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Indications: Weight loss surgery, also called bariatric surgery, is used as a last resort to treat people who are obese and if such a obesity poses great danger to the person's health(carrying an abnormally excessive amount of body fat). This type of surgery is only recommended to treat people with potentially life-threatening obesity when other treatments, such as lifestyle changes, haven't worked. Potentially life-threatening obesity is defined as:
having a body mass index (BMI) of 40 or above.
having a BMI of 35 or above and having another serious health condition that could be improved if you lose weight, such as type 2 diabetes or high blood pressure.
The relationship between BMI and Obesity is as follows:
Less than 20 - underweight
20 to 25 - normal weight range
25 to 30 - overweight
30 to 40 - obese
40 to 50 - morbidly obese
More than 50 - super-obese.
Indians are considered to have lesser muscle mass per kg body weight compared to the western population. Hence the standards of BMI and Obesity along with the values for potentially life threatening obesity varies in the Indian population. Your doctor is the best judge to suggest if you fall in the potentially dangerous bracket.
Treatments: The two most widely used types of weight loss surgery are:
Adjustable Gastric Band (AGB):
AGB works mainly by decreasing food intake. Food intake is reduced by placing a small bracelet-like band around the top of the stomach to restrict the size of the opening from the throat to the stomach.
Roux-en-Y Gastric Bypass:
RYGB restricts food intake. RYGB also decreases how food is absorbed. Food intake is limited by a small pouch that is similar in size to the pouch created with AGB.
Fig.1. Diagram of (A) gastric banding and (B) gastric bypass surgeries.
Do not eat and drink at the same time. Drink fluids 30 minutes after you eat food. Drink slowly.
Take a short walk. Do not lift any heavy things.
Do not wear tight clothing that rubs against your incisions while they heal.
Keep your dressing (bandage) on your wound clean and dry.
Do not shower until your doctor tells you to do so.
Take medicines as prescribed.
Things to expect at home: You will lose weight quickly over the first 3 to 6 months. During this time, you may have body aches, feel tired and cold, have dry skin, mood changes, and hair loss or hair thinning. These problems should go away as your body gets used to your weight loss and your weight becomes stable. You will need to be careful that you get all of the nutrition and vitamins you need as you recover.
Side Effects/Risks: Some side effects may include bleeding, infection, leaks from the site where the intestines are sewn together, diarrhoea, and blood clots in the legs that can move to the lungs and heart. Other side effects include nutrients being poorly absorbed, especially in patients who do not take their prescribed vitamins and minerals. Other late problems include strictures (narrowing of the sites where the intestine is joined) and hernias (part of an organ bulging through a weak area of muscle).
Typical follow-up schedule: By the time you leave the hospital, you will likely have a follow-up appointment scheduled with your surgeon within a few weeks. You will see your surgeon several more times in the first year after your surgery.
You may also have appointments with:
A nutritionist or dietician, who will teach you how to eat correctly with your smaller stomach. You will also learn about what foods and drinks you should have after surgery.
A psychologist, who can help you follow your eating and exercise guidelines and deal with the feelings or concerns, you may have after surgery.
You will need blood tests for the rest of your life to make sure that your body is getting enough important vitamins and minerals from food after your surgery.
Medical Instructions: As per doctor's instructions.
Typically, you are required to quit smoking much prior to the surgery. Post-surgery don't restart, as smoking delays recovery and increases the risk of complications like gall stones, ulcers, leaks etc. Call - the Quit Line, 1800-22-77-87.
Abstinence is the best policy
Alcohol is calorie-rich and can increase acid reflux which can aggravate the pain, discomfort and further complications.
Post-surgery can be a challenging period to manage emotions and mood swings associated with sudden weight loss. Find an emotional anchor - either a family member or a friend who can help you cope with the feelings.
Caffeinated beverages like colas, tea, and coffee arediuretics which can cause dehydration, leading to other complications. Caffeine is also known to hinder Calcium absorption.
After your doctor approves of exercise, adapt a moderately intense workout regime gradually increasing the intensity. It is important to exercise regularly to keep off the kilos.
Nutrition plan It is important to modify the diets post bariatric surgery. Since your stomach size has been reduced, the natural urge to eat and drink will also get reduced. Regular meals cannot be consumed for almost 2 months post-surgery, but it is extremely important to remain well-hydrated.
Sip 1 Cup of regular, plain water or unsweetened, non-carbonated fluid over one hour.
Consume about 2 liters of water/fluid in one day.
Don't drink any fluids 30 minutes prior to meals and 60 minutes post meals.
CHEW every bite for about 30 seconds or more before swallowing it.
Don't use a straw as unwanted air can get filled into the stomach.
No chewing gum.
Be sure to eat at least 55-70 grams of protein daily. Protein powders per meal should not exceed 25 grams.
Supplementation is crucial post-surgery -Multivitamin, Calcium citrate, Vitamin B12, Vitamin D
Restrict fiber rich foods such as fruits and vegetables for the Stages I and II.
Once you are in Stage III, avoid refined, sugary, high fat and processed foods. Include whole grains, poly and mono-unsaturated fats and gradually reintroduce fruits and vegetables. Make healthy, balanced and nutritious food choices.
Keep the food non-spicy, bland and non-fried.
Full liquid diet (1-2 weeks post-surgery)
- 1Cup Whey protein shake OR vanilla flavored protein powder made with water or Skim milk
- Unsweetened Jell-O OR Ice Lolly (Popsicle)
- 1 Cup strained Dal water OR strained, clear vegetable /chicken soup
Early Dinner Snack
- Unsweetened frozen lemonade
- 1 Cup strained coconut water OR Skim milk
Puree diet (3-6 weeks post-surgery)
- 1 Egg (Soft boiled) OR 1 Cup Oatmeal made with skim milk
- 1/2 Cup Sweet potatoes (boiled)
- 1 Cup Coconut water
- 1 Cup boiled Toor / Masoor/ Moong Dal
- 1/2 Banana (ripe)
- 1Cup well-cooked and pureed vegetables (carrots, beans, cauliflower, pumpkin) -OR paneer mixed with pureed peas.
- 1/2 Cup Skim milk
Regular diet (2 months post-surgery)
- 1 egg omelet made with soft vegetables OR Moong Dal dosa
- 1/2 Cup Potatoes/Sweet potatoes (boiled) OR1/2 Cup well blended Badam kheer made with skim milk
- 1 Cup Coconut water
- 1 Cup Toor/Masoor/Moong/Channa Dal
- 1/2 Cup Brown rice
- Fat free yoghurt
Early Dinner Snack
- 1 Cup Decaffeinated tea
- 2 Ragi CrackersOR1/2 Cup Papaya/Mango/Melon/Banana
- 1 or 2 Roti
- 1/2 Cup Vegetable curry
- 1/2 Cup Paneer curry
- Fat free yoghurt
- 1/2 Cup Skim milk
Life Long Instructions: Bariatric surgery is a big one to go through, but to have long lasting effects one needs to adapt a healthy lifestyle. After your doctor approves of a regular diet, eat balanced and nutritious diets. Eat foods that are low in saturated fats and cholesterol. Avoid refined, sugary, high fat and processed foods. Increase protein sources and keep yourself well hydrated. Stay away from caffeinated, carbonated and alcoholic beverages. Follow an exercise routine and make sure you never gain those kilos again. Do not smoke.
Eat Right and Exercise your way to a Healthy Body.