Surgical Weight Loss

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QUESTION

Is weight loss surgery a cosmetic procedure?

DR. ALAN GREENE

No, weight loss surgery is not considered cosmetic. It is performed to improve your overall health, not to change or improve your appearance. Most programs require that you have a BMI over 35 AND medical problems stemming from your weight (such as high blood pressure, diabetes, abnormal cholesterol levels, obstructive sleep apnea, gastroesophageal reflux, infertility, some cancers, or arthritis of weight-bearing joints); OR a BMI over 40, even without medical problems, if the weight is interfering with daily life AND dietary attempts at weight control have been ineffective. In practice, if anyone has a BMI over 30 for more than a year, they will probably show evidence of having medical problems if they are being evaluated carefully by their health care provider. Abnormal cholesterol levels, impaired handling of glucose, and fatty liver changes all occur early in obesity. Although major weight loss may indeed give you an improved appearance, the reasons for performing these major procedures are to avoid or reverse the potentially life-threatening complications of obesity.

QUESTION

I'm considering having weight loss surgery before I try to have children. Is that all right?

DR. ALAN GREENE

If you are obese, it's an excellent idea to try to get yourself in optimal health prior to conceiving a baby. If you do undergo weight loss surgery, however, you should not try to get pregnant during the period of time directly after surgery when you will be experiencing the greatest rate of weight loss. This period of time is usually 12-18 months after the operation. You should plan on using reliable birth control throughout this period of time. Before you become pregnant, it's a good idea to visit the healthcare provider you'll use for your pregnancy to discuss your health history and to have a pre-pregnancy check-up.

QUESTION

What will my diet be like after weight loss surgery?

DR. ALAN GREENE

Carefully following the prescribed diet after surgery is essential both to protect your body and to ensure weight loss. Typically, for the first 1 - 3 days after surgery the diet is clear liquids only (water, broth, high protein fruit drinks, or other clear liquids). After the initial liquid-only period, the diet should consist of pureed or blended foods (yogurt, pudding, cream soup, liquid supplements). After a week or so of this, soft foods are very gradually added -- about 1 ounce of a new soft food every 2 or 3 days:

  • After 1 week: scrambled eggs, cottage cheese, low-fat refried beans, mashed potatoes, hot cereal
  • After 3 weeks: tuna salad, ground turkey, baked fish, canned vegetables, bananas, seedless watermelon or cantaloupe

One month after surgery, some normal foods can be a regular part of the diet, although limiting food selections may be a permanent part of the new diet. For example, you might need to avoid steaks and chops, apple skins, citrus fruit membranes, incompletely chewed raw or fibrous vegetables, and fresh bread (because of the tendency to form a solid "bread ball" in the stomach pouch -- toasting may prevent this problem).

Although each person is different, and there are different recommendations depending on the specific type of weight loss surgery you have, some of the basic recommendations are as follows:

  • You will need to adjust portion sizes. In general, a small stomach pouch will hold only about 2 ounces of food at a sitting.
  • Food choices will need to be blended, soft, or easily chewed. Limit foods that are dry (turkey, roast beef), sticky (peanut butter), gummy (fresh bread), or stringy (fibrous fruits or vegetables).
  • Eat a balanced diet that is low in fat, high in protein. Protein is important for healing directly after surgery, and it's also important during weight loss in order to help you preserve muscle mass. About 60 g of protein is recommended daily.
  • Avoid foods that contain sugar, especially if you've had gastric bypass surgery. Eating foods containing concentrated amounts of sugar may cause an uncomfortable reaction called dumping syndrome (sweating, low blood pressure, dizziness, abdominal cramping).
  • Don't drink fluids just before or with your meals. Drink well before or at least 30 minutes afterwards.
  • Eat slowly (at least 20 minutes per meal), and chew your food very thoroughly.

QUESTION

Will I need nutritional supplements after surgery?

DR. ALAN GREENE

Actually, you'll need to use nutritional supplements permanently after you have weight loss surgery. You'll need to take both a multivitamin with iron and a calcium supplement daily. You may need additional calcium and/or iron supplements. You may also need vitamin B12 shots. Your healthcare provider will perform regular blood tests to monitor your body's levels of micronutrients.

QUESTION

Will I have a lot of extra skin after I lose weight?

DR. ALAN GREENE

Excess skin can be a problem for some people. Because everyone feels differently about these kinds of things, and because there are individual differences with regard to the elasticity of skin, it's not easy to predict what will happen with your skin after major weight loss. Exercise seems to be helpful, although some people are still troubled by the extra skin, and may even choose to have plastic surgery to remove loose skin. If you are considering plastic surgery, however, you should wait about two years after weight loss surgery, so that your weight has stabilized before any procedure to remove excess skin.

QUESTION

Are there any medications that I can't take after weight loss surgery?

DR. ALAN GREENE

You won't be able to use nonsteroidal anti-inflammatory medications (such as ibuprofen, naproxen, aspirin) after weight loss surgery, because they may cause ulcers (shallow, irritated pits) in the lining of your stomach pouch. You should also avoid diuretic medications. Their use, in conjunction with changes in the way your body absorbs potassium and other nutrients after surgery, may result in a serious potassium deficiency.

QUESTION

Will I be able to return to my usual level of activity after weight loss surgery?

DR. ALAN GREENE

Actually, it's hoped that you'll be able to increase your activity comfortably and happily after weight loss surgery. With less weight to carry around, you should notice improvements in your respiratory capacity and your stamina. With less weight and stress on your joints, any problems with arthritis should also improve.

Review Date: 12/16/2012

Reviewed By: Robert A. Cowles, MD, Associate Professor of Surgery, Yale University School of Medicine, New Haven, CT. Review provided by VeriMed Healthcare Network.

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