Dear Jenn,
In your last article you discussed the pros and cons of using medications to help weight loss efforts. I am wondering what your opinion is regarding bariatric surgery as an alternative way to help lose weight. I am considering this option as well.
Sincerely,
Searching for Weight Loss Solutions
Dear Searching for Weight Loss Solutions:
Yes, my last column discussed the pros and cons of using weight loss medications as an option. I emphasized reaching out to a support group and /or dietician/personal trainer to help the weight loss effort, motivate adherence to diet and encourage exercise consistency. Remember the following: 1) Weight loss medications can be stopped, but in order to avoid adverse effects some medications must be weaned via doctor’s instructions. 2) Under the influence of weight loss medication, appetite is suppressed, followed by desired weight loss. If medication is stopped, weight maintenance is challenging.
Definition: Bariatrics: The branch of medicine that deals with cause, prevention and treatment of obesity.
Bariatric Procedures
The Lap-Band: A reversible laparoscopic surgical procedure. An adjusted band reduces physical hunger and provides satiety with small meals. Patients may require revision surgery. Average weight loss is 50-60 % body weight over two years. However, half of gastric bands are removed due to inadequate weight loss or complications within 7-10 years.
Gastric Balloon (intragastric balloon or belly balloon): A non-surgical and reversible procedure. A soft balloon is inserted into the stomach via endoscope. The intragastric balloon is removed after 6 months. A new balloon may be placed, depending on you and your doctor. Patients lose 10-15% of body weight, significantly reducing obesity-related health problems.
Sleeve Gastrectomy (Gastric Sleeve): The stomach is surgically reduced in size (75-80%) allowing satiety with small portions. Faster gastric emptying and improved gut hormones decrease hunger and promote satiety. This surgery is generally irreversible, but in rare cases, with considerable risk, may be reversed. Patients lose at least 50-70 % of “excess body weight” (IBW-CBW) within 12-24 months, but half regain 5% body weight within 2 years.
Gastric Bypass Surgeries
Roux-en-Y Gastric Bypass (RYGB): A small stomach pouch is created and connected to the small intestines. Individuals feel satiety after eating small meals and absorbing fewer calories. The RYGB can be reversed or converted into a gastric sleeve.
Duodenal Switch (not reversible), Bilio-pancreatic Diversion (certain adjustments possible) and Distal Gastric Bypass (risky to reverse). These are surgeries that cause severe mal-absorption and nutritional deficiencies and are done infrequently.
Positive Outcomes of Bariatric Procedures
Gastric bypass procedures have been noted to achieve resolution or remission of type 2 Diabetes, hypertension, high cholesterol, sleep apnea, morbid obesity, and urinary incontinence (females) in 90% of patients. Preferably, gastric bypass surgeries are performed via laparoscope. On average patients lose 50-75% “Excess Body Weight” within a year. A small percentage of patients regain 30% body weight after 10 years.
Are you a candidate for bariatric surgery?
You may qualify if you have a BMI of 35-39, significant health problems like type 2 diabetes, sleep apnea or high blood pressure. A BMI of 40+ is a qualifying factor.
Factors to consider
1. Requirements: Gastric sleeve and RYGB surgeries may require patients to lose 5-10 % body weight prior to surgery, depending on initial weight. Reduction of fat in the liver is necessary for safe laparoscopic procedure. Adhering to the pre-op diet and making lifestyle changes prior to surgery acknowledges that this is not a quick fix.
2. Resolving issues: Certain medical problems need to be resolved prior to bariatric surgery: Unstable mental health conditions, eating disorders and alcohol and drug addictions. Bariatric surgery requires adhering to strict dietary regimens, developing new lifestyle habits and having patience while recovering.
3. Diet journey: The post-op diet schedule ensures proper healing and avoidance of side effects. There are food texture stages: clear liquids (24 hrs) followed by weeks of full liquids > pureed foods > soft foods > and regular foods. It is a journey and process.
4. Food eliminations: Carbonated beverages, high sugar and fat items, breads, cereals, rice, pasta, cakes, crackers and fruit juices are some items to avoid after surgery. There are lists of foods to avoid and include in bariatric diet plans.
5. Lifestyle habits: Chewing gum, drinking with straws and smoking must be eliminated to avoid serious adverse side effects.
5. Adjusting eating patterns: Eating slowly, mindfully and chewing foods thoroughly, separating solids and liquids, consuming three meals and two snacks daily is the new lifelong regimen.
6. Nutrition supplements: Protein supplements and bariatric vitamins-minerals are a lifelong necessity due to small amounts of food that can be consumed and mal-absorption consequences.
7. Fluids: Proper hydration is essential. Solid foods and liquids should be consumed separately, timing to incorporate both is essential.
8. Prioritizing eating of foods: Protein intake insures healing and prevents muscle wasting. Consumption of foods in specific order is mandatory: protein < non-starchy vegetables < fruits < legumes.
9. Keeping a journal: A dietician may require you to keep a detailed “food journal” to ensure adequate nutrient intake.
9. Exercise: Exercise is recommended before and after bariatric surgery. Exercise helps weight management and has other health benefits.
10. Side effects: Most adverse side effects are temporary. Many can be avoided by following doctor and dietitian instructions.
Bariatric surgery is not a cure. It is a tool to help reduce weight. Successful bariatric-induced weight loss requires combining surgery with diet, exercise, stress management and mindfulness.
Bariatric surgery is life-altering and serious. Consider reaching out to someone who had bariatric surgery and discuss their experience. It may help to join a bariatric weight support group and /or work with a dietician-personal trainer experienced with this process. Nutrition Transformations can help you get through this undertaking. Reach out to us for more information. If you are interested in improving your diet, exercise regimen, weight and health—we do that too!
Yours in good health,
Jenn
718-644-1387
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