Nearly a quarter-million people in the United States will undergo weight loss surgery this year to arrest their morbid obesity and lose weight. In spite of the drastic nature of gastric surgeries not all patients will reach a healthy weight and some may eventually regain weight they lost initially with surgery. Obesity is not a simple cosmetic problem of excess body weight than can be corrected with surgery. It is a metabolic disorder where the body stores an abnormal amount of body fat. Bariatric surgeries help arrest the disease by reducing the amount of calories a person may eat and some surgeries reduce the amount of nutrients the body absorbs and stores as fat. The surgery does not remove the disease but with patient compliance weight is lost and obesity can be put in remission.
Chances for healthy weight loss and weight maintenance with surgery can improve with patient commitment to recovery. Patients must accept that the burden of treatment for their disease obesity is with them. Bariatric counselors tell patients the surgery is only a tool and it is up to the patient to use it correctly. This applies to all procedures including gastric bypass, gastric sleeve, and adjustable gastric banding (lap-band). There are three pro-active things patients can do to use their tool wisely:
Lifestyle: Accept that bariatric surgery brings with it an entirely different lifestyle that you must adopt for the rest of your life. Unlike conventional diets there is no finish line: surgery requires an almost religious-like lifestyle change. Patients must follow a high protein, low carbohydrate diet every day for the rest of their life in order to lose weight and maintain that weight loss. Patients will need to avoid simple carbohydrates including sugary snack foods and fried food. Snacking, when allowed, must be mindful including lean protein and low-glycemic fruits and vegetables. Liquid restrictions mean no beverages before or after meals and no drinking with meals: this helps the surgical pouch work correctly. Patients learn and accept that some things will make them sick, smells will affect them differently, and sometimes they will feel emotionally blue because of the irreversible restrictions of surgery. We have this life-changing surgery with all its restrictions and then return to the very environment in which we became obese: of course we suffer feelings of sadness at times.
Support: As with other life-changing disease, patients seeking treatment and recovery from morbid obesity with surgery benefit from support. While no one can understand another persons exact journey we can certainly share the collective experience of obesity, life long dieting and weight gain, and finally the somber decision to undergo treatment with surgery. While patients are likely to cluster to support groups both live and online before surgery and in the first year following surgery, there is a tendency to drift away from support groups as time passes. Evidence suggests, however, that solid support relationships are a key in sustaining personal efforts for health, weight control and wellness with bariatric surgery.
Activity: The inclusion of physical activity as part of lifestyle change with surgery will make a difference in the long term successful weight management of bariatric patients. Early post-operative patients are directed to get 150 minutes of exercise a week, that is about 20 minutes a day. Patients who do this and more will successfully manage their weight loss and weight maintenance. Patients who regain weight often admit they never really got around to including physical activity in their new lifestyle. Studies indicate exercise need not be strenuous or exhausting. Physical activity simply must move us beyond the normal motion required of daily life.
Weight loss surgery patients tend to idolize their surgeons and bariatric teams crediting them with restoring their health. But long after the surgical wounds have healed and the routine checkups are simply annual office visits it is up to the patient to own their surgical tool and manage it in a way that keeps their disease in remission.