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Bariatric Surgery
Obesity, a risk factor for diseases including
Studies show that the risk of death from these conditions drops significantly after weight loss
Obesity contributes to numerous other medical conditions, including:
What is BMI (Body Mass Index)?
It is the measure of body fat based on height & weight of the adult
| Weight Classification | BMI |
| Ideal Weight | 18.5 - 24.9 |
| Over Weight | 25.0 - 29.9 |
| Obese (Class I) | 30.0 - 34.9 |
| Obese (Class II) | 35.0 - 39.9 |
| Clinically Severe Obesity (Class III) | > 40.0 |
Why surgery for obesity?
Who is a candidate for weight-loss surgery?
What are the options?
Laproscopic sleeve gastrectomy
It is procedure that involves the removal of major portion of the stomach. Following this the patients stomach will be significantly reduced in size, and will accommodate volume of food less than 100 ml. This is a restrictive procedure by this method the patient will loss about 40-50% of his /her excess body weight.
Laproscopic RouxEn - Y gastric bypass/ One anastomotic Gastric Bypass/ Mini Gastric Bypass
this procedure involves creation of a gastric pouch which will only accommodate about 30-50 ml of food. To this pouch a loop of small intestine will be connected so that the entire stomach will be bypassed by the food and it will later mix with the digestive juices lower down in the small intestines. This procedure is the both restrictive and the malabsorptive procedure. There by the patient will loss more weight compare to other procedures the patient can expect about 60-65% loss of excess body weight.
Abdominoplasty
This involves the surgical removal of excess fat in the belly a person having only a flabby belly may benefit from this procedure however recurrence rates are high. It is indicated after a weight loss surgery, once the belly starts hanging because of the weight loss.
Benefits
The medical and emotional benefits of the procedure begin almost immediately after surgery, and the cosmetic benefits follow in due time.
Over time, the benefits may include:
Nutrition and Obesity
An imbalance between the total calories consumed and the calorie spent in activity is the major cause of obesity. Consuming calories more than what is expended gets accumulated in the body as fat tissue, resulting in obesity. High calorie intake comes from the increased consumption of energy dense foods that are high in sugar and fat. The current nutritional scenario is a “Nutrition Transition”where healthy traditional diets are being replaced by modern high calorie, non nutrient dense diets. This paradigm is stated by United Nations as “Food Swamps”- an abundance of high-calorie, low-nutrient, processed foods and “Food Deserts” facing an absence of healthy food options.
Adding to this, increased physical inactivity, sedentary life style, due to changing modes of transportation and rapid urbanization paves the way for overweight followed by obesity.
Dietary Management
A plethora of dietary management exists across population. Despite all these, the crucial strategy for weight management lies only in reducing Dietary Energy Density, which has been scientifically proven to be effective in weight loss and sustenance of lost weight. No magic/crash diets have been successful in achieving either of these preferable outcomes.
Emphasizing portion control, and improving dietary quality is a central point in achieving sustainable weight loss. These strategies coupled with behaviour therapy can effectively reduce weight under continuous professional monitoring.
A variety of practical means and tools can help facilitate successful weight management by reducing energy density by limiting energy intake from total fats and sugars; increasing consumption of fruit and vegetables, as well as legumes, whole grains and nuts.
“Sustained adherence to a diet” rather than “following a certain type of diet” is the key to successful weight management which can certainly prevent the prognosis leading to surgery.
Medical Nutrition Therapy and Bariatric Surgery
If, however, an individual had to undergo a Bariatric Surgery, it is essential to follow an appropriate pre operative and a post operative dietary advice to continue to maintain a good health. Diet plays a vital role before and after bariatric surgery. Previous studies have shown that adherence to a regular nutritional follow-up contributes to post surgical weight reduction and prevents weight regain
Pre-operative weight management
Preoperative diets focus on “low-carbohydrate diet” than a “low-fat diet” with regard to short-term weight loss, improvement in insulin sensitivity, and reduction in lipid concentrations. Various national and international guidelines recommend an intake of 800–1000 kcals for a maximum of three months pre-surgery. It is also essential to consider one multivitamin supplementation daily. Pre-operative low-energy diets with supplemented micronutrients are expected to reduce liver size, making surgical access and liver retraction easier. Impaired pre-surgery nutritional status is found to be related to postoperative nutritional deficiencies and is associated with metabolic complications.
Postsurgery diet progression
Post surgically the patients are at risk of loss of lean muscle mass. Therefore, an adequate intake of protein rich foods is to be emphasized and met, despite the reduced portion size of the foods, without compromising other vital nutrients. Postoperative dietary recommendations are based on gradual progression in food consistency and texture over 1 to 2 months. the post-surgery liquid diet is for 1–2 weeks, the soft/pureed diet for 2 weeks and solid food to begin only one month post-surgery. Timely initiation of solid food ensures satiety and better nutritional composition in the diet. After two months post surgery, patients can consume a regular balanced solid diet.
An individualized tailor made dietary management of the obese individual opting for bariatric surgery, from a well trained Registered Dietitian, is essential to achieve a supervised and sustainable weight loss.
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