| Dr. Thomas Inge is a member of the American Society for Metabolic and Bariatric Surgery. Here the Doctor has answered some of the common questions Bizymoms visitors have about Bariatric Surgery.
Q. What can one do to prepare for surgery?
A. All surgical candidates should undergo a nutritional evaluation (past weight loss attempts, eating patterns, food allergies/sensitivities) and selective micronutrient measurements to determine if there are any pre-operative nutritional deficiencies. Prior to surgery many patients may already have micronutrient deficiencies due to nutrient poor food choices, lack of dairy, low fruit and vegetable and/or whole grain intake.
A healthy balanced diet and meal pattern consisting of lean protein, fruits, vegetables, whole grains and low fat dairy products is advised during the pre-operative period to assist in weight loss or weight maintenance.
When considering weight loss surgery it is important to become informed. Ask the surgeon about the risks and benefits of the surgical options to make the most appropriate choice for your individual needs.
Patients having bariatric surgery need a strong support system before and after surgery. Discuss your surgical decision with the supportive people in your life and inform them of the lifestyle changes that will be necessary. Involvement in a bariatric support group is very beneficial.
Q. Can you brief us a bit about the 'Endoluminal Sleeve' treatment?
A. The endoluminal sleeve is an innovative way to achieve similar effects of the gastric bypass operation, without an actual operation. A plastic cylindrical tube that is open on both ends is put in the stomach either at the top of the stomach or the bottom, and the plastic sleeve "deploys" downstream into the intestines to cause food that is eaten to internally bypass part of the absorptive surface of the intestine. It is being used in Europe but is not approved for use in the U.S.
Q. Are The Health Risks Of Bariatric Surgery Greater Than The Risks Of Obesity?
A. Most believe that the risks of surgery are outweighed by the longterm risks of obesity. Indeed, several scientific studies have now shown that people who undergo weight loss surgery have a longer life than similarly obese patients who do not undergo surgery. This is presumably due to the adverse health effects of carrying extra weight for long periods of time.
Q. Are there any restrictions on Eating after bariatric surgery?
A. The post operative eating pattern focuses on weight loss with preservation of lean body mass by recommending a diet high in protein ( approx. 60 grams/day or 1.0 – 1.5 g protein/kg ideal body weight), low in simple carbohydrates, free of added simple sugars, and with modest fat intake.
The diet is typically ‘staged’ over a 3-4 month period with progression of types of food, textures, consistencies and amounts as tolerated by the patient. In general, the more malabsorption that is created from a procedure, the greater the weight loss, but there is also a greater risk of complications. It is important for the health care professional to know the exact type of procedure that will be done so that the diet modification, ‘post- operative staging’, can be appropriate for that procedure. To date there are no published evidence based post operative nutritional guidelines. Each institution adapts best practice guidelines to their population.
The postoperative diet is started with frequent small servinigs ( 1 oz/per hour) of water, ice chips, or sugar free clear liquids for the first few days. The diet is advanced as tolerated to high protein liquids and foods with a smooth consistency. The goal is 3-4 small meals per day, 60 grams of protein and 80-90 ounces of water and sugar free fluids.
The next stage is semi-solid high protein foods pureed or chopped into pieces no larger than the size of a pea. Advancement to other foods, fruits, vegetables and grains is progressed as tolerated by the patient. Individuals vary on their readiness to advance. Foods that are dry, sticky, gummy or stringy in texture may present the biggest problems.
The goal is a portion controlled eating plan including all food groups achieved over a 3-4 month period.
Major adjustments in eating behavior are necessary following bariatric surgery:
• Patients need to take small bites and chew food thoroughly (¾ - 1½ cups of food per meal)
• Meals should be eaten in approximately 20 minutes.
• Do not eat or drink past the first feeling of fullness.
• To prevent dehydration it is important to encourage the patient to continually sip fluids throughout the day. Liquid goal/daily intake of a minimum of 64 fluid ounces (water and/or sugar free fluids)
• Separate liquids from meal time – stop drinking 30 minutes before a meal and do not drink until 30 minutes following a meal ( for at least the first 6 months following surgery) eating and drinking at the same time may decrease satiety and/or increase the incidence of vomiting
• Include a lean protein at each of 3-4 meals per day, a complex carbohydrate with emphasis of fresh fruits, vegetables and whole grains, and unsaturated fats. Protein goal of 60 grams per day.
• Follow the recommended vitamin/supplement regimen provided to you. The risk of developing micronutrient deficiencies increases with bariatric surgery. It is important to monitor/address these nutritional deficiencies in a timely manner.
• Avoid sugar and foods with high sugar and/or fat content to prevent ‘Dumping Syndrome’.
The dumping syndrome is caused by eating foods with too much sugar and/or fat.
Symptoms include: cramps, clammy feeling, sweating, heart racing, vomiting, and/or diarrhea.
Late dumping may occur up to 2 hours after eating a meal or food high in sugar or fat.
• Total energy expenditure ( TEE) should be calculated based on the clinical center’s pre-established route of ascertaining energy expenditure to elicit weight loss. This value should be reassessed with significant changes in weight or when expected weight loss is not evident.
Q. How do you advice your clients to prepare for Bariatric Surgery?
A. Prior to surgery, candidates should begin to implement the lifestyle changes that will be necessary for the rest of their lives:
• Healthy eating strategies – establishing a regular meal pattern
• Daily physical activity
• Keep a daily food diary
• Daily multivitamin/mineral supplementation
• Drink 64 ounces of water daily
In addition, clients that smoke must stop smoking to decrease the risk of surgical complications. Prior to surgery, patients are also encouraged to wean themselves from carbonated beverages and caffeine.
|
