weight loss surgery Archives

Management of Pregnancy after Bariatric Surgery

Obese women in reproductive age, looking forward to bariatric surgery as a weight loss option, are usually dubious about chances of conception and pregnancy after bariatric surgery.

Women with a high BMI, have a lower likelihood to become pregnant as compared to lean women, mainly due to irregularity in menstrual cycles or anovulation associated with obesity.

About 50% of obese women with infertility or PCOD are dissatisfied with their sexual life. This might be caused by increased circulatory androgens (testosterone and DHEA-S), raised due to decreased hepatic production of sex hormones-binding globulin (SHBG). Hyperinsulinaemia also triggers lieutinizing hormone mediated androgens production in ovarian theca cells, these hormonal imbalance cause infertility.

Bariatric surgery also called as weight loss surgery improves chances of conception, pregnancy and delivery. Weight loss surgery cures PCOD (Poly Cystic Ovarian Disease), improves hormonal balance and fertility. After bariatric surgery there is a steep rise in SHBG and a drop in testosterone, androstenedione and DHEA-S levels in women which thereby improves menstrual irregularities and infertility.

As the fertility improves after bariatric surgery, all women in reproductive age should take additional contraceptive measures. Oral pills may not provide sufficient protection after bariatric surgery especially after gastric bypass due to malabsorption.

Pregnancy should be planned after 12 to 18 months post-bariatric surgery and requires regular and more frequent follow-up visits to the doctor. Delivery should be planned in a tertiary care center with experienced interdisciplinary teams and the availability of a neonatal intensive care unit.

After bariatric surgery, micronutrient supplementation is advised to all the pregnant women. Supplementation of Iron, calcium, zinc, vitamin D, folic acid, vitamin B12 and vitamin A are important to prevent maternal and fetal complications.

During lactation, regular follow-up at every 3 months is recommended for new moms after bariatric surgery. Regular examination of the new born is highly recommended.

Mothers who have got bariatric surgery done should also exclusively breast fed the baby for 6 months after birth and should be monitored for nutritional intake and deficiencies. Mothers should take advised micronutrient supplementation regularly, as maternal intake of nutrients has strong influence on the quality of the breast milk delivered to the offspring. Malnutrition of the mother can potentially cause undernourishment of the breastfed baby, especially vitamin B deficiency can cause megaloblastic anaemia and development delay in the offspring. Calcium deficiency may lead to reduced calcium secretion in the breast milk and might cause insufficient mineralization of the bones of baby.

Pregnancy after bariatric surgery is safe, if properly planned and monitored. Several research studies have reported decreased risk of maternal complications in post bariatric surgery pregnancies, and improved neonatal outcomes, compared with obese women. Also in pregnancy after bariatric surgery, lower risk of gestational diabetes, high blood pressure, miscarriages and preterm birth are detected as compared to obese women.

Why Gradual Diet Progression is Advised After Bariatric Surgery

Candidates for bariatric surgery often wonder why there is gradual progression of diet after weight loss surgery?? They ask me why they have to be on liquid diet for first 15 days, and they question me if they have to be on liquids for weight loss then why surgery is required?? It is important to make prospective patients understand that they have a key role in their healing process. They have undergone a major change physically and emotionally. The purpose of dietary phases is to provide appropriate time for proper healing. Also, gradual progression helps decrease acid reflux, provide early satiety, prevent dumping syndrome while maximize weight loss and at the same time should prevent lean body mass during the period of extreme weight loss.

That is why the gradual dietary progression must be adhered strictly in order to support tissue healing, aid in weight loss and to prevent possible complications.

The diet progresses in 4 phases, such as:

• Clear liquids
• Full liquids
• Pureed diet
• Soft to normal diet

Clear liquids include sugar free, non-aerated liquids which supply fluid and electrolytes and also helps in encouraging the restoration of gut activity after surgery. Patients usually follow this diet post-operatively during hospital stay only, i.e. 1 to 2 days. From the day of discharge, they may start introducing full liquids including skimmed milk, lassi, butter milk, strained veg/dal and chicken soups etc. and continue the same for 2 weeks. Then from week 3 they are advised to take pureed diet consisting of foods that have been blended or liquified to a puree consistency like milkshakes, well cooked and mashed pulses and vegetables, scrambled eggs and grilled fish. They need to be on pureed diet for next 2 weeks. After 4 to 5 weeks of surgery they may gradually progress from soft to normal diet including well cooked foods, avoiding sugary and fatty meals.

The post-surgery diet is designed to restrict calorie intake, as well as to help develop appropriate eating habits and diet behaviour to promote weight loss while maintaining good nutritional status.

The primary nutritional goals and diet behaviour involve:

• Taking adequate liquids say around 1 to 1 .5 lts to stay hydrated.

• Consume protein first in each meal to minimize loss of lean body mass and facilitate healing. It is usually difficult to get enough protein through food that is why protein supplements are recommended to meet the needs.

• Avoid 5 “S”, i.e. Sugar, Spirits, Smoking, Soda and Straw.

Sugar and spirits are avoided to prevent dumping and also to aid weight loss, straw and soda may cause bloating and patients may suffer with stomach discomfort, pain or feeling of fullness. Smoking is prohibited to prevent reflux and marginal ulcers.

Bariatric surgery procedures alter gastro-intestinal tract, hence modifies many food related behaviours such as portion size, perception of taste and smell, likes and dislikes or food choices. Patients are advised and educated to learn new diet behaviours to easily adapt modifications. They should eat at regular intervals, by including 6 to 7 meals a day. They are advised to chew the food very well and eat at a slow pace. Avoid drinking liquids along and for 30 minutes before and after meals as drinking beverages along with meals can cause early satiety and may hinder adequate protein intake. The meals portion should be small to avoid over eating and vomiting.

At our Institute we assess each patient in detail pre-operatively to recognize their nutritional and dietary patterns as well as to evaluate their ability to incorporate nutritional changes after weight loss surgery.

Each patient may have different capacity and appetite to eat; one should listen to his/her body as to when to stop eating. Be definite to abide by the instructions of your surgeon and/or dietitian to reduce your risk of developing malnutrition and surgical complications and all of this will be well worth it!

What is Bariatric Surgery? Risk, Complications and Side Effects

Bariatric Surgery or weight loss surgery is done to help you lose excess weight by making changes to your digestive system.

Gastric bypass is one of the most common types of bariatric surgeries or weight loss surgeries being performed all over the world. Gastric bypass surgery is also done to reduce your risk of life-threatening weight-related health problems, including:

Type 2 Diabetes Mellitus
Heart disease
High blood pressure
Severe sleep apnea

Gastric bypass and other weight-loss surgeries are typically done only after you’ve tried to lose weight by improving your diet and exercise habits.

In general, gastric bypass and other weight-loss surgeries could be an option for you if:

Your body mass index (BMI) is 40kg/m2 or higher.
Your BMI is 35 to 40 kg/m2 and you have a serious weight-related health problem, such as type 2 diabetes, high blood pressure or severe sleep apnea. In some cases, you may qualify for certain types of weight-loss surgery if your BMI is 30 to 34 and you have serious weight-related health problems.

This surgery requires permanent changes to lead a healthier lifestyle, and long-term follow-up plans that include monitoring your nutrition, your lifestyle and behavior, and your medical conditions.

Risks of Gastric Bypass Surgery:

Risks associated with the surgical procedure are few and rare. They might include:

Excessive bleeding
Infection
Blood clots in your legs
Lung or breathing problems
Leaks in your gastrointestinal system

All the above mentioned risks and complications can be identified early and taken care of only at a high volume and experienced center with staff especially trained in Bariatric Surgery.

Long term risks and complications of weight-loss surgery vary depending on the type of surgery. They can include:

Bowel obstruction
Dumping syndrome, causing diarrhea, nausea or vomiting
Gallstones
Hernias
Low blood sugar
Malnutrition
Ulcers
Vomiting

After gastric bypass and other types of weight-loss surgery the diet begins with liquids only, then progresses to ground-up or soft foods, and finally to regular foods.

You’ll also have to undergo frequent and regular medical checkups to monitor your health in the first several months after weight-loss surgery. You may need laboratory testing, blood work and various exams at fixed intervals to monitor the nutritional profile.

You have to keep all of your scheduled follow-up appointments after weight-loss surgery. It is mandatory to see your doctor immediately for any unusual symptoms or complications. You don’t need to weigh yourself frequently. Weight is monitored by the bariatric nurse and dietician at regular intervals. You might not lose enough weight or regain weight after any type of weight-loss surgery, even if the procedure itself works correctly. This weight gain may be due to loss to follow up or excessive liquid calorie intake. To help avoid regaining weight, you must make permanent healthy changes in your diet and get regular physical activity and exercise and follow all the instructions by your bariatric dietician.

Bariatric Surgery in Delhi

There is a dramatic increase in prevalence of obesity. The traditional approaches like dietary and lifestyle modification, physical activity and pharmacotherapy fail to facilitate weight loss and treats obesity. So, bariatric surgery is the most sustainable treatment option. Bariatric surgery also promises improvement in obesity related comorbidities like type 2 diabetes, hypertension, dyslipidemia, arthritis etc. so, the term bariatric surgery is now replaced with bariatric and metabolic surgery. These days metabolic surgery for diabetes has emerged as a proven tool for resolution or control of type 2 diabetes. This weight loss treatment in Delhi is being done only at specialized centers, by adequately trained and expert surgeons. Thus it gives a permanent cure to this traditionally regarded as a progressive, unrelenting disease called type 2 diabetes.

In last few years there has been an increase in weight loss treatment in Delhi. Many centers are currently performing bariatric surgery. Patients from every corner of India prefer to come to Delhi for bariatric surgery owing to the availability of best medical facilities, trained and experienced bariatric surgeons and specialized paramedic staff. Even International patients prefer Delhi, India for bariatric surgery.
Sleeve gastrectomy and roux-en-Y gastric bypass are the most commonly performed weight loss procedures. Metabolic surgery for type 2 diabetes targets patients with uncontrolled diabetes who are currently on oral drugs and insulin. Scientific literature reports that bariatric and metabolic surgery results in weight loss, improvement/ normalization of blood sugar levels, reduction/ withdrawal of diabetes medications and decrease in cardiovascular disease risk factors. It is a simple procedure and the patients may be able to leave the hospital in one day or even the same day in selected cases.

In patients with reflux disease and type 2 diabetes the results of sleeve gastrectomy may be inferior to the roux-en-Y gastric bypass but the excess weight loss of both the procedures may be comparable in a select subgroup of patients.

Nutritional deficiencies are present in obese patients as consumption of high energy diet compromises on protein, vitamin and mineral intake. As Sleeve gastrectomy and roux-en-Y gastric bypass involves removal or bypassing of some parts of stomach and /or small intestine, so, macronutrient (protein) and micronutrient deficiencies (calcium, iron, B12, vitamin D, folate etc.) are very likely to occur post- operatively in the patients. Nutritional assessment remains the key component pre-operatively and post-operatively to identify, prevent and treat nutritional deficiencies at an early stage. Nutritional assessment involves taking physical measurements of body (height, weight etc.), analyzing blood and urine samples, identifying deficiency signs and symptoms and performing a comprehensive dietary assessment.

Consuming a well- balanced energy restricted diet with vitamin and mineral supplements and timely follow up with the bariatric team promises success of the surgery.

Importance of Protein post Bariatric Surgery

The Power Of Protein
Protein is practically a component in each cell of our body. It is known for their ability to build and repair our tissues. Along with carbohydrates and fats, protein is also called a MACRONUTRIENT, which means body needs a large amount of it for daily wear and tear activities.In your first consult with Team Bariatric, you are made familiar with the diet post weight loss surgery and importance of protein is explained as a top priority.
A meal rich in protein and low in carbohydrate will help you lose weight faster, as protein makes the digestive system work harder to metabolise and digest the food. In simple words, you will burn more calories when you consume proteins.

What is your protein requirement?
Generally as per the RDA an adult needs 50-60 grams of protein per day, but these recommendations change post your surgery. ASMBS recommends 60- 90g of protein daily, depending on their medical conditions, type of surgery and activity level.

5 Best Sources of Protein

Meat and Poultry: This group is one of the most generous sources of proteins for you. 1 serve of 30 grams would give you approximately 7 grams high biological value protein, which is easy to absorb by the body and good news it is nearly free from carbohydrates. Choose only lean meats and don’t forget to remove the skin and fat.
Fish: Fish has been known to be the best source of not just protein, but also omega 3 fatty acids. 30 grams of fish would give you roughly 7 grams of protein and a good dose of healthy fats. Try flaky fish, including tuna, tilapia or salmon.
Egg: Egg is my favorite and most versatile ingredient. One serving equals one egg or two egg whites, which gives you roughly 7 grams of proteins. Prepare eggs without added fat by using a nonstick pan. Make an omelet or scrambled eggs of whole eggs or egg whites with spinach, onions, cheese or chicken for added nutrition.
Legumes: dried pulses and peas, provide about 7 grams of protein in one cup. Add kidney beans (Rajmah) or chickpeas (white channa) or Black Channa to your salad or mix brown rice with peas. A mixture of rice and pulses becomes a source of complete protein. Soy and its products are another great source of protein for you.
Milk and Its Product: Dairy provide you both calcium and protein, but choose the nonfat or low fat options to avoid consuming too many calories. One cup of skim milk gives 8 grams of protein. Low fat plain yogurt or curd is very good to maintain the healthy bacteria’s in the gut and drinks made using it can be great to meet your protein and water requirements of the day. Buttermilk is your best bet. Paneer or low fat cottage cheese can be used very flexibly.

Along with the above food items it is always recommended to include a high quality low calorie protein powder in your daily diet to help you meet your protein requirement.

It is best to discuss your protein requirements and options with your bariatric dietitian. They will help you plan your meals, so that you can get the best result from your weight loss surgery. It is a very vital step towards a “new you”.

Good Luck

Infertility in Women and Bariatric Surgery

The relationship between PCOS, obesity and infertility has been documented for many years. Anovulation, miscarriage, impairment in follicle formation and altered activity are the known effects of these. These women also face difficulty in managing diabetes, pre-eclampsia, growth disorders, higher rates of caesarean delivery, higher maternal mortality, and increase their children’s risks for metabolic disease in the future.

A considerable weight loss can increases the chances of spontaneous ovulation, which is why the solution – bariatric surgery. This surgery is known to improve both fertility and pregnancy in women with reproductive concerns, polycystic ovarian syndrome (PCOS), along with metabolic syndrome (MS).

Bariatric surgery’s positive effect on women

Bariatric surgery in reproductive age women has been shown to decrease menstrual irregularities. Women suffering from hormonal imbalance show considerable improvement post operatively, and chances of conceiving increases after this surgery. Sensitivity to leptin levels increases post-surgery, reflecting improved reproductive metabolic status. Many women (about 10%-25%) with subclinical hypothyroidism, haven also shown a significant improvement following surgical weight loss.

Women already take pregnancy into consideration when electing for bariatric surgery. Nowadays women undergoing surgery are aware of their own reproductive risks and a significant number of these women are thinking ahead.

Studies on infertility in women and bariatric surgery

Bariatric surgery has attracted interest of many scholars with more individuals showing improved fertility post weight loss treatment. An older study, implied that a BMI drop greater than 5 kg/m² was a significant predictor of fertility within 2.5 years of follow up after surgery. There was also a trend to a reduced need for fertility treatment in women conceiving within 3 years of weight loss surgery compared to their need for fertility treatment prior to surgery. Reports also show previously anovulatory women conceiving post-operatively without ovulation induction agents.

A study comparing pregnancy outcomes in women before and after weight loss surgery showed improvements in pregnancy related hypertension and diabetes mellitus, and a significant drop in caesarean delivery rate too. Moreover, bariatric surgery did not result in increase rates of post-partum haemorrhage, infection, shoulder dystocia or foetal demise.

The benefits of bariatric surgery in women suffering from PCOS with metabolic syndrome are discussed extensively on various platforms, leading in favour of surgery in such cases. Nutritional and vitamin deficiencies in these women during that time frame of rapid weight loss can be dealt with supervised supplementation, regular follow-ups with the surgeon and obstetrician. There were no differences in maternal complications, foetal outcomes or delivery complications, making bariatric surgery a highly recommended solution and one of the best way to lose weight in morbidly obese people.