Team Approach – for long term weight loss

Many people having weight loss surgery start off doing very well, but unfortunately significant weight regain occurs in about 1/3 of people around 2 to 3 years after surgery. The reasons for this are complex but can be simplified into three key areas; due to changes in gastric anatomy (shape and size), physiology (function) and patient psychology (behaviour). We believe that coaching people along the way will maximise their chances of getting the most out of their surgery and avoiding both weight regain, and nutritional complications.

• Gastric Anatomy (shape and size). The anatomy of your surgery will change over time. Bariatric surgery changes the way the body processes food but over months the stomach adapts to the surgical changes by stretching slightly and becoming significantly suppler and therefore able to process food faster. This has the effect of lessening your perceptions of restriction and discomfort if you over eat. In some cases this stretching can lead to reflux or other problems, but a “loss of restriction”, especially to high calorie and liquid foods, is experienced by everyone after the first few months.

• Physiology (function). The most significant effect of surgery is suppression of appetite. The majority of patients gaining weight after bariatric surgery do so in the absence of hunger (and while some patients do
  

  Watch out for taste changes…

  need more surgical therapies to help them lose hunger this is uncommon). Larger operations, such as the gastric bypass, can drastically change people’s tastes so they begin to dislike the smell and taste of many high calorie foods. Weight loss surgery can also reduce enjoyment of food, so eating for pleasure becomes a thing of the past. While appetite suppression persists in almost all patients the stronger effects such as taste changes fade after 2 years and are present in only about a 1/3 of patients after this time. Not being hungry is quite different to “being full”. A key part of coaching after surgery involves retraining people to eat “enough” rather that eating until they cant eat any more.

• Psychology (behavior). People are usually highly motivated before and soon after surgery, but after the first few months the desire to return to old habits comes back and they can slip back into their old routines. A number of things can happen that will lead to issues in many patients. While most patients still have very significantly suppressed appetite it is very common for people to eat in the absence of hunger. Over time after surgery people also learn that eating some foods like meat, chicken, salad and vegetables remains difficult but having liquid calories (milky coffees, sweet drinks and alcohol) or high carbohydrate and high fat foods becomes easy again. The change in feeling of restriction during meals, the gradual disappearance of discomfort when foods are overeaten and the tendency for people to “graze” and move unconsciously to soft foods that they can eat more of inevitably leads to people eating more food and being at risk of weight regain. Another big problem is that the large majority of people with a weight problem have spent many years or decades snacking on high calorie foods and liquids between meals. While these habits usually disappear in the first few months after surgery they re-appear down the track especially if people go through periods of stress in the future. The most common cause of weight regain after any weight loss operation isn’t due to patients eating large meals but due to patients eating in between meals or changing from low calorie normal food to high calorie junk food.

How Our Support Team Helps Maintain Weight Loss

The team that supports you during weight loss surgery and the years afterwards includes your surgeon whose job it is to keep an eye on surgical complications and discuss how surgery affects your body function, a bariatric physician who works in the same way that the surgeon does but often with a more in depth focus on some long term nutritional aspects of surgery, a dietitian who helps remind patients to keep eating on track and often a psychologist for people who find that snacking or other eating behaviour and response to stress are difficult to get on top of.

Unless patients come in for follow-up after surgery they lose the opportunity to benefit from the advice that we give.

Our Support Team is here to help you achieve long-term weight loss success

This advice is based on our experience managing many thousands of patients over years and decades. Every year after surgery the advice we give patients is different because the difficulties and risks that patients face are different during the first year, second year, third year and out to five years post surgery. After about 5 or 6 years we feel that most patients should have learned enough to be fine to get by with their local doctor only.

Another very crucial group of team members that are often ignored are family members and friends. It is well worthwhile keeping them involved with your weight management by asking them to come to your pre-and-post operative appointments with you. In the future, especially if they are worried that you are partaking in bad health decisions which will sabotage your desire to lose weight a friend or family member can prompt you to either change back to doing the things they know are healthy or come in and see us for further follow-up.

Our team at Upper GI Surgery are keen to be with you not just for the short term but for the long term. If you decide to go ahead with weight loss surgery it is important not to become one of the 1/3 who falls short of their long-term goals.