FAQ

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

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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.

• 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.

Risk of food bolus getting stuck and an increase in reflux symptoms

• 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.

Our staff and dietitians will ensure you are well supported thru the follow up period.

• 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

• 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.

• 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

• 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

• 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.

• 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.

• 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.

• 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.

In the first months after surgery, you are relearning how much you can eat (portion size as well as “bite” size), how well you have to chew, and what you can eat without developing problems. Although everyone is different, usually by the sixth month patients are eating most regular (healthy) foods – but in much smaller portions than they did before surgery.

There will definitely be foods that you will never want to eat again because they will cause some type of “intestinal distress.”

Surgery gives patients the physical tool to assist with weight loss. Patients must be committed to making the emotional and physical changes necessary after weight loss surgery. This commitment will ensure successful weight loss and long-term weight maintenance.

Lack of exercise, poorly balanced meals, constant grazing, eating processed carbohydrates and drinking sweet drinks are some of the most common preventable causes of failure to achieve adequate weight loss and maintain it.

• 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.

Regarding your meals, the first couple of months will be the hardest times, as you have to adapt to your new stomach size. You must chew food well and eat smaller amount of food within longer meal time (30-45 minutes for meal). You must stop eating once you feel full.

You should have 3 meals per day but the most important thing is to reduce fats and carbohydrates and make the main nutrient of your diet protein.

It will start to slow after that, but can continue for a total of 12-18 months. You may intermittently have plateaus in your weight loss for up to a month. This is usually an indication that you are eating too many carbohydrates or calories and/or not exercising enough. Take this as a sign to re-examine your eating and exercise habits.

Most patients’ weight will plateau after 8-12 months view success stories…(Link coming soon). After this time, additional weight loss may be difficult. Weight regain may also occur if too many calories are consumed, exercise is discontinued or old habits, such as grazing, snacking, or poor eating habits return.