Severe obesity is a chronic (long-term) disease. This means that there is no cure but with the development of FDA approved surgical procedures like gastric bypass and the sleeve gastrectomy, there are now effective tools to manage the disease. The body will continue to change after surgery and the nutrition plan that works immediately after surgery will not be the same in the months and years to come. Most primary care physicians are not qualified to adequately take care of weight loss surgery patients.
Your bariatric surgeon and his trained staff will be able to offer you the best follow up care to ensure the most complete long term care. The secret to success after weight loss surgery is utilizing your multidisciplinary team to assist you in determining your specific nutritional and dietary needs, guidance with vitamin and mineral supplementation including regular lab work, along with support and encouragement for implementing and maintaining a healthy lifestyle change.
There is no arguing that introducing and maintaining healthy food choices can be difficult. Immediately after surgery patients are given specific guidelines and work through specific stages of diet starting with only liquids eventually adding small portions of regular foods. Finding the right balance of protein, carbohydrates and fat is crucial for losing and maintaining weight loss. Meeting regularly with a registered dietitian can be extremely beneficial. They can help you implement healthy food choices, direct you with portion control and make specific suggestions based on your personal medical background. Most patients are consistent with their follow up appointments the first two years after surgery; however many nutritional problems start to appear and become more prominent as time goes by, according to Jacqueline Jacques, a Naturopathic Doctor with more than a decade of expertise in medical nutrition. (2)
Having a professional talk with you about daily food choices and eating patterns regularly will help to reinforce healthy eating habits and often prevent nutritional deficiencies that can lead to more serious medical problems.
The American Society for Metabolic and Bariatric Surgery (ASMBS) has specific recommendations on the recommended doses, (of vitamins and minerals) but be sure that you follow your surgeon’s advice. (1)
The following questions and answers were taken directly from the ASMBS official website. For more information you can follow the direct link listed in the references.
Q: How much protein do I need daily?
A: Most patients need 60-80 grams daily, but some may require more depending on their response to surgery or their type of operation. Your dietitian can provide more detailed information. (1)
Q: How should I get my protein? With shakes? Bars? What if I’m a vegetarian?
A: There are many options even for those with special dietary needs or preferences. Your dietitian can provide additional information on protein sources. Meats, eggs, dairy products, and beans are common protein sources in everyday foods. Protein extracts made from soy, brown rice and whey are commonly sold in stores. Protein shakes or bars may offer additional ways to meet your protein needs. You may find it helpful to calculate your daily protein intake to be sure you’re not falling short. As you are able to tolerate more regular foods, you get a higher portion of the requirement during regular meals and supplements become less necessary. (1)
Q: What happens if I don’t take in enough protein?
A: The body needs additional protein during the period of rapid weight loss to maintain your muscle mass. Protein is also required for your metabolism to occur. If you don’t provide enough protein in your diet, the body will take its protein from your muscles and you can become frail. (1)
Q: Why is fluid intake important?
A: Dehydration is the most common reason for readmission to the hospital. Dehydration occurs when your body does not get enough fluid to keep it functioning at its best. Your body also requires fluid to burn its stored fat calories for energy. Carry a bottle of water with you all day, even when you are away from home; remind yourself to drink even if you don’t feel thirsty. Drinking 64 ounces of fluid is a good daily goal. You can tell if you’re getting enough fluid is if you’re making clear, light-colored urine 5-10 times per day. Signs of dehydration can be thirst, headache, hard stools or dizziness upon sitting or standing up. You should contact your surgeon’s office if you are unable to drink enough fluid to stay hydrated. (1)
Q: How much exercise should I get?
A: Current recommendations for activity are 150 minutes of moderate activity each week such as brisk walking, jogging, Zumba, swimming, or using exercise machines. Please note that the ability to safely tolerate exercise differs from person to person. Please make sure that your chosen exercise and amount will be safely tolerated by you. (1) Many bariatric programs have exercise physiologists available to you who can help you determine the best types of physical activity while understanding your medical limitations. Including some form of exercise will help ensure significant weight loss with a smaller risk of weight regain and most people will benefit greatly with encouragement and accountability from a healthcare professional by your side through all the ups and downs of living with and controlling severe obesity.
Q: How long will I need to take vitamin supplements?
A: Vitamin supplements will be a lifelong requirement. (1)
One of the most important elements of long term follow up is having regular blood work drawn at least once a year, preferably twice a year. Most primary care physicians are unaware of the needed labs so this is best done through your bariatric surgeon’s office where the bariatric team can order the specific blood tests needed to monitor nutritional, vitamin and mineral proper levels. Vitamin deficiencies can be life threatening and cause very serious health problems. According to clinical data from The New Life Center for Bariatric Surgery, 75% of all bariatric surgery patients have at least one vitamin or mineral deficiency PRIOR to surgery and after surgery it is known that chances are much greater of developing deficiencies due to the nature of the surgery which makes absorption of all nutrients more difficult.
There are published specific guidelines for vitamin supplementation (ASMBS Clinical Practice Guidelines) after weight loss surgery and there are very few multivitamins that contain all of the amounts of the vitamins and minerals needed to prevent deficiencies. Meeting regularly with your bariatric team and checking your labs will help determine if the vitamin supplementation plan is working and in fact preventing deficiencies. They can also recommend bariatric specific vitamin brands and guide you on the exact recommended dosing and make adjustments based on your lab results. Often by the time you experience a symptom of vitamin deficiency, damage has already occurred. The only way to know if your nutrition plan and vitamin and mineral supplementation is working is to have (at least) annual lab tests.
The American Society for Metabolic and Bariatric Surgery (ASMBS) has specific recommendations on the recommended doses, but be sure that you follow your surgeon’s advice. (1)
Q. How do your vitamins compare?
In the weeks after surgery, your surgeon will have a plan for you to follow, including instructions for nutrition and activity. This may include a liquid diet for a period of time followed by a progression to soft or pureed foods, and eventually more regular food. While you are healing in the first few months, it is extra hard to get enough fluid. Most surgeons advise a goal of 64oz or more of fluids daily to avoid dehydration, constipation, and kidney stones. You will also need a lifelong habit with daily supplements, usually including:
- Vitamin D
- Vitamin B12 (1)
A regimen including all of the above separate supplements is complicated and expensive when you try to piece it all together. That is why we created our all-in-one multivitamin solutions designed specifically for patients after bariatric surgery. An easy, no hassle delivery of all your required vitamins and minerals.
It’s all about Support!
Staying on track and motivated can be much easier with support. Continuing to meet regularly with your bariatric team will not only increase your chances of staying healthy while experiencing tremendous weight loss but it will help you maintain the weight loss for a successful life after bariatric surgery. Many studies show that patients who regularly attend support groups lose more weight and keep it off. Your multidisciplinary team will be your cheerleaders and your greatest supporters. Encouraging you to stay healthy with proper nutrition and even adding physical activity as you become healthier with the weight loss.
Many studies show that we’re all more likely to engage in better habits when we know that someone will be regularly checking in with us and holding us accountable. For this reason, most bariatric surgery programs plan for long-term follow-up visits with a healthcare provider experienced with obesity management. These follow-up visits may be the surgeon, a physician assistant or nurse practitioner, dietitian, mental health professional, exercise specialist, or a medical weight-loss specialist (bariatrician). The most important thing is that you find a bariatric surgery program that provides for this long-term care, so that any problems or concerns that develop over time can be addressed by an experienced team. (1)
Living with a chronic disease is extremely challenging with many ups and downs along the way. Bariatric surgery is a tremendous tool that can help manage severe obesity. The surgery is the first step to controlling it but maintaining the weight loss and getting and staying healthy will require a lifelong commitment.
The most successful patients make all of their scheduled appointments for the first two years after surgery and then meet with their bariatric team for blood work at least annually. Allowing a nutritionist or dietitian help you with healthy food choices and monitor your vitamin and minerals will prevent deficiencies and can be extremely beneficial. By having regular follow up appointments you can take the fear and guesswork out of your life and concentrate on living and being the healthy new you!