The important thing to remember throughout your entire bariatric journey is that you are never alone. You will have a support system of healthcare professionals and you have the opportunity to join support groups with fellow patients to guide you in the right direction. Below are the answers to common questions asked before, during, and after weight loss surgery.
For those who have qualified for weight loss surgery, it is common to have an enlarged and fatty liver. The liver reduction diet is a high protein, low carbohydrate diet created to decrease the size of the liver usually 2 weeks before surgery to avoid surgical complications. The diet consists of high protein meal replacement shakes anywhere from 2-4 times a day based on your surgeon’s recommendations. Caloric control will promote weight loss and will reduce the size of the liver to prepare the body for surgery.
All other options should be explored before weight loss surgery becomes an option. If you have pursued a healthy diet, exercise, help from a dietitian, etc., then bariatric surgery may be considered. Usual qualifications for bariatric surgery include, but are not limited to:
- Body mass index (BMI) of 40 or higher
- BMI of 35-40 including health issues caused by obesity like type 2 diabetes, high blood pressure, high cholesterol, heart problems, lung problems, kidney difficulties, and sleep apnea
Roux-en-Y Gastric Bypass - The idea is to cause caloric restriction by decreasing the size of the stomach while also causing nutrient malabsorption due to part of the stomach and first section of the small intestine (duodenum) being bypassed for the outcome of weight loss.
Adjustable Gastric Band - The purpose of this surgery is to create a smaller stomach by utilizing an inflatable band that goes around the upper portion of the stomach. The band can be adjusted and can control caloric intake, promoting a feeling of fullness when eating only a small amount of food.
Sleeve Gastrectomy - About 75% of the stomach is removed leaving a “sleeve” resembling the size and shape of a banana. This new stomach pouch holds a smaller amount of food compared to normal stomach size. There is evidence that the changes to the stomach and gut hormones after this surgery may help improve or even lead to remission of type 2 diabetes.
Biliopancreatic Diversion With Duodenal Switch Gastric Bypass - This procedure is less common than other weight loss surgeries. It results in caloric restriction, malabsorption of vitamins/minerals, and changes of gut hormones. First, a sleeve gastrectomy is done to remove a large portion of the stomach. Next, the intestine is divided further down than in gastric bypass surgery, resulting in a larger amount of the small intestine being bypassed. Due to a larger portion of the small intestine being bypassed and a smaller window for digestive enzymes to mix with food, there is a higher risk of becoming deficient in nutrients that may not be a problem in other surgeries. For example, there is a decrease in the absorption of protein as well as fat which can cause deficiencies in the fat-soluble vitamins ADEK.
Your journey begins! It’s okay to be scared, but remember you’re not doing this alone. A meeting with your dietitian will help you understand what nutrition plan is best after surgery. This usually starts with a full liquid diet for a period of time so the stomach and intestines can adjust to changes. You will progress to soft foods and then over time you will be eating smaller portions of regular foods. After the first month, you will notice increased weight loss. Medical problems you once had to deal with usually become easier to handle. Exercise will also be easier and a healthy lifestyle may become more realistic.
Protein is extremely important for the healing process and upkeep of lean body mass after weight loss surgery. ASMBS guidelines recommend 60-80g of protein on a daily basis. This is a general recommendation for protein, requirements can be individualized based on the person. Protein should be consumed at each meal and should be the first thing you start eating on your plate to ensure you are getting what you need. If you cannot consume enough protein through food then protein supplements may be incorporated into your daily regimen. Consuming the right amount of protein can help with satiety and promoting a healthy metabolism.
Hair loss is very common 3-6 months after bariatric surgery. It is possible that the changes to the digestive tract, lack of caloric intake, and hormonal changes can result in hair loss. Hair loss is usually temporary and will eventually slow down and start growing back. Stay consistent with your vitamin/mineral regimen and protein/calorie consumption to promote hair regrowth and prevent thinning. Bariatric Fusion offers a hair, skin, and nails vitamin formulated specifically for hair loss after bariatric surgery. Check it out here:
Healthy lifestyle choices will produce the best results for a better quality of life after surgery. Be conscientious of your food choices and stick with a healthy lifestyle to help improve weight loss results.
Limit foods like:
Added sugars - cookies, cakes, candy, juices and other sweets
Refined carbohydrates - white bread, pasta, crackers, refined cereals
Foods to include in your diet:
Lower fat options - try plain greek yogurt instead of sour cream or mayonnaise, buy ground turkey or ground chicken instead of ground beef, buy reduced fat cheese instead of regular cheese
Look for lower calorie options - powdered peanut butter for protein shakes and cooking, berries, legumes, fish, vegetables, etc.
This is a common issue that can be seen after Gastric Bypass Surgery and has also been reported after Sleeve Gastrectomy. The changes to the digestive tract and hormonal changes in the gut is what can cause dumping syndrome. Food, especially sugar, moves from the stomach to the small intestine too quickly. Patients may experience sweating, dizziness, abdominal pain, nausea/vomiting, and/or diarrhea. If this is happening to you, try talking with your dietitian about modifying your diet.
Bariatric specific multivitamins are made specifically for bariatric patients. They include vitamin/mineral doses above the RDA values to prevent common vitamin deficiencies after weight loss surgery. For example, Bariatric Fusion vitamins were formulated based on the ASMBS guidelines and include the most bioavailable forms of each vitamin to optimize absorption. A regular multivitamin does not contain these high values and offers vitamins in different forms that might not be what a bariatric patient needs, so there is a greater risk of becoming deficient. If taking a regular multivitamin, you would have to take more vitamins, it could end up being more expensive, and you put yourself at higher risk for deficiency. Before you buy a multivitamin, make sure you always follow doctor recommendations.
The ASMBS guidelines provide vitamin/mineral recommendations for bariatric patients to prevent nutritional deficiencies. With the proper diet and bariatric supplement regimen that follows ASMBS guidelines, you can avoid issues in this area. It is important to always follow up with lab work to catch deficiencies before they cause serious problems.