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Weight Loss/Bariatric Surgery:

Bariatric surgery is nothing but the common term collectively used for many types of weight-loss surgeries. These surgeries make changes to your digestive system to help you lose weight. They either limit the amount of food you can intake or reduce your ability to absorb nutrition and in some cases both.

Such types of surgeries are done when diet or exercise plans have not worked out for the person and when the person has some serious health condition as a result of their weight. Gastric bypass is the most common type of bariatric surgery and most surgeons prefer this surgery as it usually has fewer complications than other weight-loss surgeries do.

These surgeries generally pose major risks and side effects and the patient has to make changes to their diet permanently and also schedule a fixed exercise regime so that they can ensure the lasting success of bariatric surgeries.

Bariatric surgeries may not be suitable for everyone and so they are only performed if there is a serious health threat or impediment to the patient due to their excessive weight. It is not advised as a cosmetic procedure as there are serious risks and complications that may arise.

Biliopancreatic Diversion With Duodenal Switch (BPD/DS)

This procedure is done when the person has a high risk of potentially life-threatening health issues related to weight gain, such as the following:

• Heart disease
• High BP
• High cholesterol
• Severe sleep apnea
• Type 2 diabetes
• Stroke infertility

This procedure is not for everyone who is obese. And so screening processes are done to see if you are a suitable candidate for this surgery.

Endoscopic Sleeve Gastroplasty

This procedure is often used for candidates whose BMI is thirty and above. It is only recommended when even after trying to maintain their weight through exercise and diet they are unable to make any progress. The patient has to be willing to maintain a healthy lifestyle and go for a regular checkup and also participate in behavioral therapy to be considered as a candidate for this surgery. This procedure is not suitable for a person having gastrointestinal bleeding or hiatal hernia which is more than three centimeters or the person who had any previous abdominal surgery.

Gastric Bypass

The gastric bypass surgery is generally a suitable option for individuals whose:

• Body mass index is forty or higher
• BMI range from thirty-five to thirty-nine with health issues such as type 2 diabetes or high BP or severe sleep apnea
• In some rare cases, the surgery is done when you have severe health issues even if your BMI is thirty to thirty-four

Intragastric Balloon

This procedure is generally recommended for people who:

• Have a Body mass index between thirty to forty
• Are willing to adopt a healthy lifestyle and participate in behavioral therapy
• Have not undergone any previous stomach or esophageal surgery

Sleeve Gastrectomy

This procedure is generally recommended for people who:

• Have Body mass index is forty or higher (extreme obesity)
• BMI range from thirty-five to thirty-nine point nine with health issues such as type 2 diabetes or high BP or severe sleep apnea
• In some rare cases, the surgery is done when you have severe health issues even if your BMI is thirty to thirty-four

For each type of bariatric surgery, the results differ as follows:

Biliopancreatic Diversion With Duodenal Switch (BPD/DS)

There might be a possibility for seventy to eighty percent weight loss within the first two years. But the weight loss will completely depend upon the person's personal changes in their lifestyle. In addition to that, any other health issues which were related to obesity would be resolved.

Endoscopic Sleeve Gastroplasty

This surgery may result in a significant loss of weight. And in the studies, it has shown that 17.8 kilograms are reduced for the person with a thirty-eight body mass index in just six months and nineteen kilos in about twelve months ie. one year.

And about thirty-three kgs in a person who had a body mass index of forty-five within the first six months i.e. in just half a year. (These results are purely indicative and may vary from patient to patient.)

Gastric Bypass

This procedure helps with a long-term loss of weight. The amount of weight loss depends on the surgery as well as lifestyle changes. The person might show up to sixty percent weight loss in just two years after the surgery.

Intragastric Balloon

This surgery makes the person feel full even with much smaller portion sizes. Hence the person tends to eat less than earlier. There are also hormonal changes induced which control appetite. About ten to fifteen percent of weight loss can be observed in just half a year.

Sleeve Gastrectomy

This surgery shows major weight loss of up to sixty percent which can be maintained if the person changes to a healthy lifestyle, diet, and exercise.

The success of Bariatric surgery largely depends on the behavioural and lifestyle changes that the patient adopts after the surgery. Patients have to rigorously follow the diet plan prescribed by the dietitian and and also attend behavioural therapy to change their attitudes towards nutrition and exercise.

Diet Before Surgery

Your Bariatric surgeon might prescribe a weight loss goal and a plan that you have to achieve before the surgery. This weight loss helps in reducing excess fats around the liver as well as the abdomen region reducing the chance of complications. If you do not hit the prescribed weight goal, the doctor might choose to delay the procedure.

Diet plan (Pre surgery)

The guidelines may vary from person to person and also depending upon the type of surgery:

• Avoid binge eating
• Eliminate high sugar beverages
• Daily multivitamin supplements may be recommended
• Protein supplements may be recommended
• High carbohydrate foods must be avoided
• Eliminate saturated fats from your diet

Diet Plan (Post Surgery)

The diet plan after the surgery may go on for several stages which would be fixed by your doctor or dietician.

Stage 1: Liquid Diet

For initial days after the surgery only few ounces of clear liquids are allowed. After that, there will be graduate changes of which type of liquids can be taken.

• Skimmed milk
• Thin soup and broth
• Decaffeinated tea or coffee
• Unsweetened juice
• Sugar-free gelatin

Stage 2: Pureed diet

Pureed food consists of food of a thick, pudding-like consistency which may be blended at home itself. Spices might irritate the stomach so it would be better to avoid them completely.

Mostly prefer seedless fruits and also avoid fibrous vegetables. Fruits such as bananas, peaches, apricots, pears, pineapples, melons are generally recommended at this stage. The dietician may also prescribed pureed vegetables such as tomato, spinach, carrots and green beans.

Stage 3: Soft diet

At this phase the doctor will suggest that you start with soft and easily chewable food. This may include:

• Soft-boiled eggs
• Ground meat
• Cooked whitefish
• Canned fruits
• Yogurt
• Whitefish
• Cottage cheese
• Ricotta cheese
• Beef (Ground)
• Chicken (Ground)
• Turkey (Ground)
• Scrambled eggs

Stage 4: Stabilization

In this stage, we can reintroduce solid food in our diet. This stage basically starts only after 2 months. The food should be broken down into small pieces and chewed well as your stomach is smaller. It is better to introduce food slowly so that the tolerance of your stomach can be noted and the diet can be adapted to not cause any discomfort.

Foods to avoid in stage 4:

• Popcorn
• Tough meat
• Fried food
• Crunchy food
• Dried food
• Bread products

Guideline for post op diet

After your surgical procedure, you will have to follow certain lifelong guidelines and adapt your lifestyle. It is best to prepare your meals at home and carry them with you at all times to avoid unhealthy binge eating.

Here are the guidelines you will have to follow lifelong after the procedure.

• Eat and drink slowly and pace yourself at each meal
• Portion control is essential
• Listen to your body if it shows any signs of discomfort
• Eliminate foods rich in saturated fats
• Avoid beverages during meals especially sweetened ones
• Be hydrated throughout the day
• Chew food thoroughly and break it down to smaller pieces

Lifestyle changes after the surgery

Do not start your exercise program immediately after the surgery. Let your body heal and so go slowly. Low impact exercise is recommended in the initial months. It may include tasks such as walking, swimming, simple yoga, stretching, and deep breathing exercises.

Strength training and cardio workouts can be started only after consultation with the doctor.

Even simple changes in day to day life can be beneficial such as

• Walking
• Avoid sitting for long periods of time
• Stretching at work
• Taking stairs instead of the lift

Who needs bariatric surgery?

It is an alternative for people who are unable to lose their weight through a normal diet or exercise plan. And the surgery was recommended by surgeons to people who have a body mass index of 40 or more. Even people with serious weight-related diseases such as sleep apnea, high blood pressure may be suitable candidates for these procedures.

How do I claim insurance for bariatric surgery?

Specific conditions have to be met for you to be able to claim Bariatric surgery under your medical insurance. Ensure you check with your insurance provider in detail about their specific requirements and policies.

• Several test and authorization from the surgeon may be requested
• Medical reports may be requested
• Your Body mass index should be above 40
• For a lower Body mass index, you can claim an exception due to serious health issues such as Type 2 diabetes, heart-related conditions, etc

How much does bariatric surgery cost?

The treatment for bariatric surgery is quite expensive which may approximately be 2.5 to 5 lakhs. The cost depends on several factors such as type of surgery opted, Surgeon’s fee, Chosen hospital, Instruments used, Consultancy, Anesthesia, and follow-up procedures. (Treatment cost is purely indicative and varies from case to case)

How dangerous is Bariatric Surgery?

It is normal to have safety concerns before considering bariatric surgery. Usually, patients with complications related to diabetes, pulmonary hypertension, and sleep apnea are suggested to have bariatric surgery. Compared to these health conditions which can result in premature death, the risks of bariatric surgery are minimal. Some potential risks of bariatric surgery include:

• Dumping syndrome (symptoms like nausea and dizziness)
• Developing kidney stones,
• Not losing the desired amount of weight or
• Weight regain (in few cases)
• Acid reflux
• Anaesthesia-related risks
• Chronic nausea and vomiting
• Dilation of oesophagus
• Inability to eat certain foods
• Infection
• Obstruction of stomach

Bariatric surgery carries some long-term risks for patients, including:

• Low blood sugar
• Malnutrition
• Vomiting
• Ulcers
• Bowel obstruction
• Hernias

You can help lower some of the risks and possible side effects by decreasing your Body Mass Index (BMI), increasing your amount of exercise and most importantly by quitting smoking.

What is the safest form of weight loss surgery?

There are four types of weight loss surgery:

Bariatric surgery: This surgery is good for you if your body mass index (BMI) is 40 or higher and you are between 35 and 40 in age.

Gastric bypass surgery: People with high BMIs, severe reflux disease or diabetic patients can opt for this surgery.

Sleeve gastrectomy surgery: People who have had multiple abdominal surgeries or they are on multiple medications to treat psychiatric illness.

Duodenal switch: It is best suited for people with severe obesity, severe metabolic diseases, or who are very good at following their doctor’s orders.

Hence, which type of surgery is the best weight loss surgery will depend on your health and your doctor's recommendation.

What are the Advantages of Bariatric Surgery?

Each type of weight loss surgery carries its own advantages and possible disadvantages.

Advantages of Bariatric Surgery

• You can expect to lose on average 60-70% of excess body weight
• 96% of obesity-related health problems are reversed quickly or completely resolved

What foods cannot be eaten after Bariatric Surgery?

It’s important to avoid certain foods on a post-bariatric surgery diet to get the appropriate amount of nutrition and to lose weight.

• Food with Empty Calories
• Alcohol
• Dry Foods
• Bread, Rice, and Pasta
• Fibrous Fruits and Vegetables
• High-Fat Food
• Sugary and Highly Caffeinated Drinks
• Tough Meats

Your doctor is likely to recommend that you:

• Eat and drink slowly
• Keep meal portions small
• Drink liquids between meals
• Chew food thoroughly
• Focus on high protein foods
• Take vitamin and mineral supplements