Putting nutrition all together, step by step

Before Surgery

It is very important that you begin your new life style prior to surgery.  Four important goals need to be met:

1. Become educated about supplements. Learn how to mix your Metagenics products and determine your taste preferences (see the Metagenics section below).  It is easier with a normal size stomach to learn what’s best for you.  Find out which vitamin and mineral supplements you will need after surgery and obtain them in advance so you are all ready for your return home from the hospital. Supplements will be required to meet this goal (both vitamin and protein). The supplement industry can be difficult to navigate. Quality, content and consistency of most supplements are not equivalent to what you experience when writing a drug prescription. It is important that you give specific recommendations of a product that you can count on to provide the quality and purity your patients need. The Metagenics product line is not only Good Manufacturing Practices (GMP) certified, it holds the National Sanitation Foundation (NSF International), and the Australian Therapeutic Goods Administration (TGA) certifications. This Triple cetification ensures quality, content and consistency at every phase of manufacturing. Do not be fooled by Phrases such as “GMP compliance”, “exceeds/surpasses/meets GMP guidelines”. These products are not certified and there is no guarantee that GMP guidelines are being adhered to. This side of the supplement industry is esentially “self regulated”  with quality depending solely on the unchecked “good faith” efforts of the manufacturer.

The Metagenics BariatrX Essentials product line has been developed with the unique needs of the bariatric patient in mind. All products are manufactured by Metagenics were tight control of content, purity and freedom from contamination can be tightly controlled.  No artificial sweeteners or preservatives are used in these products. These chemicals are harmful to the body and are counter productive to our surgical goals of health and weight loss. Products to become familiar with include:

BariatrX Meal

This meal is the foundation of the bariatric diet. It is a balanced meal replacement containing vitamins, minerals and the proper combination of proteins, fats and low glycemic index sugars. The formula adds the advantages of Soy protein (cholesterol lowering, heart health, improved metabolic syndrome) to the known lean muscle preservation of Whey protein. This combination of nutrients helps maintain metabolism, promotes weight loss independent of surgery and improves body composition.

Advanced Protein

A cross flow micro-filtered whey protein isolate/hydrolysate providing the highest biological value. It contains easy-to-absorb forms of amino acids (di- and tri-peptides). The high content of branch chain amino acids (25%) and leucine are favored by muscle helping to preserve lean mass. Protein helps to stabilize blood glucose levels by slowing the absorption of glucose into the bloodstream. This in turn reduces hunger by lowering insulin levels and making it easier for the body to burn fat. This whey protein contains bioactive components that help stimulate the release of two appetite-suppressing hormones: cholecystokinin (CCK) and glucagon-like peptide-1 (GLP-1).

Multivitamin with mineral without iron-High Potency

This is the only high potency rapid release tablet shown to dissolve with in the gastric pouch. It contains a broad spectrum of essential vitamins and mineral amino acid chelates showing excellent nutrient bioavailability. A similar orange flavor chewable is available.

Iron support

A unique amino acid chelate that has increased absorption (7x) in the absence of gastric acid compared to Iron Sulfate. This formula is well tolerated from a gastric standpoint and is non-constipating in most individuals.

Zinc support

This is a liquid supplement that can be mixed with water or juice. Zinc is an essential trace mineral that is needed for the activity of more than 100 enzymes associated with carbohydrate and energy metabolism, protein synthesis, blood biosynthesis, and many other reactions. It plays a role in maintaining healthy skin and hair growth and is especially important for immune support.

Cal Apatite® Forte Capsules

This bone support formula features microcrystalline hydroxyapatite concentrate (MCHC)—comprehensive bone nourishment for all patients. In addition to calcium, MCHC contains growth factors and collagen protein, as well as phosphorus, magnesium, fluoride, zinc, silica, manganese, and other trace minerals—all in the same physiological proportions found in healthy bone. Formulas that feature these important minerals have been shown to benefit overall health. Vitamin D has also been added to improve absorption of calcium and subsequently reduce PTH and prevent bone demineralization.

Iso D₃

Iso D₃ delivers 2000 IU of the preferred form of vitamin D, as vitamin D3, in each tablet. The active form of vitamin D in the body is 1,25 dihydroxyvitamin D—1,25 (OH)₂D₃. Dietary vitamin D must be converted into this active form in order to deliver its health benefits. Continuous, routine use of Iso D₃ is guided by Vit D blood levels.

1. Break bad habits.  Begin changing habits that will not be acceptable after surgery.  Some of these habits will not be easy to break and will take time since stopping cold turkey may add additional difficulty.  Examples include eliminating sweets, breads, caffeine, alcohol, tobacco and carbonated beverages. Start exercising, limiting portion size and paying attention to the protein content and nutritional value of foods are constructive options to consider.
2. Lose weight.  Preoperative weight loss is important from the surgeon’s point of view.  When the first 15 pounds or so are lost the liver is the first organ to become smaller.  Since the stomach is located under the liver, exposing the stomach becomes much easier with a small liver.  If the liver is too large the laparoscopic approach to surgery may not be possible.
3. Improve health and nutritional state.  Most bariatric patients are not healthy from a nutritional stand point.  This situation can influence wound healing, infection rate, anastomotic leaks, liver function as well as many other important body functions.  To optimize surgical out come (minimize risk) protein, vitamin and mineral deficiencies must be corrected. This takes time.

How to:

Starting 1-2 months prior to surgery, all patients need to replace 1 meal a day (typically breakfast) with a medical grade meal substitute. I recommend the Metagenics BariatrX Essential meal replacement.  A simple protein supplement is not appropriate as it does not contain the proper balance of nutrients.  This meal substitution will provide a high protein and vitamin boost with minimal calories.  The other 2 meals each day should be primarily protein based with little or no carbohydrates.  Portion size must also be controlled to minimize calorie intake.  Don’t get caught up in the “last supper” trap thinking each meal is going to be the last.  This will cause weight gain and may result in your surgery being canceled.  You will be weighed in the hospital just prior to surgery.  Remember to drink plenty of low calorie fluids (64 oz a day minimum).  If you combine this diet with a regular exercise program the needed (required) weight loss should be no problem.

After surgery

Immediately following surgery, you will be able to take ice chips and small sips of water.  Go slow and only take the amount needed to moisten your mouth as it is not uncommon to experience nausea and on occasion even vomit.  Vomiting can be quit painful having fresh surgical wounds.  On the day after surgery, you will be started on clear liquids.  Your diet will be quickly advanced to full liquids prior to being discharge home. Remember to go low (volume) and slow (sip).

At home you will have 3 main objectives:

1. Protect the new pouch.  Solids can stress the staple lines of the new pouch and may cause the staples to fail.  Solids should be avoided until healing is nearly complete.  Eating solids to early is not worth the risk.
2. Maintain adequate hydration.  64 oz a day will be your goal.  This will be difficult but can be accomplished by sipping from a cup all day long.  When it is hot out side or you are more physically active, your fluid requirement will go up.  A helpful indicator of how well you are doing is the color of your urine.  Light is good, dark is bad.  If you become dehydrated, you may experience unusual nausea, dizziness, weakness and fatigue.  At first you will not be able to drink large volumes of fluid to “catch up” and replace your fluid deficit.  This is why it is important to anticipate your needs and stay ahead.
3. Provide nutrition.  Meeting this goal is difficult for every one.  It is said that you will earn every pound you lose.  As you will learn this is a true statement.  The work and effort is absolutely worth it.  Remember why you had surgery? The answer is – Health!  Proper protein and vitamin intake will preserve muscle and keep your metabolism high.  This makes losing weight easier.  The great thing about liquid meals is that it meets all 3 goals at the same time – protects the pouch, maintains hydration and provides nutrition.

How to:

After arriving home, you will be “enjoying” 3 meals a day with the additional of low calorie fluids between each meal.  Two of the meals should be your Metagenics meal substitute; one will be from the stage 2 diet list.  Since you will be limited on how much fluid you can comfortably drink at one time, you will need to split each of the Metagenics meals (3 scoops of powder in about 12 oz. equals 1 meal) into 3 separate small meals (1 scoop in each 4 oz.).  This will make for 6 scoops of the meal a day in 6 separate 4 oz. drinks.  I hope this make since!  This will provide you with 60 grams of medical grade protein a day in addition to 24 oz of fluid.  You will need to drink other fluids in between meals so that your total fluid intake for the day is 64oz.  As time goes on you will find that you are able to tolerate larger volumes at one time and can combine the smaller meals into a single 3 scoop drink (a full 12+ oz.).

After about 1 month, solids may be introduced.  Start with pureed foods at fist to see how it goes.  You may advance your diet fairly quickly if no problems are encountered.  Most people find if they take small bites (pencil eraser size) and chew well (baby food consistency), they have very few problems with most solids.  If you add one solid food at a time, you will know which foods you don’t tolerate.  Wait a few months and try the non-tolerated food again.  Chances are it will be just fine.  If it’s not tolerated a second time, it’s unlikely to improve in the future.  Because of a very small pouch, solid food will not provide enough nutrition as a sole source of intake.  It is therefore important to remain on 2 liquid meal replacements a day until your body composition stabilizes.  Once stable, 1 of the drinks will be replaced with a solid meal.  Most people find that 1 drink a day for life is very helpful in meeting ongoing protein needs while minimizing calorie intake and preventing weight gain.  Because the drinks are quick and easy to make, many choose to replace breakfast and drink their meal on the way to work.  Since breakfast is usually the least nutritious meal of the day (and the most important) this is probably a good choice.

Family / friend benefit:

As our bariatric patients lost weight and began feeling healthier with more energy, spouses and other family members began sneaking the Metagenics drinks.  Not surprisingly, they also felt healthier and wanted to continue the drinks on a more regular basis. Those who needed to lose weight did so very effectively.  These non surgical patients also had similar improvements in their body composition.  As a result, we now use the Metagenics supplements as the basis for a medical weight loss program for those who are not surgical candidates.

PART 5 – OBESITY:  A NEW BEGINNING

Formula for Success – Commitment:

Success can be defined as arriving at a predetermined destination.  Our goal at Surgery for Health is weight loss through improved health.  As is true with other goals, success is achieved through a process.  Elements of this process include desire, understanding and commitment.  Having a strong, steadfast desire to lose weight in a healthy and responsible manner is the foundation under which the other two principles are built upon.  With a genuine desire, our accomplishments are limited only by our imagination.  With desire providing the impetus, an understanding of the obesity problem with potential solutions must be gained.  With a clear understanding of the surgical alternative, a lifelong commitment to proper eating and exercise must be made.  Success in reaching and maintaining a satisfactory weight depends on this commitment.  Conscious and deliberate reduction in eating is aided by a decreased desire for food and heightened feeling of self-confidence.  After bariatric surgery, it will be easier to eat three small meals with no snacks in-between and still be satisfied.  A commitment to a structured exercise program that provides at least 45 minutes of aerobic activity each day is an important component to the success formula.

All of the changes in eating and exercise reflect your program.  While the surgery only constructs a new anatomic device (or tool), your lifelong effort makes the device really work.  The surgical team participates in preoperative, intraoperative and postoperative care.  We are here to support you.  The ultimate success of the operation depends upon you.  We at Surgery for Health recognize that our patients’ success is our success.  To that end, we are committed to assisting you in all aspects of your weight loss journey.

We continue to emphasize these important principles:

• The number one goal is to improve your health.
• Eat at regular mealtimes – no snacking.
• Drink an adequate amount of water each day.
• After starting solids, avoid water one-half hour before meals, during meals and one hour after meals.
• Take vitamins and mineral supplements as directed.
• Avoid alcohol, aspirin, anti-inflammatory drugs and tobacco.  These can cause damage to the sensitive inner lining of the new small stomach pouch and intestinal lining.
• Obtain support from others
• Identify those who have a negative influence on you and may try to sabotage your progress (may be friends or family) and convert them into supporters.

Learn to identify problems that could threaten or undermine your success and pursue strategies that will resolve these problems.

Activity and Exercise

Exercise is essential for the successful treatment of clinically severe obesity.  It is given a prominent role in the multidisciplinary approach to this disease.  Exercise is fundamental for good health, generally and especially important for weight loss and weight maintenance.  Some of the physiologic benefits include:

• Increased daily energy expenditure
• Decreased appetite
• Preservation of muscle mass during weight loss
• Reduced body fat
• Increased cardiac efficiency (both at rest and during exercise)
• Increased flexibility and better motor coordination

Psychological effects are also recognized with exercise.  These include:

• Increased energy
• Less fatigue
• Improvements in body image and self-esteem
• Reduced emotional and psychological stresses
• Improved ability to handle stressful situations

Our Weight Loss Center provides access to and encourages involvement with a physical therapy department or exercise physiologist.  For one month after surgery, strenuous exercise should be avoided.  A good rule of thumb is “if it takes two hands it’s too much”.  Walking and other non-strenuous activities should be emphasized.  Examples of appropriate activities:

• Walking around the neighborhood with family or friends
• Walks in the mall or another large indoor facility
• Stretching and range of motion activities
• Light yard work
• Easy treadmill or bicycle activity

After one month serious exercise can be started.  Begin slowly, gradually increasing activity as it is tolerated.  Suggestions might include:

• Begin with light aerobic routines
• When lifting weights, start light and work up slowly
• Swimming is an excellent form of exercise as are other aquatic activities, such as water aerobics
• Join the YMCA, Curves for Women or other health spa

Daily exercise is recommended.  We encourage different types of exercise to reduce the risk of injuries and boredom.  Remember this is a participatory program, not a spectator treatment plan.  Exercise cannot be stored or obtained vicariously.  Once regular exercise has ceased, the benefits are quickly lost.  Therefore, it is important to emphasize lifelong exercise habits, not short-term fitness fads.  Additional information and education can be obtained through our physical therapy colleagues.

As weight is lost and muscles become toned, exercise will become easier.  You will be able to participate in sports and other activities that you previously were unable to enjoy.  Hiking, jogging, wrestling with your children, basketball and skiing are only a few of the activities that will become much more pleasant.

Body Image and Psychological Aspects

Body image is defined as the picture you have of your own physical appearance.  This may defer with the way it is perceived by others.  Having a negative body image may impact self-esteem and become a symbol of unhappiness.  For example, an obese person may believe weight reduction is essential in order to improve body image and become happy.

Obesity is a condition that carries a unique degree of stigmatization in many societies.  Some societies seem to discriminate against individuals based on their body weight.  Obese individuals receive the message at a very early age that they are unattractive, unacceptable and unappealing.  These individuals may be perceived as being unable to control their eating habits or they are too lazy to exert the necessary control over their eating habits and/or their physical activity and exercise.  “Obesity is not acceptable” is a message transmitted to individuals at a very early age.   Suddenly you may find yourself being rejected by society, your peers and even your own family.  You are blamed for your lack of control.  You have tried countless diets, but have given up.  “You can’t control your weight”.  Your body becomes an out of control entity you would like to stop but can’t.  “It has a life of its own”.

It is important to be aware of increased scientific evidence that obesity is a disease just like diabetes or hypertension.  Indeed a genetic origin is recognized.  No one chooses to obese.  The exact cause of obesity is unknown; however, research has identified an abnormality in “leptin”, an enzyme responsible for the regulation of fat metabolism.  Furthermore, it appears that the brain does not receive the proper signal telling you when to stop eating or when you have had enough.  This is why “diets” don’t work.  Research studies have demonstrated time and time again that 95% of diets fail.  Unfortunately, most people do not understand this fact and blame themselves for the failure.  It is easy to understand how someone can become depressed and feel as though they are a failure when countless diets have been unsuccessful.  Hopefully understanding that 95% of patients are unsuccessful with their diets may give us a clear insight into what is really responsible for the failure.  For example, how do you feel about a classroom of students where 95% of them flunk?  Do we believe that all the students are lazy, have poor study habits, or are just plain stupid?  Or does the lack of performance reflect on an insufficient teaching system?  Perhaps the teaching was conducted in a foreign language not understood by the students.  I believe this example demonstrates the way we have approached obesity for many decades.  We have been trying to rearrange the same puzzle piece over and over again.  Without question, diet is a piece of the obesity puzzle, but success in the treatment of obesity will be found in our understanding and utilizing the other pieces to that puzzle.

For some of you a gastric bypass may be the last hope to control the disease of clinically severe obesity.  There are studies showing a correlation between gastric bypass and subsequent improvement in self-confidence, assertiveness and positive self image.  Furthermore, many patients report improvement in their personal relationships, social interactions and employment potential.

Frequently Asked Questions

Question:  What are the most common types of bariatric surgery?

Answer:  Most experts consider the Roux-en-Y gastric bypass (RNY) the “gold standard” of surgical weight loss options due to its high success rate. Today, RNY comprises roughly 70 percent of all bariatric procedures.

Surgeons can perform the RNY as an open procedure or laparoscopically, through small incisions. During the surgery, the stomach is made into a pouch that restricts food intake. Next, a portion of the small intestine is bypassed and attached to this pouch, which reduces the amount of nutrients and calories the body absorbs.

Another procedure that is becoming more popular and seems to work well in many patients is gastric banding. Currently the “Lap Band” is the only FDA approved device in the USA for gastric banding. In this technique a small pouch is made at the top of the stomach by placing an adjustable ring around the upper aspect of the stomach. This procedure creates a restriction so that only a small amount of food can be eaten at one time. It differs from the RNY because no intestines are cut or rearranged. The down side-typical weight loss is less than the RNY.

Question:  Is bariatric surgery considered an effective method for treating obesity?

Answer:  It is very effective; at the five-year mark, RNY surgery with appropriate nutrition and exercise boasts an 80 percent average success rate. The Lap Band 50-60% success rate. Comparatively, conventional weight-loss methods such as diet, exercise, behavior modification, and anti-obesity drugs offer, on average, a 5 percent success rate (or a 95 percent failure rate) at 5 years.

Question:  Do I qualify for bariatric surgery?

Answer:  This answer requires an examination by a qualified bariatric surgeon. However, the National Institutes of Health suggests you may be a candidate for bariatric surgery if you have:

• A body mass index (BMI) of 40 or more—about 100 pounds overweight for men and 80 pounds for women
• A BMI between 35 and 40 and a serious obesity-related health problem such as type 2 diabetes, heart disease, or obstructive sleep apnea
• Failed conventional approaches to weight-loss
• An understanding of the procedure and the lifestyle changes you’ll need to make
• The ability to tolerate the surgical procedure

Question:  If I am a surgical candidate, what else should I consider before electing for bariatric surgery?

Answer:  You should understand that surgery for weight loss is a serious undertaking and is by no means a “quick fix.” In fact, success requires a lifelong dedication to behavioral change and cooperation with your medical team. My best patients are those who are motivated to actively participate in their health and recovery, with the understanding that their health is more important than their weight.

Bariatric surgery should be considered a tool—a means to help you change your eating habits, lose weight, and become healthy. But without the lifestyle and dietary changes, your bariatric surgery will not likely be successful.

Question:  What are some common side effects of bariatric surgery that I can help control?

Answer:  After recovering from surgery “Early” problems, such as vomiting and dumping syndrome will be easily recognized and treated. Dumping syndrome occurs in RNY patients when high concentrated food (typically sweets) is “dumped” too quickly into the small intestine and results in cramping, nausea, and diarrhea. Other symptoms can include rapid heartbeat, sweating, shakiness, and faintness. Foods high in sugar and/or fat are likely to cause dumping syndrome.

Long-term or “late” problems include nutritional deficiencies. Because your new stomach pouch will resemble the size of a golf ball following RNY or Lap Band surgery, your body may not be receiving an adequate amount of nutrients to meet its needs. “Starving” your body of these nutrients can lead to malnutrition, which can manifest in a variety of ways including hair and nail loss, fatigue, anemia and bone mineral loss. All patients are susceptible to nutritional deficiencies and most require lifelong nutritional supplementation.

Patients have to be especially conscious of the following nutritional deficiencies:

• Protein
• Iron
• Calcium
• Vitamin B₁₂
• Vitamin A
• Vitamin D
• Folate
• Thiamine
• And other micronutrients

Question:  Why is nutritional supplementation so important?

Answer:  In the months following surgery, most patients find it difficult to meet their nutritional needs despite choosing the “perfect” foods. There simply is not enough space in the small pouch to hold enough nutrition. As a result, protein and vitamin deficiencies are very common. In addition, it is extremely important to drink plenty of fluids each day. Meeting the nutritional and fluid requirement is clearly impossible without a high quality supplement. When supplements are taken as a liquid meal replacement or meal enhancer both requirement are met simultaneously.

It is important to remember that not all protein supplements, meal replacements and vitamins are created equal. Quality varies greatly.  Supplements must be absorbed by your body to be of any value. Cheep, low quality products just pass through your body offering no benefit to your health.

Question:  Why use the Metagenics line of nutritional products?

Answer:  Simply put, I use Metagenics products because of the results. The health and well-being of my patients is my primary concern, and previous experiences with lesser quality products led me to Metagenics and their line of bariatric nutritional products. And since I began incorporating Metagenics products in my practice, my patients have never been happier or healthier and I believe that speaks for itself.

Unlike some manufacturers, Metagenics doesn’t cut any corners. I’ve toured their facilities and examined their raw ingredients. All ingredients that go into a Metagenics formula are provided in the right quantity, in the right form, and represents the latest in nutritional science. For example, their protein is one of the highest quality and absorbable proteins in existence, their vitamins and minerals are gentle yet designed for optimal absorption, and every formula is guaranteed for purity.

I encourage you to discuss Metagenics products with your doctor.

Question:  Will I be healthier after losing all of this weight?

Answer:  Not necessarily, and this is a critical point. Unhealthy weight loss is common following bariatric surgery. Some patients lose too much weight too quickly, or lose too much muscle tissue. I often ask my patients: yes, you’ve lost 25 lbs this month, but 25 lbs of what? Did you lose fat, muscle or water? This is a very important question because body composition can be directly correlated with your health and metabolism. If you’re diet lacks protein and other nutrients—which is common for bariatric patients—your body will borrow (or steal) these nutrients from your muscles and other tissues. The end result, poor health and low metabolism. To be “skinny” and sick is not your goal.

Again, nutritional supplementation can play a crucial role in helping you lose the right kind of weight and improve your body composition (percent body fat to lean muscle). For example, Metagenics BariatrX Essentials medial food is formulated with a blend of superior soy and whey proteins to promote the growth of lean muscle mass while supporting the loss of unhealthy fat.

If you focus on eating healthy and are committed to taking your nutritional supplements, your weight loss is virtually guaranteed—and it will be the right type of weight loss.

Question:  What is the role of physical activity in managing my weight and staying healthy?

Answer:  It is absolutely essential. In addition to a healthy diet, physical activity will fuel your weight loss while helping to maintain and grow your lean muscle mass. Exercise can also improve your emotional health and overall vitality. Speak with your doctor about developing an exercise routine. The use of physical therapy to provide personalized assistance and equipment may be helpful.

Question:  Why do some suffer more gas or diarrhea than others?

Answer:  Most of the gas within our intestines is derived from swallowed air.  Air is composed of 80% nitrogen and 20% oxygen.  The air is swallowed during eating, talking and may also be done subconsciously to clear gastric reflux and esophageal irritation.  The oxygen within the air is absorbed through the intestines, but the nitrogen must travel all the way through the colon.

Others may have the “irritable bowel” syndrome in which anxiety and other unknown factors cause colon and small bowel dysfunction.  Symptoms of abdominal cramping and alternating constipation and diarrhea can be reduced by the use of bran or other stool softeners to keep the stools soft and the work of the colon to a minimum.  The tranquilizer effect of aerobic exercise also benefits the irritated bowel.

Question:  How to do you know how large the pouch has grown to?

Answer:  The exact size of the pouch after surgery is a difficult perimeter to measure.  An upper GI series, endoscopy and other radiographic tests have not been of much value.  A simple and seemingly accurate means of sizing can be done at home.  Using a new carton of cottage cheese (or firm yogurt), spoonfuls are eaten until the beginning of a full sensation is achieved.  The resulting defect in the cottage cheese carton can then be measured by adding water in the place where the cottage cheese used to reside.  The amount of water required represents the size of the gastric pouch.  Hopefully the size will be less than 300 cc.

Question:  May I have my pouch made smaller if it grows too much and what is involved?

Answer:  It can be made smaller by another operation.  This is rarely necessary.  The operation is much more difficult and dangerous than the first because of the degree of scarring around the stomach due to the original operation.  It is much easier and safer to follow postoperative dietary instruction.  This is certainly a case where an ounce of prevention is worth of pound of cure.

Question:  Is there a chance to regain weight?

Answer:  Some patients may become frustrated and discouraged after weight loss levels off, but is yet too high or when slow weight gain occurs.  This cannot go uncorrected.  While responsibility to continue making progress and to avoid regression remains with the patient, help is available.  It is important to realize that the pouch is there only as a tool and must be used properly.  If this leveling off or regression occurs, support may be necessary and it is important that you return to Surgery for Health so that we may evaluate your situation.  We will review your history and the items you have learned and experienced during your initial evaluation and reading this booklet.  Reevaluation does not mean either the operation or you have failed.  We are aware if often requires considerable time and effort to change the habits formed over half a lifetime.  We understand your predicament.  We want to be viewed as a coach and friend and not as a critic.

Question:  Besides a healthy diet, nutritional supplementation, and exercise are there any other factors of a healthy lifestyle that I should incorporate?

Answer:  Your emotional health should not be underestimated, and for many patients, this represents a significant hurtle to get over. But there are solutions. In my practice I incorporate a team approach to bariatric surgery that includes psychiatric counselors (coaches) and specialized support groups to help with the psychological adjustments that every patient will have to make. Even professional athletes, who are the best in their sport, have coaches to assist them.  I encourage you to seek out these resources prior to your surgery and develop a detailed plan of action with your doctor that will put you on the path to success. Good luck and good health!

Summary

As a potential candidate for bariatric surgery, it is important to recognize that complications may occur.  In fact, the national mortality rate for this form of surgery is about 1%.  Of course, the risk of death is greater in extremely heavy patients and in those who have serious medical complications such as heart disease, hypertension, diabetes and significant lung disease.

Bariatric surgery IS NOT COSMETIC SURGERY.   Although weight loss eventually leads to dramatic physical improvements, gastric bypass should not be undertaken for cosmetic reasons.  This procedure is performed only to minimize major illnesses and prevent premature death as a result of the complications of clinically severe obesity.  In fact, there may be some less desirable effects on appearance, such as temporary hair loss and the development of unsightly skin folds in various parts of the body that may require plastic surgery.

We want each person considering bariatric surgery to make a well-informed decision. Carefully evaluate the non-surgical efforts you have made and determine whether further efforts would be productive.  Please compare this to the risks and benefits of gastric bypass surgery.  We encourage patients to discuss their thoughts and feelings about the operation with family and other support persons, especially those who have already undergone gastric bypass.  Only after these considerations can one make a fully informed decision about bypass surgery.  For those who feel that gastric bypass is a good choice for them, we at Surgery for Health believe our program is second to none.