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.