During your first consultation you should remember to bring the following with you:

• Your GP referral
• Any relevant blood test results, scans and X-Rays
• A list of current medications (prescription and over the counter)
• Your private health insurance card
• A list of questions you wish to ask

To optimise your consulting time with Dr Jorgensen, please print out and bring in the new patient form pre-filled. If you are a bariatric patient please print and pre-fill the New Patient Form and The Considering Weight Loss? forms attached here. If you do not have a printer at home we will print out for you and you can fill these out in our office.

Every patient will be different but as a rule of thumb, the following range is typical of expected excess weight loss post surgery.

• Gastric Bypass – 75% excess weight loss
• Sleeve Gastrectomy – 65-70% excess weight loss
• In the overwhelming majority of cases  patients are able to maintain weight loss long-term. Many studies show that bariatric surgery is the only durable form of weight loss. 
• Long-term weight loss depends on the surgery, and most importantly, dietary change and regular exercise. These lifestyle changes are as important as the surgery.

A person cannot change their genetics or epigenetics. What they CAN change is surgery (to change biology) combined wtih healthy lifestyle measures to support the surgery.

Patients will be given a quote for Dr John Jorgensen’s Bariatric Programme for two years which includes

This includes:

• Dr John Jorgensen’s surgical fee which includes the surgical assistant fee.
• Psychological support for a 2-year programme worth $1200. This structured program helps to improve your mindset for weight loss and to re-program Negative food behaviours. It includes pre and post psychological support, group support, phone support, online support and group sessions every three months.
• Two-year unlimited consultation with either Dr John Jorgensen, dietitian or bariatric nurse on a bulk-billed basis.
• A well-planned regular follow-up for two years with blood tests

• You have a BMI above 40 (morbidly obese)

• You have a BMI between 30 and 40 plus one or more serious obesity-related comorbidities such as Type 2 diabetes, obstructive sleep apnoea, osteoarthritis, depression and high blood pressure

• You do not excessively consume alcohol or other drugs of dependence

• You are ready to embrace significant lifestyle modifications, including changing eating habits and embarking on a regular exercise program

• You are willing to challenge negative food thinking patterns.

• Yes in fact 45 different scientific and medical groups in 2016 recommended that obesity surgery should become a standard treatment for obese patients with diabetes. 
• These new recommendations represent the biggest change to the treatment of diabetes in decades.
• About 80 per cent of patients who undergo bariatric surgery will either completely resolve their diabetes in hospital or weeks or months after surgery.
• The remainder will usually be able to significantly reduce their medication.
• Type II diabetes is considered one of the strongest indications for weight loss surgery.
• Both sleeve gastrectomy and Roux-en-Y gastric by-pass induce hormonal changes which encourage Type II Diabetes remission. Hence these are called “metabolic” surgeries.

• Bariatric surgery today is a very well tolerated surgery and has a similar surgical safety profile to a standard hip or knee replacement procedure.
• According to the latest figures from the Bariatric Surgical Registry, of the 22,000-odd patients who underwent bariatric surgery in 2017, only 2.5% of patients had an adverse event during surgery (that required a return to theatre, ICU or hospital re-admission).
• And more than 99.9 per cent of patients survived their bariatric surgery.
• On the other hand, for the morbidly obese patient the risks of NOT having the surgery are much greater and include heart disease, diabetes, sleep apnoea, obesity and a significantly greater chance of premature death.
• Dr Jorgensen will provide more information on side effects of surgery during your consultation.

As a Bariatric Centre of Excellence, St George Private Hospital has one of the safest surgical safety records for bariatric procedures in the world and is Australia’s first Internationally Accredited Centre of Excellence for Bariatric Surgery, as accredited by the Surgical Review Corporation, which accredits centres of excellence around the world.

• The set-point theory states that the hypothalamus will rigorously defend a person’s highest weight.
• Diet and exercise will trigger the famine reaction which will eventually defeat weight loss.
• Weight loss surgery works by changing the individual’s biology – reducing the  “pull” to regain weight  and enabling an individual to maintain long-term weight loss.
• Put simply, surgery lessens the task of weight loss maintenance, but does not eliminate the task as diet and exercise changes remain critical.  

• Both the sleeve gastrectomy and Roux-en-Y gastric by-pass reduce meals to an entrée size. Hence in three meals all the daily nutrients need to be delivered.
• There is no “room” for empty calories.
• Also, the human body functions better on real food. We recommend the CSIRO low-carbohydrate diet book as a template for eating.
• Modern processed foods (bread, high sugar, fiberless, industrial fat, additives, antibiotics etc) will sabotage any surgery so are best avoided.

• No study has ever been published with negative results about modest exercise.
• In short, exercise is good for you. In the context of weight loss surgery exercise helps maintain muscle mass as well as providing increased calorie burn.
• Exercise improves insulin sensitivity which is critical in health and weight management; 10,000 steps is really a baseline requirement.
• People who cannot exercise can still undergo surgery but the results will be compromised.
• When it comes to weight loss though remember it’s 90% diet and 10% exercise.

• Generally you will be able to return home after 48 hours, go back to a desk job in one to two weeks and a more physical job in 2-6 weeks.
• Initially, the surgery is very restrictive, meaning that you won’t be able to eat a lot and it may take some time before you can tolerate most things, albeit in small amounts.
• However over the next 12 months, as the smaller stomach recovers, patients move toward the ability to eat normal consistency meals.
• Your diet will move through 3 different phases. Post-operatively, patients are on puree diet for 3 weeks and then progress to a soft diet. At 9-12 months most patients can eat an entree sized meal with generally not much difficulty with any food items.
• The majority of the weight loss occurs in the first 6-9 months post-surgery. Weight will than continue until 12 months and then stabilise.

• Yes – in fact surgery generally leads to improvement in many heart conditions including blood pressure, coronary artery disease, cholesterol and heart enlargement.
• Please tell Dr Jorgensen of any previous surgeries, heart conditions or if you are on blood thinners of any kind.
• It is also advisable to provide medical clearance from your cardiologist and provide details of any other treating specialist doctors.

• Many patients who undergo bariatric surgery choose to have excess skin removed post-bariatric surgery. However not all patients will need plastic surgery – with the likelihood of “leftover skin” largely dependant on:
• How much weight is lost
• Genetics and how springy the skin is
• The age of the patient – younger patients often have excellent outcomes without any skin procedures needed; while about half of older patients opt to have excess skin removed.
• I generally advise all patients to wait for at least one year until weight has stabilised before considering plastic surgery.

• Keep meals small
• Drink and eat slowly
• Avoid snacking and grazing
• Use meal replacement as needed
• Avoid alcohol after surgery and limit alcohol
• Think high-protein foods
• Practice mindful eating – eg not while watching TV
• Sit at the table, chew well and eat slowly
• Drink liquids between meals
• Chew your food 20 times per mouthful
• Avoid a sugary and fatty foods
• Try new foods one at a time
• Take recommended vitamin and mineral supplements
• Exercise regularly – Aim for 10,000 steps per day
• Eat real food not processed food
• We recommend the new CSIRO low-carbohydrate diet book as a template for eating.

DON’T

• Focus on looks, obesity, will power or weakness when it comes to food decisions.
• Compare weight to siblings, relatives or friends.
• Use  “shame” statements such as – “Do you really need to eat that?”  Or “I’ve noticed you’re still eating after dinner.” Shame does not engender meaningful change.
• Use ominous or fearful pretexts such as:  “We need to have a talk”.
• Judge. No one chooses to be fat (except sumo wrestlers). Obesity is a complex cocktail of genetics, diet, environmental factors, medication side effects, engineered or “hyper-palatable junk foods” and other contributing factors.
• Have one set of rules for other members of the house, yet ban chips and chocolate for the person who needs to lose weight.

DO

• Choose your time and place. Weight is a sensitive topic that needs to be treated with respect. Discussing weight whilst out on a walk or in the park, will be much better than the dinner table where there is immediate pressure to make food decisions.
• Always display empathy and take a positive, proactive position. A “let’s-all-embrace-this-together-attitude” is far more beneficial than “you-are-the-one-with-the-problem attitude.” Many families today are able to lose weight/maintain a healthy weight together.
• Frame the conversation about health and happiness rather than around food, eating habits or willpower. For instance: “Darling I’m really worried about your diabetes and the amount of medication you are taking keeps getting higher. Do you think we could be prepared to make some diet changes together or at least go to see the doctor?”
• Encourage a visit to the GP to reinforce health concerns and track weight progress
• Encourage healthy shopping and eating and have healthy snacks close by

BCOE accreditation is only awarded after an audit and inspection process by an International Accrediting body (the Surgical Review Corporation) – the biggest surgical organization for the specialty in the world.

Accreditation is only offered to hospitals where surgeons and staff work together to provide the highest level of care including:

• High caseload
• 24 hour cover and support for patients in and out of hospital
• Support group meetings for patients post-procedure
• ICU and X-Ray/CT availability 24/7
• Prospective audit and monitoring of long-term outcomes