Bariatric surgery (weight loss surgery) is major surgery, and even with sufficient medical insurance, it can still carry a significant out of pocket cost. It requires lifelong changes to diet and lifestyle in order to be successful and most often is non-reversible. 

Today we are going to cover some of the common questions we are asked about bariatric surgery, to hopefully provide more insight for those who are curious whether it would be an option for them (or a family member/friend) to consider to help achieve a healthier lifestyle. 

Let’s tackle the big ones first. 

How much weight will I lose after bariatric surgery? 

This is the question that every patient wants to know the answer to, as bariatric surgery is a tool to help obese patients lose excess weight. How much weight a patient will lose is individual to the patient; it depends on what type of bariatric surgery they have, their individual genetic makeup as well as adherence to the post-bariatric surgery program of diet and exercise. To give you an idea: 

Gastric Band Surgery (Lap Band Surgery) – on average patients will lose 15 – 25% of their total body weight. 

Sleeve Gastrectomy Surgery – on average patients will lose 25 – 30% of their total body weight. 

Gastric Bypass Surgery – on average patients will lose 30 – 40% of their total body weight. 

It’s important to remember that each surgery is different, carries different risks and required lifestyle changes in order to be successful. For example, gastric bypass surgery may demonstrate the highest overall weight loss, but is a more complicated procedure and requires taking vitamin supplements for the rest of your life. Your doctor will be able to determine which surgery type is most suitable for your condition. 

Do I have to lose weight before bariatric surgery? 

Yes, your weight loss journey will start usually at least 2 weeks before your surgery date (some patients may be required to start 4 – 8 weeks before surgery). With the guidance of a dietitian, patients will be provided with a VLCD (very low-calorie diet) to follow leading up to surgery. The aim of this is to shrink the liver which sits above the stomach, allowing the bariatric surgeon to perform the operation safely as there is then more space to operate. Even a 3 – 4kg weight loss is usually sufficient for surgery. 

As well as losing weight even before surgery, this gives a patient the opportunity to understand the restrictive nature of their new diet following bariatric surgery, as the diet kick starts the body into ketosis, a state it will be in for the first 6 months following surgery (the body metabolising fat as energy). 

How much does bariatric surgery cost?

Bariatric surgery is tailored around individual patient care and needs, meaning that the costs for surgery vary. Click here to read a more detailed breakdown of the costs involved with bariatric surgery. The cost of surgery is the same for patients that have health insurance that covers bariatric surgery and those that don’t, but it is the ‘out of pocket cost’ that differs significantly. 

How long will I have to stay in hospital after my bariatric surgery?

Most patients will only need to stay in the hospital for 2 nights (sometimes 3). Generally, once a patient can tolerate a litre of fluid within 24 hours, are comfortable on oral painkillers and are mobilising freely they are safe for discharge. Following bariatric surgery most patients are fit to return to work between 2 – 4 weeks. 

Now for some of the more obscure, less thought of questions that we get, that are still quite common… 

When can I get pregnant following bariatric surgery?

Patients are advised that pregnancy should be delayed until weight has been stable for at least two consecutive months. This is approximately around the 12-month mark for those who have undergone sleeve gastrectomy surgery, and 18 months for those who had a gastric bypass. 

If I’m eating well, why do I still need to take multivitamins? 

Sleeve gastrectomy and gastric bypass procedures change the way that your stomach functions permanently, leading to a reduction in absorption of minerals that require stomach acid to be best absorbed (such as Iron, Calcium, Magnesium etc). Patients who stop taking supplements are almost guaranteed some sort of vitamin or mineral deficiency. 

Will I be left with excess skin following bariatric surgery? 

The amount of loose skin varies from person to person when they have lost weight following bariatric surgery. The older you are and the more weight you lose, the more likely this is going to happen. Unfortunately, there is no way of getting rid of excess skin through exercise or toning; the only way to deal with excess skin following bariatric surgery is through body contouring surgery (around ⅓ of patients seek this option after bariatric surgery).

If you have a question about bariatric surgery that we haven’t covered in our blog today, click here to read our FAQs page. Or you can contact our practice online with any questions you may have, or call us on (02) 9553 1120 to book an appointment with one of our bariatric specialists. 

Recently, Dr Jennifer Matthei joined Dr Georgia Rigas as a SCOPE Certified bariatric practitioner. The SCOPE Certification is the international standard of obesity management expertise, recognising excellence in obesity. The SCOPE Certification is part of the World Obesity Federation, whose mission is to reduce the global burden of obesity and the understanding of obesity as a multifactorial disease. The WOF is also working hard to combat the stigma associated with obesity.

Who is eligible for the SCOPE Certification? The SCOPE Certification is the only internationally recognised certification in obesity management. If a healthcare professional wishes to become certified, they have to meet the following criteria to apply:

Evidence of 6 months practical experience related to obesity management within a medical or allied healthcare professional setting.
Completion of the Core Learning Path (4 SCOPE points).
To achieve certification, 12 SCOPE points are required in total. The remaining 8 points can be achieved through e-learning with SCOPE Schools or other SCOPE Accredited courses.

In addition to their busy days as Bariatric Medical Practitioners here at Upper GI Surgery, both Dr Rigas and Dr Matthei have had to complete additional learning and training in their spare time towards achieving this certification.

The certification is renewable annually, by completing two additional SCOPE modules.

Why is this important?
SCOPE certified practitioners have access to an international community of obesity experts and credible and up-to-date obesity education materials developed by leading experts in the field. Obesity and bariatric surgery is a very specialised area of expertise, and at Upper GI Surgery all of our medical team ensure that they are up-to-date with the latest information to use when treating patients.

1. 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.
2. 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.
3. 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.

So, what can be done about this?

First up, its important not to let worry 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.

1. 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 on the steps we need to take than what may pop up from unofficial sources and armchair experts.
2. Ensure your medical conditions are optimally controlled. Now is a perfect time to get in touch with your GP and get a check-up.
3. Work on your fitness. This will improve respiratory health, reduce your blood pressure and help control your blood sugars.
4. 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 bodies vital functions if you are overweight.
5. 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 Kg’s.
   1. 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.
   2. 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”.
   3. Medically supervised options. These are more complex and rely on a mix of exercise, dietary change and VLCD, and occasionally medical therapies to suppress hunger or cravings.

While weight loss surgery has been proven to provide a sustained weight loss greater than 5-10 times what can be achieved with the methods above it will not be an option for us until some of the social isolation restrictions are lifted in the coming months. 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 offer 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

People with obesity are constantly shamed and blamed for their disease. This is because many people – including doctors, policymakers, and others – do not understand that obesity is a chronic disease. They see it as a simple lack of willpower, laziness, or a refusal to “eat less and move more”. But like all chronic diseases, the root causes of obesity run much deeper. They can be genetic, psychological, sociocultural, economic and environmental. 

It is time we break the cycle of shame and blame and revaluate our approach for addressing this complex chronic disease that affects 8 million Australians and 650 million people worldwide.

Join us and organisations around the world for a new World Obesity Day on March 4, 2020, as we push for more comprehensive solutions, treatment and collective responsibility for addressing this global epidemic. Together, we can address the far reaching personal, societal, and economic impacts of obesity.

Dr Rigas’ take home messages this World Obesity Day: 

• “People don’t choose to develop obesity; therefore the shame and blame needs to stop!”
• “We need to shift the conversation from loss of weight to gain in health”
• “Effective treatments such as anti-obesity medications and bariatric surgery do exist and may health improve your health and function” 
• “I encourage people living with obesity or who have a strong family history of obesity to make an appointment with a GP who understands the science underlying obesity”

Together we can create a healthier future. For more information on World Obesity Day 

Spread the word: #worldobesityday

]]> https://bariatric.uppergisurgery.com.au/world-obesity-day-wednesday-4th-march-2020/feed/ 0 https://bariatric.uppergisurgery.com.au/support-group-meeting-14th-november-2018/ https://bariatric.uppergisurgery.com.au/support-group-meeting-14th-november-2018/#respond Wed, 21 Nov 2018 03:53:04 +0000 https://uppergisurgery.com.au/?p=5637 Our most recent support group was held by our psychologist Fiona Tzouramanis and focussed on a discussion of the 4 eating cycles developed by Dr Michelle May, the founder of “Am I Hungry, Mindful Eating Programs”. You can check out her website www.amihungry.com for great ideas and a wealth of knowledge on how to eat mindfully.

The four eating cycles are based on:

Why? – do we eat

When? – do we eat

What? – are we eating

How? – do we eat

How much? – time do we take to eat

Where? – does our energy go

Restrictive Eating Cycle – The restrictive eating cycle is based on people that are on a diet. The basis of the diet is to follow the rules i.e. the allowed foods and rigid eating cycle. Energy is focussed on eating and exercising.

Overeating Cycle – The overeating cycle has no rules, a person eating whatever provides them comfort and pleasure, eating mindlessly, being uncomfortable and having excess fuel stored in the body.

Mindful Eating Cycle – The mindful eating cycle is the cycle that bariatric patients will benefit from most; using it as a guide to manage eating habits and lifestyle changes. It is questioning yourself at every point to ensure you are moving in the right direction. Being mindful we can develop healthy long-term mechanisms relating to food. This cycle is the GO TO of all of the cycles for bariatric patients.

Why – do I eat?

When – do I want to eat?

What – do I eat?

How – do I eat?

How much – do I eat?

Where – do I invest my energy?

Instinctive Eating Cycle – The instinctive eating cycle is the cycle you get to once you have mastered the mindful eating cycle. This cycle is based on eating when we are hungry, until we are satisfied and learning how to eat and respond to our biological hunger signals (not our thinking or feeling hunger signals), and learning to live a full and healthy life.

If you would like to attend our next support group meeting then please call us on 02 9553 1120 to book your space.