LivLite - The Surgical Solution for Serious Weight LossBariatric - The Surgical Solution for Serious Weight Loss
1-877-LIV-LITE
1-877-548-5483
Home Contact Us Learn More About LivLite Featured Surgeons FAQs Our Store

Psychology of Obesity

How Weight Loss Surgery Works

Treatment Options

Testimonials

What it Costs

In the News

Upcoming Events

Get Started Today!

   
Obesity Action Coalition  

Post Bariatric Surgery Survey

Dear Bariatric Surgery Patient,

We are currently developing a Follow-up Care Program at LivLite. Your input to help guarantee the long term success of battling obesity is invaluable. If you don’t know the answer to a question it’s okay to skip it.

We are going to present the global results of this study to the ASMBS in Washington D.C. in June of 2008. To thank you for providing your feedback we will give you:
  • A chance to win a FREE cruise (proof of bariatric surgery required at time of announcement) on our Follow-up Care cruise event in the Fall 2008.
  • The results of the survey in emailed to you in June of 2008
The only thing you have to do is fill out the survey and provide us with your email address. See our privacy policy.

Name:
Email:
Your information will not be sold or shared with anyone. Please see our Privacy Policy for more information.


1. What bariatric surgery procedures have you had, if any ?
Biliopancreatic Diversion (BPD)
Duodenal Switch (DS)
Mini Gastric Bypass (MGB)
Roux-en-y (RYN)
Silastic Ring Vertical Gastroplasty
Vertical Banded Gastroplasty (VBG)
Vertical Sleeve Gastrectomy (VSG)
Lap Band
Other

2. After the first bariatric operation above, did you have any other bariatric surgeries or revisions?
Yes
No

3. If the answer to no.2 was yes, which one was it?
Biliopancreatatic Diversion (BPD)
Duodenal Switch (DS)
Mini Gastric Bypass (MGB)
Roux-en-y (RYN)
Silastic Ring Vertical Gastroplasty
Vertical Banded Gastroplasty (VBG)
Vertical Sleeve Gastrectomy (VSG)
Lap Band
Other   

4.Were you re-admitted to the hospital due to post-op complications?
Yes
No

5. If yes, how long after the surgery were you re-admitted?
Within 30 days
31 days to 90 days
91 days to a year
Longer

6. How long ago was your most recent bariatric surgery procedure?
Within the past year
1-2 years
2-3 years
3-4 years
4-5 years
Over 5 years ago

7. What comorbidities were either improved or now under control by the gastric bypass surgery operation?
Type 2 Diabetes Hyperlipidemia
Hypertension Back Pain
Sleep Apnea High Blood Pressure
Depression Heart Disease
Gastroesophageal Reflux Disease (GERD) Gallbladder Disease
Liver Disease Hypercholesterolemia (High Cholesterol)
Hypertriglyceridemia (High Triglyceride Levels) Venous Thromboembolic Disease
Degenerative Disc Disease Osteorathritis
Atherosclerotic Cardiovascular Disease

8. List the medications you were able to stop taking or reduce dosage after the surgery.

9. What was your greatest weight loss?
Less than 50 pounds
51-100 pounds
101-150 pounds
151-200 pounds
201-300 pounds
301-400 pounds
Over 400 pounds

10. Did you achieve your goal weight?
Yes
No

11. If no, how far were you from your goal?
Within 5 pounds
Within 6-10 pounds
11-20
21-30
31-40
41-50
51-100
151+ pounds

12. Are you still at about that weight?
Yes
No

13. If no, how long were you at that weight?
Three months or less
4-6 months
7-9 months
12-18 months
19-24 months
2-3 years
3-4 years
4-5 years
Over 5 years

14. If you have gained back weight, how much?
Less than 5 pounds
6-10 pounds
11-20
21-30
31-40
41-50
51-100
101-150
151+ pounds

15. Were you happy with the results?
Very happy
Fairly happy
Not very happy
Not at all happy
Why did you say that?

16. If you have gained weight, have you re-acquired any of the following comorbidities returning?
Type 2 Diabetes Hyperlipidemia
Hypertension Back Pain
Sleep Apnea High Blood Pressure
Depression Heart Disease
Gastroesophageal Reflux Disease (GERD) Gallbladder Disease
Liver Disease Hypercholesterolemia (High Cholesterol)
Hypertriglyceridemia (High Triglyceride Levels) Venous Thromboembolic Disease
Degenerative Disc Disease Osteorathritis
Atherosclerotic Cardiovascular Disease

17. Have you experienced any new illnesses?

18. What, if any, medications did you have to start taking again or alternative medicines for same illnesses?

19. What was your greatest joy in losing your weight?

20. What was your greatest challenge?

21. If you have gained back weight, are you frustrated by your gain?
Yes
No

22. Have you gone back to some of your old habits?
Yes
No

23. Do you feel you are out of control?
Yes
No

24. Have you experienced emotional eating?
Yes
No

25. Do you want to lose any additional weight?
Yes
No

26. Can you see a benefit to having help?
Yes
No

27. Do you think you can reach your goal more quickly with help and motivation?
Yes
No

28. Would it be reassuring to be in control with other people who understand you and your food issues?
Yes
No

29. Are you currently in any aftercare program?
Yes
No

30. Would you be interested in joining a formalized aftercare program?
Yes
No

Nutritional Information

31. Was any nutritional support offered to you after the surgery?
Yes
No

32. Were any post-surgical nutritional guidelines offered by the surgeon or related staff?
Yes
No

33. What time period did the guidelines cover?
3 months
6 months
12 months
Longer

34. Were the nutritional guidelines offered 1 to 1 or in a group?
1 to 1
Group
Non Given

35. Were you given any guidelines for total protein intake?
Yes
No

36. Did it include both food and supplement?
Yes
No