The Coastal Center for Obesity FAQ area is designed to help with
pre and post-op patients concerns. The Ask The Expert Area, and
the Exercise Training areas also contain valuable
information to the pre and post-surgery patient.
Should I stop my medications before surgery?
Some anti-inflammatory medications make bleeding more of a problem and if they can be discontinued without too much discomfort a week or two preoperatively it is desirable.
Should my bowel be cleaned out before surgery?
Some surgeons believe that a ‘bowel prep’ decreases constipation after surgery and makes managing a colon injury safer. In my experience colon injury is extremely rare and constipation is not a post-surgical problem. Therefore I do not recommend cleaning out the bowel prior to surgery.
Can I shower after surgery?
The reason for not showering after surgery is fear that infection will be introduced into the wound. However nearly all wound infectins come from bacteria present at the time of surgery and the incision itself is sealed within hours after surgery. It is probably even safe to get the intravenous site wet so long as it is reprepped and dressed after the shower.
Can I drive after surgery?
So long as discomfort does not prevent you from rapidly hitting the brake or steering effectively and you are not taking medications that impair your reflexes or judgment, it is safe to drive after surgery.
What happens to the bypassed stomach?
The only change that appears to be of clinical significance is a marked decrease in the production of ghrellin and a consequent marked decrease in hunger sensations.
Can I get pregnant after surgery?
As a generality weight loss increases fertility and improves the likelihood of a normal delivery. However, getting pregnant while rapid weight loss is occurring may not be safe and commonly results in less final weight loss.
How much time should I take off work?
If you have had laparoscopic surgery there are no limitations on your activity except the presence of a drain and your general energy level. Most people are quite ready to return to work in 10 days to two weeks, right after the drain comes out. When circumstances permit some people choose not to return to work until they feel completely ‘on top of their game’ again and they may take considerably more time off work than a week or two. Following open or incision surgery, heavy lifting must be avoided for eight weeks, Otherwise the timing of a return to work is as for the laparoscopic patients.
What about drinking alcohol after surgery?
The amount of alcohol absorbed before gastric bypass is limited to about 50% by the presence of an enzyme in the stomach which breaks down the alcohol before absorption. After a gastric bypass this enzyme does not come into contact with ingested alcohol and more is absorbed, so it is easier to get drunk. Also alcohol is a significant source of calories: 7 calories per gram as compared to 5 with carbohydrates or protein. After the adjustable band alcohol is digested the same as before surgery.
Are staples used during surgery and, if so, how?
Surgeons use staples much as they use stitches, to hold tissues together. Most abdominal surgery today makes use of both stitches and staples and the choice of which to use has more to do with the surgeon’s personal preference than anything else.
Are carbonated drinks bad after surgery?
There is no evidence that carbonated drinks expand the pouch or otherwise impair the surgical result. The bubbles make some people feel ‘gassy’ and that seems to be commoner after weight loss surgery.
Is diarrhea a problem after weight loss surgery?
The first weight loss procedure was an intestinal bypass and it commonly caused diarrhea. Diarrhea is not a consequence of proximal gastric bypass or the adjustable band. Some increase in the frequency of bowel movements may occur after distal gastric bypass.
Does weight loss surgery cause bad breath?
Weight loss and the breakdown of fats cause the formation of ketones which are volatile and are partially exhaled. The odor however is not unpleasant and has been likened to that of Juicy Fruit chewing gum. It is important however to maintain normal dental hygiene and to brush your teeth even when taking only a liquid diet; otherwise, bacteria accumulate on the tongue and between the teeth and can cause bad breath.
Will I lose more weight on some place of my body than others?
Yes. There is a general tendency for weight loss to occur from the head and neck first and thereafter from the upper body and abdomen but people differ and where you lost weight before is likely where you will experience the most weight loss again.
What about loose skin after surgery?
The amount of loose skin after surgery depends on the amount of weight loss, your age—younger skin is more elastic than older skin—and individual differences. When weight loss is rapid, skin tightening may continue to occur after weight loss has stopped. In general, if you have lost a lot of weight you are likely to have some loose skin and may want some plastic surgery to correct it.
What causes hernias?
Hernias occur where the abdominal wall is weaker and from increased intraabdominal pressure.
It is somewhat speculative but most incisional hernias probably occur with straining and coughing
while the patient is waking up from anesthesia. Patients waking from anesthesia are pain free so
when they strain their effort is not restrained. Sudden severe straining after surgery which happens
more quickly than can be modified by reaction to discomfort is another likely cause for hernias.
Examples include straining from falling, coughing, or vomiting. A sudden response to an unexpected
weight (child jumps into your lap) can also cause hernias. A smaller contribution to the development
of hernias can come from ordinary efforts that rely on abdominal musculature such as lifting and other
forms of exercise. Standard advice is that following open surgical procedures with abdominal incisions,
one should not lift a weight greater than 10 lbs for the first month and not greater than 30 lbs for the
second month. Risk of hernia after laparoscopy is so low that full activity can be resumed almost immediately.
What type of previous surgeries would prevent me from having laparascopic surgery? All
previous abdominal operations make abdominal laparoscopic surgery more
difficult but most do not force us to make an incision. A few, mostly those
on the upper stomach like previous weight loss operations, make laparoscopic
surgery so difficult that usually we find it is safer to make and incision in
order to do the surgery.
What is the significance of the drainage tube? With
regards to the drain: The amount of drainage is not of much significance. If
the drainage begins to look like oral intake that is of concern and should be
confirmed by drinking something blue or purple (food coloring or grape juice)
and seeing if the color appears in the drainage. If it does it should
occasion a call to the physician. Drainage or wetness outside and around the
drain tubing is usual and does not signify that anything is wrong, in
particular it is not a sign of infection. Redness extending more than two
inches from the drain site should be seen by the surgeon. The drain is
protection against a wound infection at the drain site and against the life
threatening consequences of a leak. Leaks are very rare after two weeks.
Removal of the drain before two weeks after surgery entails some extra risk.
Patients who want the drain removed early should consider the risk. About
2% of patients will develop a leak. It is ok to shower and get incision
sites or drain sites wet and soapy after surgery. The area should be dried
off afterwards and dressed if wetness at the site might stain clothing. A
temperature greater than 101 degrees is reason to call the doctor. Lower
temperatures are not usually of much significance. Patients often complain
that the drain site hurts and that relates to two considerations: First, the
drain is brought out the largest and therefore the most tender port site. Second,
the drain is sutured to the skin so that it will not be accidentally pulled
out and if it is not taped so that pulling on the drain does not pull on the
suture a good deal of discomfort can result from normal activity
What if I'm having constipation?
Constipation after
gastric bypass surgery is a common complaint. It is caused by decreased
food and water intake and, in some people, supplemental iron, or narcotic
pain killers, tranquilizers, and antidepressants. It is often aggravated by
weak abdominal muscles or busy schedules wherein people defer having a bowel
movement when the urge exists. Our approach is to provide the following
advice:
Do exercises that strengthen the abdominal muscles
and assist in bearing down. Most people experience the need for a bowel
movement after breakfast and that is the natural and easiest time to have a
bowel movement and should not be ignored. Increase water intake. An
increased intake of any vitamin except B12 and vitamin A tends to produce
diarrhea and has not significant other side effects and is helpful in
eliminating constipation. Especially useful in this regard is Vitamin C or
ascorbic acid since in addition to preventing constipation it enhances the
absorption of iron in Trinsicon or other forms. Next add fiber to the diet:
Eat high fiber breakfast (bran-based cereals, oatmeal) add vegetables to
other meals. Miller’s unprocessed bran found in the cereal section of
the grocery store can be taken with juice, or sprinkled into salad, meatloaf,
cereal, etc. The same thing can be done with Metamucil, or psyllium seed.
These are more expensive forms of non-digestible cellulose or fiber. The
water content of stool can also be increased with a stool softener, docusate
sodium, marketed as Colace, or Peri-Colace or P-Col-Rite. If the above
measures are still not correcting the problem the electrolyte laxatives such
as Fleet Phospho-Soda, Magnesium citrate, Milk of Magnesia, or Colyte, to
name a few, should be tried. Avoid laxatives that directly stimulate
the bowel smooth muscle eg. Senecot, as tolerance develops and more and more
is required over time.
What if I'm having gas?
Excessive air swallowing
is probably the commonest cause and may result from deliberately belching to
relieve a sense of fullness or from swallowing frequently as sometimes occurs
with anxiety and nervousness. A deliberate change in behavior is usually
effective. Simethicone, marketed as Gas X, helps reduce large bubbles of gas
to small ones and may relieve the cramping sensations. Nullo which is a
chlorophyll derivative also may be helpful.
After
gastric bypass, excessive dietary intake of fat increases intestinal transit
time and delivers undigested food to the colon. Food in the colon is broken
down by resident bacteria and results in a very malodorous gas. A
restriction of dietary fat intake may be sufficient to eliminate the
problem. Bismuth subgallactate marketed as Devrom (1-800-972-5184) is also
helpful. If the problem occurs soon after a distal gastric bypass, Pancrease—a
pancreatic enzyme supplement—taken with meals may be useful.
Milk sugar called
lactose is digested by an enzyme called lactase the production of which
declines with age and following gastrointestinal surgery. Lactase
tablets, drops and milk products with pre-added lactase are available.
Beans, cauliflower,
onions, broccoli and other vegetables contain complex carbohydrates
(oligosaccharides) which are broken down in the colon to form gas.
Beano contains
a-galactosidase
which helps to convert the oligosaccharides to simple sugars which can be
absorbed and gas is thereby prevented.
An
alteration in intestinal flora usually caused by antibiotics may produce
gas. Ultraflora—a bacterial preparation—may be given to repopulate in
intestinal tract normally. When the cause is fungal overgrowth, Diflucan (fluconazole)
may be effective. Flagyl is sometimes tried to suppress anaerobic bacterial
growth in bypassed portions of the intestine.
Other causes
are gallstones, diverticulosis, irritable bowel syndrome, and parasites, and,
rarely, cancer of the ovary or bowel.
Is hair loss typical? Hair
loss is commonly assumed to be due to lack of adequate dietary protein but a
clear cause and effect relationship is lacking. Nevertheless, one should
measure the prealbumin, and if it is low, increase protein intake.
Ephedrine is said to be effective in restricting protein weight loss and
enhancing fat weight loss. Hair loss due to dietary restriction is nearly
always temporary. Rogaine and Nexium shampoo have both been reported to be
effective and should be tried if the loss is excessive.
What is Coastal Obesity's relationship with physicians I already see?
If your physicians have doubts about bariatric surgery we provide literature and attempt to educate
them as to its merits. In any case we work with them to be sure that you are in the best shape you
can be so that surgery may be safely done. Afterwards we send them a summary of your surgery
and hospitalization with pertinent laboratory results and a letter describing your future needs
as a gastric bypass patient.
How is laparoscopic gastric bypass different than open gastric bypass? Laparoscopic gastric bypass is accomplished with 5 small incisions rather than one long incision.
A camera is placed through one of the incisions and long instruments through the others. The
operation is performed while watching a video screen. The actual operation on the stomach and
intestine is the same with both approaches.
The gastric bypass open incision is approximately 3/4 of the distance from the breastbone to the belly button. That is about 4-5 inches in some people and as much as 15 inches in others.
Is laparoscopic gastric bypass safe?
Many studies done by experienced laparoscopic bariatric surgeons have demonstrated laparoscopic gastric
bypass to be safe. Laparoscopic gastric bypass is technically demanding and studies show that the amount
of experience a surgeon has contributes to safety.
How does laparoscopic gastric bypass compare to open gastric bypass?
Laparoscopic gastric bypass results in a shorter hospital stay, less pain, less scarring, and a
quicker return to usual activities. Complications such as wound infections and wound hernias
are nearly eliminated with the laparoscopic approach. The risk for serious complications (such
as leak) is similar with both laparoscopic and open gastric bypass.
Why aren’t all gastric bypasses done laparascopically?
Laparoscopic gastric bypass is a difficult operation to learn to do safely. It also takes longer
and is more expensive. The result is that most gastric bypasses in the United States are done
open at this time. For most patients laparoscopic surgery is better (less pain, shorter hospital
stay, less scarring, quicker return to usual activities). As more surgeons learn to do
laparoscopic gastric bypass safely and patients demand it, more laparoscopic gastric bypasses
will be done.
Is laparoscopic surgery right for me?
Laparoscopic surgery is a good choice for most people. People who have had previous bariatric
surgery or surgery on the stomach are probably better candidates for the open approach. People
with BMI > 60 (more than 200-250 pounds overweight) may be better candidates for open surgery.
Can the surgery be reversed?
Yes, but it would take another operation. No one, in my experience, has asked to have the surgery reversed.
What are the main risks of surgery after gastric bypass?
Put simply the main risks are death and complications. Mortality risk reported across the US is 0.5% or
1 patient in every 200. By recent count our mortality risk is less than one patient in every 500 gastric
bypasses. The commonest causes for death are pulmonary emboli and infections. The commonest complications
are wound infections, strictures, and hernias. The risks after adjustable band surgery and after gastric
bypass are different (see Information Seminar). The major problems that occur with any frequency after
gastric bypass are 1) leakage from the bowel connection to the pouch, 2) pulmonary emboli, 3) bowel
obstruction or kinking, 4) bleeding, 5) stricture. The major problems after an adjustable band are
1) erosion, 2) slippage or herniation of the stomach up through the band, 3) pulmonary emboli,
4) esophageal dilatation.
What are the symptoms of a leak?
The symptoms can vary from sudden severe abdominal pain, weakness, chills, and abnormal
drainage to no symptoms and unusual looking material coming from the drain site. The
treatment depends on the severity of the leak but varies from no treatment, to
hospitalization and iv’s, to re-operation.
What are the symptoms of a pulmonary embolus?
Shortness of breath and pain on breathing. Treatment involves giving ‘blood thinners,’
anti-coagulants, and hospitalization.
What are the symptoms of a bowel obstruction?
Waves of abdominal pain, nausea and vomiting sometimes preceded by a loose bowel movement.
Treatment involves surgery, usually laparoscopic, and correction of the kink or obstruction.
What are the symptoms of a stricture?
A stricture or too much narrowing at the connection of the pouch to the intestine
is usually experienced as progressive difficulty with swallowing: first solid foods,
then soft foods, finally liquids won’t pass through. The treatment is endoscopy and
balloon enlargement of the opening.
How would I know if I was bleeding?
Bleeding usually occurs in the first day or two after surgery and is recognized
by a fast heart rate, weakness, paleness, and abnormal blood tests.
How is erosion recognized and treated?
If the band rubs on the stomach too much it can wear through into the lumen
of the stomach where it can contact swallowed food and saliva. This may result
in an infection which usually is seen as redness and swelling at the adjustment site.
Sometimes no infection results and weight loss and a sense of restriction disappear.
Treatment is removal of the band surgically. It can be replaced later or a gastric bypass
can be done later.
What happens if ‘slippage’ occurs?
Slippage usually occurs in the first two weeks after surgery and is experienced as vomiting everything
that is swallowed. It can be treated by taking the fluid out of the band and in most cases it can be
re-inflated in two or three weeks. Sometimes surgery is necessary.
How do I know if I have ‘esophageal dilitation’ or enlargement?
A difficulty with swallowing is the usual experience. It is corrected by deflating the band, taking
the fluid out, for a week or two. Sometimes the band has to be removed.
Are there long term risks after surgery?
Any abdominal operation sets the stage for a possible bowel obstruction the lifetime frequency of
which is approximately 8%. Vitamin and mineral deficiencies can occur if calcium, B12, and iron
supplements are not taken as prescribed. Less commonly protein deficiency can occur.
What are the risks of hernias after surgery?
Less than 1% after laparoscopic surgery and about 10% after the open procedure.
What is the risk of an ulcer?
Pretty small. We see one about every year or two.
Can I have a hysterectomy at the same time?
We do routine pelvic ultrasounds in patients who have not previously had a total hysterectomy.
When the findings indicate the need a gynecologic surgeon may scrub in and do the appropriate surgery
at the same time as the bypass.
Under what conditions is the gallbladder removed?
In patients who do not have gallstones at the time of surgery only 4% subsequently develop stones.
We therefore only remove the gallbladder in patients who have stones diagnosed before or during surgery.
In general we do not remove the gallbladder unless it is diseased or there is a strong family
history or gallstones and gallbladder removal.
Are there medications available for gallstones?
Yes, ursodiol is given to prevent gallstones in high risk patients. Because it
is expensive, we do not prescribe it for every patient.
How can stomach surgery cause me not to crave ice cream or mayonnaise?
Food preferences change for many patients after surgery; others have to make do with discipline.
The reasons for changes in food preferences are unknown.
I have irritable bowel syndrome. Will that go away after surgery?
Irritable bowel syndrome is neither improved nor worsened by surgery.
Will my sex life improve?
Not guaranteed, but it is a common experience.
What if my friends accuse me of taking the easy way out?
You and your friends should be aware that there is no easy way out. Surgery makes the discipline
of exercise and dietary control effective when it would not otherwise be effective. Obviously,
surgery also entails risk and the courage to take that risk.
Do all medications
need to be crushed after surgery?
Yes, with a few exceptions. Small tablets,
the size of the end of a pencil or smaller, will pass readily through the
pouch into the intestine and are not a concern. Examples include thyroid
medication, BDP's, and other hormone tablets. Many larger tablets may stop
in the pouch and sit in one spot, will slowly disolve. As some are quite
caustic, they will burn an ulcer, and cause pain that will last for days,
until the ulcer is healed. It is therefore important to crush them prior to
swallowing.
What is dumping?
Foods high in sugar and some fats will cause the intestine to release vasoactive chemicals which cause
sweating, flushing, weakness, fatigue, and sometimes abdominal cramps and diarrhea—a phenomenon
called 'dumping.' This is not a problem after LAP-BAND® placement.
Why is Trinsicon required? Why can’t I just get iron or B12 over the counter?
After gastric bypass but not after placement of the adjustable band (LAP-BAND®) absorption of iron, B12, and calcium is impaired and extra amounts need to be taken. Trinsicon is an iron, B12, folate and intrinsic factor combination which is simply a convenient
way to get iron and B12 which certainly can be taken separately and are available over the counter.
Calcium should not be taken at the same time as iron since they compete for absorption.
Iron absorption is enhanced if taken with vitamin C (ascorbic acid).
What is the reason for protein shakes after surgery?
The shakes ensure adequate protein and calorie intake after surgery which is important for healing
and other reasons. A liquid diet ensures that the pouch and opening will not be stretched early on
when that is more easily accomplished. The shakes also interpose a significant change between the
way you have eaten and the way we hope that you will eat in the future. Because the shakes are somewhat
monotonous when you switch to a low fat more healthy diet it is ‘tasty’ by comparison and therefore
more likely to be preferred in the long run.
How long do I have to take the shakes?
Four weeks; and it is a good test of your willingness to make some dietary changes. Taking the shakes for a week or two before surgery will shrink the liver and make surgery easier and safer. This is advised in some very heavy patients.
How long do I have to take vitamins?
A daily multivitamin is probably a good idea for everyone to take to prevent the fairly common and widely varied deficiencies seen as people get older.. The iron, B12, and calcium supplements should be taken for life, if you have had a gastric bypass, but are not necessary if you have an adjustable band(LAP-BAND®).
How much food can I eat after surgery?
The gastric pouch although initially very small has a hole in the bottom so that a reasonable amount
of food can be eaten if taken slowly. As time passes the pouch enlarges and where initially only one
or two bites could be taken without a sense of fullness, later a small adult meal can be consumed.
As it becomes possible to eat more food it becomes also more important to have developed good habits
with regards to food choices.
Are there specific foods or drugs that I should avoid after surgery?
Except for the tiny hormone replacement pills most tablets should be crushed after surgery. Foods high
in sugar and some fats will cause the intestine to release vasoactive chemicals which cause sweating,
flushing, weakness, fatigue and sometimes abdominal cramps and diarrhea—a phenomenon called 'dumping.'. What prevents wound infections? Wound infections occur because bacteria inevitably get into the wound
during surgery . Some types of bacteria may be difficult for the body to
eliminate. Also, local factors like variations in tissue blood supply, small
amounts of blood, sutures, and othe things beyond the surgeon or patient's
control, influence the likelihood of wound infection. Antibiotics are
routinely given and used to irrigate wounds. Wound infections occur about one
time in ten after open gastric bypass. They are quite unusual after
laparoscopic bypass because the wounds are much smaller.
Is it possible to rupture the staples after surgery?
Vomiting may sometimes cause a tear and a leak, but usually does not. After
about three weeks it is nearly impossible to rupture the staples.
Why don’t people just keep losing weight until they get sick or die?
Everyone who has gastric bypass surgery has a strong genetic capacity to use calories efficiently.
So it is always possible to provide high calorie foods and induce weight gain. In practice what
happens is that with time people are able to eat more at a time, they lose weight and require fewer
calories just to move around and their metabolism becomes even more efficient that it was preoperatively.
How can I prevent stretching out my new stomach?
Don’t eat after you feel full.
Does surgery affect how well I absorb my medications?
Generally speaking not, but with certain medications it may be wise to check blood levels after surgery.
Can I drink carbonated beverages after surgery?
They may make you feel gassy, but I know of no other problems. They idea that they may stretch the
pouch seems to me illogical, since no real pressure buildup can occur when both ends are unobstructed. Try blowing up a balloon with a hole in the end; it is impossible and similarly it is impossible to distend your pouch unless the inlet and outlet are completely obstructed.
How long before I can go to work? Exercise? Drive a car? Have sex?
We advocate walking and light weight lifting immediately after surgery.
If you've had laparoscopic
surgery you can lift weights immediately. If you've had open surgery, do not
lift more than 10lbs for the first six weeks. After that, you can increase to
30 lbs. for 2 weeks and no limit after 8 weeks. This is because hernias
almost never occur after laparoscopic surgery, but are quite common after
open surgery with an incision. It
is unlikely that effort that does not cause abdominal pain will affect the
likelihood of hernia. Similarly, if you can hit
the brake hard without discomfort and are not taking painkillers then it is ok to drive a car.
The discomfort standard should be applied to sex as well: if it doesn’t hurt, go for it.
Will I ever eat normally again?
It depends on what you mean by normal. Many overweight people eat more and make higher calorie
food choices than the rest of the population. So it is possible that you were not eating 'normally'
to begin with. After surgery although you can eat small amounts of anything, we hope that you will
choose low fat foods for the most part. Also you will in general consume fewer calories than someone
your size who was not previously overweight. Your could eat frequent small amounts of high calorie
foods and gain your weight back.
What kind of exercise should I do after surgery?
We advocate increasing two kinds of exercise as part of a post surgical lifestyle change: 1) Increase
the difficulty of unscheduled everyday activities. For example, try to walk farther—a pedometer is
helpful in this regard—climb the stairs instead of taking the elevator; volunteer for small tasks that
you might not otherwise choose. 2) Schedule workouts two or three or four times a week simply for the
purpose of exercising. Although any activity is helpful, weightlifting is the most efficient for extra
weight loss.
How soon after surgery can I bathe or shower?
Infections virtually always come from bacteria present in the wound at the time of closure. Wounds
seal to the outside within hours after surgery so it is safe to bathe or shower the next day. Similarly,
iv and drain sites can be cleansed and redressed with minimal likelihood of infection.
What will the support group do for me?
It provides people with similar experiences to use as a sounding board for common problems.
Like Church attendance serves to remind you to behave morally, support groups serve as a reminder
to maintain a healthy lifestyle. Support groups can also educate you in what constitutes a healthy
lifestyle.
What if my overweight friends reject me?
This is a difficult area. If you change your activity and dietary behaviors so as to be more healthy
you may at the same time change what you had in common with your friends. Moreover, what you do may
be threatening to them. In some cases it may be easier to find new friends. The support groups can
help you make the change.
How about my scar? Can I make it go away or become smaller?
Except for using steroid injections to stop keloiding I have heard of no tested way to diminish
scarring, but lots of remedies are tried and perhaps some work. In any case it seems harmless to try.
Will I need plastic surgery after I lose weight to remove loose skin?
Whether plastic surgery is desirable depends on how old you are (skin is less elastic with age) how
much weight you lose (the more the more skin) and individual differences in elasticity. Loose skin
bothers some more than others, but there is nothing shameful about wanting to look your best and we
will try to help anyway that we can.
Getting rid of loose skin requires plastic surgery, some types of which we do ourselves.
Does exercise help prevent loose skin?
Exercise is wonderful for many things but unfortunately does very little for loose skin.
What causes some people to regain their weight?
Most often it is forgetting that weight control is a lifelong project. But obviously the genetic
pressure to gain is greater in some than others and although we cannot currently recognize it the
surgery may be better for certain types of obesity than it is for others.
ADVICE ON ACCELERATING EARLY WEIGHT LOSS, MAINTAINING
AFTER WEIGHT LOSS AND REVERSING LATER REGAIN
Current understanding is that the tendency
to gain weight is largely genetic with a whole lot of modifiers or triggers
like upbringing, stress, advertising, etc. Not surprisingly, short of
genetic re-engineering, to effectively lose weight and maintain, it takes
surgery and a lot of personal effort. In my opinion, the main component
responsible for roughly 50%-60% of weight loss is the surgery. Weight loss
in the first 10 to 12 months after surgery is much easier than later on and
can be accelerated with dietary discipline and exercise. In general you lose
weight in the first ten to twelve months and not much thereafter, so it is
worth making an effort to maximize the early weight loss and not test the
surgery with dietary lapses as many poorly committed patients do.
Another 20%-30% of weight loss is due to a
combination of dietary discipline, exercise, and behavior modification:
Dietary discipline means making a
consistent effort to maintain a very low fat diet. Ideally it means three to
five protein and produce meals a day and no ‘grazing in between’. Trying to
be a vegetarian, eat no salt, and avoid sugars, noble as it sounds, distracts
from avoiding fats and processed carbohydrates and is likely to be
counterproductive. Replace high cal snacks like cheese, nuts, crackers,
seeds, with proteins like shakes (Carnation non-fat breakfast, Trader Joe’s
soy protein, HMR, etc), hard boiled eggs, jerky esp turkey, non-fat milk,
non-fat yogurt, non-fat cottage cheese. Other snacks like baby carrots,
lettuce with salt, fruits etc are low calorie and crisp substitutes but not
as satisfying as proteins. Chocolate cravings can be managed somewhat with
bananas or other fruit dipped in chocolate syrup—it makes a little chocolate
ago a long way.
Exercise, exercise, exercise is the mantra
of long-term success and short term weight loss acceleration. It should be
one of life's rituals like showering or combing one's hair. If you have
never exercised, pick any activity schedule it and try to increase the
intensity and duration. Any exercise that you can do week in and week out is
desirable but the best exercises are muscle building. Muscle has a higher
resting energy expenditure than many other tissues and an increase in muscle
mass, most effectively produced through weight lifting, can elevate resting
energy expenditure for days rather than hours as is true with other forms of
exercise.
Behavior modification in practical terms
means struggling with your habits and inner demons. It is going to support
groups to remind yourself that obesity is a chronic illness that requires
lifelong attention. It is sessions with a counselor of your choice to
discover and deal with the reasons you eat. It is part of your prayers and
it is helping others to find a means to lose weight.
Psychologic counseling: An occasional
patient will be losing weight quite satisfactorily and then without
explanation begin to sabotage the process. An underlying anxiety with
regards to the danger—often sexual—of being thin may be the cause and can be
helped with counseling. Other causes of an emotional nature are not uncommon
and counseling is often helpful.
Fine tuners: Five to ten percent of weight
loss can be ascribed to a number of `fine tuners' some of which can become
habits while others can be used when regain threatens:
Pills. Chromium may be particularly
helpful to diabetics but is also of some small benefit to others. Two
hundred micrograms three or four times a week appears safe and may aid in
weight loss. DHEA in people over fifty has beneficial immune stimulation
properties and may help slightly in weight loss and body fat
distribution. Anorectic medications like phentermine have a role if
you aren't where you want to be and some appear to be safe for long term
administration. Ephedrine although victimized with a lot of bad press is
inexpensive, relatively safe, and a very effective way to increase metabolic
rate and decrease appetite over the long haul. Feeling like you had too much
coffee is an early side effect that disappears after about 8 weeks. The
metabolic effect increases slowly for at least one year.
Eating behaviors. If you must snack choose
a protein. Hardboiled eggs, jello as a drink, deli turkey or beef jerky
provide longer periods of freedom from hunger and lower your metabolic rate
less than do other foods. High paid models drink lots of water to turn off
hunger and the same technique is available to the rest of us. Coffee, and
tea may be better choices even than water as they contain caffeine and
theophylline which speed the metabolism and increase the rate at which
calories are burned and therefore promote weight loss. Unprocessed bran
mixes well with juices, salads, cereals, meat loaf casseroles, pastas etc.
and it prevents constipation, diverticulosis, and colon cancer as well as
lowering cholesterol and decreasing appetite.
Casual exercise, the stairs instead of the
elevator, kind of exercise is always available and an excellent habit to
acquire. If you are desk bound all day long, do five minutes of isometrics
two or three times a day against the desk even just flex and hold; it's
exercise and it is every bit as effective as exercise that moves you if done
for the same amount of time. A pedometer can be very useful as a means to
recording and increasing the total number of miles you walk every day.
Self-analysis. If you are tending to
regain, start a diary and record your intake. Analyze what you eat: some
innocent looking foods are actually quite high in fat and therefore
calories. Examples include many crackers, nearly all cheese, nuts, and grain
bars. Look at where you store what you eat. Do you keep it in your desk or
somewhere quite handy or is some effort necessary to make it available? If
stress is making you eat, identify the stressor and find ways to eliminate or
reduce the stress. Nothing invigorates like a few decisions even if some of
them are wrong and have to be changed later.
When is it safe to get pregnant?
Ideally, pregnancy should be delayed until weight loss is maximal, usually around 12 to 18 months
after surgery. Weight loss makes women more fertile and decreases the likelihood of complications
related to pregnancy.
It is safest to get pregnant after weight loss is complete as there is some
theoretical risk to the fetus with rapid weight loss
How much weight should I gain?
Enough to account for the baby, the placenta, and some amniotic fluid—about 35 lbs. Ask your obstetrician.
Will I be able to lose my pregnancy weight?
Excess weight is hard to lose. It is best to gain only
the amount necessary for a normal baby and
pregnancy.
How long after surgery before it is desirable to think about cosmetic surgery?
Results are best after weight loss has maximized—12 to 18 months after surgery.
Will I lose hair after surgery? If I do will it come back?
Hair loss is common and has never been conclusively related to any particular deficiency although
many suspect that protein intake is important. If you do not have an ongoing tendency to baldness,
it will all come back.
I don’t have a support group where I live. What is the best way to stay in contact?
It is very important to try to follow up with us at least once and better twice a year. At those
times support groups can also be attended. We don’t cure the tendency to gain excess weight; we manage
it with discipline, support groups, accountability and sometimes adjunctive medications like ephedrine.
View Online Seminar
Attend a Free Seminar
Research
Presurgical Education
