Considering bariatric surgery? If so, set yourself up for the best possible outcomes by:
- Minimizing the risk of negative outcomes
- Achieving significant weight loss (exactly how much depends on a number of variables)
- Sustaining your weight loss over time, i.e., keeping the weight off
- Reversing co-morbid conditions, especially diabetes, sleep apnea, fatty liver disease
- Improving your quality-of-life
I recently spoke with Christopher D. Still, DO, FACN, FACP, medical director at the Center for Nutrition & Weight Management and Director of the Geisinger Obesity Institute, who was an attendee and presenter at ObesityWeek 2016 in New Orleans. Dr. Still confirmed that for patients diagnosed with obesity, bariatric surgery has proved to be the most effective treatment for long-term weight loss and the reduction or remission of co-morbid conditions.
He suggested that one of the major and significant changes in the bariatric surgical industry was the established accreditation — Bariatric Center of Excellence (COE) — which requires hospitals performing this surgery to conduct a minimum of 140 bariatric surgical procedures each year.
Other standards that hospitals must meet to earn Bariatric Center of Excellence accreditation include:
- Obesity sensitivity training
- The use of proper techniques by hospital staff for moving patients with obesity
- The ability to quickly recognize signs and symptoms of bariatric surgery complications
- High-quality post-operative care of bariatric surgical patients
- The establishment of specific post-operative nutrition protocols
For the person who is considering bariatric surgery, the first step, then, is to look for these Centers of Excellence.
Next, I asked Dr. Still about other elements he believes are necessary to ensure an optimal outcome for patients who decide to have bariatric surgery. He acknowledged that “obesity is still a chronic relapsing condition,” so it is critical to adequately prepare for and be given proper support prior to surgery.
The bariatric support team at his facility includes six members, each with a specific area of expertise:
- Primary care obesity medicine specialist (either an internist or endocrinologist who is board-certified in obesity medicine)
- Nurse practitioner/physician assistant
- Clinical nutrition specialist
- Exercise physiologist
- Clinical psychologist
The six-month pre-operative program provides ongoing medical care, education, and support to optimize the surgical experience and establish a strong foundation for patients’ post-surgical success. It is imperative that the relationships between each patient and key support team members continue after surgery. Patients have ongoing post-surgery recovery needs and changing nutritional requirements, so guidance from the team members can minimize any potential complications while optimizing weight loss.
Dr. Still pointed out that many bariatric patients have unrealistic expectations, expecting to lose far more weight than is reasonable, given their personal variables and issues that can confound weight loss efforts. Bariatric surgery and the subsequent weight loss fundamentally changes a person’s physiology, most notably their gut–microbe balance, the various hormone levels that modulate hunger and satiation, and their metabolic rate (as lean muscle mass is often lost).
These changes can counteract weight loss. That’s why it’s crucial to exercise after surgery — to help with energy balance and to maintain muscle mass (through weight-bearing exercise). The diet that post-surgical patients follow is typically “protein-heavy,” with strict complex carbohydrate portion control. Keeping a food journal long term has been shown to help patients be honest about their calorie intake and to stay committed to the dietary component of post-surgical care.
When a patient is six to nine months post bariatric surgery, experience shows that “life can get in the way,” so to speak, and de-rail patients’ diet and exercise commitment. At this stage, patients also are typically tapering the frequency of their visits with the support team. Adhering to regular follow-up appointments, especially with their team dietician, psychologist, and exercise specialist, helps patients remain committed to their lifestyle changes.
If a patient starts to experience weight regain, it’s crucial that they reach out to their team for help. Ignoring the issue or feeling mortified or like a failure is effectively a self-prescription for significant weight gain. Dr. Still emphasizes the importance of immediate intervention if a patient sees even a small uptick in weight.
A relatively new and free app now available for smartphones (iPhone or iPad right now, Android to follow) is the Get-2-Goal app. This app was created by students from Bucknell University in collaboration with the Obesity Institute at Geisinger Health System to help current, future, and prospective patients who are considering bariatric surgery. The person inputs certain body measurements and other pertinent medical information and the app then provides “reasonable weight loss expectations” for that person. This dose of reality sets patients up for success. The app also can be used post-surgery to track a person’s progress with weight loss and to provide guidelines for reasonable expectations given their lifestyle habits and other contributing variables.
A recent column in Bariatric Times suggests five “pearls” that can help optimize weight loss following bariatric surgery: 1) behavioral health support, 2) maintaining a diet that supports weight loss, 3) weight maintenance, 4) utilizing specialists in obesity medicine, exercising, and 5) having the support of a nurse or other team member long-term. These recommendations echo Dr. Still’s suggestions.
So, if you are seeking maximal payoff from bariatric surgery, do these activities to boost your chances of best success:
- Seek a Center of Excellence
- Have reasonable weight loss expectations
- Work with a pre-surgery team for at least three to six months
- Continue to access support from this team over the long-term post-surgery
- Adopt a personalized diet that is rich in lean protein with measured amounts of complex carbohydrates
- Take the recommended supplements to prevent vitamin and mineral deficiencies
- Embrace regular aerobic and especially weight-bearing exercise
Bariatric Times. 2016;13(11):10-16
Amy Hendel, also known as The HealthGal, is a Physician Assistant, nutritionist and fitness expert. As a health media personality, she's been reporting and blogging on lifestyle issues and health news for over 20 years. Author of The 4 Habits of Healthy Families, her website offers daily health reports, links to her blogs, and a library of lifestyle video segments.