Month: June 2021

After Bariatric surgery you are likely to lose anything between 4 and 8 kgs every month.  However, day to day or even week to week, fluctuations in weight may occur due to many reasons. Sometimes patients stop losing weight for no apparent reason. This is known as the plateau phase. You can get worked up and wonder there is something wrong with you or if the surgery is not working properly.

Bariatric surgery helps in losing weight fairly rapid at first, and then over the time the weight loss becomes more gradual. Usually weight loss happens for about 12 to 18 months post-surgery and stabilizes after that. During this period, weight loss does not follow a certain trend, but can be erratic with alternating periods of significant weight loss followed by no weight loss.

Status of hydration is the most common cause of this variation. Other factors are gaining muscle mass, empty or full bladder/constipation or oedema before menstrual cycles. Thus, patients are recommended not to weigh themselves too frequently to avoid inaccuracies due to these factors.

Exercise routine and eating habits also affects your metabolic rate and weight loss pattern. Exercise increases muscle mass which is beneficial in many ways, however may result in slower weight loss. Patients are advised to eat several small meals a day high in protein. A reduction in the frequency by starving during the day and binge eating at night may disturb weight loss pattern.

Over the time the stomach and the intestines adapt to its new surgical change which allows for better absorption of food, especially fats, though adhering to eating small meals high in protein may limit this effect. The newly made gastric pouch may enlarge over the time and accommodate larger meals, which interferes with the weight loss and may predispose weight gain. To resume weight loss your surgeon may advise surgical revision in select cases. This dilatation of the stomach can be prevented by avoiding using straw and aerated liquids.

After bariatric surgery, you should not drink during meals, to prevent rapid transition of food from the stomach, resulting in elimination of the feeling of fullness and ingestion of larger meals.

In general, it is normal to have periods of plateaus during all phases of weight loss journey. Complying with the post-surgery diet and lifestyle modification advice may shorten the periods of plateau and finally lead to greater long-term weight loss.

It is important to remember that Bariatric surgery is a tool, if used appropriately may help you achieve successful weight loss, if not, overall weight loss may fall below expectations.

To achieve your health goals stay in touch with us, we are with you through THICK and thin!!!

Overweight and obesity strains your joints and makes them weak and painful. Constant pain reduces mobility and worsens the obesity. Obesity alone have been associated with altered levels of calcium, vitamin D and parathyroid hormone in all ages.

Shedding extra kilos will make your joints stronger, helps in getting relief in aches and also reduces risks of fracture specially the hip joint. Losing weight also decreases the possibility of getting a joint transplant done.

Bariatric surgery is a proven tool to help obese people get all these benefits and improve quality of life.

Despite the undoubted health benefits, bariatric surgery requires an extensive preoperative nutritional assessment and also calls for a life-long commitment from the patient for follow-up to focus on weight loss maintenance and compliance to aftercare recommendations.  In general, gastric bypass procedures will have greater potential risk of micronutrient deficiency than a gastric sleeve.

All patients preparing for bariatric surgery should be screened for the presence of vitamin D deficiency and hyperparathyroidism. DEXA scan for all obese patients is not recommended, however women aged more than 65 years or younger post-menopausal females and men 70 years or older may be advised by the bariatric surgeon based on their clinical risk factor profile.

After bariatric surgery calcium and vitamin D deficiency may develop due to reduced dietary intake and decreased intestinal absorption, though research studies do not conclusively support any increased incidence of osteoporosis or increased fracture risk after bariatric surgery.

I always advise my bariatric surgery patients to include naturally rich or fortified food sources in their diet to get enough of calcium and vitamin D. To get good amounts of calcium including milk and milk products, fish, green leafy vegetables, ragi, kidney beans and almonds in the daily diet is a good idea.

For vitamin D, fortified dairy products and cereals, fish (sardines, salmon and mackerel) and egg yolks makes a great choice, also exposing to the sun between 10am to 3pm for 15 to 30 minutes in minimal clothing is good to produce vitamin D in the skin.

Regular, long-term follow-up and nutritional supplementation is important to prevent and overcome already existing deficiencies and should be provided according to the type of procedure and the individual patient’s risk for bone loss.

People undergoing bariatric surgery require 1200–2400mg calcium per day, depending on type of procedure, to be taken into 2–3 divided doses. In our practice we prefer Calcium Citrate Malate (CCM) tablets in chewable form as it  possesses highest bioavailability and doesn’t require stomach acid for absorption.

To prevent vitamin D deficiency 60,000 IU of vitamin D is required once a week for 8 weeks. Severe deficiencies can be treated with higher doses up to 60,000 IU 3 times a day. Vitamin D supplements are easily available in different forms such as powder, syrup or soft gels, any of them can be taken.

It is important to stay in to stay in regular touch with your bariatric surgeon and dietician for annual monitoring of bone loss and to correct the causes in time to prevent further damage.

Healthy bones are happy bones….