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Why Weight Loss is still difficult after bariatric surgery
Obesity has quickly become one of the biggest topics in healthcare. It can lead to diabetes, heart disease, joint problems, and sleep apnea, just to name a few. Most people know the risks of being obese, but some still find limited success with diet and exercise. Many people turn to bariatric surgery to further assist them in their goals. This paper will describe bariatric surgery, the strict diet patients must follow after surgery, and touch base on some of the reasons for failure even after a successful surgery.
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What exactly is Bariatric surgery? Bariatric surgeries “make changes to your digestive system by limiting the amount of food you can eat or limiting the absorption of nutrients”. (MayoClinic.org) There are many types of surgeries, most of which reduce the size of the stomach and enables you to become full after eating smaller meals, therefore you are able to lose weight due to a reduced calorie intake. This includes the Roux-en-Y and the Biliopancreatic diversion with duodenal switch. In these surgeries eighty percent of the stomach is removed creating a pouch for holding food, where the end of the pouch is connected to part of the small intestine. Other weight loss surgeries include the Laparoscopic adjustable gastric banding and sleeve gastrectomy. These surgeries cover and reshape the stomach making it unable to expand which can help prevent overeating. (Mayo Clinic.org) The surgeon determines which surgery will best meet your needs, but regardless of which type is chosen the patient must commit to diet and lifestyle changes. Before surgery you will go through a screening process by a physician to make sure that you are a candidate for a bariatric surgery. Candidates must have a body mass index of 40% or higher, or have BMIi of 35% and higher and a known weight related health issue, such as diabetes. Patients will also meet with a nutritionist to design a diet plan specifically tailored to meet their nutritional needs.
After the surgery is complete, patients must follow a very strict diet plan to lose weight. Most patients are expected to lose at least fifty percent of their overweight pounds within the first year and most lost by the second year after surgery. While it is considered rapid weight loss because the calories are so restricted, it is still a slow process. First the patients will start with a liquid diet, common after most digestive system surgeries, to allow the digestive system to heal. At that point, the patients will progress onto soft food ,and then finally to regular food. Mayo Clinic.org states that “this can take up to 12 weeks”. “Immediately following surgery the patient’s stomach is about the size of an egg and can only hold about ¼ cup of food or liquid at a time.” (UCSFHealth.org) For this reason it is recommended that you go slow and take your time until you are aware of what amount your body can process and how fast it metabolizes. At the beginning after surgery, your calorie intake should be no more than 300-600 cal. and by the end of the first year gradually reach to 1000 cal. per day. Your nutritionist will establish a diet for your particular needs but meals will be broken down into small meals several times a day. The common diet will include high protein, low-fat, and low-carbohydrate foods. It is also important to supplement the diet with vitamins to maintain proper nutrient intake. You should be avoiding sugar, bread, meat that is not easily chewed, raw vegetables and fresh raw fruits as these may be hard to digest at this time.
As time goes on, your daily diet will become routine and the pounds of excessive weight will drop.
Or at least that is the idea behind weight loss surgeries, but it is not always the case. For some it is difficult to lose the excessive weight or difficult to not gain it back. There are usually several reasons for this occurrence. If you are an emotional eater it may be harder, even after bariatric surgery, to lose weight. An emotional eater is one who handles stress by eating comfort foods. These usually contain high amounts of sugar or starches that are not part of your regular diet. Stress causes your body to release cortisol which makes you feel hungry, eating fat or sugary foods help calm this urge down. It is important to be aware of your stress triggers and know the difference between psychological and physiological hunger. This also rings true if you eat more to relieve boredom. This is another form of emotional eating, stay busy and active, remember you are changing old habits and creating better healthy ones. There is a cycle of emotions that some people encounter when stress eating. You over eat then feel ashamed for not having control over your eating habits which in turn causes more stress, then the cycle is repeated because you over eat again since you are stressed. Learning how to resist and have control over your food choices and serving sizes is very difficult to achieve when it is constantly around you and accessible.
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As spoken of before bariatric surgery is only part of losing weight, you must be committed to lifestyle changes to see results. Most of the hard work is psychological. You have to create anew normal way of thinking about food. This can be a difficult challenge; food has been intertwined into every culture through the ages. It is present at every social event and all around us in everyday life. Eating should be a part of living not the only thing we think about. With time, patience and redirection, we must re-focus our attention to maintaining a balanced diet and an active fulfilling life. I think that more people considering weight loss surgeries should first try the meal plans that are supposed to be followed after surgery. If followed strictly they may be able to lose weight with out surgery, or at least know the regimen they would have to follow. Although I do not consider myself a candidate for weight loss surgery, I do need to lose some weight. My biggest hurdles are emotional eating and that I am not consistent with any weight loss diet I have ever been on. I usually only make it about a week or so of restricted dieting and then I relapse. It is difficult trying to lose the excessive weight without constant encouragement. Conducting this research has helped me to better understand what bariatric surgery fully entails and to me it would be very difficult to maintain my diet afterword. I need to first address my emotional stress management issues before I can seriously have any restrictive diet. I think for me this would be the key to any weight loss success. My cousin Casey had a sleeve gastrectomy surgery done a couple of years ago, she lost over a hundred pounds, but it was a long journey. She had a hard time not eating junk food, during the death of my grandmother. Casey is much happier and active after losing the weight and her health concerns have improved. She has always had a bubbly personality and losing weight helped her gain self confidence in her appearance, and generally feel better about herself.
- Bariatric Surgery Patient care and health procedures, (n.d.) Retrieved from https://www.mayoclinic.org/tests-procedures/bariatric-surgery/about/pac-20394258
- Dietary Guidelines after Bariatric Surgery, (n.d) Retrieved from
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