Frequently
Asked Questions
1.
Blood clots after gastric bypass surgery
2.
Eating a few days after gastric bypass
surgery
3.
Eating in restaurants
4.
Fast food
5.
Exercise
6.
Bariatricians
7.
Prevalence of Obesity
8.
Childhood obesity
9.
Health Implications of Obesity
10.
Determining BMI Related Health Risks
11.
Life after gastric bypass surgery
12. Eating after the gastric bypass
surgery
Why
do blood clots sometimes occur after gastric bypass surgery?
A: Blood
clots form because of pooling of the blood in the large veins in the
legs. This occurs when patients move their legs less, such as either
during surgery or when spending a time in bed recovering after
surgery. Stress, such as from gastric bypass surgery or injury,
causes the blood to clot in these pools to clot more easily. Combine
these changes with thickening of the blood that can occur after
surgery due to mild dehydration, and the result is an overall
increased risk of blood clots forming in the legs. Your doctors will
use early ambulation, automatic compression stockings, and blood
thinners to prevent these clots from forming. Be sure to do what you
can to help, by getting up as much as is practical, and by putting
your compression stockings back on when you get back into your
hospital bed, and your risk of forming blood clots will stay low,
hopefully just a few percent or less.
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What
if I can't eat a few days after gastric bypass surgery?
A: It
is hard to eat much 5 days, or even a week or 2 after surgery. Your
small stomach pouch, and the opening between the pouch and your
intestine are swollen and almost closed off. You also are recovering
from major surgery, and don't feel like eating much. Concentrate on
taking liquids so you don't become dehydrated, and eat simple pureed
and soft foods as you are able to. The problem up till now has been
too many nutrients. You probably have great nutritional reserves,
and can go for some time without depleting your stores. As you feel
better and the swelling goes down, and you learn what agrees with
you, you will take more. As you begin to take more, try to lean
toward high protein foods and supplements, bearing in mind that some
people can't take dairy products or dairy based supplements. Do let
your doctors know how you are doing, especially if you have
diabetes, so that they can adjust your medicines as your intake goes
up and down.
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What do
I do if I want to eat in a fancy restaurant?
A: The rule of thumb is
always eat protein. Most will gladly grill or roast a piece of
chicken, fish or steak. Even if not mentioned on the menu
restaurant's menu most willingly makes substitutions of permitted
vegetables spinach, green beans etc., instead of potatoes or rice.
If the restaurant simply will not prepare a dish which you are
permitted to have order something with fish, poultry or steak and a
separate plate. Take the protein and scrape off the offending sauce,
breading, etc. and place it along with any permissible vegetables on
your "keeper" plate and give the "Fattening Stuff" back to the
waiter (you don't need the temptation to sneak a taste and no-one in
your party needs extra fat or calories). If there is one food you
can eat with impunity it is protein. At the dinner party load up on
salad and protein (push the gravy or sauce to the other side of your
dish) and dig in! Although you may not be following the program 100%
it won't be too bad or hurt your progress that much.
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Can I eat fast food?
A: Many patients worry
about where they can get meals in fast food chains or restaurants.
It is very easy to get the types of food you need at many of the
fast food chains such as Burger King, Wendy's, or McDonald's. (These
are good choices to make even if you have not had the surgery.) All
three offer salads that are low in calories and fat. Both Wendy's
and Burger King offer Chunky Chicken Salads. Unfortunately, Long
John Silver's offers fish and chicken entree's which are both fine
(remember no rice, cole slaw or bread sticks) and they will be happy
to substitute a salad for the starches you are not permitted to
have. Hardee's offers a grilled chicken sandwich, which will be
permissible for lunch if you eat only one slice of bread and request
it without mayonnaise. Arby's offers the only turkey sandwich in the
fast food circuit, which is fine with only 1 slice of the bread.
Mrs. Winner's offers broiled chicken with green beans. Remember the
old standby at any of these fast food places. You can always order a
garden salad and a hamburger pattie with mustard. This is a quick
meal that is available at all the fast food chains.
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What
about exercise?
A: It's important to
exercise while trying to lose weight. Walking is the key. The bike
manufacturers and gym owners would like you to think that heavy
exercise is the key, but, research is recommending less vigorous and
stressful physical activities for those of us who wish to lose or
control our weight.
Most patients have adequate amounts of lean
body mass. In many overweight individuals this mass will be very
close to or exceed their ideal weight range. This means that they do
not need additional muscle and need to lose fat.
Remember
you cannot exercise fat and
can only exercise muscle. Our body responds to exercise by
increasing muscle size and thereby increasing lean body mass. Adding
additional lean body mass to an individual who is trying to loose
fat undermines the whole process. It is quite likely that you will
gain weight if you exercise extensively. This will be more
pronounced if your protein intake is increased while dieting.
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What
is a Bariatrician?
A: A bariatrician is a
licensed physician (Doctor of Medicine [M.D.] or Doctor of
Osteopathy (D.O.) who, as a member of the American Society of
Bariatric Physicians (ASBP), has received special training in
bariatric medicine the medical treatment of overweight and obesity
and its associated conditions. Bariatricians address the obese
patient with a comprehensive program of diet and nutrition,
exercise, lifestyle changes and, when indicated, the prescription of
appetite suppressants and other appropriate medications. (The word
bariatric stems from the Greek word barros, which translates as
heavy or large.)
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How
Prevalent is Obesity?
A: Obesity is a chronic,
debilitating and potentially fatal disease that requires treatment
by a physician trained in bariatric medicine. It is marked by an
excess accumulation of body fat sufficient to endanger health. The
United States is currently suffering an obesity epidemic
contributing to the premature death, sickness and suffering of
millions of Americans.
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What
about childhood obesity?
A:
Approximately one in five children in the US between the ages of 6
and 17 is overweight. The number of overweight children in the US
has more than doubled in the past 30 years. The number of overweight
children (age 6-17) has doubled within three decades. Obesity in
children is a chronic disease that overshadows all others in
frequency in the pediatric population. Changes in the Western
lifestyle have led to significant reductions in energy expenditure
of children and have encouraged "super-sizing" of calorie-dense,
high-fat foods and snacks. Physical inactivity, "junk" food diets
(including high calorie soft drinks and fruit beverages), increased
television watching accompanied by snacking, increased time playing
video and computer games all contribute to increased obesity among
the young. When we think of the major problems facing pediatrics in
the next millennium, the disturbing trend toward obesity has to be
among the most serious, with all the adverse health implications
that obesity carries. (Pediatric Alert, March 27, 1997)
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What
are the Health Implications of Obesity?
A:
Obesity has been established as a major risk factor for diabetes,
hypertension, cardiovascular disease and some cancers in both men
and women. Other co morbid conditions include sleep apnea,
osteoarthritis, infertility, idiopathic intracranial hypertension,
lower extremity venous stasis disease, gastro-esophageal reflux and
urinary stress incontinence. Obesity-related medical conditions
contribute to 300,000 deaths each year, second only to smoking as a
cause of preventable death.
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How is a Patients BMI Related Health Risk
Determined?
|
|
No Obesity |
|
|
BMI >= 27 kg/m2
(approximately 20% above ideal weight) |
|
|
BMI >= 30 kg/m2
(approximately 30% above ideal weight) |
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What
happens after the gastric bypass surgery?
A: After your Gastric Bypass surgery, you will begin to awaken in
the post-op recovery room, in what may seem like just an instant.
Many patients will have little or no recollection of being there, a
normal side effect of the medicine given to you during anesthesia.
Ordinarily, your breathing tube is removed from your throat as you
begin awakening usually before you are aware of it being there.
You will be started on pain medication by the nurses in recovery as
soon as you need it. The IV line for fluids and medications that was
started in the operating room will remain with you for your entire
stay in the hospital and will take care of your required fluid
intake. Although you won't be allowed to drink water for the next
day or so, you will be allowed to suck on ice chips after the first
day if your mouth is dry. About 4 hours after surgery, the nurses
will ask you to sit up again, only this time, you will dangle your
legs off the side of the bed and put your feet on the ground. We
check to see that your vital signs are ok, your pain medication is
ok and that you are recovering normally in preparation for your
first walk. The nurses will get you up again in preparation for your
first walk about 5 hours after surgery. Along with your deep
breathing and coughing exercise, walking is essential to your
recovery. For your entire stay in the hospital, the nurses will get
you up and make you walk around the floor about every 2 hours. As
your recovery continues, we monitor your pulse, your temperature,
and your blood count carefully. If you are showing good medical
progress, we start you on swallows of water, followed by Jell-O and
broth your meals for the next few days. Don't worry about
finishing your meals. When you feel full or just don't feel like
eating stop. Depending on the patient, on the second or third day
you will be instructed in preparation for leaving the hospital. If
you are taking fluids well, can tolerate Jell-O and broth, don't
have a fever and are breathing and walking well, we will send you
home.
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What should I eat after gastric bypass surgery?
A: Follow these four simple rules faithfully and the weight will
come off and stay off. Break these rules continually and long term
you will gain weight. Your surgery is a tool to be used with these
four rules and experience shows that unless you follow them, we
cannot predict any weight loss results. When patients reach a
'plateau' and stop losing weight, it is usually because they are not
following these simple but very important rules!
Protein first every meal:
Eat the protein portion of your meal first, very meal! One to three
meals per day. Eating protein helps the body to feel 'full' and
sends a signal to stop eating. Protein is very important to building
tissue in the body muscle, your organs, your brain everything is
built with proteins. Now, the body does not need three meals a day,
so listen to your hunger cues and don't worry about the clock. It
the beginning - after you can tolerate solid food - most patients
only eat one or two meals a day.
No snacking between meals:
Eating anything flavorful or containing calories in between meals is
considered snacking. Do not eat between meals at all! If you
absolutely have to snack, the only snack that is acceptable is
protein. In the beginning, turkey jerky is a good protein and you
must work at it a little to eat it! Later on, after 6 months, beef
or venison jerky is acceptable but only if you just have to eat
something. The main problem with snacking on flavorful food is that
it contains glucose or some other sugar. We feel good when we eat
sugar and when that sugar is gone one to three hours later our
brain sends a message to snack again! Snacking actually makes us
hungrier! Do not open the door to snacking. Snacking will slow down
or even stop your weight loss! And depending on how much or how
often you snack, you can actually gain weight! Not good! You can get
this big again. Remember, the surgery has only changed your
digestive system and not your eating habits. Your commitment to a
change in lifestyle is the key to making the surgery work for you
for the rest of your life.
Drink water:
Drink water, drink water, drink water! Especially in the beginning,
when you can only tolerate a mouthful at a time, it is so important
to continually sip water all day - and make sure you drink 48 to 64
oz. a day minimum - that's 2 to 3 quarts per day. Eventually, you
will able to drink 2 to 4 oz. at one time. No tea, soda (with or
without sugar), coffee, or juice are allowed. There are a couple of
problems with drinking flavorful liquids in between meals. First and
most importantly, it encourages snacking not good! Second,
flavored drinks with any sugar can cause dumping making you very
sick!
Exercise:
Exercise every day for at least 30 minutes. Walking is fantastic
exercise and is probably the easiest way to get started exercising.
We understand that in the beginning you may struggle with a simple
walk down the hall and that your energy level can be very low. Your
job is to move your body a little more every day. At 4 to 8 weeks
(everyone is different) you will mostly feel back to normal. After
you have been cleared by your physician, you may begin other forms
of exercise. Eventually, incorporating both aerobic and resistance
training into your daily exercise routine will help you remain
healthy - at a healthy weight - for the rest of your life.
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