What Every Potential Bariatric Surgical Patient Should KnowMarch 16, 2022
For potential bariatric surgical patients, we often begin our consultations for weight loss surgery by explaining, “We are operating on you, not making the Twinkie or potato chips healthier.” Sounds obvious, but the point is often missed. For those afflicted with weight issues, there is constant turbulence.
They are often judged as not caring about their health and unable to execute the council given by physicians, dieticians, and other weight loss experts. So, they come seeking what they believe will be the ultimate solution. After all, each has contact with someone that has succeeded following surgical intervention.
Following years of consideration, they finally pursue surgery, accepting that the only option will be a permanent change of their digestive anatomy. As this is a major decision, they come to believe that it is the surgery that causes weight loss.
In fact, for bariatric surgery, weight loss is a side effect. The cause of weight loss is eating differently. To maintain weight loss, even after surgery requires a lifetime change in diet. Although the surgical changes offer a powerful effect on hunger and satiety, these signals fade with time.
As a result, the real purpose of a surgical procedure is to make a healthy lifestyle with proper food choices more sustainable. It is not a substitute! Many believe that to be successful they merely need to eat less of the same foods that they have always eaten. In truth, that is a path for weight regain and why we begin our consults by emphasizing that we do not make processed foods healthier.
What Potential Bariatric Surgical Patients Need to Know
Many reading this will withdraw and hesitate. They will wonder, if I have to eat differently and exercise more, why have surgery? Logic tells them that if this was possible, they would never have had a weight problem and be successful with non-operative weight loss modalities. However, this thought process is scientifically wrong. Those with serious weight-related issues are wired differently.
For fuel, the body utilizes food and converts it to chemical energy. To power our muscles, we can metabolize carbohydrates, fat, and rarely protein. These macronutrients are vital to our existence, performance, mood, concentration, and daily function.
In healthy individuals with a proper proportion of fat to lean muscle mass, there is an ordered sequence of utilization. Fat is preferentially burned at rest and at a low-grade activity. With intense exercise and immediately after meals, carbohydrate is utilized. For those with obesity, they will store and not burn fat. How this happens is still being determined. Certainly, the elevation of the short-term energy hormone insulin plays an important role.
Excess insulin promotes ectopic, (meaning going where it does not belong), fat storage in the liver, muscle, pancreas, and brain. It also limits fat breakdown.
In simple terms…insulin is a “fat-storing hormone” and ectopic fat is what elevates the risk of metabolic disease. The net result, explains what those with weight-related issues have experienced. They don’t lose weight because they do not burn fat and create a trifecta of metabolic syndrome, where the body's furnace to utilize energy is broken. Surgery alters this balance and is able to restore the ability to burn fat.
This now takes us to another key fact. What destroyed the body's burning ability were poor food choices and the consumption of processed foods. Thus, if the thermostat is reset by surgery, and there is a return to poor food choices, the impact will be fleeting.
Laparoscopic Sleeve Gastrectomy
Laparoscopic sleeve gastrectomy has become the most common bariatric surgery procedure. It is an excellent weight loss operation, but there is a large incidence of recidivism. Immediately after surgery, there is rapid weight loss, induced by the dramatic reduction of food intake.
With time, larger portions of food can be consumed. Additionally, with weight loss, the body becomes more efficient. There is less surface area (less of you that the body needs to maintain) thus the heart rate slows, blood pressure goes down and less energy is burned at rest. Furthermore, not just fat is lost. Lean muscle mass or the good portion of the body also declines. The net result is that you burn far less energy doing your tasks of daily living.
At 8 months, most patients reach their maximal weight loss. As you move away from the procedure, they become at great risk of weight regain. Because of the metabolic efficiency caused by weight loss and breakdown of lean muscle, they can eat far less than prior to surgery and still can gain weight. Proving that eating less of the same diet is akin to a long-term poor outcome.
Arya Sharma, a leading weight loss expert stated, “Weight is like a rubber band and wants to return to its natural position.” If utilized correctly surgery can help prevent the bounce back.
The key step is to understand that you must eat differently, be active, and increase your lean muscle mass. Exercise is a purposeful activity, whereas physical activity is the movement for daily living. At least 30 minutes of daily low-grade cardiovascular activity is necessary to maintain weight loss.
Building muscle can only be done with some form of resistance training 2-3 times per week and proper protein intake. But what will be the most important for the long term is your food choices. (In our practice, we refrain from the word diet, as it instills restriction and our mission is to encourage healthy living with REAL WHOLE FOOD, void of grab-and-go processed foods and simple carbohydrates that get easily metabolized and disrupt energy regulation and then stored as fat.
To simplify, our dieticians give every patient the COMMANDMENTS TO EATING. Simple rules that can be applied for life. They include:
In summary, those with weight problems utilize fuel differently. They store, rather than burn adipose tissue. Surgery resets this balance and is an underutilized and powerful remedy. Bariatric surgery will never be a substitute for proper eating.
Adopting the Commandments To Eating will ensure sustainable weight loss and wellness all around including social, mental, emotional, spiritual, intellectual, and most importantly physical health.
We conclude all of our consults by explaining that we cannot out operate a poor diet and unhealthy lifestyle. Surgery can give you a fresh start. We take great pride in explaining what you need to do to succeed and providing the tools required to make this happen. We are hopeful, that this perspective can make these complex issues clearer and provide the framework necessary to succeed for years following the surgical procedure.
Sharon Zarabi is a Registered Dietitian, Certified Dietitian Nutritionist, and Certified Personal Fitness Trainer with the International Fitness Professional's Association (IFPA) and Aerobics and Fitness Association of America (AFAA). She is Program Director at Katz Woman’s Institute and Northwell Heath
ABOUT THE AUTHORMitchell Roslin, MD, FACS is the Director of Bariatric Surgery at Lenox Hill Hospital and Northern Westchester Hospital Center. He has performed bariatric surgery since 1994 and is internationally renown in the field. In addition, to his clinical work he has authored numerous research articles and chapters in medical textbooks. Dr. Roslin has appeared on Good Morning America, Nightline, CBS Early Show, World News Tonight and countless other media outlets.
Read more articles by Dr. Roslin!
ABOUT THE AUTHORSharon Zarabi is a Registered Dietitian, Certified Dietitian Nutritionist, and Certified Personal Fitness Trainer with the International Fitness Professional's Association (IFPA) and Aerobics and Fitness Association of America (AFAA.) She is Program Director at Katz Woman’s Institute and Northwell Heath. As she continues her life’s work, her vision is to continue to use fitness and nutrition as a means to offer spiritual and emotional upheaval in people's lives.