Information | Upper GI Surgery | Bariatric Surgery

What is the post-bariatric surgery diet?

Upper GI Surgery — Tue, 23 Apr 2024 03:49:11 +0000

If you have been researching bariatric surgery as a tool to help you return to a healthy weight and lifestyle, you will understand that your eating habits and diet following surgery will need to change significantly. Not only as a result of structural changes to the digestive system because of the surgery, but a healthy diet and lifestyle are always required to ensure a life-long change and to avoid weight regain.

You may have read that you need to follow a diet before your surgery (you can check out our blog about the pre-bariatric surgery diet here), but although this is required to make surgery safer, the post-bariatric surgery diet is a bit more complicated and more important.

Post-op diet

Once you have had bariatric surgery your recovery diet will last six weeks.

First 2 weeks – fluid diet

During your first two weeks following surgery, you will still be in recovery. You should aim to consume a diet of thin blended soups or smoothies, that are high in protein; some patients may choose to continue with the use of meal replacement shakes for convenience (for example Formulite as pictured below). Patients are all encouraged to ensure they are consuming adequate fluids during this time to reduce their risk of dehydration. During this time, you will also start your chewable multivitamins.

As you are still in recovery, ensuring you follow strict guidelines during this period is essential.

No eating and drinking at the same time once you move to solids to avoid unwanted gut symptoms.
No fizzy fluids are allowed.
Meal portions should be ¼ to ½ cup to avoid overeating.
Very lumpy food could get stuck, leading to vomiting and putting unwanted pressure on staple-lines and surgical join. Very lumpy foods could contribute to leaks in some circumstances.
Protein is vital and requirements need to be discussed with your dietitian but typically you are aiming for between 60-80g of protein per day. Most patients only achieve 30-40 grams per day in the first few weeks, however.
Discuss supplements such as whey isolate powders or protein water and how to incorporate them into your diet in order to keep your protein levels up.

Weeks 3 and 4 – Puree diet

Once you have made it through the first couple of weeks you are most certainly over the hardest part. Introduction of thicker food makes things a lot more interesting however most people still have some fluid meals for convenience. The eating guidelines around small portions and aiming for protein still apply.

Weeks 5 and 6

Weeks five and six see the much-anticipated introduction of actual food as opposed to just shakes or purees. During this time, you can begin to consume a diet of soft foods, although solid foods can cause problems, and you should still be following the same eating guidelines as specified during the first two weeks.

Week 6 onwards

Congratulations, you have made it to week six! Those first weeks following bariatric surgery are certainly challenging as they require significant dietary and lifestyle changes, so congratulations for making it through.

During this period of recovery and adaptation, you will also have started to lose a significant amount of weight each week, which will continue as you follow your new diet and lifestyle.

From week six onwards you can start to slowly introduce solid foods to your diet. It is important during this time to ensure that you are using the new limited amount of space that you have to consume the right foods that are of high nutritional value.

What is the pre-bariatric surgery diet?

Upper GI Surgery — Thu, 04 Apr 2024 23:00:50 +0000

A question we are often asked by our patients is whether or not they need to go on a diet before they have bariatric surgery. So today we thought we would explain the pre-surgery diet that we recommend to our patients and why.

Why do I need a special diet pre-bariatric surgery?

Although bariatric surgery is a very safe procedure, it is still major surgery and with all surgery, there are risks involved. The pre-bariatric surgery diet is designed to assist in making your surgery as safe as possible by increasing the amount of space in your abdomen to allow easier laparoscopic surgery.

When someone goes on a high protein Very Low Energy Diet (VLED) ½ the weight they lose comes from their abdomen. A 6kg weight loss will lead to an increase of 3 litres of intra-abdominal space for surgery to occur for example. This leads to less pain and faster recovery for you as internal cuts and bruising is less.

Other benefits;

Patients with bad diabetes will get a reduction in their blood sugars which significantly reduces their risk of post-operative infections.
Patients with sleep apnoea will reduce their risk of post-op breathing complications by over 50%
Weight loss improves overall immunity
Weight loss softens the abdominal wall, so if other issues such as hernias are found during surgery, they can be fixed without needing further surgery down the track.
This diet allows people to try different formulations of VLED that they can use for the post-op diet.

How much weight someone “needs” to lose before surgery is different from person to person, however for many, 2 weeks on a VLED pre-op is sufficient to do the job. This equates to 4-8 kg for most people.

Special Cases

People with a BMI over 50 or weighing over 160-200 kg, those with significant and poorly controlled medical problems, and people who have had complex abdominal surgery before may need to lose a greater amount of weight before they can safely have surgery. In these circumstances we may set a specific weight target before surgery, with a plan to delay the procedure until the goals are met.

These goals may include, for example, achieving a 10% bodyweight reduction or getting to a certain nominated weight. In these circumstances the pre-op diet may need to be extended out to 4-12 weeks, depending on the goal.

What is the pre-bariatric surgery diet?

Our patients are asked to follow an intensive phase of VLED (very-low-energy-diet) or VLCD (very-low-calorie-diet), of three meal replacements and two cups of vegetables (sometimes an additional protein serve to ensure protein requirements are met if BMI is too high) for 2 weeks. Additional fibre and plenty of water are also advised during this VLED period.

The meal replacement that we often recommend to our patients is Optifast. It is a low carbohydrate, total diet replacement consisting of three Optifast products (meal replacement shakes or bars) that total 600-800 calories per day. Another really good product that we also recommend is Formulite, however any commercially available VLED will be OK as long as it has the protein and nutrients you need.

This diet puts patients into mild ketosis to help them lose weight rapidly, yet safely (on average 1.5 – 2.5kg per week). The low-carb nature is critical to success. Being in Ketosis forces us to burn glycogen and fat, but also suppresses hunger. Most other low energy diets promote hunger which isn’t very tolerated by most of us for more than a day or two.

It is important before you start on any diet to ensure that you have the approval of your doctor or dietitian, to avoid any nutritional deficits and to make sure you are losing weight safely.

Pre-op Diet Troubleshooting.

VLED’s or “diet shakes” are formulated foods. This means they have a number of natural and synthetic ingredients, and not everyone tolerates them or likes the flavours. It’s worthwhile for people to try different varieties before committing to the diet, not just to make the pre-op diet easier but also to make the post-op diet easier as well.

Common issues include

Lactose intolerance which leads to wind and diarrhea in some people. There are lactose-free variants available (Tony Ferguson and some Vegan Shakes) however Lacteze tablets taken with the VLED will sort out most symptoms.
Optifast Bars are an alternate for people who want a solid VLED or are lactose intolerant.
Soy intolerance and artificial sweetener intolerance is an issue for some patients, in which case an individualised pre-op high-protein and low carb diet can be worked out with our dietician.
Headaches/crankiness/hunger. The most difficult time of the diet is the first 24-48 hours when ketosis is “switching on”. Taking regular Panadol and avoiding stressful work over this time will help.

If you are considering bariatric surgery and would like to know more then contact our practice on (02) 9553 1120 or you can

Book an appointment online

Obesity Medication Perspective by A/Prof Michael Talbot

Upper GI Surgery — Tue, 21 Nov 2023 23:00:18 +0000

A counterpoint to the argument for denying effective anti-obesity therapy during a time of medication shortage.

In response to criticism about previous statements that were directly stigmatising of persons with a lived experience of severe obesity, the Therapeutics Goods Association (TGA) and others have appropriately altered their language regarding the use of GLP-1 agonists which have clinical effectiveness for the management of Type II Diabetes as well as clinically significant obesity. They have now asked clinicians prescribing these medications to consider delaying prescription unless other suitable alternatives are not available, rather than seeking to deny patients with severe obesity the opportunity to receive treatment.

While the best of these agents are only approved for use in Australia for the treatment of Type II Diabetes, ample research data and clinical experience are showing excellent results when used for severe obesity, which has subsequently led to widespread “off-label” prescription by Obesity Practitioners in Australia. Some versions of these drugs which are approved as obesity therapies are clinically inferior and more expensive than the newer and potentially scarcer agents.

The widespread success stories of people living with severe obesity who have lost weight with these medications have subsequently been shared on social media support groups set up by patients, which has then led regulatory agencies and the press to be aware of the potential contribution of these prescriptions to medication shortages. Unfortunately, this has potentially trivialised the importance of providing effective anti-obesity therapy to those in need, and it denies the validity of their experiences and health as being important.

While it is obvious that a poorly available therapy should not be used for frivolous purposes, appropriate consideration should be given to the needs of people living with severe obesity before denying them the opportunity to receive appropriate care. Overweight and obesity have skyrocketed in prevalence over the last 40 years and is Australia’s second largest cause of fatal disease and the largest contributor to non-fatal disease.

While substantial increases in the prescription of diabetic and cardiovascular therapies over this time have blunted the effects of obesity on mortality rates, little has been done with regard to managing obesity itself. No one is going to argue about the importance of lifestyle changes in obesity prevention as part of the suite of interventions for those living with obesity-related diseases. However, we have overwhelming evidence that lifestyle change as sole therapy is universally inadequate for those with severe disease, even though its effects in so-called multi-modality or combined therapies are important.

We know enough about obesity to predict, before treatment, the likely outcomes for an individual depending on the treatment prescribed. Patients requiring health improvement and weight stability should therefore be prescribed differing obesity therapies than those presenting with poorly controlled medical conditions, disabilities or diseases likely to become life-threatening soon.

While offering obesity therapies to patients has been made more difficult by the relative scarcity and complexity of treatments until reasonably recently, those treatments that are suitable, successful and cost-effective are rarely offered. The cost of therapy is often cited as a reason, but there appears to be a double standard applied to those seeking or who are eligible for obesity treatment. Therapies for obesity that are known to be more cost-effective than what we currently offer other patients with chronic disease (such as renal failure, osteoarthritis etc) or which are even potentially health-cost neutral, are consistently denied to patients by Federal and State healthcare systems.

Clinically severe obesity is the only major health condition where all healthcare costs are expected to be covered by the person with the disease. Most successful medical therapies for obesity are not approved for use by the TGA and are prescribed “off-label”, and even those that are TGA approved receive no government subsidies, which somewhat negates the point of seeking TGA approval in the first place. Patients presenting for treatment in public hospitals with life-threatening or disabling obesity-related conditions will have their condition treated but are virtually guaranteed to receive no obesity directed care other than documentation of their body mass index (BMI).

It is beyond the scope of this opinion piece to discuss the many complexities of obesity stigma, but for those who are interested, The Obesity Collective provides succinct and easily readable information for the public and lay-press, and the Weight Issues Network, a person-centred support group created by those with a lived experience of obesity, for those with a lived experience of obesity, have created an excellent position statement detailing the experiences of seeking health care when one has obesity. It’s unlikely that anyone reading these documents would come away without increasing their understanding and empathy for those negotiating their lives and the healthcare system with obesity as a front and centre issue.

A more nuanced way of managing the potential conflict between the requirements of those with severe diabetes or obesity is to make decisions based on the clinical needs of the patient. There are multiple drugs known to improve diabetes and prolong survival approved for use in Australia. If a diabetic patient does not require significant weight loss and is being prescribed one of the new GLP-1 agonists that are in short supply, alternatives could be prescribed without sacrificing their care.

Similarly, if a patient is being prescribed a GLP-1 agonist for obesity and is at the weight maintenance part of their therapy, other alternatives are available. Those requiring a lesser degree or slower weight loss have other options as well. This would leave scarce agents available for those patients requiring reliable and consistent weight loss to treat significant illness, and for those diabetics where significant weight loss and lifestyle modification are part of the management of their complicated diabetes associated illnesses.

GLP-1 agonists are part of the first of a suite of anti-obesity medications being released which are effective and well-tolerated when appropriately prescribed. Whether or not these make it into the hands of those in need will depend on our Health system’s re-evaluation of the importance of the needs of those affected by severe obesity, as well as advocacy by patients, clinicians and healthcare institutions.

Dr Talbot is a surgeon working in a multi-disciplinary clinic that provides treatments to patients referred for management of severe obesity. He is a past president of the ANZ Metabolic and Obesity Surgery Society (ANZMOSS) and is on the Board of The Obesity Collective.

Reflux: what is it & how is it treated?

purpleeffect — Wed, 02 Aug 2023 04:01:32 +0000

The oesophagus is like any part of our body, we don’t really think about it until it starts to fail in its function. It is a thin muscular tube about 20 cm long, running from the back of the mouth, through the neck and chest (behind the heart and lungs), and into the abdomen where it joins to the stomach. It functions like a rapid conveyor belt, propelling food into the stomach which pulverises and liquifies it before its long journey through the small then long intestine for digestion and waste management.

The stomach is one of the most toxic environments you can imagine, full of powerful acid and other chemicals that perform a useful function when they are contained in their rightful place, but cause trouble if they escape up the oesophagus.

What is “Reflux”?

The term “Reflux” is used to describe what happens when acid or other gastric content leaves the stomach and moves up the oesophagus. When someone says they have “reflux” (or “acid reflux”) we ask them specific details about their symptoms to get a better idea of what they are experiencing, as many patients labelled as having reflux disease have other conditions. The symptoms that people with reflux experience can include:

Heartburn – the word is used to describe pain felt behind the lower breastbone that feels as if it has a “chemical” or “burning” component.
Regurgitation – this occurs when people feel food or fluid move back up their oesophagus, and it’s quite different from vomiting.
Epigastric pain – patients often struggle to describe this symptom. When pain occurs at the point where the breastbone meets the abdomen it is often hard to figure out where it is exactly.
Chest Pain – this pain is often associated with a feeling of food or liquids getting stuck, chest tightness or pain in the jaw, back, or left arm. Sometimes it occurs when people eat or drink, and sometimes it happens in between meals.
Cough – repetitive coughing can be a symptom of reflux when acid or other toxic chemicals escape out of the stomach and irritate the larynx (voice box).
Asthma/breathlessness – a feeling of chest tightness that limits the ability to take deep breaths or breathe effectively is often called asthma. Some patients get asthma-like symptoms from reflux.
Belching/gas trapping – belching, or discomfort relieved by belching is a common symptom with many oesophageal and gastric disorders.
Bitter taste – some patients with reflux-like symptoms complain of a bitter taste in the back of their throat and in their mouth.

What causes Reflux?

Reflux is not something that is supposed to happen frequently in healthy people, and it occurs only when the pressure inside the stomach becomes greater than the pressure keeping the lower oesophagus closed. The five main causes/drivers of reflux are:

Hiatus hernia
Weak lower oesophageal sphincter (valve)
Weak or abnormal oesophageal function (peristalsis)
Oesophageal sensitivity
Gastroparesis (paralysed stomach)

The large majority of patients with reflux experience symptoms but are lucky enough to avoid significant complications. As reflux, unless treated surgically, is a permanent and usually progressive condition, it is worthwhile to consider for each individual affected the potential long-term consequences of the condition.

Reflux Testing & Treatment

When people develop symptoms of reflux or difficulty swallowing (dysphagia) we want to offer them treatment to improve their symptoms but also do tests to determine what the cause of the problem is. If we treat the symptoms but take no action to treat the underlying condition we may miss the opportunity to treat it effectively.

The majority of people who experience “reflux” symptoms try antacids or acid suppression medication prior to having any tests done. If their symptoms don’t improve quickly, if the person is over 50, has anaemia or symptoms of difficulty swallowing (dysphagia) are present, then investigations to rule out serious conditions are worthwhile. No single test is able to diagnose every condition or its severity, so patients with complex problems can sometimes need to undergo several tests before they get an accurate diagnosis or management plan.

Find out more about Reflux Testing here.

Reflux treatment using medications reduces acid but doesn’t reduce reflux. These medications reduce exposure of acid to the oesophagus, but will not change non-acid or weak acid reflux events. They are usually safe however there are a lot of misunderstandings about how they work. These medications reduce the strength of acid that the stomach produces so that reflux episodes can occur without causing discomfort.

Anti-Reflux Procedures (Reflux Surgery)

Endoscopic Surgical Therapies

These work by correcting/repairing the mechanical causes of reflux. The larger the procedure the more effective, but the larger the procedure the more important it is that accurate tests are done in order to avoid overtreatment and side effects.

Find out more about Reflux Treatments and Anti-Reflux Procedures here.

Laparoscopic Surgical Procedures

These all have a lot in common. General anaesthesia, 1-2 night hospital stay, mostly 5mm incisions, and the ability to correct hiatal hernia which is the greatest driver of reflux in most people with oesophagitis (oesophageal ulcers) or Barrett’s oesophagus.

Hiatus Hernia Repair and Hiatus Hernia Repair with Fundoplication

The aim of this procedure is mostly to restore normal anatomy. Most people with reflux have symptoms that progress over years. This progression is mostly due to a gradually enlarging hiatus hernia with more and more stomach delivering more and more acid up into your chest.

To repair a hiatus hernia, the stomach is first pulled back into the abdomen and then the hiatal muscles are tightened to snug around the oesophagus. In those who are identified to have very weak lower oesophageal valves the upper part of the stomach can be wrapped around the lower oesophagus, a “fundoplication”. Wrapping the stomach around the oesophagus creates an additional clasp around it which helps prevent reflux from occurring.

Benefits of Reflux Surgery

People with reflux and oesophageal symptoms are able, thanks to improved diagnostic testing, to get diagnosis and treatment for unpleasant symptoms, even if they have been present for years and endoscopies are “normal”. Endoscopic and surgical therapies for these conditions are safe and effective, as long as appropriate steps have been taken to confirm the diagnosis beforehand.

At Upper GI Surgery we offer sophisticated reflux testing at our main practice in Kogarah, as well as effective reflux (GERD) treatment options.

Doctors at Upper GI Surgery

Upper GI Surgery — Fri, 02 Sep 2022 03:30:05 +0000

Our Surgeons

Dr. Michael Talbot |MB ChB FRACS

Dr. Gary Yee |MBBS FRACS

Dr. Jason Maani |BHB MBChB FRACS

Our Doctor

Dr. Jennifer Matthei |BSc(med) MBBS (hons) FRACGP

Bariatric Surgery Information Webinar – what you need to know

Upper GI Surgery — Fri, 24 Jun 2022 04:30:39 +0000

If you’ve visited the weight loss surgery section of our website or followed us on social media, you have probably encountered the promotion of our Bariatric Surgery Information Webinar. If you or a loved one are living with obesity and considering bariatric surgery as an option to help lose weight, this informative webinar is a great place to start.

The live webinar is split into two main sections; the first is a short presentation (around 30 minutes) given by one of our bariatric surgeons, who will then answer any of your questions during the second part of the webinar (usually another 15 minutes depending on the number of audience questions).

Here’s a quick insight into what you can expect to learn during our free Bariatric Surgery Information Webinar.

Our Team

We start with a quick overview of our medical team, as we believe the best outcomes from bariatric surgery come from a team approach. Our team facilitates treatment and surgery from different locations in New South Wales, as well as offering different appointment types (for example telemedicine).

Why do people develop severe weight problems?

Understanding why people develop severe weight problems in the first place. Obesity is not a choice, nobody wants to be overweight and deal daily with the stigma that can surround it. Being overweight can drastically impact your day to day activities, health and self-image. We explore the reasons behind this (genetics vs the environment), to provide the foundation for why bariatric surgery is a long-term treatment for people who have long-term weight issues that can only be resolved with change.

How does weight loss surgery work?

Next, we explain how bariatric surgery works. Weight loss surgery can’t change your genes, but it can help you to change your appetite and eating habits. Over time all procedures become less powerful, which is why it is important that we work with our patients to learn new skills, centred around portion size, reducing meal frequency and reducing calorie density.

How do we choose the right operation for you?

During this part of the presentation, we will explain how deciding the right treatment for obesity, whether that be diet, medication or surgery, mostly depends on your own individual circumstances. We evaluate the risk vs benefit profile of the different options and your own personal health profile (health conditions, stage in life, your health goals). Including an overview of expected weight loss from different treatment options, and their long term success.

Purpose & importance of follow up

Typically a bariatric surgery patient will experience rapid weight loss, often half of their overall weight loss in the first 3 – 4 months after surgery. Over the next 12 – 18 months they will lose the remaining weight, but how much depends on the effort of the patient, their age, and what procedure they have had. We expect people having sleeve gastrectomy to lose about 30% of their starting weight, with Bypass patients to lose up to 40% of their starting weight. While it is rare for patients to achieve or maintain a weight below BMI 25 (the so-called “normal weight”), most will be far healthier, be able to carry out activities of daily living and fit into regular clothes. We explain how after a period of 6 – 12 months of ‘easy’ weight maintenance, approximately 18 months – 3 years later the majority of patients will experience some weight gain. Coming back for conversations around weight management is incredibly important to ensure lifelong weight maintenance and commitment to a healthier lifestyle.

Bariatric Surgery Options

The final section of the presentation explains in more detail the different bariatric surgery types; from the most popular sleeve gastrectomy, to the different forms of gastric bypass and the less common gastric band procedure. This helps you to gain a better understanding of each of the procedures, how they work, and potential side effects and risks.

Q&A Section

After absorbing so much information, you’re sure to have some questions by the end of the presentation. Or maybe you already had some questions in mind and have come prepared beforehand. This is your opportunity to ask one of our bariatric surgeons your own specific questions and get answers straight away. Don’t worry you don’t have to speak up in front of everyone attending, you can simply send a message over the Zoom chat function.

We run our Bariatric Surgery Information Webinar sessions once a month, at 7.30pm via Zoom on the first Tuesday of the month. If you think that you would benefit from joining our next webinar, you can click here to register and you will be sent the Zoom invite details as well as a copy of A/Prof Talbot presenting the webinar after you attend.

Revision or Re-Do Bariatric Surgery – what you need to know

Upper GI Surgery — Sat, 14 May 2022 02:34:43 +0000

If a previous weight loss surgery (bariatric surgery) operation has failed to give adequate weight loss, someone has regained weight or they have significant side effects, it is possible for this procedure to be revised or even converted to another procedure that may be more suited to the individual. Today we are going to talk about the reasons why patients may need revision bariatric surgery and the options that they have.

Why do people need revision surgery after bariatric surgery?

Surgery isn’t perfect and people aren’t perfect. Sometimes someone can have a weight loss operation that allows them to lose weight, but over time it can stop working so well, or the person can start neglecting their diet and regain weight. In other circumstances the weight loss achieved initially is insufficient, and in other cases the person develops side effects early or late that means the surgery is no longer a “good fit” for them.

“Operation failure” may mean that the reason that surgery hasn’t worked, and while we always look for reasons as to why this has happened, we don’t like the idea that the “patient failed”, rather than as a treatment failure.

The sorts of things that can lead to a bad patient experience from surgery include postoperative infections, bad reflux, malabsorption, diarrhoea, constipation, food intolerance/vomiting, reactive hypoglycaemia and abdominal pain. And the sort of problems that lead to requests for further weight loss include low self esteem and body image, back and limb pain, diabetes, breathing problems, the need for hernia repair and a whole other host of problems that people living with severe obesity can experience on a day to day basis.

Individual responsibility

There are sometimes also reasons for less-than-perfect results that lie with the individual. For example, developing “bad habits” over the years can lead to weight gain if somebody isn’t following a healthy diet and exercise/daily activity. The line between personal responsibility and apportioning blame however is too often crossed. We believe that if people are seeking help, they are therefore meeting their personal responsibilities now, regardless of what has gone on beforehand. It is still very important to know what’s gone on in the past however, in order to prevent problems in the future.

Revision bariatric surgery options

Bariatric revision surgery can take place to correct issues that have occurred after previous surgeries.

For example, if a patient previously had a gastric band and that procedure failed over time, either because of grazing, or because of a mechanical band failure, there needs to be a period of assessment before choosing another operation. If someone’s oesophagus no longer works properly after many years with a band a sleeve gastrectomy, which also puts pressure on the oesophagus may also lead to further reflux and regurgitation, so a procedure such as gastric bypass surgery may be more suited. However, despite these concerns, probably up to 80% of people who are unhappy with a gastric band will be satisfied by conversion to a sleeve, as long as they are assessed pre-surgery as being suitable.

If you have failed to lose weight with your first bariatric surgery, or did initially lose weight but have regained it over the years, it is important to know that there are other options available for you that can work.

In over 95% of these cases, procedures can be performed with keyhole surgery (laparoscopically) or robotically. However, it is important to note that revision or “re-do” surgery is typically more complex, and patients therefore are theoretically at greater risk of complications than others. Cautious assessment and consultation are required for all patients who are seeking revision bariatric surgery.

If you are considering revision weight loss surgery and would like to know more about your personal options, please call our practice today to make an appointment on (02) 9553 1120 or contact us online for more information.

How to stay safe from COVID-19 if you have a weight problem

Upper GI Surgery — Sun, 29 Aug 2021 23:56:56 +0000

People who are overweight or living with obesity that become infected with Covid-19 have a number of issues that potentially make them more vulnerable to severe illness.

Increased adipose tissue increases how much Angiotensin-converting enzyme 2 (ACE2) your body produces. This enzyme binds to the Covid virus and may therefore increase disease severity.
People with weight problems are more likely to have diabetes, high blood pressure, heart disease, respiratory disease (sleep apnoea, asthma, reflux-related lung disease), kidney disease and other conditions that increase risks of causing severe illness from Covid.
People with weight problems are harder to look after in ICU and are more prone to complications when on a ventilator for a prolonged time.
We now know that people carrying extra weight are also far more likely to die after a covid infection.

So, what can be done about this?

First up, it’s important not to let fear dominate our lives, as that gets in the way of living. It is possible however to use legitimate concerns as a “call to action” to improve not just our health as it relates to Covid but our health overall. Experts have a number of suggestions that will help.

Get vaccinated. Any vaccine is ok for a very large number of people over the age of 20. The risks of the AZ vaccine that everyone is concerned about have been massively blown out of proportion, this has led to people taking bad advice which has led to preventable illness and death.
- If we vaccinated the whole Australian population in 2 weeks with the AZ, we would get around 25 vaccine-related deaths and around 50-100 ICU admissions. In NSW alone we have had a tiny percentage of the population infected with COVID leading to many ICU admissions and an increasing death rate. It’s likely that almost all these ICU admissions and deaths would have been avoided had the people affected had the AZ vaccine.
- 25 people die every week crossing the road in Australia and about 60 people a week from suicide. Clearly, the risks of vaccination need to be understood in this context.
- We should, as adults, be more concerned about our children’s welfare. Every time someone over the age of 50 has a Pfizer COVID vaccine they are effectively preventing a dose from being available for a child or adolescent, and it’s clear that they won’t get their schooling, friends and future opportunities back until they are vaccinated.

Take social isolation and personal hygiene seriously and ensure that those around you do as well. Official government guidelines have been consistently accurate for the last few weeks, and they do a far better job to inform us of the steps we need to take than what may pop up from unofficial sources and armchair experts.

Ensure your medical conditions are optimally controlled. Now is a perfect time to get in touch with your GP and get a check-up.

Work on your fitness. This will improve respiratory health, reduce your blood pressure and help control your blood sugars.

Eat well and avoid snacking. If you are eating more than 3 times a day you are highly likely to be gaining weight. Calorie containing drinks (milky coffee, alcohol, juice etc all count as snacks). Weight gain increases stress on all your body’s vital functions if you are overweight.

Consider short or long-term weight management strategies. While many traditional weight management options are not available during this time there are things you can try that can work well. Losing 5-10% of your weight can have profound effects on many illnesses if you are carrying too many kgs.
- Very Low-Calorie Diets (VLCD) such as Optifast ™. These high protein/low carbohydrate meal replacements can replace 1-2 meals a day to promote weight maintenance, or 2-3 meals a day for rapid and safe weight loss.
- Intermittent fasting. The 5:2 diet whereby you fast 2 days a week or the 16:8 diet where you only eat or have calorie-containing liquids for 8 hours a day are options that may work while our new routine is in “lock-down”.
- Medically supervised options. These are more complex and rely on a mix of exercise, dietary change and VLCD. There are also several new and very effective weight-loss medications available that can help people lose up to 15-20 kg (10-15% of starting weight).

While bariatric surgery has been proven to provide a sustained weight loss greater than 5-10 times what can be achieved with the methods above, there are many people who may not wish to do this during the Pandemic. Now however could be a good time to consider a long-term weight management plan that could help protect you from this and other dangerous health problems in the future. Our offices are open to offering medical advice to people with a weight problem or people who have had previous weight-loss surgery to help keep them safe during this time.

A/Prof Michael Talbot

Eating tips during lockdown following bariatric surgery

Upper GI Surgery — Fri, 06 Aug 2021 03:45:29 +0000

Eating tips during lockdown following bariatric surgery

With Sydney facing lockdown until at least the 28th of August, knowing that we are not alone while other states continue to go in and out of different levels of social restrictions, these uncertain times have made serious changes to our day to day lives. Whether you’re having to homeschool your children, can no longer get to the gym for your regular classes, or even meet that friend for coffee as you usually do each week, things are definitely different for most of us. This can be especially difficult for those who are adjusting and adhering to a new healthier lifestyle following bariatric surgery.

Adapting to new eating and activity habits can be difficult enough, without the disruption of social restrictions enforcing that we remain at home whenever possible. Today we want to share some crucial tips from our Dietitian Tania Chaanine.

Be Organised – Plan your food and meals for the week ahead, to avoid missing out on any essentials that you need to ensure a healthy week of eating. Meal prep is a great way to avoid the temptation of ordering food delivery services on a regular basis.

Get Creative – It’s the perfect time to pull out the recipe book that we provided you (if you are one of our bariatric patients, if you aren’t we are referring to Your Complete Guide to Nutrition for Weight Loss Surgery by Sally Johnston) and make some of those healthy meals that you never got around to making.

Stock Up – Stock up on healthy foods such as chicken breast, lean mincemeat, eggs, fish, dairy foods, tofu, legumes, fruits and vegetables. And don’t forget that frozen fruit and vegetables are just as nutritious and fresh, and are perfect to keep on hand during times like these. Make sure you stock the pantry with healthy essentials too, such as tinned fish, tinned legumes and wholegrain cereals. Having a kitchen stocked with healthy food will help avoid the temptation to detour from your healthy balanced meal plans.

Snacking – It is inevitable that you may want to snack sometimes, so make sure that you have healthy, portioned options available such as high protein yoghurt, grainy crackers, low-fat dips such as hummus (which is great with the grainy crackers or crunchy vegetables). Avoid buying discretionary foods right now, as they can be a big temptation that you probably don’t need.

Be Active – We know that it’s difficult for some to find the motivation for exercise right now, and with the stay at home/work from home orders, not many of us are as active as we usually are in general. But try to include a daily walk of at least 30 minutes (not forgetting your mask of course), which will not only help contribute to keeping you on track with your eating but also help your mental wellbeing too.

We hope that everybody is staying safe and well during these uncertain times. If you feel that you are struggling with maintaining your weight during lockdown then please contact us or your GP to discuss options to help keep you on track.

Weight Regain Following Bariatric Surgery – Weight Loss Medication

Upper GI Surgery — Mon, 02 Aug 2021 00:00:25 +0000

In Australia there are over 22,000 people each year undergoing bariatric surgery, helping those living with obesity move towards a healthier body and lifestyle. Many people view bariatric surgery as their final and best chance to lose weight. Following bariatric surgery (depending on the procedure and how their body responds to the procedure), a person can often expect to achieve a weight loss of between 25-35% percent of their starting weight. This weight loss will transform someone’s life, but it won’t transform their eating habits – that part of the post-surgical care needs to be gotten right to reduce the amount of weight regain in the future.

Weight gain following bariatric surgery

Although bariatric surgery is a fantastic tool used to aid in weight loss, it requires important, lifelong commitments to a change in diet and activity levels (exercise) to be effective in the long term. Even with consistent healthy lifestyle changes, some weight regain can and does recur. Typically, weight regain can be expected to occur after 12-24 months, and while in some the weight gain is minor, in others it is progressive which can be very disheartening. From our clinical experience, patients who attend regular follow-up with their clinic, tend to regain less weight than those who don’t come back for follow-up.

What causes weight gain after bariatric surgery

The reasons why a person may gain weight following bariatric surgery can be categorised into four main factors, bearing in mind that any/all of the below might apply to an individual.

Physiological – bariatric surgery can alter fat metabolism, resulting in easy fat storage and limited fat burning. Body fat is subject to metabolic pressure to regain lost weight. This means that everyone who has lost weight needs to restrict their intake to be less than their friends/family/colleagues. Typically, people who have lost >20 kg who wish to keep their weight off need to keep their daily intake under 1200-1500 kCal. We also see a change in so many hormones in the body that govern hunger and cravings, which are not under our voluntary control and encourage the body to regain weight.

Anatomical – over time, the stomach will soften and stretch. While the stomach after the sleeve and gastric bypass procedures will always remain small compared to how it was pre-op, people find over time that they can eat more food per sitting if they choose to. The amount of stomach stretching is the same in patients who have gained weight and those who haven’t gained weight. Patients with weight gain after bariatric surgery generally don’t eat larger meals than people without weight gain, they just eat more frequently (snacking and calorific liquids) and consume more addictive, hunger generating foods/drinks such as alcohol, milky or sweet drinks, salty/fatty snacks and processed foods. The narrative that stomach stretching leads to weight gain is a false narrative that’s popular on the internet, but it diverts people from focusing on the real underlying cause of weight regain which is addiction/grazing/comfort eating. While it’s true that the person’s softer stomach now allows them to eat more of the wrong thing for the wrong reason, it’s the choice/habit of doing the wrong thing that’s the underlying problem.

Psychological – obesity is a chronic condition and requires significant life changes following bariatric surgery in order to effectively manage weight. Psychological reasons for weight gain can be observed in many ways such as – a person slipping back into ‘old habits’ of an unhealthy relationship with food, especially the addictive foods and drinks we consume to make us feel better; they may feel a loss of identity following weight loss, or even become depressed due to factors they may not have considered such as excess skin, or because their relationships with friends/colleagues/partners have not improved even though they have lost weight.

Behavioural – as mentioned above, lifelong commitments to behaviour are required to manage weight long-term. Despite the inability to consume large amounts of food, behaviours such as grazing in between meals or eating the wrong foods (such as processed or fast foods, consuming alcohol) can have a negative impact on diet. Another aspect of a person’s behaviour is levels of daily activity (or inactivity).

Sadly we live in an obesogenic environment (an environment that promotes obesity), and this combined with an individual’s own challenges to change their thinking and behaviour can lead to weight gain being quite common following bariatric surgery.

Non-Surgical Weight Loss Treatments for Weight Regain

The most important thing to do when you recognise that you have regained weight is to acknowledge it early by regularly weighing yourself and thinking about whether or not you are happy with how your weight is tracking. Many people when they are gaining weight stop weighing themselves, stop exercising, stop taking their multivitamins and stop thinking about their food choices.

In fact, when a person regains 3-5kg this is the perfect time to ask for help, rather than waiting until they have gained 10-20-30 or more kg in weight. Seeking advice from your GP, dietitian and bariatric specialist team is critically important when you feel that things are not going the way you want them to. On-going support is available and vital for long-term weight management, and we are happy to provide it at any time along your journey.

If someone is struggling to lose weight they have regained through diet and exercise alone, there are plenty of non-surgical weight loss treatments, such as weight loss medication, that can help them get back on track and lose the regained kg’s. At Upper GI Surgery our bariatric specialists can offer a large range of powerful medications to help with hunger and weight loss while you work on some of the “triggers’ that have led to weight gain.

If you have experienced weight gain following bariatric surgery and are interested in learning more about weight management medications and if they would be suitable for you, please contact our practice on (02) 9553 1120 who will be able to arrange an appointment with one of our Bariatric Specialists.