Monday, 14 September 2015

Life after weight loss surgery

Weight loss surgery entails long term modification in the diet and lifestyle of patients. This has to be clearly explained to the patients in the pre-operative counselling sessions so that they have a good compliance after the surgery which in turn would lead to the desired weight loss goals.

The post-operative diet is low in calories (carbohydrates and fats) with high protein. This helps in fat loss without causing loss of muscle mass which could be harmful for the body. The diet is gradually progressed from a clear liquid to normal diet over several stages to allow the person to adjust to the new anatomy and allow the internal organs to heal. A clear liquid diet is usually started the next day after the surgery which is continued for 4-5 days.

The patients asked to sip slowly and take only 30-50 ml at one time to prevent bloating and vomiting. This is then progressed to full liquid diet containing juices, soups, buttermilk, dal and rice water in the next week.  After 15 days of surgery, a pureed/soft diet can be given and patients are usually on a normal diet one month after their procedure.
There are several do’s and don’ts for the patients

1.            Eat regularly at proper scheduled time.
2.            Meals should be small and frequent, usually 3-5 meals with two in between snacks
3.            Eat food slowly and chew thoroughly
4.            Take measured portions to avoid overeating
5.            Proteins should be taken at the beginning of the meal

1.            High calorie drinks like shakes, smoothies and sweet juices are a strict no-no
2.            Avoid drinking water during and for 30 minutes before and after your meal
3.            Avoid aerated drinks and using straws as they can cause bloating
4.            Avoid alcohol and smoking

Exercise is an essential part of any weight loss programme and the same is true of bariatric surgery. Light exercise is started after the first week of surgery. This includes walking on level ground or working on a cross trainer/stepper. Resistance exercises are usually recommended after the first month. Moderate weight training is also helpful to prevent muscle wasting and loss of bone mass. 

Generally, a patient is told to do moderate level aerobic exercise (i.e. jogging) for 20-30 minutes every day and a total of 300 minutes every week. This also helps maintain healthy skin and muscle tone which prevents skin sagging which might be experienced by older patients after their surgery.
There is a need for strict follow up for some time after your bariatric surgery to ensure that weight loss is according to the plan and there are no any side effects. We advise follow up visits at 2 weeks, 1 month, 3 months, 6 months and 1 year after the procedure. Thereafter, follow up can every year by visits or simply telephonic consultations or via e Email.

We check for the following things during the visit

1.            Weight loss- real and expected
2.            Diet plan
3.            Supplements
4.            Blood tests to detect deficiencies
5.            Consultation for any medical problems
6.            Exercise programme
7.            Support group activities

The weight loss after bariatric surgery is usually in two phases- initial phase of rapid weight loss which lasts 3-5 months and the second phase of more gradual weight loss which may continue for 1-2 years
The total expected weight loss is calculated as in terms of the excess weight which was present before the surgery. 100% of EWL (excess weight loss) is ideal which means that the person would reach his/her ideal weight after the procedure. The percentage of excess weight loss varies according to the procedure and is usually as follows-

1.            Gastric banding – 50 -60%
2.            Laparoscopic Sleeve gastrectomy – 60- 80%
3.            Laparoscopic Mini gastric bypass – 70- 90%
4.            Laparoscopic Roux en Y gastric bypass – 70 -90%

The main advantage of bariatric surgery over other weight loss treatments is that the weight loss has been demonstrated to be sustained over the long term eg. 5-10 years after the procedure. This makes it a permanent solution for obesity.

Monday, 10 August 2015

What are Bariatric surgery and its benefits?

Bariatric surgery is a group of surgical procedures which help to decrease the body weight of an individual. It is indicated for people having morbid obesity (BMI> 35 kg/m2 with significant comorbidities or BMI > 40 kg/m2 with or without associated comorbidities).  The reduction in body weight is primarily due to loss of body fat which is a result of the negative energy balance achieved after the surgery. This is done by either reducing the capacity of the stomach to limit the intake of food at one time (restrictive procedures) or by decreasing the effective length of intestine available for absorption of food (malabsorptive procedures) or both mechanisms (combined procedures).

Restrictive procedures include 

1. Gastric Sleeve in which the majority of stomach is removed using a stapling device to create a long, narrow tube of the stomach
2. Gastric Banding in which an adjustable silicon band is placed around the upper portion of the stomach to limit the intake of food
3. Gastric plication in which the stomach is sutured in 2 layers to reduce its capacity

Malabsorptive procedures include

1. Jejunoileal Bypass in which the first part of the intestine is cut and connected directly to a part which is present distally reducing the effective length of the intestine. This procedure is not performed nowadays

Combined procedures

1. Gastric Bypass – In this, a small pouch of stomach is created which is joined directly to the cut portion of the small intestine. The small pouch restricts the quantity of food taken while the intestine is bypassed to limit absorption.

2. Biliopancreatic diversion- The stomach is divided as in a sleeve gastrectomy and the cut portion is connected to the small intestine for malabsorption

3.      Bariatric surgery has been proven to be the only effective procedure for long term weight loss in patients with morbid obesity. Besides this, it helps in reversal or improvement of the majority of associated medical conditions and increases lifespan as well as the quality of life. 

A large number of scientific studies as well as meta-analyses have shown an average excess weight loss of more than 60% over a five year period. In absolute terms, this amounts to a weight loss of 35-50 kg depending upon the BMI of the individual and the procedure performed. Long term follow up (> 15 years) has shown that this weight is maintained in the majority of people.

Medical illnesses associated with morbid obesity like diabetes, hypertension, increased cholesterol and heart diseases have been shown to be improved or reversed in up to 60-80% of patients undergoing bariatric surgery. This leads to reduction in the cardiovascular morbidity and mortality. Other conditions like obstructive sleep neap, joint disease, reflux disease and fatty liver have shown significant improvement after surgery in patients suffering from these conditions. The primary mechanism for this is weight loss and other factors such as decreased visceral fat and improvement in insulin resistance also contribute. Besides these, weight loss surgery is associated with improvement in gout, asthma, varicose veins, urinary incontinence and infertility.