Considering weight loss surgery? Read this.

Embarking on a weight loss journey can be downright frustrating, especially if there is urgency involved like necessity for health concerns.  Whether it be needing to lose weight to have a joint replacement, improve sleep apnea, or just overall improved health, it is common to get to the point of feeling defeated and discouraged after unsuccessful attempts.  Your mind wanders to weight loss surgery and you question if this is a feasible option.  Before calling your primary care physician to request this referral, here are some things to consider.

What are the surgery options?

The three most common weight loss surgeries performed in the United States are the adjustable gastric band, the gastric sleeve, and gastric bypass (also known as Roux-en-Y).  There is a fourth option known as the biliopancreatic diversion with duodenal switch, however this is less commonly performed.  All of these surgeries decrease the stomach size and capacity, which decreases the amount of food one can consume in a single sitting.  The gastric sleeve is a permanent option, as about 80% of the stomach is removed and it cannot be reversed (although the new stomach can stretch over time).  If medically necessary, gastric bypass can be reversed but it is difficult to do.  A gastric band is adjusted as appropriate and can also be removed if intolerance occurs.

Who is the ideal candidate?

An adult with a Body Mass Index (BMI) of 40 or above may be eligible for bariatric surgery.  If BMI is under 40, individuals typically need to meet these three guidelines:

1. BMI of 35 or higher
2. One or more obesity related health condition (such as diabetes, heart disease, sleep apnea, etc)
3. Proven track record of at least 6 months of supervised weight loss attempt

If the guidelines are met, an individual will then meet with a team of professionals to determine if they qualify for surgery.  These professionals include a primary care doctor, the surgeon, a dietitian, nurses, and a psychologist or psychiatrist who will work collaboratively to determine if you are ready – physically and mentally – for this type of surgery.  A thorough psychological and behavioral screening will be completed to ensure the individual is ready and capable of following guidelines after the surgery, which is critical for positive outcomes.

They will also provide education on what to expect before and after surgery, including physical changes, how to incorporate appropriate physical activity, setting up a plan for mental health therapy, and nutritional guidelines.  The dietitian is an important piece in the education stage, as they will thoroughly review timing of meals, stages of diet progression, food/beverages to avoid, and strategies for ensuring optimal nourishment.

What can I eat after surgery?

Weight loss surgeries performed in the US have increased over 60% in the last decade.  However, despite its rising popularity, it is not the easy route to weight loss.  Life will change drastically following surgery and it is of utmost importance to follow the guidelines provided by your treatment team.  It is important to eat and drink slowly with thorough chewing for optimal tolerance.  To avoid dehydration, it is recommended to drink 64 ounces of fluid per day, avoiding alcohol and limiting caffeine.  Vitamin and mineral supplements are necessary due to surgery and limited diet, as directed by your physician.  Typical diet advancement following surgery consists of four stages:

• Stage 1: Liquid diet. 1-2 weeks post op. Liquid diet that is low sugar, low fat, and high protein to aid in recovery. Examples of liquids consumed are water, low sodium broth, protein drinks, or sugar free non-carbonated beverages like Crystal Light. It can be helpful to set hourly goals of consumption to ensure adequate intake.
• Stage 2: Blended or pureed foods. 1-2 weeks after the liquid diet. This stage consists of adding in pureed or blended lean proteins. Examples include chicken, tuna fish, soft scrambled eggs, cottage cheese, greek yogurt, etc. It is helpful to consume about 6 small meals per day, with liquids between, as meals are only about 4-6 tablespoons during this stage.
• Stage 3: Soft foods. Up to 3 months. Continue with Stage 2 foods, however they no longer need to be pureed. In this stage, you can add foods such as low-fat cheese, refried beans, no sugar added canned fruit, and soft cooked vegetables. Most will aim for 3-5 meals per day, consisting of about ⅓-½ cup of food each.
• Stage 4: Solid diet. About 3-4 months after surgery. This is the stage to focus on appropriate portion sizes. Importance is still stressed on adequate hydration to prevent dehydration, still with the recommendation to consume liquids between meals. Three meals a day will consist of about 1-1 ½ cups of food each, ensuring a protein source at each meal and stopping when you start to feel full. Grains can also be added in as tolerated at this stage; however, it is recommended to consume protein foods first at each meal for muscle mass preservation.

Straying from the nutritional guidelines post op can result in undesirable effects such as dumping syndrome, which is when food passes too quickly from the stomach to the small intestine and can cause symptoms like nausea, abdominal pain, and diarrhea.  There is also a higher risk for constipation, dehydration, and of course failure to lose weight or increased likelihood of regaining the weight lost.

Does insurance cover it?

It is important to look into the cost of surgery as your insurance may or may not cover it.  Most will require that the surgery has been determined medically necessary by your treatment team and that there have been documented attempts at weight loss with supervised programs prior to surgery.

Choosing bariatric surgery is a lifelong commitment.  Do your research and make an informed decision with a trusted medical provider on what options you have.  Thoroughly review the risks and benefits.  A registered dietitian can help you navigate this journey, whatever route you decide to head.

If you have more questions about this topic, it’s always a great idea to speak with a registered dietitian. Registered dietitians are the only credentialed experts qualified to address your unique health questions.

References:

English, W. J., DeMaria, E. J., Hutter, M. M., Kothari, S. N., Mattar, S. G., Brethauer, S. A., & Morton, J. M. (2020). American Society for Metabolic and Bariatric Surgery 2018 estimate of metabolic and bariatric procedures performed in the United States. Surgery for Obesity and Related Diseases, 16(4), 457–463. https://doi.org/10.1016/j.soard.2019.12.022 

Nutrition Care Manual. (n.d.). Bariatric Surgery. Nutrition Interventions. Retrieved May 8, 2022, from https://www.nutritioncaremanual.org/topic.cfm?ncm_category_id=1&lv1=274558&lv2=274569&ncm_toc_id=274569&ncm_heading=Nutrition+Care