Recently the updated clinical practice guidelines for bariatric surgery were released, cosponsored by American Association of Clinical Endocrinologists, The Obesity Society, and American Society for Metabolic & Bariatric Surgery (ASMBS).
For us practitioners it was a welcomed document since the last guidelines were published in 2008. In those five years, we have learned a lot more through research and we are always looking for the best practices and recommendations to treat weight loss surgery patients. There has been a lack of standards as you may know since recommendations vary between surgeons and practices. If you talk to friends or family who have had weight loss surgery at a different location than yourself, you know what I mean.
The new guidelines are somewhat lengthy and technical. I would like to point out the postoperative items of interest that I have shared with my patients. Many of these are not new, but have new research to substantiate the recommendation. (My comments follow.)
Please keep in mind that these are guidelines and recommendations, not absolutes. Follow the guidelines provided by your bariatric team since they know you and are best suited to meet your individual needs.
Vicki Bovee, MS, RDN, LD, Vicki Bovee, MS, RD, Wellesse Bariatric Expert, is a registered dietitian with over 25 years experience in weight management with specialization in bariatrics since 2003.
*Clinical Practice Guidelines for the Perioperative Nutritional, Metabolic, and Nonsurgical Support of the Bariatric Surgery Patient- 2013 Update: Cosponsored by American Association of Clinical Endrocrinologists, The Obesity Society, and American Society for Metabolic & Bariatric Surgery.
Congratulations! You've just had bariatric surgery and you're excited to get started with your new life (or you are researching for after your surgery). Part of that new life includes exercise. If you want to keep the weight off, you need to make physical activity a regular part of your life. It may be one of the most important lifestyle changes you make for long-term success. Where do you start?
Start with walking a little bit at a time...
Obesity can take a toll on the body, increasing a person’s risk for heart disease, certain types of cancer, fatty liver disease, osteoarthritis and many other diseases. And, to add insult to injury, obesity appears to launch an attack on the body’s defense network, the immune system. And, this attack appears to be multifaceted – there are several ways in which obesity may negatively affect the immune system, some of which haven’t been totally elucidated just yet.
Vitamin D Deficiency Link
Given the impact obesity has on the body’s defense network, it shouldn’t come as much of a surprise that research often shows obese hospitalized patients are more likely to develop secondary infections and complications.
If you have pounds to lose, don’t fret. Start by cutting down on sugary snacks, baked sweets and fried foods. Add vegetables to every lunch and dinner and fresh whole fruit to your breakfast. In addition, drink at least 8 glasses of calorie free fluid per day and get exercising. If you don’t exercise now, start by taking the steps instead of the elevator everywhere you go and take the long route when possible (park far from the store entrance for instance). Build up your exercise routine slowly (by 10% per week) to give your body time to adapt and minimize the likelihood of developing injuries.
If you have struggled with your weight for many years and still unable to lose the weight you need to for your health, consider weight loss surgery. Talk with your healthcare professional about the options available to you. Bariatric Weight Loss Surgery can be the needed tool for those who are obese and are unable to lose the necessary weight. It can be a critical step towards a healthier, longer life.
Keep in mind that malnutrition and deficiencies can occur even if you are overweight, due to poor diet and/or inability to absorb enough nutrients from food.
For those that have already had bariatric surgery, be sure to always take your recommended bariatric vitamins and supplements for the rest of your life to protect against deficiencies such as vitamin D and calcium for immune and bone health. Vitamin D is very important for the absorption of calcium for strong bones to prevent osteoporosis. Make sure to get your blood levels tested regularly.
PLOS Medicine 2013;10(2):1-13.
J Clin Invest 2003;112:1796-1808.
J Investig Med 2011;59:881-6.
Clin Exp Immunol 2006;146:39-46.
When I hear people say they need to get back on track or get refocused, my first recommendation is to start tracking food intake. But recording isn't just for those folks, it plays an important part in your diet progression right after surgery too.
There is so much research on the benefits of recording to prove it makes you more successful, and if you've kept an honest record, you know this to be true. Notice I said an honest record. I've had people tell me they don't record "the bad stuff". It's not calorie-free because you didn't write it down or had selective amnesia.
Many people think the most important thing to track is calorie intake, and for some people, it is. But after bariatric surgery, it's equally important, if not more important, to track your protein intake. Recommendations vary depending on your surgeon, but typically the goal is 60-90 grams of protein a day. This can seem daunting in the early post-operative stages if you've had a gastric bypass or sleeve. This is a time when it is critical to track your protein intake. Further out from surgery, it might be more important for you to know where your calories are coming from: the distribution between protein, fat, and carbohydrates.
There are different tools to track your intake. Paper and pencil is better than nothing but to have any sort of meaningful analysis you have to look up your foods for their nutrient value. Let technology do the work for you. All you need to know is what did you eat and how much, and let technology figure out the rest. In a study presented at the American Heart Association meeting last year, a group of 210 obese adults tracked food and activity intake with either a handheld electronic device or a paper diary. Those who used an electronic device had significantly more weight loss than those using a paper record.
Most of us have cell phones and 15 percent of us have a health app for our Smartphone. There are also online programs like WebMd and Spark People and 27 percent of internet users track weight and fitness goals online. If you have looked at using an app or an online program you know there are a multitude of choices. So, how do you pick the best one for you?
There are many free programs available or apps that are a minimal investment. You will need to know what is important for you to track. Are you good with the basics of calories, protein, fat, carbs, and exercise or do you want more detailed information to include fiber, sodium or other nutrients? Read the reviews, comments, and look at some sample pages. Most programs allow you to enter custom foods or labels, but a feature I find helpful is the one that allows me to enter a meal. For example, when I make a leafy salad I usually use the same veggies. I entered my salad into my meal program as Vicki's Salad. Now when I eat it, I can just enter Vicki's Salad rather than spend the time entering each salad component.
It may take a while for you to be comfortable with the program or app you select. Initially you will be spending more time recording as you enter your custom foods. If you don't like the program after a few days or a week, it's easier to switch to another before you get too many of your custom foods entered. If you have a lot of time invested in setting up your database, you will be less likely to switch and if you don't like the program, you will be less likely to use it. Keeping track with technology isn't time consuming after you've got your custom foods and meals entered. You should be able to track your food and activity in less than five minutes a day. Recording as soon as you have eaten something makes it easier than trying to remember at the end of the day and you will less likely to forget what you ate.
It's also a great idea to track when you take your supplements especially those that you need to take more than once such as calcium.
Set a reminder on your phone to help remember or use a post it note if you don't have a smartphone.
Whichever program or app you settle on, just use it. Remember, research continues to show that people who record are more successful.
Vicki Bovee, MS, RDN, LD, Wellesse Bariatric Nutrition Expert
Here are a few apps to try and most have fitness trackers as well:
Pew Research Center, Pew Internet & American Life Project. (2011). Half of adult cell phone owners have apps on their phones. Retrieved from www.pewinternet.org
Styn M. Et al. (2012, March). Overweight, obese adults use electronic device to stick to diet, exercise. Meeting report presented at American Heart Association scientific meeting.
As a dietitian you might think I never have to battle with my weight. You would be wrong.
I have lost 25 to 30 pounds and regained it four times. I have lost 20 pounds in the last 6 months, 17 of those in the first four months, and I now weigh what I weighed in 1991. That was a long time ago and I was a lot younger. People keep asking me for my secret or what diet did I use. I have been working with weight loss surgery patients for the past 10 years and I am walking the talk. Here is the "secret."
"Secret #1"- I know from patients that boredom eating is the biggest emotional eating issue. I keep myself busy. Often too busy. Evening TV is not my friend. The TV and the sofa are not a good combination for me. I have a list of things to do in the evening that don't involve being a couch potato.
"Secret #2"- I eat very few meals out, maybe 1 to 2 times a month. I pack my lunch to work every day. I eat my dinner at home. I do not eat fast food. When I do eat out, I dine. I focus on the company, conversation, and atmosphere. The food has become secondary.
"Secret #3"- I do not keep problem foods in the house. Yes, I have my "difficult to control foods" and if I eat them, it's in a controlled situation with a controlled portion. If I have those foods in the house, they call my name and earplugs don't always work. If you don't buy it, you can't eat it. The first line of defense is in the grocery store.
"Secret #4"- I eat mostly the same foods. I drink a protein shake for breakfast six days a week. I eat a salad with a protein food on top for lunch six days a week. I eat a protein food and veggies for dinner. I eat Greek yogurt, fruit, and veggies for snacks. Sundays I break from the routine but I still stick to healthy food choices. I do not eat the food that comes into the breakroom at work since most of it is empty calories.
Now I have had people tell me that I don't enjoy my food....wrong. I eat foods that I like but that don't tempt me to overeat. I'm not going to waste my calories on food I don't like. People have told me that I have taken the "fun" out of eating. Food is not entertainment. Please tell me what is fun about diabetes, sleep apnea, hypertension, heart disease, gout, back pain, knees that need to be replaced, etc. Fortunately, I don't have these health problems but I work with people every day who do and I see the pain, agony, and expense they cause.
"Secret #5"- I go to bed early and usually get 7 to 8 hours of sleep a night. Remember, I keep myself busy from Secret #1 so I am pretty tired when I climb into bed. If you don't get enough sleep you have a greater release of the hormone that says, "I'm hungry." And that hormone is hungry for high calorie foods, not carrots.
"Secret #6"- This is the kicker....I exercise six days a week. I thought about all the times I regained the weight lost and realized every single time it was when my exercise slacked off. Research shows that in order to sustain weight loss you have to be physically active 30 to 60 minutes most days of the week. I walk briskly 30 to 45 minutes six, sometimes seven, days a week. I do strength training three days a week. I go to Tai Chi two times a week. I climb the stairs at work every day. I get up from my desk every 45 minutes and walk up and down the hall. I park at the far end of the parking garage. I wear a pedometer to make sure I get my 10,000 steps a day. I look at my work schedule for the week and write my exercise time in my planner just like an appointment. Do I work out like I did in 1991 when I was at my fittest? Not even close, but I do something and that is the key. I have arthritis in my lower back and although the exercise causes discomfort, without it I have pain. Anything is better than nothing when it comes to physical activity. Just get up and move. Our bodies are not meant to sit all day and it is killing us.
Am I perfect? No, but I am on track about 95% of the time with my food choices and 99% of the time with my exercise. I am still working on eating slower and that is a constant effort.
So, all these "secrets" come down to eating healthy and moving more. Use your weight loss surgery to help you manage your eating. It is a tool but you have to do the work. Work on focusing on eating to live rather than living to eat. The more you practice the easier it gets.
Vicki Bovee, MS, RD, Wellesse Bariatric Expert, is a registered dietitian with over 25 years experience in weight management with specialization in bariatrics since 2003.
What is bariatric weight loss surgery?
Bariatric surgery is a term that covers a wide range of weight loss procedures. A bariatric surgery is an option for people who have tried many traditional ways to lose weight with no success. National Institute of Health recommends bariatric surgeries for obese people with a BMI (body mass index) of at least 40 or for people with a BMI of 35 with serious medical conditions such as diabetes, high cholesterol and others. Those procedures consist of reducing the size of the stomach with a gastric band or even removing a part of the stomach which is called gastric sleeve or by rerouting the small intestines to a small stomach pouch which is called gastric bypass surgery. A few possible advantages of bariatric surgery are significant weight loss in the long run, improvement of cardiovascular risks and recovery from diabetes (actual results vary from person to person). However, bariatric surgery won’t make you lose weight without a healthy nutrition and an exercise plan.
Nutrition after a bariatric procedure
After bariatric surgery it is very important to adapt your lifestyle to achieve maximum results and facilitate weight reduction. A very good tip is to change your diet even before you have bariatric surgery so you can be prepared. You won’t be able to eat the same foods you ate before, at least not for a few months, depending on your recuperation and type of surgery.
Stage 1: Liquids
Right after the surgery, in the hospital, you will receive a clear liquid, sugar free diet. Do not use a straw to drink the liquids, using a straw can increase your gas problems and make you uncomfortable. The first few sips is normal to be hard to swallow but it will get better with time. The portions may be regular size, but normally you will be able to consume about 4 ounces every waking hour, remember, your stomach is a lot smaller now. As soon as you will be able to tolerate it, your surgeon will decide if you can move to the next step, full liquids, which includes fat free cream soup, pudding, sugar free yogurt (no fruits) etc. You might be sent home after you tolerate a stage 1 diet, but this depends for every hospital and surgeon.
Stage 2: Pureed or mushy foods
This diet will go on for about 4 to 6 weeks and may vary by surgeon and the bariatric surgery type. It is very important to eat about 500-700 calories a day and at least 60 grams of protein as the proteins take an important role in your recovery. You should eat small and frequent meals; your new stomach can only hold about an ounce at a time. It is also very important to drink enough fluids to prevent dehydration.
A Few Extra Tips:
Stage 3: Soft and healthy foods
After about 6 to 8 weeks you may introduce into your diet soft solid foods, it is important to continue to eat 4 to 6 small meals every day. Focus on high protein foods and avoid foods that are high in fat, sugar and fiber. You may start to introduce one solid food per meal every day depends how you can tolerate it and remember to chew well so the food will be nearly pureed by the time you swallow. Some examples of food items for this stage are: eggs, light yogurt, soft fish, lentil dishes and soup.
Stage 4: Solid foods
Eventually you will probably be able to eat most foods, just in smaller portions; however, you should be making healthy food choices including lean meat or vegetable protein incorporating fruits and vegetables as you can and avoiding junk foods. The volume you can eat will always be limited so choose foods wisely.
A few more tips that you will have to take into consideration permanently
Guest post by Dr. Jeremy Korman, M.D. at L.A Bariatrics within Marina Del Rey Hospital, a bariatric surgery center of excellence.
Successful post-op starts before surgery.
I love my job as a bariatric dietitian. One of the most rewarding parts of my job is seeing the post-op patients who have lost weight to become healthy and have a much improved quality of life. And a successful post-op starts with the work and commitment before surgery. Your program dietitian is part of the team at your surgeon's practice.
Working with your team from start through your years of follow-up means you are more likely to successfully maintain your weight loss by adhering to your lifestyle changes.
First – Nutrition Evaluation and “Training Camp”
One of the requirements prior to surgery is a nutrition evaluation. This visit will help educate you for lifestyle changes that need to happen and provide you with realistic expectations from the surgery. Working one-on-one with you, your dietitian can evaluate your needs and help with problem-solving. This time gives you a chance to practice the "mechanics of eating", as I call them and work on the recommendations recommended by your dietitian. She/he can be your guide, or coach, through the preoperative phase. I tell my patients that this pre-op stage is like the athletes' training camp. Athletes practice and practice some more before their season starts. This is your time to practice and practice some more because after surgery it is "game on."
After – Monitor and Support and a “Tune Up”
After surgery you may experience food intolerances, difficulties with the diet progression, meeting protein goals, taking your required supplements, and/or following the guidelines from your surgical practice. Your dietitian can access and monitor your nutritional adequacy and help prevent nutritional deficiencies. Someone before you has been down this road and working with your bariatric team can help you over the bumps in the road. Most often, your dietitian can a great support for you since she/he was working together with you from the beginning. All the changes to be made can seem overwhelming and your dietitian can help you make smaller, achievable goals to build upon. I also encourage patients who are doing well to come in for a motivational "tune up."
Help With Setbacks to “Get Back On Track”
Even long-term successful patients can run into trouble with slipping back into old habits. A crisis arises and it is easy to go back to using food for dealing with the stress, depression, or other emotional issues. Sometimes weight regain can keep you from keeping your follow up appointments. When you know you are in trouble, that is the time an experienced helping hand can work with you to get you back track to maintain success.
Support Groups Recommended to “Stay on Track”
Don't underestimate the power of support groups. You may have a great support system at home, but unless your family has had weight loss surgery, they may not fully understand the process and changes you need to go through. Ten studies totaling 735 patients reported on social support and weight loss outcomes and all found a positive association between post-op support groups and weight loss. I co-facilitate four support groups a month and those patients who remain involved are doing a good job of maintaining weight loss. For those I see in clinic who are struggling, attending a support group is one of my top recommendations.
Remember, your dietitian is the nutrition expert and support groups will keep you in contact with people who "have been there, done that." We all get by with a little help from our friends.
Vicki Bovee, MS, RD, Wellesse Bariatric Expert, is a registered dietitian with over 25 years experience in weight management with specialization in bariatrics since 2003.
American Dietetic Association. (2010, April 12). Registered dietitians play essential role in management of gastric bypass patients [Press release]. St. Louis, MO: Elsevier Health Sciences.
Livhits M, Et al. Is social support associated with greater weight loss after bariatric surgery?: a systematic review. Obesity Rev. 2011; Feb 12(2): 142-8.
It is well known that obesity is a risk for poor cardiovascular health. Hypertension, hyperlipidemia, diabetes, congestive heart failure, and stroke are common problems associated with obesity. Carrying excess body weight makes the heart work harder and this can cause structural changes and enlarge the heart.
Standard recommended treatment for poor heart health includes medications and weight loss. We know the weight loss can reduce blood pressure and cholesterol levels but how does bariatric weight loss surgery compare with traditional treatment to decrease cardiovascular risks?
Effects of Weight Loss Surgery on Heart Health – A Review
A review of the literature produced several studies and results from systematic reviews involving the effect of weight loss surgery and heart disease risk factors. Although several of the studies involved a small number of people, the results all point to a decrease in risk factors after bariatric surgery.
The Swedish Obese Subjects (SOS) study followed 2010 obese subjects who underwent bariatric surgery and 2037 matched obese controls who received the usual care. Surgery patients included gastric bypass, banding, and vertical banded gastroplasty. At 10 years after surgery, improvements were still noted for blood pressure, blood triglycerides, and diabetes. There were fewer cardiovascular deaths in the surgery group compared to the control group, 28 vs. 49 deaths. This study concluded that compared with usual care, bariatric surgery was associated with a reduced number of cardiovascular deaths and lower incidence of cardiovascular events in obese adults.
Research has shown that Bariatric surgery can significantly reduce risk factors
Cleveland Clinic researchers conducted a systematic review involving almost 20,000 patients who had weight loss surgery and examined 73 bariatric surgery and cardiovascular risk factors. Prior to surgery about 44 percent had hypertension, 44 percent had high cholesterol, and 24 percent had diabetes. After surgery 63 percent had improved blood pressure, 65 percent saw a decrease in cholesterol levels, and 73 percent had improvement in their diabetes at a mean of almost 5 years after surgery. In addition, the heart remodeled, or became healthier. Researchers in this study concluded that bariatric surgery can significantly reduce several risk factors for cardiovascular disease and can improve the structure and function of the heart in much less time than standard weight loss and/or medications.
The American Heart Association (AHA) made a statement in 2011 concerning bariatric surgery and cardiovascular risk factors. Read Here http://circ.ahajournals.org/content/123/15/1683.long#sec-23
Bariatric surgery is not without risks but the benefits to reducing cardiovascular risk factors warrants a discussion with your physician about possible surgery.
Vicki Bovee, MS, RD
Ashrafian H, Et al. Effects of Bariatric Surgery on Cardiovascular Function. Circulation. 2008;118:2091-2102.
Cleveland Clinic. Weight Loss Surgery Should Be Considered Life-Saving Procedure for Overweight and Obese Patients with Cardiovascular Risk Factors. Retrieved from http://my.clevelandclinic.org/media_relations/library/2012/2012-10-18-cleveland-clinic-study-finds-bariatric-surgery-reduces-heart-disease-risk-factors-and-improves-heart-function.aspx
Sjöström L, Et al. Bariatric Surgery and Long-term Cardiovascular Events. JAMA. 2012;307: 56-65.
Bariatric surgery and cardiovascular risk factors: a scientific statement from the American Heart Association.2011 Apr 19;123(15):1683-701. doi: 10.1161/CIR.0b013e3182149099. Epub 2011 Mar 14.Poirier P, Cornier MA, Mazzone T, Stiles S, Cummings S, Klein S, McCullough PA, Ren Fielding C, Franklin BA; American Heart Association Obesity Committee of the Council on Nutrition, Physical Activity, and Metabolism.
The research studies presented here are summarized from credible, peer-reviewed journals. Conclusive evidence about the effectiveness of any treatment is rarely found in a single, individual study. Anyone who is considering starting or changing a medical treatment should consult with their doctor.
If you’ve been given your BMI (body mass index) at a health fair or your doctor’s office and told what range you are in (underweight, normal weight, overweight or obese) or maybe even using an online tool, you may be left wondering if there’s more to health than just BMI. And, indeed there is.
BMI is most often calculated from a person’s height and weight. BMI = ( Weight in Pounds / ( Height in inches x Height in inches ) ) x 703
This formula was developed as a quick and inexpensive way to assess overweight and obesity in a population of people. And though the CDC says that BMI is a good measure for body fatness, it doesn’t measure body fat directly, it overestimates fat in muscular people and can underestimate body fat in older people who have lost muscle mass due to aging, inactivity and a protein-poor diet. I’ll be honest I dislike BMI because so many healthcare practitioners use it incorrectly. They tell someone where they fall on the BMI chart without explaining the limitations of this formula or taking other aspects of health into consideration.
Why you shouldn't use BMI alone as a measure of health
BMI shouldn’t be used by itself as a measure of health, overweight or obesity. First and foremost, musculature should be taken into account. A person with a lot of muscle will have a higher BMI though their body fat may actually be low. And secondly, other aspects of health should be considered before making an assessment of health risk based only on BMI. These aspects include but not limited to:
Other methods to measure body fatness include skinfold thickness measurements (with calipers), underwater weighing, bioelectrical impedance, dual-energy x-ray absorptiometry (DXA), and isotope dilution. However, these methods are not always readily available, and they are either expensive or need highly trained personnel. Furthermore, many of these methods can be difficult to standardize across observers or machines, complicating comparisons across studies and time periods.
According to the National Heart, Lung, and Blood Institute, anyone with a BMI in the overweight or obese range and two or more risk factors for heart disease, should lose weight. Even losing a few pounds can decrease risk. However, those who have a high BMI but a normal waist measurement and fewer than 2 risk factors need to focus on preventing further weight gain, rather than losing weight while also continuing healthy habits such as exercising and eating a nutritionally sound diet.
Calculate Your BMI. National Heart, Lung and Blood Institute. http://nhlbisupport.com/bmi/
About BMI for Adults. CDC http://www.cdc.gov/healthyweight/assessing/bmi/adult_bmi/index.html
If you want to change your direction
If your time of life is at hand
Well don’t be the rule, be the exception
A good way to start is to stand
Put one foot in front of the other
And soon you’ll be walking cross the floor
Put one foot in front of the other
And soon you’ll be walking out the door
Lyrics Jules Bass
It’s the end of January and I see the crowds at the gym are thinning out. All those well-intentioned resolutions are fizzling out. You may find yourself in this group or maybe you never got out the door to get started. It takes time to make physical activity a part of your normal routine and it doesn’t happen without some effort. Take time to go through the steps and you’ll find it easier to move more.
Step 1: What’s in it for you? Check off the benefits that apply:
Step 2: What gets in your way (also known as excuses)?
Schedule your activity time the same as you would schedule any other appointment or meeting. Look at your day. Where can you save some time to gain the benefits you checked? Try to keep it the scheduled time consistent. It is easier if you know you have a standing appointment with yourself at 6AM or 6PM.
Chances are your will feel more energized when you finish your workout. Get going and give it a good 10 minutes. If at the end of the 10 minutes, you are still too tired, then you can stop.
No exercise experience
Walking is fine and it something you know how to do. You can have the American Heart Association develop a walking program for you after taking a short quiz at http://www.StartWalkingNow.org If you're going to the gym, find a qualified personal trainer to set you up with a tailored program. Learning the proper technique and form greatly reduces the risk of injury.
Find a workout partner, one who won’t let you off the hook. When you make a commitment to be there you are more likely to show up.
Step 3: Choose an appropriate activity
Select something you enjoy doing and that is within your fitness level. Walking, Biking, golfing, weight training, yoga, martial arts, swimming, and the list goes on.
Step 4: Set realistic goals.
It sure can be discouraging if you set yourself up to fail from the start. If you are just starting out, you might want to schedule 3-4 days of activity a week rather than 6-7 days. Start walking before you start jogging.
Step 5: Track your progress
Log your minutes of activity. Compete with yourself to increase your time until you reach your goal.
So as the song goes, put one foot in front of the other and soon you'll be walking out the door and on the road to better health.
Guest Post by Vicki Bovee, MS, RD and Bariatric Expert.
You have had Bariatric Weight Loss Surgery, now what?
One of your next big challenges is learning portion control. You will systematically measure out your food for each meal, use one of the new measuring containers or serving ware available, or get really good at eyeballing what the portion size should be. The last is really hard to do for any of us since the typical American diet is not anywhere near a correct portion size. It is something we could all stand to learn – surgery or not.
Here are a few tips to get you started on your learning journey. Your physician will give you information through your process and you will likely receive a set of measuring cups after you surgery to help measure out the food you should be consuming at each meal.
Food portion: 4 oz. of food.
Your physician will direct you when it is safe to move to more solid foods after surgery. When you start eating more solid food your meals should consist of no more than 4 oz. of food at each meal. Your new measuring cups will help you measure out exactly 4 oz. This sounds relatively simple but most people have tended to over-fill the cup because they are not sure how to visualize “enough.” How much is 4 oz. of food anyway? For example a serving of meat or fish will be the size of a deck of cards. Visualize a domino piece, which will be your one oz. serving of cheese. You could also purchase a small scale to weigh your food.
Photo source: ultimatefitnessbreakthrough.com
Why is the measurement so critical? If you don’t measure out your food correctly many bariatric patients will experience a “dumping” after eating. This means you may vomit from eating too much and the pouch fills to overflow and the extra has to come out. This may happen frequently until you get used to the portions. Certain foods may also trigger this especially those high in sugar or fat. Be sure to ask the doctor what foods to avoid especially at first.
Tools that have been designed to help you measure your food:
Foods to avoid:
Take Your Supplements!
Be sure to always take your recommended vitamin and mineral supplements. Because a portion of your small intestine is bypassed after surgery, your body won't be able to absorb enough nutrients from your food. Talk to your doctor and nutritionist to find out what supplements you will need to take probably for the rest of your life such as multivitamin and calcium. The ASMBS offers guidelines for how much you will need for each type of surgery. Liquid supplements are a great alternative as they absorb easily and do not need to be digested in the stomach.
You too the biggest step and had surgery so now make sure to use these suggestions and those of your physician and support groups to heart to take the next steps that are necessary for success. If you are used to inhaling your food or mindlessly eating you will need to re-program your eating behavior to make sure you set yourself up for success after your surgery. Set yourself a nice pleasing table, set down and relax and stop eating as soon as you feel full to avoid getting sick.
Feel proud as you see the pounds melt away and know you are setting yourself up for a healthy lifestyle with your commitment to a healthy eating pattern. Don’t worry if you have a few setbacks – that is normal. Join a support group either in person or online like www.bandedliving.com or webinars to help you get back on track. Or attend a great event such as the upcoming WLSFA Meet and Greet in May in Vegas and meet Carnie Wilson!
Featured Speaker Carnie Wilson, Sponsored by Wellesse Liquid Supplements!
While there are plenty of potential routes to go with bariatric surgery, the process of preparing for weight loss surgery is fairly uniform for most patients. Your surgeon will provide specific instructions to follow, however the general preparation can be broken down into four core categories: meeting with specialists, lifestyle changes, “the week before” and “the day before.”
Meeting With a Variety of Doctors and Professionals
There are a number of healthcare professionals you will meet with during the process of preparing for weight loss surgery. Depending on your health, you will meet with some combination of specialists, including a dietitian, psychologist, cardiologist or pulmonologist to ensure the surgery is appropriate and can be accomplished safely. The nutritionist and psychologist will help you manage your post-surgery expectations and implement healthier eating and lifestyle habits.
When preparing for weight loss surgery, there are a handful of lifestyle changes you may be required to make. You should stop smoking at least six months before the surgery and reduce your caffeine intake. Many surgeons will also ask you to lose 10-30 pounds before the bariatric surgery to ensure you are serious about keeping the weight off. Also make sure you sure you have plenty of psychological support both before and after surgery. Having support to keep you grounded and in check is essential.
The Week Before
The week before the bariatric surgery includes a variety tasks to complete. The most common steps include:
• Purchasing post-surgery supplies. This typically includes a variety of nutritional supplements such as calcium and vitamin D3 and a Multivitamin, bandages, Neosporin and certain types of easy-to-eat foods.
• Find someone to drive you home and help out for a few days. After your surgery, you aren’t going to feel like doing a whole lot. Make sure you have a friend or family member who can drive you home. They should also be available for a few days to help out as needed.
• Fill all postoperative prescriptions. Nothing is worse than getting home after bariatric surgery, only to realize you forgot to fill your prescriptions – especially your pain medication.
The Day Before
Effectively preparing for weight loss surgery ensures you don’t have to do much the day before. All you need to do is get packed. Your surgeon will give you a list of items to bring with you. Common items you will need to bring include:
• Comfortable clothes
• Insurance card
• Driver’s license
• List of current medications
• Lip balm
This list is not meant to be all-inclusive, so always talk to your surgeon about any concerns or questions you may have. If you’re preparing for a weight loss procedure, best of health and good luck in your new healthier lifestyle to come!
by guest blogger Jason Knapfel who manages web content for Oregon Weight Loss Surgery in Portland, Oregon.
Guest post by Vicki Bovee, M.S., R.D., L.D., a registered dietitian with over 25 years experience in weight loss, weight management, and specializing in bariatric nutrition since 2003.
As we approach the final few weeks of the holiday season, it's a good idea to check in with the scale to see how you are doing with your weight management goals. So how much weight do we gain over the holidays? Well, you can't believe everything you hear or read. We often hear that Americans gain anywhere from 5 to 10 pounds. Where did this number come from? Did you know this is a popular belief without any scientific basis?
Average Weight Gain is One Pound but More for Those Already Overweight
There is actually one study that measured weight gain from mid-November to early January and it dispels the myth of the significant holiday weight gain. In a study published in 2000, 160 people were weighed before Thanksgiving and after New Year's. The average weight gain was less than 1 pound. Less than 10% gained more than 4 pounds. However, those who were overweight or obese had a significant weight gain of about a 10 pound average.
Unfortunately, It Stays All Year
Now a 1 pound weight gain probably doesn't seem too bad but the problem was that these people never lost it over the year. In, fact they gained about another 0.4 pounds when they were reweighed the following September. If they made New Year's resolutions to lose weight, they didn't follow through. So the weight that was gained over the holidays stuck around and the researchers concluded that holiday weight gain contributes to the gradual weight we experience as we age.
From this study it would seem to be prudent not to gain weight over the holidays. There are still several weeks left to stay focused. If you have had bariatric surgery, you are not immune from weight gain especially if you are more than a year post-op. Be choosey about holiday treats. On those days when you don't have a party or holiday meal, toe the line and stay on track. It's much easier to stay on track if you don't veer too far off.
Vicki Bovee, MS, RD
Reference: Yanovski JA, et al. A Prospective Study of Holiday Weight Gain. New England Journal of Medicine, 2000.
by guest blogger Jessica Tyner a freelance writer with Webfor, who manages web content for Northwest Weight Loss Surgery, a bariatric surgery clinic in Everett, Washington.
Only a small sliver of the population understands what you’re going through. The decision to undergo weight loss surgery is serious. It comes with risks, sometimes a significant financial burden and severe changes to your body. Some people think that because the changes to their body are positive, there aren’t any residual psychological effects.
It’s equally important to have psychological support both before and after surgery. While friends and family are likely well-meaning, they don’t have the professional background to support you. You need to know that you’re choosing surgery for the right reasons. Afterward, it’s wise to have a pro in your corner as you adapt to your changing body.
Getting to the Root
Consulting with a therapist or psychologist can help you determine if surgery is indeed what you want. Many people think they understand the implications, but it’s very different when your surgery is around the corner. While you might know, on the surface, that there’s no magic surgery to change your life, your subconscious might think otherwise. I know exactly how you feel.
I lost over 100 pounds in less than a year via diet and exercise. This extreme amount of weight loss resulted in loose skin that called for four major surgeries to remove. It took me seven years to get the surgery. I had it done while living abroad in Central America with no one to talk to before or after.
Rallying the Troops
It wasn’t until long after the surgery that I understood how much easier it could have been. Prior to the surgery, there’s likely a part of you that hopes you’ll wake up one day soon with a new body. This isn’t realistic, and you might be disappointed when it doesn’t happen. The fact that you’re still you is unchanging.
It’s important to have a strong support system of your own. A significant other, close friends and family members can all help. Unfortunately, they might not always support you 100 percent. This is where a non-biased, informed professional steps in.
Some Things Never Change
Even after you’ve reached your goal weight, there will be times where you’ll slip. You might find yourself shopping in the XL section when you’re now an S. You might not recognize yourself when you catch a glimpse in a mirror. Coming to terms with who you truly are, including your changes, is critical.
It can be easy to lose yourself during your transformation. Having support to keep you grounded and in check is essential. This can be a journey of great discovery and joy, but it also has frustrating detours. Remember that preparation demands the right support network, so plan accordingly.
Guest post written by board certified bariatric surgeon Dr. Jeremy Korman, M.D., the medical director of L.A. Bariatrics weight loss center at Marina Del Rey Hospital, serving greater Los Angeles area.
Technological innovation and constant development is at the heart of success in the medical field and this is no different when it comes to bariatric surgeries.
The surgical techniques and procedures performed today to address morbid obesity and to treat the high risk health conditions associated with it, have evolved over the years; while also new, less invasive methods are being developed and introduced. Minimally invasive surgery with modern laparoscopy makes possible faster recovery times, minimal to almost no scarring, reduces chance of infections and makes the majority of weight loss surgeries available at outpatient facilities.
The STARR Treatment Offers Rapid Recovery
One of the innovative tools available for bariatric surgeons today is called the "SPIDER", a flexible laparoscopic device that allows abdominal surgeries to be performed through a small single incision. The STARR treatment, or "surgical tiny access and rapid recovery", as it is known in the bariatric field, gives surgeons improved dexterity and offers patient's fast recovery times and with almost invisible scarring. The surgical team at L.A. Bariatrics, a weight loss surgery center located at Marina Del Rey Hospital in California, with office locations across Beverly Hills, Los Angeles, Tarzana and San Pedro, have successfully adopted and are using this revolutionary medical tool to offer patients the most efficacious surgical options available today. With the passing of time the experience of the surgeons is also getting higher and that plays a crucial role in obtaining positive outcomes for patient's battling obesity.
Weight Loss Surgery is Only a Tool Not the Solution
Bariatric surgery, however, shall never be confused with a "magical solution" and thought of as the easy way out. It may "be the most effective and long lasting treatment for morbid obesity and many related conditions" as stated by the American Society for Metabolic and Bariatric Surgery, but still requires commitments to developing and maintaining healthy habits from patients too. Dietary changes are required after weight loss surgery and for long term success regular exercise must be introduced in the daily/weekly routine.
To be successful on a bariatric weight loss journey support is always available, from the weight loss clinic's nutritionists and skilled medical team, through support groups and seminars organized by the clinic and from a highly active and supportive online WLS community. On a bariatric journey you are never alone.
Guest post by Vicki Bovee, M.S., R.D., L.D., a registered dietitian with over 25 years experience in weight loss, weight management, and specializing in bariatric nutrition since 2003. www.chefdave.org
Rates of diabetes cases has tripled the past 30 years according to the Centers for Disease Control and Prevention. For many of the bariatric patients I see, the possibility of "getting rid of" their diabetes and its accompanying medications is a huge motivator.
Doctors have noticed for some time that their gastric bypass patients were experiencing remission of their diabetes, and for some patients it was before they left the hospital after their gastric bypass surgery. In a study conducted in Rome, patients who had gastric bypass surgery had a remission rate of 75%. Although it was a small study, the results are worth noting. In another study The Cleveland Clinic conducted a study comparing gastric bypass, sleeve gastrectomy, and intensive medical therapy and their effects on diabetes. Both surgeries showed remission but the gastric bypass had a slightly higher rate, and both surgeries showed far more improvement than medical therapy alone.
We know that diet and exercise alone or medications cannot produce these results. It is the changes in the anatomy from the surgery that alter gut hormones and affect the metabolism of fats and sugars. The American Diabetes Association sponsored two studies to further investigate. These studies concluded was that there is an increased amount of certain kinds of circulating amino acids (protein building blocks) that are linked to insulin resistance and cardiovascular disease. Gastric bypass surgery reduced the levels of these amino acids significantly so that remission occurred.
Is gastric bypass surgery for every diabetic? Probably not, but if one has uncontrolled type 2 diabetes and a BMI over 35, it is certainly worth investigating. Yes, one can improve diabetes control with weight loss, but not to the same extent as with gastric bypass surgery. From my personal observations of my patients, "getting rid" of their diabetes was worth the time, effort, work, and expense of the surgery and they would do it again in a heartbeat.
Vicki Bovee, MS, RD
Schauer PR, e. a. (2012). Bariatric Surgery versus Intensive Medical Therapy in Obese Patients with Diabetes. N Engl J Med366:17 .
American Diabetes Association. (2012). Changes in Amino Acid Levels Following Gastric Bypass May Improve Diabetes. www.diabetes.org/news-research
by Guest Blogger, Jason Knapfel who manages web content for WeightWise Bariatric Program, based in Edmond, OK.
The Cleveland Clinic has just released its top 10 medical innovations for 2013 and bariatric surgery for diabetes control is at the top of the list. Though weight loss surgery is not a recent medical innovation, the added benefit of controlling diabetes is a relatively new discovery.
The impact weight loss surgery can have on healthcare in 2013 and beyond is significant, not the least of which is affecting positive change in the diabetes epidemic. This will be aided by the fact that both public and private insurance programs are covering weight loss surgery, in part because of its proven effectiveness in controlling type 2 diabetes, the most common form of the disease.
"Bariatric surgery has been around for a while. The reason it was chosen as the top innovation is because Medicare has broadened its indication for payment, and Medicaid in many states follows Medicare,” says Dr. Michael Roizen, the Cleveland Clinic's Chief Wellness Officer. “A lot of the other (private) insurance companies started covering it, so it's much more accessible."
The Cleveland Clinic announcement conveniently coincides with American Diabetes Month, the annual campaign by the American Diabetes Association (ADA) that raises awareness of the disease.
Diabetes is one of the biggest health threats facing Americans today. Here are some staggering statistics to consider:
- Nearly 26 million children and adults in the United States have diabetes. According to the Centers for Disease Control and Prevention, that number has tripled over the last 30 years.
- An additional 79 million Americans have prediabetes and are at risk for developing type 2 diabetes.
- The ADA estimates the total national cost of diagnosed diabetes in the United States is $174 billion.
What the Cleveland Clinic has done with their announcement is to highlight an important, but sadly overlooked, benefit of weight loss surgery. It’s not just a matter of losing weight and making patients feel better about themselves (both perfectly great benefits!), but bariatric surgery can be an important tool in preventative care and saving significant healthcare dollars over the long haul.
Guest post by Vicki Bovee, M.S., R.D., L.D., a registered dietitian with over 25 years experience in weight loss, weight management, and specializing in bariatric nutrition since 2003. www.chefdave.org
In the 1990's we had the lowfat/fat free diet craze. In 2002, Dr. Atkins launched his revised low carb diet and the food manufacturers flooded the markets with low carb and no carb products. Now our grocery stores are stocking the shelves with gluten-free products and many people are paying more for these foods with hopes of losing weight and/or feeling better.
Clearly there is a need for gluten-free products for people who have Celiac disease, gluten sensitivity, or gluten intolerance. The number of people who have been diagnosed with these intestinal disorders has risen in the past 50 years, and for these people it is a blessing to have a wide variety of gluten-free products to choose from.
Gluten-free does not necessarily mean healthy or low in fat and calories
But there is no published data to support weight loss claims for eating gluten-free. Gluten-free does not mean calorie free or low calorie. Many of these products are just as high in calories as their wheat-based counterparts. The fat and sugar is still there. The wheat flour has been substituted with another grain, such as rice. These products are also typically more expensive than the gluten containing products.
Gluten-rich grains may have health benefits by creating healthy colon bacteria and may protect the gut from some cancers, inflammatory conditions, and cardiovascular disease. One of the components in gluten may help control blood pressure.
Some people eat gluten free because it makes them feel better. In some instances it is because they are eating less processed and refined foods and more fruit and vegetables. Personally, I think as long as someone is eating healthier and making better food choices, it's not important if they are eating gluten-free (unless they have Celiac or are gluten sensitive and must eat gluten free). But is important to remember that a gluten-free diet is not a weight loss diet and is of no significant benefit to the general population.
Vicki Bovee, MS, RD
Gaesser GA, Angadi SS. Gluten-Free Diet: Imprudent Dietary Advice of the General Population?, Journal of the Academy of Nutrition and Dietetics, 2012.
Weight loss surgery may seem like a magic bullet but unfortunately many people gain the weight back. In fact, a study published in the Annals of Surgery found that 20.4% of morbidly obese and 34.9% of super obese patients gained their weight back within 10 years after surgery. What can you do to minimize your chances of gaining weight back? When you commit to the surgery make sure you commit to making a lifestyle of balanced healthy eating and exercise so your efforts and investment in yourself are successful.
Weight Loss Surgery is Not the End
Just because you had surgery, you still need to fix the underlying behavioral patterns that caused the weight gain in the first place.
Ann Surg 2006; 244(5): 734–740.
National Institute of Diabetes and Digestive and Kidney Diseases