By CHISTIE ROY, Beth Israel Deaconess Medical Center Correspondent
You're watching TV and a photo of an extremely overweight person appears on the screen. A voiceover explains that this person has since had weight loss surgery and … here they are, less than a year later and more than 100 pounds lighter!
But this person's new appearance may be a little deceiving — it is about a lot more than just looking great. The decision to have weight loss, or bariatric, surgery is not an easy one, nor is it an easy process for many patients.
Due to the restrictive nature of weight loss surgery, most patients will begin to drop pounds quickly after having a procedure, but those who ultimately find long-term success also make significant changes to their everyday life — and stick to them.
"One of the first things we explain to patients considering weight loss surgery is that it is not a 'quick fix,' nor is it an 'easy' way out," says Linda Trainor, RN, BSN, Bariatric Nurse Coordinator in the Weight Loss Surgery Center at Beth Israel Deaconess Medical Center. "We stress that surgery is a helpful tool to utilize as they strive to reach their health goals."
Trainor and her colleagues emphasize that there are many things a person must carefully consider before choosing to have weight loss surgery. Patients need to fully understand the risks and benefits of a procedure, be willing to accept the lifestyle changes it imposes, and be committed to lifelong follow-ups with their bariatric clinicians.
"We see patients in our clinic multiple times before they even undergo surgery, for pre-screenings to determine if they are eligible and, if so, to help them prepare for what's ahead," explains Trainor, a certified bariatric nurse. "Weight loss surgery is not for everyone, but for many patients, especially those dealing with obesity-related illnesses, the risks of remaining obese are greater than the risk of problems from the surgery."
Depending on the procedure, patients generally stay in the hospital for one to three days after having weight loss surgery; this time period has decreased over the years as procedures have become less invasive.
The inpatient bariatric nursing staff at BIDMC begins working with patients immediately after surgery, reviewing specific plans for diet, activity, supplements and general recovery — all important steps to which patients must adhere.
Nutrition and Exercise after Surgery
All types of weight loss surgery change the digestive system, and patients are carefully advised about what and how to eat after surgery.
"We always tell patients that however old you are when you have surgery is how many years of eating behaviors — like how many times you chew before you swallow — that may need to change," says Kate Otto, RD, LDN, a bariatric dietitian at BIDMC. "Developing new eating techniques takes time, but eventually it will become the patient's new 'normal.'
"Early on, there are certain foods that patients need to avoid to ensure proper healing," she adds. "Long term, our goal is not to be thought of as 'food police' and dictate what a patient can and cannot eat, but aim to be a patient's nutrition coach, to help them develop a plan around their individual lifestyle so they can achieve their goals."
Patients follow five diet stages after surgery to help condition their newly "remodeled" stomach:
- Stage 1: sips of water only (1 day or less after surgery)
- Stage 2: clear liquids low in sugar that are not carbonated or caffeinated (1 day or less)
- Stage 3: high protein, low fat, and low-sugar modified liquids (about 2 to 3 weeks)
- Stage 4: puréed, soft foods that are high in protein (about 5 weeks)
- Stage 5: overall healthy balance of solid foods with a focus on high-quality protein, vegetables, fruits, and whole grains (beginning about two months after surgery and lasting for life)
"While it can be tempting to consume foods before they are recommended, it typically leads to pain and discomfort," notes Michelle Davis, RD, LDN, also a bariatric dietitian at BIDMC. "Pre-surgery, we encourage patients to reflect and make sure this is the right time in their lives to commit to lasting behavior changes for long-term success."
Regular exercise is an important part of the post-weight loss surgery regimen, too. Patients are encouraged to begin walking around within a few hours after their surgery, and urged to establish a realistic exercise routine early in their post-op period. The bariatric team helps patients identify how they can stay physically active on a regular basis, and provides guidance for different types of exercise that may work best with their lifestyle.
Adjusting to life after bariatric surgery can be challenging, and achieving long-term success may be more difficult if you're on your own. Many of BIDMC's patients agree that having family and friends there for support and encouragement, as well as connecting with others who have traveled the same road, is vital.
"There are new issues to deal with, new questions that need answers," says Sue Levy Walker, MSW, a bariatric social worker at BIDMC. "Engaging in a support group with others who are working through similar situations can often help patients meet their goals. The value of talking with others who are dealing with the same questions, concerns, and challenges is crucial for patients who can often feel misunderstood, judged and alone on a journey that can all too easily become derailed."
BIDMC's Weight Loss Surgery Center offers monthly support group sessions for post-op patients, featuring different discussion topics as well as cooking and exercise demonstrations. Some patients also volunteer to become "Bari-Buddies," sharing their strength, hope and recovery with those considering weight loss surgery. A Bari-Buddy book can be reviewed by patients in the outpatient bariatric clinic at BIDMC.
"Keeping your scheduled pre-op and post-op appointments with the bariatric clinicians is also a key to success," adds Trainor. "We all want our patients to succeed and we're here to support them on their journey any way we can."
Above content provided by Beth Israel Deaconess Medical Center. For advice about your medical care, consult your doctor. Posted February 2015
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