FAQ
Our team and community are always available to answer questions you may encounter along your weight loss journey. If you cannot find answers here, please contact us directly.
What qualifies a patient for surgical treatment of obesity?
Usually patients with a body mass index greater than 40
or
a patient with a body mass index greater than 35 with other co-morbidities, including diabetes, high blood pressure, or sleep apnea
Where are Dr. Balsama’s office locations and where does he operate?
In February 2024, Dr. Balsama moved from Jefferson Health to Virtua health. He does office hours currently in Haddon Heights and Sewell NJ. He operates exclusively at Virtua Health – Marlton hospital.
What insurances are accepted?
Most private insurances, medicare and medicaid are covered by our practice. Feel free to call our office and check with our staff before setting up an appointment.
What services does Dr. Balsama provide currently?
Dr. Balsama provides both medical and surgical weight loss options, as well as performing skin removal procedures such as tummy tucks. He performs limited general surgery (gallbladder surgery/hernia surgery) in his weight loss patients.
What is the first step in controlling my weight?
Simply give our office a call and make an appointment with Dr. Balsama to discuss the different options available.
What ancillary services are provided for both medical and surgical weight loss?
We offer behavioral coaching, dietician support, as well as a multitude of other specialists. Most surgical patients will require additional support from cardiology, pulmonary and gastroenterology. We provide all ancillary services ‘under one roof’ at our Sewell campus.
How long has Dr. Balsama been in practice? How many bariatric procedures has he performed?
Dr. Balsama went into practice in 2005 and started performing bariatric procedures in 2007. He has completed 1500+ bariatric procedures. He obtained robotic privileges in 2022 and now performs these procedures exclusively with the davinci robot.
How long does it take to complete a workup for bariatric surgery?
It can take 4-6 months with most insurances, as a minimum nutrition requirement is 3 months, but this may vary.
How will I know if medical or surgical treatment is better for me?
This topic will be discussed during the initial appointment and has many factors. Typically, surgical treatment is more effective, but there are sometimes situations when medical treatment is more appropriate.
If I choose medical therapy, what are the most common medications used?
GLP-1 medications are felt to be the most effective weight loss agents currently. These include Zepbound and Wegovy. It is recommended to call your insurance company prior to your visit to make sure you are familiar with your coverage for these medications.
What is the expected weight loss for these GLP-1 medications? For surgery?
Average weight loss is around 15-20% of your starting weight, at about 18 months after starting the medication, although these results vary from patient to patient and depending on which medication is used. A 300 lb patient on average would lose between 45-60 pounds.
Surgical weight loss depends on the type of procedure but is generally thought to be 25-35% of starting weight at 1 year after the procedure. A
300 lb patient on average would lose between 75 and 105 pounds
What are the requirements to receive these medications?
A BMI of 27 or above with weight related comorbidities
What are the requirements for surgical weight loss?
A BMI of 35-40 with weight related comorbidities - usually include diabetes, high cholesterol, hypertension (high blood pressure), and/or sleep apnea or a BMI of 40 or above, regardless of health issues.
What factors play a part in whether a patient is a candidate for weight loss medication or weight loss surgery?
Many factors go into this determination, some of which are:
Previous bariatric surgery, thyroid cancer history, abdominal surgical history, history of ulcers, history of vitamin deficiencies or iron deficiency, failure or intolerance of medication in the past, reflux, weight loss goals, patient preference, and history of smoking. This should not be considered an inclusive list, but only an example of some factors that may affect the course of management. In some cases, medication is recommended in anticipation of surgery to begin the weight loss process as early as possible.
How is the medication administered?
GLP-1 medications are self-injected (similar to an insulin shot) weekly. The medication dose is increased monthly under physician supervision until a maintenance dose is reached.
What types of bariatric surgery are offered? How long does each procedure take? How long is my hospital stay?
We offer both Robotic Sleeve Gastrectomy and Robotic Gastric Bypass. The sleeve takes about 1 hour and the bypass about 2 hours to complete. The hospital stay for either is generally 1 overnight and expected recovery is 2-3 weeks at home, although this varies with the patient.
What will my pre and postoperative diet?
We ask that you complete a 2 week preoperative diet consisting of a protein shake for breakfast, one shake for lunch, and a light dinner (think Lean Cuisine)
Postoperatively, your diet will be advanced with guidance, starting from liquids to soft foods and eventually solid foods over the course of a few weeks.
What are the most significant immediate complications associated with these procedures?
The most threatening complications are rare and include staple line ‘leaks’, blood clots, blood loss, and infection, although this is not an exhaustive list. Our program requires postoperative heparin treatment to prevent blood clots. Our overall program complication rates are very low and consistent or better than national standards.
What are some side effects of weight loss medications?
The most common side effect is nausea, followed by changes in bowel habits, such as diarrhea or constipation. Most of these symptoms are tolerated well by patients and uncommonly cause discontinuation of the medicine.
What are some common side effects of weight loss, either with medical or surgical treatment?
Joy, excitement, happiness and improvement in your daily quality of life!
Hair loss is common but usually mild, this can improve once the weight stabilizes. Gallbladder issues are more common in patients who lose weight rapidly. Excess skin and dermatologic issues can occur, there are surgical options for this but not recommended until a patient’s weight is stable. Vitamin deficiency is uncommon and easily treated. A daily multivitamin is recommended for all patients.
I have a unique medical issue that may affect my candidacy for this procedure, will you still consider me?
Dr. Balsama has performed successful bariatric procedures on patients with Crohn’s disease, Celiac disease, Multiple Sclerosis, Renal failure, history of heart attacks, cancer survivors, and more. He considers these medical issues carefully before approving surgery and will review your risk tolerance before proceeding.
Do you have age criteria for performing these procedures?
Dr. Balsama does not operate on pediatric patients (less than 18 years of age). There is no upper limit for age but Dr. Balsama exercises caution with patients over the age of 70. All risks and benefits must be evaluated carefully in elderly patients.
Is skin removal surgery covered by insurance? Can Dr. Balsama perform these procedures? How long will I wait to have this procedure after my bariatric procedure?
Sometimes procedures such as panniculectomy (tummy tucks) are covered by insurances. Recurrent rashes and hygiene issues are the most common indications for these procedures after significant weight loss. Coverage is insurance dependent and not guaranteed. Out of pocket options are available for those without coverage. Dr. Balsama focusses mostly on the abdomen, therefore plastic surgery consultation is advised for skin removal in other areas, such as breasts, back, arms, and thighs. Generally, it is recommended that your weight is stable (more than a year after bariatric surgery) before skin removal is considered.
