Please circle the best response.
1.
Morbid
obesity is defined as
a.
Body
mass index greater than 40.
b.
Greater
than 100 lbs. overweight.
c.
Greater
than 200% over the ideal body weight.
d.
All
of the above.
2.
The
long-term success of Lap Band surgery depends on:
a.
The
tightness of the Lap Band.
b.
Whether
a client has open or laparoscopic surgery.
c.
Your
long-term commitment to dietary, exercise, and medical guidelines.
3. In the first two weeks following surgery,
clients are required to
a.
Consume
only pureed foods.
b.
Consume
only liquids.
c.
Consume
regular foods.
d.
Consume
only soft foods
4. Once weight loss surgery clients
reintroduce “regular foods” to their diets, they will
a.
Eat
as much as they want of regular foods.
b.
Still
need to limit high fat and high sugar foods for life.
c.
Need
to only eat two meals per day.
d.
Try
to eat as many fruits as possible.
5.
As
part of new eating habits following weight loss surgery clients may be encouraged
to:
a.
Eat
smaller meals at regular times during the day.
b.
Drink
64 ounces of water per day.
c.
Eat
meals more slowly than before.
d.
All
of the above.
6.
In
order to achieve and maintain weight loss goals, it is recommended that people
a.
Exercise
a minimum of 30 to 45 minutes a day, most days of the week.
b.
Exercise
for one hour, one day per week.
c.
Exercise
when there is time.
d.
Exercise
only if they are not losing weight.
7. What rate of weight loss I can expect after
the Lap Band procedure?
a.
1
to 2 pounds every day.
b.
1
to 2 pounds every week without proper Adjustments.
c.
1
to 2 pounds every month.
d.
1
to 2 pounds per week with proper Adjustments.
8. Followings are the potential complications
after the Lap Band procedure, except:
a.
Intestinal
or stomach leak.
b.
Erosion
and slippage
c.
Pulmonary
embolus (blood clot to the lung).
d. Tubing and access port failure.
9.
Open surgery (as opposed to laparoscopic surgery)
a.
Is
not likely to happen
b.
Can
result in poorer weight loss results.
c.
Is
possible if unable to do the laparoscopic surgery.
d.
Usually
results in a shorter hospital stay.
10.Choose
the statement that is most true:
a.
After
the Lap Band procedure, re-operation is never necessary due to bleeding,
erosion, slippage or perforation and other causes.
b.
The
Lap Band procedure is a tool to help people achieve weight loss; clients must
follow the program’s recommended lifestyle changes in order to have long-term
success.
c.
It
is ok to substitute soft drinks and coffee for the 64 ounces of water that
clients need each day as long as it is in moderation.
d.
It
is ok to drink from a straw following surgery.
11.
After
weight loss surgery, the general progression from liquids to normal foods is
about:
a.
6
weeks.
b.
2
weeks.
c.
2
days.
d.
6
months.
12.
You
are required to take a multivitamin after weight loss surgery for:
a.
About
5 to 10 days.
b.
Three
months.
c.
Five
years.
d.
The
rest of your life.
13.
Diabetes,
high blood pressure, back pain and similar ailments always get better after
weight loss surgery.
a. True b. False
14.
Vomiting
can occur after surgery due to the followings, except:
a.
Drinking
too fast.
b.
Advancing
the diet too quickly.
c.
Eating
too little.
d.
Not
chewing up food well.
15.
With
the Lap Band procedure, I
a. Can have an adjustment to have the band
opened more to eat more for a special occasions, like a wedding.
b. Understand that weight loss and surgical
outcomes are not guaranteed.
c. Expect to melt pound off of me without
lifestyle changes of dietary and exercise, since these have not helped in the
past.
d. Will follow up with my surgeon for the
first year, and then I will be okay on my own once I lose my weight and change
my diet
To be signed after meeting
with Dr. Shin:
This
is to certify that I have completed this questionnaire myself and that any
incorrect responses have been corrected and discussed with Dr. Shin.
________________________________ ____________________________________
Client Print Name Client
Signature Date
I
certify that this questionnaire was reviewed with the above-named client.