- Have you tried everything to lose weight? Really tried?
- Have you had the support of a qualified dietitian to lose the weight?
- Have you tried changing your lifestyle and maintain those changes for more than six months?
- Have you engaged in any sort of activity in the last six months?
Answering these questions truthfully can help you decide whether weight loss surgery is the right decision for you. If you have answered no to a question, take a step back and avoid jumping to the conclusion that weight loss surgery is the only solution.
Weight loss surgery, also known as bariatric surgery, is usually the last resort an extremely obese person will undergo in order to lose weight. But why take such extreme measures? Suitable candidates for bariatric surgery are those with a BMI (body mass index) of more than 40 and those patients with a BMI of more than 35 with medically important obesity-related conditions that could be improved by weight loss. Priority should be given to those with significant chronic illnesses that are currently not well treated but which are known to respond well to weight loss. These conditions include high blood pressure requiring medication, type 2 diabetes and a few more. Other selection criteria include history of weight loss attempts, age, surgical risk and mental health status.
Despite international guidelines highlighting such specific criteria for patient selection, bariatric surgery has turned into a craze where it can be seen as a ‘free card’ to a speedy weight loss. Unfortunately in some parts of the world, such as in the UAE, an important factor is often disregarded: all non surgical measures should have been tried but failed to achieve or maintain weight loss. What many don’t understand is that, just like any surgery, the risks and complications should not be ignored! Also, if you haven’t changed your lifestyle and eating habits before surgery then your chances of experiencing nutritional complications post surgery are extremely high. Let us dig deeper into the common surgeries performed:
- Gastric Bypass: In very simple terms, your stomach and intestines are divided and rearranged to make a new small stomach. Also, parts of the stomach and intestines are bypassed.
- Sleeve gastrectomy: A large part of your stomach (50-70%) is removed.
- Gastric Banding: An inflatable silicone ring is placed around the upper part of your stomach. The ring is adjustable where the surgeon can add or remove saline through a port which is placed under the skin and accessed with a needle.
The risks of bariatric surgery should never be taken for granted and they include complications such as excessive bleeding, blood clots, infection, stomach perforation, unfavourable reactions to anaesthesia and in rare cases, death. In situations of extreme obesity, the risk of death from not having the surgery could be greater than the risks from the possible complications of surgery. For this reason, assessing whether surgery is the right thing for you should be done carefully with a qualified surgeon and never rushed. Moving on, your team should include the following health professionals if surgery is a ‘go ahead’:
- An experienced and accredited bariatric surgeon
- A physician with a special interest in obesity
- An accredited dietitian
- A psychologist or licensed mental health care professional
- Anaesthetist
Now the reasons for consulting a dietitian before and after the surgery are endless! Usually, you will need to be on a specialised diet prior to surgery which can include meal replacements in the form of liquids. Also, thorough nutrition counselling and education should be provided to you such as discussing the importance of taking responsibility, the degree of calorie restriction and possible need for multivitamin supplementation. A dietitian will also help you modify any behaviours that will need to be changed for successful weight loss after surgery.
Once your surgery is completed successfully, you will need to be on a texture modified diet which will eventually be upgraded until a normal diet is reached. This means that your diet will change from a liquid diet, then to a pureed diet until a more solid texture is tolerated. This gradual progression can only be guided and monitored successfully if a dietitian is on board. Additionally, some nutritional complications may occur after surgery and they can include any of the following:
- Swallowing difficulties
- Vomiting, diarrhoea or constipation
- Low blood sugar levels
- Vitamin and mineral deficiencies
Being a dietitian who has worked in the area of bariatric surgery, I have witnessed happy endings and successful weight loss but only with the right health professional team and with a solid support system. Yet the complications are very real where any of the following scenarios can take place (and actually, already have in the past):
- Extreme loss of total weight leading to malnutrition and death
- Extreme loss of muscle mass causing physical problems such as inability to walk
- Constant vomiting and diarrhoea leading to hospitalisation due to extreme dehydration
So before making a rushed decision about surgery, put your frustrations about not losing weight aside and try to answer these questions with a clear state of mind:
Are you ready for a life long commitment to medical and dietetic follow up?
Are you determined to keep the weight off after surgery and improve your health and lifestyle?
Are you fully aware of the surgical procedure, potential complications and of how your life may change after the surgery?
Weight loss, whether surgically or conservatively, is not something to be rushed since success is not a race! Be patient, be committed and get the support your need!
If you or someone you know have undergone bariatric surgery, please share your stories and experiences which may help others in their journey…
Dolphin Solutions
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