The Weight is Over: Your Guide to Bariatric Surgery

7/25/2019 The Weight is Over: Your Guide to Bariatric Surgery

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The Weight is OverYour Guide to Bariatric (Weight Loss)

SurgeryBy Alma Orozco

Disclaimer

This book is for educational purposes only. The material enclosed is

considered to be accurate at time of publication, however, techniques,and surgical instruments and supplies can change over time. Pre-op and

poste-op recommendations for diet and drugs can also change.

Therefore, it is not intended as a replacement for consulting with

your personal physician. It is strongly advised that before you

consider having bariatric (weight loss) surgery you consult your

physician in regard to your health and lifestyle and your prospects for a

successful outcome.


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Copyright 2015 by Alma Oroczo

All Rights Reserved.

Table of Contents

Successful Weight Loss Surgery: Its Not Only for Celebrities 4

Am I a Candidate for Bariatric Surgery? 7

Types of Bariatric Surgery 9

Preparing for Bariatric Surgery 13

The Big Day is Here: What to Expect Before and After 16Weight Loss Surgery

Post-Surgery Diet 19

Post-Surgery Diet Phases 22

The Importance of Protein for Bariatric Patients 26

Exercise, the Key to Becoming a Successful Bariatric Patient 30

Common Complaints, Risks and Complications Associated With 33

Bariatric Surgery

Bariatric Surgery FAQs 36


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Successful Weight Loss Surgery:

Its Not Only for Celebrities

ouve heard the wondrous stories about celebrities who have successfully losthundreds of pounds through bariatric surgery and have seen the results. Women like

Sharon Osborne and Roseanne Barr come to mind. Star Jones had even more amazingresults, losing over 160 pounds in three years. As for male celebrities, John Popper, lead

singer of Blues Traveler, lost 200 pounds after having gastric bypass following a severe

heart attack. American Idol judge Randy Jackson lost 113 pounds following gastric

bypass surgery while television weatherman Al Roker dropped 100 pounds and washealthy enough to run the New York City Marathon in 2010.

You may think that celebrities losing lots of weight is all fine and dandy, but will it workfor you? To help you decide, here are two success stories from patients who had weight

loss procedures done through Bariatric Mexico Surgery.

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Lauras Story

Around 10 years ago, my mother had gastric bypass surgery and lost about 125

lbs. I wanted to have it done so badly, however, my insurance didnt pay for it. Fast

forward 9-1/2 years. I was on a plane with my daughter, who models, travelling to a

shoot in California when I was an ad in Delta Magazine advertising medical treatment outof the country. I thought, Why havent I heard about this before? Once home, I

researched as much as I could on this option along with many different doctors, includingDr. Fernando Garcia.

Within two months, I was back on a plane to California to have my dream surgery

with my mother accompanying me. We arrived in San Diego at 6 p.m. I was worried that

I would be nervous and scared, but I wasnt. I was just so happy that the time had finallyarrived. The driver who picked us up was so friendly and smelled nice. I remember him

laughing and said he was

happy that after the longday that he had that he

still smelled good. I hadnever been to Mexico

before and the driveranswered any question

on the ride to the hotel.

Once we arrived at theMarriott, we were treated

like royalty. The beds

were heavenly. It was

wonderful. When wearrived, there was a note

from the onsite I wasdownstairs by 9 a.m. forthe ride to the hospital.

Once I arrived, we filled

out forms and did labs.

After I was settled in my room, several doctors talked to me while the nurse prepped me.Dr. Garcia came in, wanted to know if I had questions for needed something to soothe

me. Since I was calm, he suggested that I take a nap. When it was my time, I told the

anesthesiologist, Lets get this show on the road! Afterward, I remember sleeping a lot,and then walking a lot when I was awake. I have to say that I was never treated so well in

my life. It was an amazing experience that I would do again.

Within five months, I was able to do things I had not done in years, such asworking as the assistant cheerleading coach for my daughters group. I was able to walktwo miles and still breathe. I was able to run and play with my kids again. I had my

thyroid medications lowered.

I am once again happy and healthy after losing just over 86 pounds with 30pounds to go. It is amazing and crazy at the same time. Thank you, Dr. Garcia and your

staff for all you did for me. You gave me the life I tried so hard to get back!


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Jeffs Story

I was near death not long before my bariatric surgery. Hospitalized for an

infection, each of my legs had swollen to 24 inches in diameter. I could barely breathe

and my personal life and hygiene were at an all time low.

My friends and family watched me die as I weighed 250 pounds, then 275, 300,350, 400, 450 and then the all time high of 489 pounds. At this point, I traveled to

Tijuana to interview six doctors before making the decision to trust Bariatric MexicoCenter to do the procedure.

Today I am a 270 lb. man who no longer has sleep apnea. I can tie my own shoes

and buy clothes at the same stores. I have 42-inch waist and wear a 2X shirt instead of a

6X. I owe all to the lifestyles changes afforded by you and your wonderful staff.I have had the pleasure of bringing new patients to you, including a lady who has

gone from a size 18 to a size 4. Another woman I referred reached her weight goal in just

seven months, losing 98 pounds.One time when I

visited your facility, Ishook hands with a man

who weighed nearly 500pounds and was having

the procedure done that

day. I shared my storyand the two of us shed

tears. I know that

wherever he is, he is

happy and his life hasbeen changed.

In Tijuana,bariatric surgery is allyou do. You have a less

than 1% infection rate

over your entire

services. I also learnedthat you have a 0%

mortality rate. When researching the procedure, I was offered surgery next to a hardware

store, next to Office Depot and was even approached by someone who claimed he was adoctor and would do the procedure in his garage. It was not difficult to choose your

hospital and staff. Your staff treats us wonderfully because you are focused on each

patient as an individual and the hotel provided is of highest American standards.I am proud of the work you do and the skillful way your staff works on each

patient. I hope that everyone who fights obesity would choose to change his lifestyle and

visit you for the chance to be happy once more. Once again, thank you, you saved my

life.


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Am I a Good Candidate for Bariatric Surgery?

eciding to have surgery to produce weight loss is a

serious matter. Many individuals come to a crossroadsto make this serious decision after failing to lose weightthrough traditional diets, exercise and medication.

Obesity is a disease with many contributing factors

including genetics, environment, metabolism and eating

disorders. Because of its complexity, overcoming obesity canbe difficult. Excess weight, medications, genetics and an

inability to be active all contribute to make the weight loss

process extremely difficult, if not next to impossible.Bariatric surgery is not a cosmetic procedure or a lazy way to lose weight.

Patients committing to one of the weight loss procedures must go through a disciplined

process and commit to lifestyle changes that will help them lose weight, keep it off, gettheir health back, and enjoy a new lifestyle.

What is Obesity?Obesity is defined as an excessive accumulation of adipose tissue to such an

extent that health is impaired. According to the National Institute of Health, an increaseof 20 percent or more above your ideal body weight is the point where excess weight

becomes a health risk. Adult obesity is commonly determined by the body mass index,

or BMI, determined by an individuals weight and height. BMI is used to help determineeligibility for weight loss surgery because for most people, their BMI correlates with their

amount of body fat and thus is related to their risk factor for disease and death. To

determine your BMI, use thiscalculatorin the footer of the Bariatric Mexico Surgery

website.

BMI Classification Health Risk

Under 18.5 Underweight Minimal

18.5 - 24.9 Normal Weight Minimal

25 - 29.9 Overweight Increased

30 - 34.9 Obese High

35 - 39.9 Severely Obese Very High

40 and Over Morbidly Obese Extremely High

Obesity is one of the leading causes of preventable death. Today 97 million

Americans, more than one-third of the adult population, are overweight or obese. An

estimated five to ten million of those are considered morbidly obese.People with a BMI

D
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of 20 to 25 have the lowest mortality risk. The higher your BMI, the greater your risk for

death. A BMI of more than 32 in women results in a double mortality rate. Obesity

causes an estimated 111,900 to 365,000 deaths per year in the United States and reduceslife expectancy by an average of seven years. A BMI of 30 to 35 reduces life expectancy

by two to four years. Morbid obesity with a BMI of 40 and over reduces life expectancy

by 10 years.

Determining EligibilityBMI classifications help medical professionals ascertain whether patients will be

good candidates for bariatric surgery. Weight-loss surgery is recommended for

individuals with a BMI between 35 and 39.9 and one or more of the following obesity-

related health conditions:

Type II diabetes

Obstructive sleep apnea

Osteoarthritis High blood pressure

Obesity hypoventilation syndrome

High cholesterol

Psudotumor cerebri

Family history of early coronary heart disease

Bariatric surgery generally provides good outcomes for individuals with the following

criteria:

More than 100 lbs. over ideal body weight

BMI of more than 40 BMI of over 35 with several accompanying negative health effects related to

being severely overweight

Between 16 and 70 years of age

Obesity-induced physical problems such as back or joint pain that interfere with

lifestyle

Body size problems that preclude or severely interfere with social life,

employment or ambulation

Unable to maintain healthy body weight even while on a medically superviseddiet

Aware of the risks and benefits of surgery and commitment to permanent

lifestyle changes

Please note that many doctors will perform surgery on patients with a BMI of

less than 35 (but not lower than 32) if certain medical criteria are met.

Women of childbearing age considering weight-loss surgery should not try to

become pregnant within the first 18 months to two years following surgery as the rapid


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weight loss and nutritional deficiencies associated with the procedure make pregnancy

dangerous for the mother and the developing fetus.

Non-Surgical Treatment OptionsMost patients unsuccessfully try several different non-surgical options to lose

weight before considering bariatric surgery. Exercise and diet is the most frequently used

option. Patients attempt to limit caloric intake while increasing activity. This option doesnot work well in morbidly obese patients as they generally lose weight while on a

program but immediately regain weight and pack on additional pounds as soon as the

program ends.

Medications provide another treatment option even though not all patients will beable to use them. Doctors generally prescribe medications for patients with a BMI of 30

or less or of 27 and higher if factors such as high blood pressure, diabetes or other risk

factors are present. The downside of weight-reduction medications is that they often have

side effects such as tachycardia (elevated heart rate), a rise in blood pressure and areduction in the absorption of fat-soluble vitamins. These medications only help while

patients use them. As with diet and exercise, many regain weight after treatment stops.Additionally, some patients dont respond at all to weight-loss drugs.

While the FDA regulates prescription weight-loss medications in the United

States, most over-the-counter weight loss remedies are not regulated. Hundreds of these

medications or supplements are on store shelves. Since they are not subject to the samerigorous standards for prescription medications, most have not been proven safe and

effective and may even be dangerous.

How Weight Loss Surgery Affects HealthThe health consequences of severe obesity affect most of the organs in the body.

Obesity is a risk factor for cancer, heart disease and stroke in addition to many other

diseases. Studies show that the risk of death from these conditions returns to normal afterweight loss. Within the first six months of having weight loss surgery, many patients no

longer need to take medications for obesity-related conditions. In addition, women who

were struggling with infertility before surgery find that conception is possible after

surgery.

Statistics of patients undergoing weight-loss surgery typically have these results:

Type II diabetes resolved in 77% and improved in 86% High blood pressure eliminated in 62% and improved in 79%

High cholesterol reduced by 70%

Obstructive sleep apnea resolved in 85%


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Types of Bariatric Surgery

urgeons use several types of bariatric procedures to help patients lose weight. A

number of factors are taken into consideration, including the amount of weight you

want to lose, which health problems need improvement, risk level and overall cost.

Your bariatric surgeon will explain your options and help you decide which

procedure is best for your needs.

Bariatric surgeries fall

into three categories:

restrictive procedures that

shrink the size of the

stomach to limit the amount

of food it can hold,

malabsorption procedures

that reroute food through the

digestive system so that the

body is only able to absorb a

fraction of nutrients and

malabsorptive-restrictive

combination procedures that encompass both.

Laparoscopic Lap Band

This minimally invasive restrictive surgery is performed via laparoscopy. The

laparoscope is a long, thin tube with a high-intensity light and a high-resolution camera atthe front. The instrument is inserted through an incision in your abdominal wall.Recovery is rapid from this reversible procedure whereby the surgeon places a band

around your stomach, just below the esophagus. The restraint creates a new stomach

pouch that controls the amount of food your body allows you to consume, but also slowsdown the evacuation process, helping you to feel fuller for longer periods of time.

Attached to the band is a narrow tube connected to a port placed beneath the skin.

Doctors tighten or loosen the band by injecting

silicone into the tube to accommodate patientneeds. The fills begin approximately four to six

weeks after surgery and then at two- to three-

month intervals until the optimal level isachieved. To prevent the band slipping out ofplace, the surgeon secures both sides of the

stomach around the band.

The Lap Band is the least invasivebariatric surgery. There is no rearrangement of the

digestive system and no malabsorption of

nutrients.

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Gastric Sleeve SurgeryThe Gastric Sleeve has recently

evolved into an increasingly popular option for

super-obese or high-risk patients. Also

performed through laparoscopy, the procedure

resections 60% to 80% of the stomach. Theportion that is left in place carries out all

necessary functions such as digestion acid

secretion, etc. No rerouting of the intestines isinvolved, so food is completely digested and

nutrients are absorbed.

Following gastric sleeve surgery,

patients are only able to intake a small portionof food. The remainder of calories needed come from fat stored in the body, resulting in

weight loss. An additional factor involves the reduction of a hormone called ghrelin, the

amino acid that signals hunger. The portion of the stomach removed produces the most

amount of ghrelin, thus, patients also feel significantly less hungry.

Gastric Sleeve PlicationThis relatively new procedure is another restrictive approach to produce weight

loss. Plication refers to the rounded shape of he stomach made by folding it in layers.During surgery, stomach volume is reduced by about 70% making the stomach able to

hold less. The outer edges of the stomach are folded around a calibration tube and then

stitched into place. There is no cutting, stapling or removal of the stomach or intestines.Gastric Plication may be reversed or converted to another procedure if needed.

Gastric Plication does not cause decreased absorption of nutrients or bypass the

intestines. After eating, patients feel full quickly and continue to feel full for severalhours. The procedure may also cause a decrease in appetite.

Gastric BypassAlso known as Roux-en-Y surgery, Gastric Bypass combines restrictive and

malabsorptive components. It involves multiple stapling of the stomach to form two

confluent pouches. The smaller pouch at the inlet of the stomach is attached to a

resected Y-shaped segment of the small

intestine where food is primarily drained.

The resection bypasses the duodenum andthe jejunum, the first two portions of the

small intestine where most food is normally

absorbed. This surgery is designed to limit

the amount of food intake as the stomach is

reduced to a small pouch, while the intestines

are also rerouted to intentionally prevent the

body from absorbing nutrients and calories.


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Mini Gastric BypassMini Gastric Bypass surgery, or the Bilroth II procedure, is a fast and efficient

laparoscopic surgery recommended for obese patients with concurrent diabetes

mellitus, hypercholesterolemia and uncontrolled hypertension. The Mini Gastric

Bypass was developed in 1997 to reduce operating time, simplify the procedure and

reduce complications.The procedure involves dividing the stomach into two pouches, with the

upper pouch along the stomachs lesser curvature, and the lower pouch along the

greater curvature of the stomach. The smaller pouch partially absorbs incoming

food and then passes directly to the jejunum level of the small intestine, effectively

bypassing six feet of the intestinal track.

Mini Gastric Bypass is both

restrictive and malabsorptive as the

small stomach pouch necessitates

earlier satiety in patients. The

intestinal bypass causes food to skip

the duodenal column where themajority is absorbed into the

bloodstream.

Generally surgeons prefer the

gastric bypass surgery over the mini,

but a consultation will confirm the

best option for you.

Duodenal Switch

As one of the more complicated bariatric procedures, the BiliopancreaticDiversion with a Duodenal Switch (PBD-DS), commonly referred to as the Duodenal

Switch, involves three features. The first involves dividing the stomach into an

elongated connection between the esophagus and the small intestine. This step

makes patients feel full sooner as the stomach retains approximately 25% of its

original capacity.

The first step your surgeon will perform in duodenal switch surgery is to

divide your stomach into an elongated connection between the esophagus and the

small intestine, shaped like a banana. The unused portion of the stomach is removed

from the body. The second feature reroutes food away from much of the small

intestine as the smaller, gastric sleeve-like portion of the stomach is linked to a

short part of the duodenum, which is turn, is directly linked to a lower part of thesmall intestine.

The distance between the stomach and the colon becomes much shorter, thus

limiting how food is absorbed. Because the stomach is simply reduced in size, its

function is not altered, helping to decrease the probability of dumping symptoms

(persistent vomiting, nausea and diarrhea).


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Preparing for Bariatric Surgery

aving weight loss surgery isnt just a matter of showing up at the medical facilityonce you have decided to undergo one of the procedures. In the days and weeks

leading up to surgery, its important to prepare your body and mind for the changesahead. Doing so will reduce stress, save money, minimize the risk of complications andpossibly even help increase the amount of weight you lose and keep off over the long

term.

Why You Should Begin Preparing Early

One of the best things patients can do for

themselves is to try to lose weight in the months before

surgery. Those who do, tend to lose more weight aftersurgery and are less likely to experience complications.

A recent study conducted by the Stanford University

School of Medicine found that for every 1% of weightloss before surgery, the average patient lost 1.8% more

weight in the year following the procedure. The same

study found that patients with pre-op weight lossexceeding 5% spent 36 fewer minutes in the operating

room as lower weight made it easier for surgeons to

perform the procedure. Another study of gastric bypass

patients found a direct correlation between pre-opweight loss and complication rates.

Perhaps the biggest reason for preparing early for bariatric surgery is long-termsuccess. Habits dont change overnight. Weight loss surgery will not work over the long

term if you dont make a commitment to change.

Think of it this way: just as athletes prepare for the biggest games of their careers,

so should those committed to having bariatric surgery prepare for it. The sooner onestarts, the more likely it is that they will establish the habits necessary to achieve long-

term weight loss and health improvement goals.

Take Care of the BasicsPrior to surgery, you must deal with a variety of practical considerations. Plan to

take care of these tasks three to six months ahead of your scheduled surgery to ensure that

you have sufficient time to address any problems or changes that may arise.

Begin working with your coordinator at Bariatric Center Mexico as soon aspossible so you can fully understand the steps you need to take to successfully complete

your chosen surgery.

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Tijuana, Mexico is a hot spot for bariatric surgery. If you are going to Tijuana,

arrange for flights or ground transportation if you are within driving distance. Your

coordinator will explain financing should you need this. Medical tourism insurance isalso available through our office to protect you against unforeseen circumstances.

Schedule your initial consultation with one of our coordinators to learn more about

what you can expect, as well as find out what paperwork youll need to move forwardwith surgery. Be prepared to supply the following information:

A review and summary of your own medical history and that of your parents andnote any anesthesia complications

List prescription drugs, over-the-counter drugs and vitamin and herbalsupplement you take regularly

Write down questions and concerns about the procedure to discuss with your

surgeon

All information provided to your coordinator will be forwarded to your surgeon, who

may give you a recommended diet and exercise program to follow in the weeks before

your procedure to help you begin to lose weight. Make sure to schedule any requestedtesting and physicals with your family doctor and forward the results to your coordinator

who will pass them along to your surgeon.

Make Lifestyle ChangesFollow your doctors recommendations for diet and exercise to improve your chances

for long-term weigh loss and health improvement following surgery. Begin post-surgery

lifestyle changes at least three months before the procedure. Tips for eating include:

Retraining your taste buds by eating for health and not just flavor and pleasure.Your smaller, post-op stomach will prevent your body from processing large

amounts of food. If you fill up on junk food, your body wont get the nutrients itneeds, which can ultimately lead to complications.

Eat lots of protein as its essential for weight loss. Protein makes you feel fullersooner and for longer periods.

Eat slowly and watch portion sizes. The feeling of fullness takes 20 to 30 minutesto reach your brain. Get in the habit of eating slowly and deliberately so you dont

stretch your new stomach and overeat after surgery.

Change your liquid intake. Begin eliminating liquids with your meals since aftersurgery youll have to wait20 to 30 minutes before or after meals before you

drink anything. Liquids can cause food to flush through your digestive system and

make you feel hungrier, leading to weight gain. Take coffee (decaf is best) only in

small amounts and try to eliminate sugar (or use a sugar substitute) and cream. Eliminate or reduce sugary beverages and alcohol and drink more water. If you

dont have any liquid restrictions, try to drink 64 ounces of water per day, by

doing so you will feel full and lose weight. Keeping well-hydrated will also flushyour kidneys and reduce the chance of developing kidney stones which can

develop after rapid weight loss. Due to changes in your digestive system, your

body will react differently to alcohol; it will be easier to become intoxicated and


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develop food cravings. Too much alcohol post-surgery can cause your blood

sugar to spike, resulting in weight gain and renewed health problems.

Increase your activity level per your surgeons suggestions. Exercise can be difficult,

but its attainable. Start slowly and increase your intensity in small steps by adding five to

10 minutes per session each week before surgery.If you smoke, you need to stop four weeks prior to surgery. It is highly recommendedthat you do not smoke for one to two months after your procedure. Of course, it is better

for your health that you quit smoking altogether and we recommend that you take this

opportunity to do so.Smoking increases the potential of complications following surgery,delays healing, promotes infection and increases the risk for ulcers.


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The Big Day is Here: What to Expect Before and

After Weight-Loss Surgery

Congratulations, youve committed to having bariatric surgery and the big day is

here. Its natural to feel nervous before having any kind of procedure, but dont

worry, before you know it youll wake up in the recovery room ready to begin your

new life. Although your experience may differ slightly, this flowchart (above) shows

what you can expect when arriving for bariatric surgery in Mexico.


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Prepping for SurgeryUpon arriving at the hospital, the procedure will be similar to that for any other

surgery. Youll fill out some forms, possibly have a test or two performed, have your

vital signs taken and be asked to put on a hospital gown in preparation for your surgery.

A nurse will place an IV in your hand or arm to start intravenous fluids and to administer

antibiotics. It is recommended that you bring along a companion. Your companion willbe allowed to stay with you until you are called to the operating room and then they will

head to a waiting room until you are moved to your own room.

Surgery and Recovery RoomAfter your anesthesiologist administers the drugs that will make you fall asleep,

surgery will last between one and two hours depending upon your procedure. When youare out of surgery, the surgeon will inform your companion that the procedure is

complete and you will be taken to the recovery room where you will wake up feeling

groggy, but happy, knowing that the surgery has been completed.

Your stay in the recovery room will last one to four hours. You may have littlerecollection of time spent here, but the care team will work closely with you to monitor

your vital signs and to answer your questions. You may experience nausea and/or pain.If you seem to be hooked up to lots of equipment, dont worry, its normal. When you are

fully awake you will be transferred to your own room where you will continue your

recovery.

The First 24 Hours

During the first 24 hours following surgery, you will continue to receivemedications and fluids through your IV. You will feel groggy and may drift in and out of

sleep for long periods. You may experience dry mouth, a byproduct of medication used

with the anesthesia during surgery. You may be allowed to brush your teeth and rinseyour mouth, but at first you will not be allowed to drink water.

PainPain is usually moderate on the first day. The IV will still be connected, so it

will be easy to ask for and receive pain medication as needed. Typically, individuals

who will have the most pain are those who have significant portions of their

stomach removed. When in your hospital bed, you may also feel a sense of general

soreness across your abdomen.

ActivityYour surgeon will probably want you to get up and walk, but getting out of

bed will be difficult. It will hurt. However, the more you walk the better you will feel

the next day and the faster you will feel more like yourself. Walking will help

prevent blood clots. You will also be encouraged to sit up in a chair.


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Mental StateYou may feel elated, knowing that the surgery is over and that the next the next

stage of your life is about to begin. At the same time, you may feel some concern,worrying that you will feel hungry yet be unable to eat. However, it wouldnt be pleasant

to eat or drink at this point because your throat will be sore and swollen from surgery.

Since a significant portion of your stomach will have either been removed or resected itwont produce as much of the hunger hormone ghrelin, so you wont feel hungry.

The Day After SurgeryMany patients experience a restless night after sleeping a lot in the hours after

surgery, so expect to drift in and out of sleep. Your surgeon will order testing to ensure

that your stomach has healed enough to begin digesting foods and you may start your

liquid diet.

PainPain is typically easier to manage at this point and will continue to be so as the

days pass. Expect different positions to offer different levels of discomfort, but keep in

mind why you had this surgery.

DietYou will begin taking sips of water to accustom yourself to how much liquid and

how often you can have some following your weight-loss surgery. If you tolerate water

well, you will begin the first phase of your post-operative diet that is limited to clear

liquids such as gelatin, broths and teas.

DischargeIf everything goes well during post op, you can expect to be released anywhere

from 24 to 48 hours following your procedure. In the hours before your release expect

your surgeon to recommend a diet and activity plan that you should follow when youreturn home. Usually, a nutritionist will also be involved to help you in your on-going

recovery.


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Post-Surgery Diet

ongratulations! You have come through weight-loss surgery and are now ready to

begin the next phase of becoming the new you. The next three to six months will beamong the most important of your life as you relearn how to eat. You will experiencesignificant changes not only on how you eat, but on what you eat.

The greatest weight loss will occur in first four

to nine monthsfollowing surgery and will slow

afterwards, although you will continue to drop poundsfor 12 to 18 months and sometimes longer. Plateaus,

an intermittent stalling of weight loss can occur during

this period for up to a month. Most patients willexperience a plateau after eight to 12 months following

surgery. The plateau is generally an indication that the

patient is consuming too many calories orcarbohydrates or that increased levels of exercise areneeded. After this period, weight loss will slow, but

can still occur for 12 to 18 months or even longer in

some individuals, even though it is more difficult.

Weight may be regained if too many caloriesare consumed, exercise is discontinued or old habits

such as grazing, snacking or poor food choices,

especially from sugary foods like soda, ice cream, etc., occur.

Water Everywhere, So Make Sure You DrinkOne of the most important tasks that you can do following bariatric surgery is to

drink a sufficient amount of liquids, mainly water and sugar-free drinks. You should tryto drink 64 to 80 fluid ounces in small amounts throughout the day. A simple way to

accomplish this is by buying a 32-ounce water bottle and consuming at least two bottles

per day via small sips. Note that it may take several weeks to build up to this amount.

Getting enough water immediately after surgery may be difficult. Take a sip, thenafter several minutes sip again. You need to keep drinking water and shouldnt wait until

you are thirsty to do so. Increase water consumption when weather is hot and humid to

avoid dehydration. Pay attention to your urine especially during the first few weeks. If itlooks darker than normal, you are not getting enough liquid.

Diet ProgressionBefore your release from the hospital, your surgeon and the nutritionist will give

you a detailed bariatric diet plan to follow for the first weeks and months after surgery.The purpose of this is proper healing, engaging in a healthy lifestyle and maximizing

your chances of losing weight.

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For the first several weeks after surgery your diet will consist completely of

liquids. The length of this phase depends on the type of surgery you selected. Following

the liquid phase it is important to avoid damage to your new stomach and to avoidcomplications and setbacks such as hospital readmission and repair surgery. The

consistency of your liquid diet will be watery at first and gradually thicken as you add

items such as protein powder for shakes, cream soups and yogurt for smoothies. At firstyou may only be able to sip an ounce or two of your liquid meals every hour or so.As the weeks progress, you will slowly be able to eat more, typically taking four

or five small meals per day. When you resume solid foods, eat three times per day at

usual meal times. There is no hard and fast rule as to how many times per day you shouldeat as some individuals may need to eat five to six small meals per day to obtain adequate

nutrients and calories. Make sure that you are not grazing, however, as this habit can

sabotage weight loss. You will feel full quickly, so do what is best for you. Reintroduce

solid foods one at a time to determine which your digestive system can or cannot tolerate.Cook everything well and chew it thoroughly before swallowing.

Diet ComponentsProtein should be your primary source of nutrition, with 70 to 75% of calories

coming from foods such as fish, eggs, soy, dairy products, legumes, lean meat and

protein shakes. Carbohydrates should make up 10 to 20%, while you should limit fats to

5 to 15% of total calories.

When selecting protein, be mindful of fat content as many sources contain amplepercentages. A diet of 600 to 800 calories is a good goal for the first six months. Caloric

intake will increase as your stomach stretches. Your body will do everything it needs to

get enough protein and will begin to break down muscle. Inadequate protein can result inswollen ankles, fatigue, hair loss, cracked nails, impaired immunity and slow wound

healing.Avoid simple carbohydrates such as white bread, potatoes, white rice, corn peas

and anything full of excessive sugar such as candy, ice cream and donuts. Even orangevegetables like carrots and sweet potatoes can hamper weight loss as they are high in

sugar. Select good carbohydrates in small portions, including vegetables, low sugar fruits

and quality foods like brown rice, quinoa and whole-grain breads as these foods are often

high in fiber.

Overall FocusEat protein fi rstso you can get enough of it and avoid the problems that come

with inadequate amounts. By eating protein first, youll have little room left for

carbohydrates and simple sugars. Try protein shakes if you have difficulty gettingsufficient protein. Sugars and carbohydrates may slow weight loss because they are easily

digested and absorbed. Sugars, artificial sweeteners and sugar alcohols lead to gas,

bloating, diarrhea and a mad dash to the bathroom. Starches like mashed potatoes andcereals can also slow weight loss. Learn to recognize feeling full and avoid stuffing


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yourself. By six months, most patients are eating a regular, healthy diet in smaller

portions.

Vitamins and SupplementsEven though you have committed to a lifetime of eating properly, your diet may

not have enough vitamins and minerals. Ask your surgeon or nutritionist for

recommended supplements. A multi-vitamin and mineral supplement, extra vitamin B12,

calcium and vitamin D may be recommended for most patients. Iron is recommended formenstruating women and individuals with anemia.


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Post-Surgery Diet Phases

ollowing bariatric surgery, patients go through as many as four stages of diet

progression. Dont worry as its not as difficult as you may think. The length of eachphase depends on the type of surgery you have, how your digestive system reacts toreintroduction of food and your surgeons recommendation. These stages involve clear

liquids/pureed foods, soft foods and

finally solid or regular foods. By one

year post-surgery, you should be able toconsume a regular diet, albeit with much

smaller portions than previously.

Diet progression varies frompatient to patient. Proceed with caution

to minimize vomiting and the disruption

of staples or stitches. You can progressto the next stage asper your doctorsguidelines and when feeling completely

comfortable with the current stage,

meaning no nausea or vomiting. If you

progress to the next stage andexperience problems, return to the

previous stage for at least 48 hours

before trying again.

Stage One: Clear LiquidsThe goal here is to try to drink 64 ounces of liquid per day, although this may be

difficult in the first days after surgery because your stomach may be swollen from theprocedure. Sugar-free gelatin, ice pops; diluted sugar free juice and sugarless powdered

drinks like Crystal Light also count toward your liquid intake.

Your liquid diet may also include whey protein bullets, vitamin water zero and

similar commercial drinks, ice chips, chicken or beef broth, consomm and mild teas (nocinnamon). Drink a minimum of two quarts of water every day at your own pace. Always

sip, never gulp or drink quickly.

Stage Two: Full LiquidsThis transition stage helps keep your body hydrated and readies it for soft, solid

foods. Continue to sip water all day.At this point, youll add a protein supplement toyour diet. These supplements are plant-based or whey-based. Some people tolerate one

type better than the other. Note which works for you, and look for supplements with at

least 15g of protein and up to 30g, less than 5g of carbohydrates and under 130 calories

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per serving. You can also purchase commercial protein shakes, but sample before buying

large quantities.

Skim milk 1% or 2% will also become part of your diet (Lactose free in gastricbypass and duodenal switch, due to malabsorption). Individuals who are lactose

intolerant can substitute non-GMO soy, unsweetened coconut, almond or rice milk. Low-

sugar fruit juices without pulp, and blended cream soups without chunks may also beadded. Initially avoid tomato soup because of its acidity.

Other foods that may become part of your diet include:

Strained creamy soups

Chunky vegetable soups, thoroughly blended and thinned with water

Cooked hot cereals (oats, cream of wheat or grits) blended and thinned with skim

milk

Low fat and low sugar drinkable yogurt

Blended fruit smoothies

Thin egg custard

Fresh vegetable juice (Prepared in a juicer not a blender) or V-8 juice Applesauce

Stage Three: Pureed FoodsYou will attempt to eat more foods in this transition stage as your digestive

system begins to acclimate to its new way of eating. You may puree some foods at first to

make them easier to digest. Introduce one new food each day or every other day to allow

you to identify which may cause digestive problems. The most common foodintolerances are red meat, chicken and bread. Meats are better tolerated when moistened

with broth. You may not be able to tolerate beef for several months.

Eat only until you feel full and then stop. Dont force yourself to finish what is onthe plate. Measure out half-cup portions to place on your plate, dont guesstimate. Try

small amounts, sometimes as little as a tablespoonful at a time to see how your stomach

handles it.

Foods in this step require minimal chewing

Creamy vegetable soup (carrot, zucchini, asparagus, spinach, peas prepared with skimmilk instead or water) *Avoid broccoli, Brussels sprouts, cauliflower, as they might

cause gas.

Fruits and vegetables (cooked-peeled- pureed).

Unsweetened applesauce with non-fat dry milk powder or peeled and cooked apples,pear, peaches with yogurt.

Greek yogurt (


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Stage Four: Soft Diet

At this point, you are consuming 600 to 800 calories per day. Learn how to read food

labels to see how many calories a serving of each food contains and what is the percent of

protein, carbohydrates and fat. Keep carbohydrate intake to less than 30g per day. Add

non-fat powdered milk or unflavored protein powder to foods to obtain extra protein.Always remember never to eat and drink at the same time.

Examples of food to add in this stage include:

Egg salad

Canned tuna or salmon, well-moistened with low-fat mayonnaise

Plain chicken salad

Mashed, pureed, canned or cooked fruit or vegetables

Fat-free refried beans

Soft, fresh bananas

Occasional sweet potatoes or mashed potatoes

Stage Five: Regular Solid FoodsGetting to this stage signifies that you now have a healthy diet that you can eat for therest of your life. You have learned to eat slowly, savor your meals and listen to your body

to understand how it handles certain foods. Its important to continue protein intake to

maintain muscle mass and to avoid malnutrition. Consume 800 to 1,000 calories per day

and dont exceed 1,200. Get at least 65g of protein per day, some people need up to 90-100g a day. Use food scales or small plates to help guide portions. Never put more than 4

ounces of food on a plate at one time.

In addition to avoiding grazing, emotional eating and other unhealthy habits, youneed to avoid certain foods in order for your diet to have long-term success. White

starches (low fiber) and sugars are easy to overeat so managing carbohydrate intake is

essential. Being aware of hidden carbohydrate and fat sources and extra calories is alsoimportant.

Starches include: breads, cereals, grains, noodles, baked goods, snack foods and

crackers. Many starchy foods are low-fat or fat-free but contain hidden sugars. If you

must eat starches, opt for whole grains. Learn to read labels to look for additives like fatsthat increase caloric content. If an item states that it is fat-free, it may be loaded with

carbs. If the item is sugar-free, it is likely loaded with fat. When in doubt, simply look at

the calorie count as foods with few calories will be okay.

Foods you should avoid are:

Ice cream, unless sugar-free and fat-free

Sodas

Chocolate milk or other flavored milk products

Regular lemonade

Highly sweetened iced tea

Dried fruits


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Canned or frozen fruits with high sugar content

Table sugar

Candy

Pastries, pies and cakes

Sugar-coated cereals

High-fat meats such as sausages and lunchmeat Breaded and fried foods

Creamy dressings

Cheese with high fat content (Monterey Jack, Cheddar, Brie)


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The Importance of Protein

for Bariatric Patients

s you have already read, protein is an essential part of your diet following bariatric

surgery, but you may wonder why it is so important. Protein is the second most

abundant substance in the human body, following water. Amino acids that make upproteins are not stored in the body, therefore we need to consume sufficient protein daily

to meet requirements. Proteins play important roles

in metabolism, digestion and DNA replication and

help speed healing of wounds, minimize hair loss,increase body metabolism and repair and rebuild

damaged cells.

Weight loss surgery stresses the physical andpsychological condition of patients, making the

inclusion of protein in the diet vital for acceleratedrecovery and the healing of surgical wounds. Its not

easy to consume sufficient protein following

surgery, therefore most bariatric patients incorporate

liquid protein supplements in their diets to fulfillrecommended amounts.

The Benefits of ProteinA high protein diet at the beginningis essential for maximum weight loss and surgicalrecovery. Here are some of its most important benefits:

Assists in early wound healing

Enhanced growth of nails, bone and hair

Forms hormones, antibodies and enzymes

Helps burn fat instead of muscle

Results in sense of fullness after meals

Promotes recovery of tissues and helps build lean muscle

Powerful source of energy

Strengthens the immune system

Helps regulate functioning of the bodys systems

Protein deficiency can make you prone to infection and may cause muscle or hair

loss. Because your stomach is smaller following bariatric surgery, you simply cant eateverything that comes your way as you are only able to have small portions at one time.

Thus, it is important that everything you consume is filled with health and nutrition.

Choose food wisely for the sake of your health.

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Surgery can be traumatic if you are obese because, most likely, you suffer from one

or more health conditions including diabetes, hypertension, high blood pressure and

cardiovascular disease.

How Much Protein Do Bariatric Patients Need?Because protein is present in all major parts of your body, it is important to have

sufficient intake for proper functioning of your body. The best way to know your

nutritional needs after surgery is to consult a qualified nutritionist or dietician. They willbe your best source of advice to establish your diet plan according to your type of surgery

and health conditions. Your nutritionist will also help point you to foods that are highest

in protein and best for your health.

Protein comes primarily from animals and plants. Animal proteins are consideredcomplete as they have all essential amino acids. Plant proteins generally lack one or more

amino acids, except for soy proteins. Animal proteins are higher in fat and calories.

Approximate protein requirements after surgery is about 60 to 100 grams per day

(60-80g for women and 80-100g for menfor the first year). This number dropsgradually as you recover and lose weight. The exact amount also depends on the type of

surgery you have, so working with your surgeon and nutritionist to develop a healthyplan is in your best interest.

The Best Protein SourcesProteins should be the primary foods for bariatric surgery patients and should be

consumed first before carbohydrates and fats, although you may consume the latter twoin small amounts. Healthy carbohydrates like vegetables, fruits and whole grains can be

included. Acceptable healthy fats include oils, fish oils, olives, nuts, seeds and avocado.

Select proteins that are rich in nutrients and low in calories and fats like soy, meats,beans, seafood and low-fat milk. Whatever protein sources you choose, make sure you

are getting enough nutrients and are able to consume the recommend amount of proteins

daily.

Protein SupplementsProtein shakes and other supplements used to help maintain proper protein intake

levels are usually derived from whey, casein, egg white, soy and milk. Whey protein is

relatively inexpensive as it is a byproduct of cheese making. It is easily digested and isavailable in concentrate and isolates. Patients who are lactose-intolerant should take

whey protein isolate as it contains only trace elements of milk solids.

Supplements derived from casein take longer to digest and do not dissolve as

easily in milk and water when compared with whey supplements. Egg proteinsupplements come from egg whites and take between one and three hours to digest. They

are ideal for lactose intolerant individuals. Soy protein supplements contain several

essential amino acids and are good for lactose-intolerant vegetarians, but may lead todigestion problems in some individuals.


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Animal Protein Foods AmountGrams of

Protein

Beef, lean 1 ounce 7 grams

Cheese (American, cheddar, provolone, Swiss) 1 ounce 7 grams

Cheese, cottage 1/4 cup 7 grams

Cheese, ricotta 1/4 cup 7 grams

Chicken 1 ounce 7 grams

Egg or egg substitute 1 egg 7 grams

Fish: catfish, cod, flounder, haddock, herring, orange roughy,

trout, salmon, tuna (fresh or canned, in water only)1 ounce 7 grams

Shellfish: clams, lobster, oysters, scallops, shrimp 1 ounce 7 grams

Milk, skim (recommended) 8 ounces 12 grams

Pork 1 ounce 7 grams

Turkey 1 ounce 7 grams

Yogurt, plain nonfat or low-fat fruit flavored 3/4 cup 12 grams

Plant Protein Foods AmountGrams of

Protein

Beans and peas (black-eyed, garbanzo, kidney, pinto, split,

white)

1/2 cup 7 grams

Cereal, ready to eat 3/4 cup 3 grams

Lentils 1/2 cup 7 grams

Lima beans 2/3 cup 7 grams

Non-starchy vegetables (tomatoes, green beans, cucumbers)1/2 cup

cooked2 grams

Oats 1/2 cup 3 grams

Soy burger, veggie burger 1 ounce 3 grams

Soy milk 8 ounces 7 grams

Nuts and seeds (After the third month) cup 7 grams

Tofu 4 ounces 7 grams


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What Medical Studies SayParticipants in a study published by the Journal of Nutrition showed that a high-

protein diet after bariatric surgery, along with exercise, helped patients lose weight

without causing any deficiencies while also reducing blood fat levels. A high-protein diet

also allows better control of appetite and caloric intake.

Patients who undergo bar iatr ic surgery have, over time, an i ncreased r isk ofdevelopi ng k idney stones. Limiting protein consumption can be helpful. Following

weight loss surgery, protein is emphasized as a high priority food, but that doesnt mean

you are on a high protein diet. Most patients who have undergone weight loss surgerycannot eat large portions of animal protein. Therefore, exploring more plant-based

protein like legumes (beans) isnt a bad idea as they tend to be tolerated well after

bariatric surgery.

See more athttp://www.drbrianstork.com/blog/tips-kidney-stones-weight-loss-

surgery/#sthasg.Znsc4GbY.dpuf
http://www.drbrianstork.com/blog/tips-kidney-stones-weight-loss-surgery/#sthasg.Znsc4GbY.dpufhttp://www.drbrianstork.com/blog/tips-kidney-stones-weight-loss-surgery/#sthasg.Znsc4GbY.dpufhttp://www.drbrianstork.com/blog/tips-kidney-stones-weight-loss-surgery/#sthasg.Znsc4GbY.dpufhttp://www.drbrianstork.com/blog/tips-kidney-stones-weight-loss-surgery/#sthasg.Znsc4GbY.dpufhttp://www.drbrianstork.com/blog/tips-kidney-stones-weight-loss-surgery/#sthasg.Znsc4GbY.dpufhttp://www.drbrianstork.com/blog/tips-kidney-stones-weight-loss-surgery/#sthasg.Znsc4GbY.dpuf


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Exercise, the Key to Becoming

a Successful Bariatric Patient

ouve breezed through surgery and progressed through the clear liquid diet and have

now gone on to full liquids. You may have even noticed that your pants are even

starting to get a bit loose, so whats next?The answer is a good exercise

program. Adhering to the diet program

prescribed by your surgeon is the easier

portion of the program, especially in thebeginning. If you dont follow it, youll get

sick, which can range from digestion problems

to vitamin deficiency, and seriously who

wants to be sick? Yet if you dont start andmaintain an exercise program, your chances of

successfully losing weight and maintainingthat weight loss will diminish significantly.

Despite what has just been stated,

regular exercise is the component of a

successful weight loss program that mostoften slips. Why? Lets face it, as an

overweight person, exercise was more than a

chore, it was almost impossible. Your mindharkens back to these realities and says no. In

your new life, you have to throw out suchthinking and tell yourself, Yes, I CAN do it.

Why Exercise?Recent analysis shows that consistent exercise for bariatric surgery patients leads

to a 4.2% lower BMI. Another study compared weight loss of gastric bypass surgery

patients who partook in 2.5 hours of physical activity per week compared with those who

did not. Those who were active showed 5.5% greater weight loss six months after surgeryand 5.7% greater weight loss 12 months after surgery.

Obviously, exercise burns calories, but a more important reason is it also boosts

your metabolism. This means your body will burn calories more efficiently, whichbecomes even more important as you lose weight because your metabolism tends to shut

down as you drop pounds. By establishing a higher base metabolic rate through exercise,

your body will automatically burn calories faster even while you are resting, leading toadditional weight loss.

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Start SlowlyOne of the biggest reasons that people fail at exercise is that they try to do too

much too soon. Lets face it, youre probably not going to be an elite marathoner, and

thats quite okay. Most people in the world are not and never will be. The idea is simple.

Get up, get moving and burn more calories than you have in the past because that is what

you need to do to lose weight. Do you think you cant do it? Sure you can. Exercise is assimple as walking, which is also one of the most underrated exercises you can do.

For maximum success, begin your program within a month following surgery.

Dont overdoit, but remain consistent. One week after surgery try to walk for 15 to 20minutes each day. If you are able to do so, avoid dehydration by walking inside on a

treadmill in a climate-controlled environment where you are out of the sun. A week later,

start increasing your daily exercise time to reach 40 to 60 minutes of activity.

For your exercise program to be successful, it must be progressive. This simplymeans as the weeks and months go on you need to add elements to your exercise

program, along with increasing the time and/or the intensity. In other words, exercise

needs to become a way of life.


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Find Something You EnjoyYou wont stick to your program if you dont enjoy what youre doing. There is

also no single right way to exercise. Although walking is an excellent way to begin to

increase physical activity, you could become bored with it. You may prefer walking

outdoors to be in tune with nature, or may prefer the social aspect brought about by

walking on a track inside a facility. For others, cycling is a great way to burn calories, ormaybe you would rather get into a pool where you can get an aerobic workout along with

strengthening your muscles in a non weight-bearing environment.

As you lose weight and become stronger, you can try activities such as intervalclasses, weight training, kickboxing or similar classes. Again, dont try to do everything

at once and think you have to work as hard as the instructor or the other class

participants. A good instructor will recognize your fitness level and will work with you

and encourage you to work to the best of your ability. If you feel self-conscious aboutexercising in a group situation, find a personal trainer who can help design a program that

you can do on your own at home or at an exercise facility.

Whatever you choose, be aware that you will have days where you dont feel well

or simply dont want to exercise. Although everyone needs a restful day here and there,dont make it a habit as talking yourself into not exercisingas this is one way you will

start to regain weight.

Tips to Stay On Track Find an exercise partner. You are more likely to work out if someone is

depending on you to go with them to work out.

Join an exercise gym or class. Park district facilities are a good place to start as

these often have a variety of classes suited to all fitness levels. Develop a weekly routine. Take a look at your schedule at the beginning of the

week and find ways to include exercise. If you have appointments or events thatwill prevent you from exercising on one of the days, look at substitute times or

activities that will suffice.

Buy good, supportive shoes. Theres nothing worse than working out with achy

feet. Comfortable and stylish athletic clothes also make working out more fun.

Do little things like taking the stairs instead of the elevator or parking your car far

away instead of finding the nearest parking space. Actions like these add up.

Listen to music on your iPod or MP3 player for motivation.

Reward yourself when you reach a weight-loss goal.


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Common Complaints, Risks and Complications

Associated With Bariatric Surgery

ll medical procedures have some risks and potential complications, with bariatricsurgery being no exception. The best advice is to follow your doctors orders as

closely as possible, but even when doing so, you will most likely have some discomfort

along the way. Heres what you may experience.

Wound CareSimilar to other surgeries, you need to be careful with your incision. Generally,

youllbe able to shower 24 hours after surgery with your back to the showerhead. Baths

are permissible two weeks post-op if all incisions heal.

Bruising around the incisions is common anddisappears slowly. Any increase in redness, warmth or

pain is cause for concern as you may have an infection. Asmall amount of redness is normal at the beginning and

disappears with healing. Some patients may experience

minor drainage, which is also normal unless it begins to

increase and become foul smellinganother indicator ofinfection. If this occurs, visit your doctor and inform your

bariatric follow up physician if required.

Tugging, pulling, pinching or burning sensationsmay accompany larger incisions. This is also normal and

will resolve itself when swelling reduces and the suturesdisappear.

LeakingLeaks from the stomach or intestine that go into the abdominal cavity usually

appear within two weeks after surgery. When leaks occur they must be treated

immediately with surgery and another hospital stay. Following your liquid diet is

important because liquids cause less tension or stress on your stomach, minimizing thechances of a leak. Signs of a leak include:

Abdominal pain

Fever Sweating

Difficulty breathing

Rapid heartbeat

Chills

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If you have already been discharged, notify your surgeon as soon as possible.

Diagnosis is via an X-ray test with contrast material or a CT scan.

Gas Pain and Discomfort

Two types of gas pain can appear following surgery. The first is the result ofcarbon dioxide that is pumped into your abdominal cavity that helps the surgeon

distinguish between organs during laparoscopic surgery. Usually this gas is released right

after surgery, but sometimes it can hide between organs and rise up to the diaphragmwhere it irritates a nerve, causing pain in your upper left shoulder.

The new size of your stomach causes the second type of pain. Because its

smaller, your stomach can only hold smaller amounts of gas or air. Everyone has air in

their stomach. Normally, you burp this out, but for the first few days, you may havetrouble doing so, just like a newborn baby. In a similar way, you ingest air with liquids,

so drinking from a straw is not recommended. Sipping from a glass or sports bottle will

minimize the amount of air you ingest. While someone can pat you on the back to burp

you to help the air escape, the best remedy is walking because it will either move the airdown into your intestines or move it upward, causing you to burp.

Nausea and VomitingMild nausea is common in the first few months following surgery. Try

decaffeinated green tea to ease it. If its more than just mild, contact your doctor for

prescription medication. If severe nausea persists, contact your doctor and your bariatric

follow up physician if required.Nausea and vomiting may also occur when drinking while eating, not chewing

enough or eating too much. Trying new foods can also trigger nausea. When this occurs,

consume only liquids for 12-24 hours after nausea subsides. Wait a few days beforetrying a particular food again. Repetitive vomiting to the point where nothing can be kept

down is dangerous. Contact your doctor and inform your bariatric follow up care

physician.

HeartburnAcid reflux may initially worsen after surgery because of delayed emptying.

Eating or drinking too quickly can also cause heartburn; stomach spasms or a stricture are

other causes. If you are having this problem, dont wait more than a day or two to callyour bariatric doctor so you are advised about over-the-counter medication or visit your

local doctor to get a prescription that will help this problem to subside.

Stool Frequency and DiarrheaYou may have loose, frequent stools in the weeks or months following surgery.

Remember that at first, you will only consume liquids, resulting in loose stools. This will

slowly improve as your diet changes. Avoid foods that seem to cause diarrhea. However,


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there is a wide spectrum of bowel regularity after surgery, with some patients

experiencing constipation and others having soft or even loose stools. Symptoms also

vary with the type of surgery you have. Occasional OTC medications for constipation ordiarrhea are okay. If you have constipation, drink more liquids and consider adding more

fiber to your diet. You may need stool softeners once or twice daily. If you get diarrhea

while on protein drinks, switch to a different kind. Remember to give your bowel time tocompensate and adapt.

DysphagiaMore commonly known as difficulty swallowing, this is a subtle side effect of

any procedure that causes restriction. It may be caused by eating too fast, too much or not

chewing well enough. Food backs into the esophagus and causes chest pressure or eventightness in the throat. Stop eating and drinking if this occurs as vomiting or regurgitation

may follow. Avoid this symptom by chewing food at least 15 times, putting your fork

down between swallowing bites and avoiding foods such as doughy bread, overcooked

steak or dry chicken breast.

Hair LossIt is common in people with rapid weight loss to experience hair loss, hair may

come out in clumps while brushing. Hair loss diminishes as you approach your weightgoal and weight loss slows. Most of the time hair loss occurs from hormonal changes in

fat cells. Some people find commercial hair and nail supplements to be helpful as well as

supplements such as biotin, co-enzyme Q, flax seed oil and zinc.


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Bariatric Surgery FAQs

atients considering bariatric surgery have many concerns about what surgery will be

like and what will happen after the procedure. Here are some of the most commonlyasked questions and answers.

How much weight will I lose and will I regain

any weight?The amount of weight you lose, and how fast you lose it,depends on which weight loss surgery you have. Patients

who have the lap-band surgery usually lose weight more

slowly during the first year than those who have the sleeve,gastric bypass or duodenal switch surgery. The amount of

weight loss also depends on your age, gender, starting BMI

and your ability to adhere to lifestyle changes necessary to

make surgery a success. In most cases, you will lose 90%of excess fat. The more you weigh, the more weight you

will lose. With any bariatric procedure, however, there is

always the chance that you will regain weight, particularlyif you do not follow your surgeons program.

What is BMI?BMI is the abbreviation for body mass index, a key index that relates weight to height.BMI is determined by taking a persons weight and dividing it by his or her height

squared. The National Institutes of Health (NIH) defines normal weight, overweight, and

obesity according to BMI rather than the traditional height/weight charts. Overweight is a

BMI of 27.3 or more for women and 27.8 or more for men. Obesity is a BMI of 30 ormore for either sex (about 30 pounds overweight). A very muscular person might have a

high BMI without health risks.

Will I need to have plastic surgery to get rid of loose skin?Most patients experience loose or sagging skin at some point after surgery, but often this

condition is temporary. Your individual appearance will depend upon several factors,

including how much weight you lose, your age, genetics and whether or not you exerciseor smoke. Weight training and strengthening exercises can help avoid loose skin. Yet

some patients may opt to have plastic surgery to get rid of loose skin and fix certain areas

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particularly on the abdomen, legs, arms and breasts... even a facelift. If you want to do so,

wait at least six months after you have reached your ideal weight.

How long after bariatric surgery will I have to be out from work?Most patients return to work within two weeks. You may have low energy for a while

and may need to work some partial days, but this is normal. Your surgeon and nutritionist

will advise on what you can and cannot do after weight loss surgery.

Do I have to do anything special

immediately prior to surgery?Patients only need to fast for eight hours beforethe procedure. There is no need for colon

cleansing or laxatives related to the sleeve andbanding procedure but it is highly recommended

on bypasses and DS.

How long will I be in surgery?Length depends on several factors like what

type of surgery you have, your medical

condition and what your BMI is. Patients with

a lower BMI have less visceral fat allowing

the procedure to go more quickly. Generally a

banding procedure takes about 45 minutes

and with a sleeve procedure you will spend

45 minutes to just over an hour in surgery. Bypasses require around one and a half

hours and sometimes a little longer.

Will I be in the ICU?No, unless, you have pre-existing conditions that require the support of an ICU, you

will go to a regular room to recover.

Do I have to stay in the hospital until I have a bowel movement?Due to the diet before surgery and as you follow a liquid diet afterward; your

intestines will have nothing solid. Thus, a bowel movement may take a few days and

will normally occur during your stay at the hospital or after you are released.


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What could prevent or delay my surgery? What if I have heart disease?Abnormal findings in blood work that could make surgery risky or unsafe can prevent

surgery, along with severe respiratory infections that produce mucus and secretions thatcan make intubation and maintaining an open airway difficult during the procedure.

If you have heart disease, you will need medical clearance from your cardiologist.Bariatric surgery often leads to improvement in many problems related to heart disease

including:

High blood pressure

Cholesterol

Lipid problems

Heart enlargement

Vascular disease

Even patients with atrial fibrillation, heart valve replacement, stents or heart bypasses

usually do very well. If you are on blood thinners, expect special instructs just before and

after surgery.

Does Type II Diabetes Make Surgery Riskier?It can. Be sure to follow instructions from your surgeon about managing your diabetes

prior to surgery. Almost everyone with Type II Diabetes sees a big improvement or evencomplete remission following the procedure. Some studies have even reported

improvement of Type I Diabetes after bariatric procedures.

Will I need to stop taking medication before surgery?You can continue to take most medications, except for NSAIDs such as Ibuprofen, Advil,

Motrin, Naproxen, Aspirin and Plavix. Check with your doctor if you should stop or

replace specific medications before surgery such as Warfarin. NSAIDs are notrecommended after surgery as these can irritate the stomach lining.

Will I be able to eliminate some medications following surgery?As you lose weight, you may be able to reduce or eliminate the need for many of themedications you take for high blood pressure, heart disease, arthritis, cholesterol and

diabetes as these conditions will improve.


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When Can I Get Pregnant After Bariatric Surgery

and Will the Baby Be Healthy?Many OB/GYN refer patients who cant get pregnantdue to

severe obesity or polycystic ovarian syndrome (PCOS), which is

reversed with bariatric surgery in most patients. Wait at least 12

to 18 months, or until you have reached your goal weight beforegetting pregnant. After surgery, you will have a lesser risk of

experiencing problems during pregnancy, such as gestational

diabetes eclampsia, etc., and during childbirth. You will alsohave less risk of having a C-section. Children born following

bariatric surgery have less risk of being affected by obesity later

in in life due to activation of certain genes during fetal growth.

Will my hair fall out?

Hair falling out is more likely to occur if your post-surgery diet consists mainly of foodswith little to no nutritional value. Because you will have a smaller stomach, if you

initially eat non-nutritious foods instead of protein, you wont have any room left forwhat your body really needs. If hair does start to fall out, take supplements to help this

from occurring and to start regrowth.

Will I have to diet forever following surgery?The word diet not necessarily means you will deprive yourself from all type of food.

Every person is different, therefore through trial and error you will see what foods suits

you the best but remember, try to make healthy choices as your portions of food will besmaller. Your commitment is to make smart choices but you can still enjoy pretty much

any type of food..

Will I be able to drink alcohol?Drinking alcohol is not recommended following bariatric surgery as alcohol will takelonger to metabolize and you will become drunk more quickly. If you do drink alcohol,

take small amounts and be aware that you may take longer to become sober. Socially

speaking it is fine to have a glass of wine or maybe two but not right after your bariatric

procedure, remember to follow your post-op guidelines and be in communication withyour dietician and follow up care physician for questions and concerns.

You can enjoy your weight loss journey and love the person you will become; bariatric

surgery can be the key to your health and happiness!


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Are you ready to have Bariatric Mexico Surgery help you take control of your life as youdiscover the new you? Your decision to take control of your weight and your health right

now will not only increase your life expectancy, but will also enhance the quality and

happiness of your life.

Experience what thousands of bariatric patients have already enjoyed since making the

positive choice to have life-changing laparoscopic bariatric surgery under the expert care

of Dr. Fernando Garcia and Bariatric Mexico Surgery.

Bariatric Mexico Surgery in Tijuana, Mexico provides a customized approach to your

specific weight loss needs including gastric sleeve, single incision, and lap band

surgeries.

Visit our website for more information athttp://bariatricmexicosurgery.com.

Send us an email from our contact form or call us directly at 1 (800) 316-8234to speak to

one of our customer service consultants about your specific needs and to learn more

about bariatric surgery.

We look forward to hearing from you.
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Documents

The Weight is Over: Your Guide to Bariatric Surgery