Before Surgery

Metabolic and bariatric surgery expectations

Before the surgery, the patient, family, surgeon, and advanced care provider will gather to discuss what to expect. Topics will include:

  • Expected benefits
  • Realistic outcomes
  • Long-term consequences
  • Possible risks of surgery
  • Treatments, medications, and changes to diet and activity before and after the surgery
  • What medications and foods need to be stopped prior to the surgery, and when

Metabolic and bariatric surgery lifestyle program

Patients will be required to see our dieticians individually at the beginning of the program and right before surgery. They are also required to join our Registered Dietician lead educational groups at least 3 times before surgery and 4 times in the year following surgery. A monthly support group is also available. All of our medical visits and dietician visits are Virtual, so access to The Stanford Children's Health - My Health app is required. Patients with access or IT issues can usually work with their local pediatrician or school to attend these visits.

Stanford 360, or the “60/60/60” rule. Our program will help the patient and their family learn the Stanford 360 rule. This is a simple plan for lifestyle modification that supports weight loss after MBS with a minimum of complications.

In addition to stopping all sugar-sweetened and carbonated beverages (like sodas and juices); eating at least three to five times a day, or every three to four hours while awake; and limiting portion size through the plate method, patients are asked to follow the Stanford 360 rule:

  1. Eat a minimum of 60 grams of protein per day, every three to four hours. When patients take in protein, they activate their sleeve to produce intestinal hormones that promote satiety (feeling full) and to burn fat instead of muscle.
  2. Drink a minimum of 60 ounces of water per day. Keeping a water bottle on hand or drinking at least four 16-ounce bottles of water per day will ensure that patients continue to feel full, stay hydrated, and prevent postoperative complications. Water can be flavored with sugar-free flavoring or fresh fruits and vegetables if preferred.
  3. Get at least 60 minutes of physical activity daily. This can be in small 15-minute walks four times a day or all at once. Regular physical activity, like going up and down stairs at school, walking to or from school, and participating in after-school or in-school sports or physical education all count. Regular exercise has been shown to prevent weight regain after weight loss.

Our nutritional manual and workbook is used to lead our Nutrition Group classes, help patients learn how to count proteins and water intake, and give them ideas of how to stay motivated to get physical activity every day. 

Metabolic and bariatric surgery required testing

Before the surgery, patients should expect to undergo baseline laboratory tests, clinical consultations, and diagnostic tests. These tests include:

  • Blood work to look at the patient’s liver, kidney, and thyroid function in addition to baseline vitamin levels.
  • A STOP-BANG screening will be done and a sleep study to evaluate for obstructive sleep apnea if indicated by screening.
  • Electrocardiogram to evaluate the heart’s electrical activity, structure, and function, with follow-up echocardiogram if abnormal.
  • An endoscopy, which is a test that looks at the inside of the esophagus, stomach, and small intestine to check for gastroesophageal reflux, H. pylori (an ulcer-causing infection), and celiac disease.
  • A DEXA scan to assess bone calcification and total body fat and muscle composition.
  • A psychological assessment to make sure that any eating disorders or psychiatric conditions are treated and stable prior to surgery, and to assess the patient’s motivation, support system, and understanding of surgery.