According to the CDC, approximately 127 million adults in the U.S. are overweight, 60 million are obese and 9 million people are morbidly obese. Unfortunately, based on current obesity trends, these numbers are likely to increase. Individuals carrying 100+ pounds of excess body fat are more likely to die prematurely and are plagued by chronic medical problems, including heart disease and diabetes. Not only do these individuals suffer from medical problems, their quality of life also suffers due to impaired mobility, difficulty breathing, and depression.
Obesity is the second leading cause of preventable death in the U. S. and in the wake of the obesity epidemic, chronic dieters are frustrated to find their waistline getting bigger, not smaller. Once frustration sets in, hopelessness soon follows. At this point the morbidly obese are willing to take extreme measures to lose weight. One of the most popular, yet invasive, means of weight loss among the obese is bariatric surgery (gastric bypass). Many celebrities, such as Carney Wilson, Roseanne Bar and Al Roker, sing praises about their experience with bariatric surgery. In the spot light, we see their physical, mental and lifestyle transformation and crave the same. After all, if it worked for them, it should work for me!
The number of Americans who have had bariatric surgery has increased dramatically during the last decade. In 1992, there were about 16,000 bariatric procedures performed and in 2002, there were a whopping 63,000 procedures. Despite this surge in popularity, bariatric surgery is not a magic bullet, nor is it for everyone who is obese. It's a major procedure, accompanied by significant and indefinite lifestyle changes, risks and side effects. If you're morbidly obese and you're considering obesity surgery, your journey is far from over. Sure, this may be a step towards weight loss, but you must consider the lifestyle changes that have to take place after the surgery or you'll be in even worse shape than when you began.
Before you have surgery to get your insides rearranged, let's cover a few facts the media hasn't showed with you. Bariatric surgery is reserved for those who are 100 pounds or more overweight and have a Body Mass Index 40 or higher. Candidates should also have exhausted other means of weight loss therapies such as diet, exercise, and medications. In certain circumstances, patients with a BMI of 35 may be considered for bariatric surgery, provided there are co-morbidities (i.e. diabetes and heart disease) and/or obesity-induced physical problems that are interfering with the quality of your life.
Gastric bypass is a type of surgery in which the stomach is reduced in size. The surgery serves two purposes; to reduce the volume of the stomach and shorten the food transit time in the intestine. The surgeon first staples the stomach across the top, sealing it off from the rest of your stomach and leaving a tiny pouch that can hold about an ounce of food or fluid. (Over time, the stomach pouch will stretch until it can hold 4 to 8 ounces.) Next, the surgeon cuts the small intestine and sews part of it directly onto the pouch. The size of the opening between the stomach and small intestine is roughly 1/4 inch which helps to slow the rate at which food enters the intestine. Food bypasses a large part of the intestine and has little time to interact with liver and pancreatic enzymes, thereby limiting your ability to absorb calories.
With such a drastic reduction in the ability to assimilate food, and the decrease in the stomachs ability to pulverize food to initiate digestion, it is important that patients become aware of proper nutrition to prevent nutritional deficiencies and to maintain fat loss.
At first, only clear liquids (i.e. water, sugar-free juice, clear broth, sugar-free gelatin) are allowed; no other food can be consumed for one to two weeks after surgery. Once your body adjusts to these liquids, full-liquids are gradually added (i.e. nutrient-rich protein shakes). This liquid diet may last anywhere from two to six weeks after surgery. For the next couple of weeks soft and puréed foods are added (i.e. baby foods, eggs and puréed tuna or chicken) and eventually, you will be allowed to begin to eat soft, solid foods such as mashed potatoes, oatmeal and cooked vegetables. As soon as your "new stomach" adjusts to eating semi-solid foods, it is time to graduate to "real foods". Here are some important considerations when introducing new foods to your eating program:
Protein
Protein is used in the body to maintain a high metabolism, build new tissue, and to keep maintain muscle stores. After surgery, protein is necessary to ensure that wounds heal properly. After surgery, the stomach can only hold about 1 ounce of food. This means that it is nearly impossible to get the amount of protein needed to maintain muscle stores and to allow the body to heal properly. There is no doubt that a large amount of weight will be lost after surgery. Generally, for every 10 pounds lost from poor eating habits, 4-6 pounds come from muscle mass! Many times after the patient has been on this low volume of food for several months or years, individuals with a low protein diet can experience a cease in weight loss and begin to gain weight due to a drop in metabolism.
Dumping Syndrome
The gastric bypass diet is very low in sugar for a couple of reasons. First, these foods are high in calories and in small amounts they can make weight loss difficult. Second, eating sweet or sugary foods promotes "dumping". Because sugar is no longer digested in the stomach, it passes straight into the intestine where it then absorbs water, causing diarrhea that leads to nausea, weakness, dizziness and cramping. Dumping syndrome is a real drag! Not only does it dump into the intestine, but it can also cause the fecal matter to dump right into you into underwear!
Reflux
If you've ever had reflux, you know how painful it can be, if you've never had refulx. good luck! Fats are difficult to digest after gastric bypass surgery. Too much fat will delay emptying of the stomach and may cause reflux, a back-up of stomach acid and food into the esophagus that causes heartburn. Fat may also cause diarrhea, nausea, or stomach discomfort. Generally, fat is usually ruled out because it contributes to weight gain. Unfortunately, many individuals whom are looking for that magic bullet eat whatever they want in hopes that they can still lose weight only to find their weight creeping back up.
Constipation and Blockage
High fiber diets are beneficial in reducing cholesterol levels and maintaining a healthy colon. Foods high in fiber include bran, raw vegetables, and beans. Because the stomach volume is reduced, there is less space in the stomach to hold "bulky" foods, and a reduced amount of gastric acid available to digest them. In some cases, fiber may get stuck in the pouch itself, or block the narrow opening into the small intestine. Due to a decrease in fiber intake, patients will notice a drastic change in bowel movements and frequently suffer from constipation.
Vitamins & Minerals Deficiencies/ Malabsorption Problems
Supplementation is an important part of the gastric bypass diet. Since the diet allows only small amounts of a limited variety of foods, it is difficult to get enough vitamins and minerals from food. Deficiencies in iron, folate, vitamin B-12 and calcium can develop in a matter of months. Most physicians require their gastric bypass patients to take a multivitamin/mineral supplement. Once again, there is a possibility that supplements may get lodged in the entry way of the newly created pouch. Due to the stomachs reduced capacity to hold food, we suggest to take liquid supplements between meals with liquid.
Mental weight loss
If you think that changing eating habits is the only lifestyle adjustment, think again! In many cases, the hardest lifestyle factor to change is one's psychological need for food. In many cases, morbidly obese people use food as a source of comfort, rather than a source of nutrition, thereby leading to their extreme weight. A study in Obesity Surgery found that 115 surgical candidates showed that 70% had a current or past psychological problem. The prevalence of depression was 56%, compared to 17% for the general population and 17% of patients suffered from anxiety disorders. Post surgery, many individuals may need to work with a psychiatrist to help deal with issues that may arise from a new lifestyle. Some individuals who have had the surgery the past couple of years are in a honeymoon state, they don't want to admit they've had problems because they're so happy to be thin. Changing a relationship with food is very challenging and eating linked to boredom and depression are "rituals" that are difficult to change, but necessary to maintain weight loss for a lifetime.
Cost
Your new fabulous figure doesn't come without a high price. Generally, the procedure can cost anywhere from $20,000 -$50,000 and up to six hours in the operating room. Hospitalization is required for several days and intensive post surgical care is necessary. Home recuperation takes at least one month. Let's not forget that gastric bypass surgery can bring about many health risks and side effects that can be fatal. Short-term complications include lung collapse, blood clots in the legs (which can cause a pulmonary embolism), wound infection, and fluid collection in the abdomen. Long-term complications include reopening of the stomach pouch, leakage of stomach juices into the abdomen, the formation of scar tissue and development of an abdominal hernia. More than one-third of obese patients develop gallstones and nearly one in three develop nutritional deficiencies.
Gastric bypass is an invasive procedure that promises long term results to what seems to be a life long problem. However, having your stomach reduced in size and your intestines resectioned will not fix the underlying issue. The choices and decisions that are made in regards to food, exercise and lifestyle changes are the major factors that need to be addressed, not weight loss. I understand that achieving weight loss can be more difficult for some individuals, but unless you have exercised consistently for years and have really focused on making lifestyle changes in regards to your food, nutrition, and exercise habits, bariatric surgery is not for you.
As a counselor, I have met with many individuals who consider this type of surgery. They too have claimed to have tried to alter their diet, exercise and have taken medications to help lose weight. Time and time again, I have found that lack of weight loss has nothing to do with the individual, their motivation, or discipline, but many times, success was never achieved because of inaccurate information. In fact, the weight loss methods utilized simply didn't provide the proper information needed to lose body fat and to maintain success for a lifetime. Nor do these programs address other important factors such as psychology, motivation, and the process of change. Those who were considering bariatric surgery quickly changed their mind after discussing health risks and drastic lifestyle changes. Those who had the surgery regained most of their weight or currently suffer from severe nutritional and gastrointestinal issues.
Imagine a young woman who resorts to gastric bypass, will she ever be able to have a healthy pregnancy? What about a young boy who needs proper nutrition to continue to grow? What about a business executive who travels and dines out regularly? Will he be able to maintain a quality of life? Bariartic surgery is not a quick fix nor is it going to bring happiness. This procedure is a very drastic and expensive way to limit food intake. Eating 2 ounces of food 4-5 times a day isn't enough to feed a small child, let alone an active adult. If the purpose of the procedure is to limit food intake and to aid in malabsorption, wouldn't it be better, healthier and safer to make simple lifestyle changes?
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