For People ConsideringWeight Loss Surgery
Who should consider Weight Loss Surgery?
What are the criteria for bariatric surgery for morbid obesity?
Obesity is very difficult to treat. Many patients have tried multiple diets, medications and exercise regimes with results that did not last. Surgery to promote weight loss by restricting food intake is an option for morbidly obese patients that have been unsuccessful with other weight loss treatments.
Eligible patients for weight loss surgery would usually have a body mass index, or BMI, of 35, or greater, however each patient is evaluated individually depending on medical co-morbidities. You can work out your BMI by dividing your weight in kilograms by your height in meters squared. Alternatively use the BMI calculator.
At Centre for Weight Loss we offer the following three options for Surgical Weight Loss. (The following is general information on these procedures. Please note that it does not take into consideration your specific circumstances.)
- Laparoscopic Adjustable
- Gastric Banding or Lap Band Surgery
Laparoscopic Adjustable Gastric Band (LAGB) or Lap Banding surgery is a popular option for weight loss surgery. This is a keyhole procedure requiring a short hospital stay and the insertion of a silicon ring around the upper stomach. This holds up the passage of food and creates a small pouch above it restricting portion size. There is also a profound effect in reducing hunger which is not yet fully understood.
Several weeks after insertion, the band is filled with saline by an injection through the skin on the abdomen into a chamber which connects via a tube with the band. This places extra pressure on the stomach and starts the process of dietary restriction and weight loss.
What are the risks and advantages of Lap Banding Surgery?
- Relatively simple and potentially reversible procedure
- The gastric band is fully adjustable
- Most patients lose 50-60% of their excess weight
- Good documented evidence of reversal of type 2 diabetes, hypertension, sleep apnoea and improvements in fertility in women
- Most patients stay overnight in hospital Risks Specific to the Gastric Band
- The gastric band specific risks of slippage of the band and a small risk of erosion into the stomach.
- A small risk of problems with the access port.
What is the follow up after Lap Banding Surgery?
- Most patients are discharged after an overnight stay
- Liquids are commenced after a swallow study (X Ray)
- For good long term success, patients are seen regularly in the clinic where the band is adjusted until a optimal stage is reached where the rate of weight loss is acceptable without being over restricted. Adjustments are more frequent in the first year.
- Some patients may not be suitable for a gastric band as they are not committed or able to attend the clinic regularly.
Laparoscopic Gastric Bypass
What is a Roux-en-Y Gastric Bypass?
Advantages Specific to the Gastric Bypass
- Of the procedures commonly performed in Australia, studies show the Gastric Bypass to be the most effective at rapidly lowering weight. The bypass also has the best Excess Weight Loss(EWL) rates amongst most weight loss operations.
- For people with Type 2 Diabetes, the Gastric Bypass has the special ability to boost the body’s natural production of insulin from the pancreas.
- People suffering from significant reflux before surgery are likely to experience a reduction or cessation of their symptoms
Disadvantages Specific to the Gastric Bypass
- Stomach ulcers and small bowel obstructions can be serious complications requiring additional surgery.
- If patients eat particularly fatty or sugary foods, they may temporarily experience the quite unpleasant symptoms of the ‘dumping syndrome’ associated with bloating and diarrhoea.
Sleeve or Tube Gastrectomy
Sleeve or Tube Gastrectomy
What are the Advantages Specific to the Sleeve Gastrectomy?
- A good single stage operation for weight reduction for moderately obese patients.
- It does not require disconnecting or reconnecting intestines.
- The stomach is reduced but functions normally and almost every type of food can be consumed, though in small amounts.
- Many patients lose up to 60% of their excess body weight within six months of their Lap Sleeve Gastrectomy surgery.
- By removing most of the excess stomach volume, the Ghrelin hormone production is mostly eliminated and therefore the sensation of hunger is being reduced.
- It is a simpler surgery than gastric bypass
- There is no malabsorption as with Gastric bypass, minerals and vitamins are not necessary, this may be important though in older patients.
- There is no dumping syndrome but sugar substitutes may be better tolerated.
- No foreign device is inserted in the body as in gastric band.
- Can be converted into gastric bypass if required
Risks specific to the Sleeve Gastrectomy?
- An internal infection from leakage of digestive juices into the body cavity.
- Risk of bleeding from the area of division of stomach
- It is irreversible operation
- Other surgical and anaesthetic risks common to a gastro intestinal operation
8 Golden Rulesto Successful Weight Loss
1. Drinking adequate amounts of liquid, preferably water, is crucial
- Patients should consume a minimum of 2- 2½ quarts (64-80 fluid ounces) of liquids per day. This should be done slowly and throughout the day. The easiest way to keep track of this is to purchase a 32-ounce water bottle and finish at least 2 bottles of liquids a day. Sip, Sip, Sip.
- This amount should be increased by 10-20% when the weather is very hot and humid to prevent dehydration.
- In the first 30-45 days after surgery, avoid drinking more than 3-4 ounces of liquids (1/3 of a cup) in a 10-minute period to avoid vomiting. Avoid gulping any more than 1 ounce (shot glass size) at a time. Eventually, you may be able to drink more at a time.
2. Solid Foods should be generally only be eaten 3 times per day
- Snacking between meals or “grazing” on small amounts of food throughout the day will sabotage your attempts at successful weight loss.
- If you “graze,” you will not lose an adequate amount of weight because you may consume too many calories.
- You will need to be the judge of your meals and snacks. Some patients need to have 5 mini-meals per day and that works for them. Since everyone is individual, there is no hard fast rule.
3. The Primary Source of nutrition should be protein
- 70%-75% of all calories consumed should be protein based (eggs, fish, lean meats, etc.; bacon is not a lean meat).
- Carbohydrates (bread, rice, pasta, potatoes, beans, etc.) should be only about 10%-20%, and fats (butter, cheese, etc.) only 5%-15% of the calories that you eat. If you must eat the carbs, opt for quality whole grains.
- A diet consisting of 600-800 calories and about 70 grams of protein should be your goal for at least the first 6-8 months. Caloric intake can increase as your stomach stretches.
- Swollen ankles, fatigue, hair loss, cracked nails, and defective healing and immunity are just some of the side effects of inadequate protein consumption (not to mention difficulty losing weight). Hair loss may also be due to hormonal changes but protein levels can be checked to be sure you are not developing a protein deficiency.
4. NEVER drink liquids when eating solid foods
5. Avoid foods that contain sugar
- You must focus on eating enough protein to prevent malnutrition and hair loss. If you eat protein rich foods first at each meal, you will have little room left in your stomach for simple sugars.
- Sugar and other carbohydrates may slow your weight loss because they are so easily digested and absorbed. Vertical Gastroplasty/Gastrectomy patients who have early plateaus are most always consuming too many carbohydrates. Because the negative biofeedback of Dumping syndrome is not present with this operation, it is all too easy to start eating too much sugar and other carbohydrates. Eating protein first and when hungry will help to minimize the chance of consuming too many carbohydrates.
- Sugar, sugar alcohols and artificial sweeteners cause gas, bloating and diarrhea. VSG patients usually do not get dumping; however they may if they eat significant amounts of fat or sugar. If too much sugar is consumed, it may enter the intestines rapidly and travel through quickly. This may lead to gas, bloating and a mad dash for the bathroom.
- Avoid starchy foods such as rice, pasta, cereals, and mashed potatoes. Again, if you must eat them, opt for better choices of whole grains.
6. Stop eating/drinking when you begin to feel full
7. Begin exercise program
8. Avoid eating too many carbohydrates!
- Lack of exercise may also limit the amount of weight loss.
- Occasionally, patients who exercise a great deal can experience a weight plateau due to increased muscle and lean body mass (like body-builders).
- Remember – muscle is denser than fat and thus weighs more. These patients often notice that they are losing inches and clothing sizes and should keep up the good work! Weight loss through exercise is the healthiest way to lose! Do not let the scale dictate your progress for you, how do your clothes feel, are you losing inches? These are the questions you should ask yourself.
Preparing For Surgery& What Follows After
How do I prepare myself for surgery?
- Start Atkins diet for 2 weeks before the surgery to reduce the fat around your liver.
- Make sure to be on a regular intake of clear fluids 48 hours before surgery.
- You must cleanse your colon before surgery by taking regular laxatives as prescribed
- Stop any medication unless indicated and recommended by your doctor.
What are the implications of weight loss (Bariatric) Surgery on diet and lifestyle?
What are the risks of Bariatric Surgery in general?
- The risks of any general anaesthetic and operation.
- Wound infections at incision sites.
- Risk of bleeding or leakage from the site of bowel division or rejoining (anastomosis), depending on the nature of the procedure
- Hernias – a weakening of the abdominal wall.
- Development of gall bladder disease and/or gall stones – due to rapid weight loss.
- Blood clots in the legs and spreading to the lungs causing a serious condition called pulmonary embolism.
- Vitamin deficiencies – may be preventable by taking daily vitamin supplements. Periodic lab testing would be required.
- As with any surgical procedure, there is a risk of mortality.