When should a person consider bariatric surgery?
Bariatric surgery should be considered after traditional attempts at weight loss including diet, exercise, drugs and behavioral modification has failed. Surgery for morbid obesity is the only successful method of long-term weight reduction, as well as, significant improvement or resolution of co-morbidities (associated diseases – like Type 2 diabetes, sleep apnea, high blood pressure).
What type of patients turn to bariatric surgery for help?
Patients seek out Bariatric and Metabolic Surgery after failing to lose weight through traditional means or keep the weight off for any extended period of time. Some have already begun researching the idea of bariatric surgery via the internet or other means, and others have heard from existing patients to attend one of our free informational seminars.
What criteria determine whether a person is a candidate for bariatric surgery?
At Catskill Regional, we follow the National Institutes of Health (NIH) guidelines which indicate the following:
- Body Mass Index (BMI = weight divided by height in meters squared) of ≥40 (@ 100 pounds overweight), or ≥ 35 to 39.9 with at least one other obesity-related disease; i.e., Type 2 diabetes, sleep apnea, severe osteoarthritis, cardiac disease including high blood pressure and high cholesterol, polycystic ovary disease, etc. Those with BMI ≥ 30-34.9 can be considered for a gastric Lap-Band ® only and must also have type 2 diabetes qualify for bariatric surgery.
- Must have tried and failed conservative treatment and be overweight for a minimum of 5 years.
- Must be 18 years of age or older.
- Must be mentally prepared for the procedure without having an untreated eating disorder such as bulimia.
How successful is bariatric surgery?
In the majority of cases, bariatric surgery patients lose anywhere from 45% to 83% of their excess body weight and improve or resolve 90% of their obesity-related health conditions within one year post-operatively. The weight loss results are based on an individual’s commitment to making lifestyle changes with the ongoing education and support from your bariatric team.
Is there more than one weight loss surgical option?
At Catskill Regional we offer three bariatric surgery options:
Gastric Banding – A laparoscopic surgical procedure where the surgeon places an inflatable and adjustable band around the upper part of the stomach, partitioning it into two parts. The band creates a small opening that allows limited food to pass through, resulting in controlled food intake. This means the patient feels full more quickly, while eating less. This procedure is adjustable and reversible, but not advisable.
Sleeve Gastrectomy – A laparoscopic surgical procedure that removes approximately seventy-five percent of the stomach and causes restriction. The result is less food consumption, causing the patient to eat less and lose weight. Following the surgery an individual is able to eat 3 ounces of food and feel satisfied. Absorption of food in the intestines is not affected by the surgery. This procedure is not adjustable or reversible.
Gastric Bypass – A laparoscopic surgical procedure that involves the rerouting of the digestive system. The surgeon creates a small pouch in the upper part of the stomach then attaches the 2nd part of the small intestine to the new stomach pouch. This results in food “bypassing” the part of the stomach that has been sealed off and the 1st portion of the small intestine causing malabsorption of calories and vitamins. The patient eats less, absorbs fewer calories, and loses weight. This surgery should be viewed as permanent. Type 2 diabetes is significantly improved and possibly resolved after having the gastric bypass surgery.
Are there risks with weight loss surgery?
There is always a certain degree of risk involved with any surgery. At Catskill Regional, all bariatric surgeries are performed as minimally invasive, laparoscopic procedures which decrease risks and complication rates. Risk of mortality has been reduced from 2% with open gastric bypass to 0.5%. Laparoscopic gastric banding is ten times safer than gastric bypass with a mortality rate of 0.05%. The laparoscopic sleeve gastrectomy mortality rate is also low at 0.39%.
What are the most common side effects?
Some of the more common side-effects after bariatric surgery are fatigue; surgical pain (mild to moderate); nausea; weakness; loss of appetite; gas pain; constipation or lose stools; emotional ups and downs and dumping syndrome (sugar intolerance after gastric bypass).
What kind of diet regimen is required before surgery?
Pre-operative diet is also important. You will be guided every step of the way by our dietitian. Learning to read labels, eating slowly, drinking slowly, and using specific protein drinks are examples of what our Dietitian will help you learn about before surgery. It is strongly recommended and sometimes required by insurance companies that bariatric surgery candidates attempt to lose five percent body weight prior to surgery. This is recommended so the liver shrinks in size, making the surgery safer.
What kind of diet regimen is required after surgery?
After bariatric surgery the stomach needs time to heal. All bariatric surgery patients are required to remain on low calorie clear liquids for a few days and then advance to phase I which includes protein drinks for 2 to 3 weeks post-surgery. The next step is phase II which is pureed/semi soft foods; the consistency of applesauce. Phase III is solid textured foods. The goal is two protein drinks a day and one meal for optimal weight loss. These strict guidelines allow the stomach adequate time to heal and prevent complications.
Very Low Calorie Diet
- Vital nutrient needed by all parts of the body
- Promotes healing
- Prevents excessive muscle loss & slowing metabolism
- Good source of fiber, vitamins, & minerals
- Contain important vitamins & minerals
- Good source of fiber
- Non-starchy vegetables are ideal
- Water or very low-calorie liquid (>5cal/serving)
- 64 oz or more per day is recommended
Eating Techniques/Healthy Guidelines
- Choose fresh unprocessed foods
- Do NOT eat high fat or sugary foods
- Eat protein first
- Eat slowly – 30 minutes per meal
- Chew thoroughly 15-20 times for each bite of food
- Stop eating just before you feel full
- Small plate/toddler fork/spoon
- Keep foods moist
- Drink only very low calorie; non-carbonated drinks
- Do NOT eat & drink at the same time
- Do NOT drink for 1 hr after eating
- Reading labels
- Avoid stress or distractions when eating
Can a person still overeat?
Attempts to overeat immediately after surgery can cause serious complications such as leakage. Over time, overeating can lead to stretching of the stomach which allows more food to be ingested at one time resulting in weight gain. Moreover, it is very important that patients continue to attend monthly office appointments with the Nurse Practitioner and Registered Dietitian. Support groups are also along with attending support groups after surgery to learn behavior modification techniques necessary to prevent weight regain.
What kind of follow-up is there after surgery?
Follow-up after surgery is extremely important to for both short term weight loss and long term weight loss. The surgery itself is a tool that one must learn over time how to master for long term success. The multidisciplinary approach our bariatric program provides teaches you the day to day tools necessary to master your bariatric surgery.
The following is a general guideline of what to expect after bariatric surgery. Office appointments: 1 wk after surgery, then every 2 wks for the first 2 months, then every month until goal weight is obtained. Once you have achieved your desired weight we request you be seen once every 6 months then once a year.
Office follow-up visits provide guidance and direction on safe weight loss progression through the support of the Surgeon, Nurse Practitioner, Registered Dietitian, Behavioral Health Therapist, and support groups. Learning how to use your bariatric surgery as a tool takes time the entire team is qualified to help you on your journey.
What are the benefits of weight loss surgery?
Open Surgery vs Laparoscopic Surgery?
Open bariatric surgery requires a larger incision, increased risks of infection, increased pain, extended hospital stay, and increased recovery time. The open approach is rarely used.
Laparoscopic bariatric surgery benefits include smaller incisions (approximately five), decreased risk of infection, decreased pain, shorter hospital stay, and a quicker recovery time compared to an open bariatric surgery procedure.
Overall Benefits of Bariatric Surgery?
The Benefits of bariatric surgery in general are improvement or resolution of Type 2 diabetes, reduction in high blood pressure, resolution or improvement of sleep apnea diminished swelling and pain of legs and joint; some infertile women become pregnant and have a safer pregnancy and delivery; changes in cholesterol and other blood lipids reduce the risk of heart attack and strokes.
Overall the quality of life after bariatric surgery improves with the support and guidance provided by our team of professionals.
TO LEARN MORE ABOUT YOUR WEIGHT LOSS OPTIONS, FIND A BARIATRIC SURGEON OR ATTEND A FREE WEIGHT LOSS SURGERY SEMINAR OR SUPPORT GROUP, EMAIL THE CATSKILL REGIONAL BARIATRIC & METABOLIC SURGICAL SERVICES AT MCKOYK@CRMCNY.ORG.