluation, you will need to complete several studies. There are two ways that this can be done:

1. You can have your primary care physician order the tests locally. If you elect this option, please bring the results of these studies to your initial appointment, or have them faxed to us at: 919-470-7028 (Durham) or 919-420-5006 (Raleigh).
2. If you would prefer to do the studies at Durham Regional Hospital or Duke Raleigh Hospital, we can arrange for them to be done at your first clinic visit.

The necessary studies include:

• Barium swallow to evaluate your esophagus/swallowing
• EKG to look for any heart disease
• Blood work:
  • Comprehensive chemistry panel (to include an albumin level and liver function tests)
  • HbA1c
  • CBC with differential
  • Ferritin level
  • Thyroid stimulating hormone level
  • Lipid panel (fasting)

In addition, if you have had any of the following studies or procedures, please bring copies or the reports to your initial appointment:

• Sleep study

Patient Manual Index

• Introduction
• Questions to Ask Your Insurance Company
• Your Health Care Team
• Roux-en-Y Gastric Bypass
• Adjustable Gastric Banding Procedure
• Sleeve Gastrectomy
• Duodenal Switch
• Revisional Procedures
• Path to Surgery
• The First Clinic Visit
• The Preoperative Surgical Clinic Visit
• The Preoperative Educational Clinic Visit
• Preparation Instructions for Surgery
• Day of Surgery and Postoperative Stay
• Hospital Course Following a Roux-en-Y Gastric Bypass
• Hospital Course Following an Adjustable Gastric Banding Procedure
• Post Surgery Follow-up Care
• Potential Complications of Surgery