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«What You Need to Know About Weight Loss Surgery Table of Contents 1-2 Welcome to My New Beginning 3 What is Obesity? 4-5 Bariatric Surgery Options ...»

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What You Need to Know About Weight Loss Surgery

Table of Contents 1-2

Welcome to My New Beginning 3

What is Obesity? 4-5

Bariatric Surgery Options 6-7

Your Obligations as a Bariatric Patient 8

Preparing for Your Bariatric Surgery 9

Checklist for My New Beginning Program 10-12 Shopping List Before Surgery 13 Good Habits to Develop Before Surgery 14 Herbal Supplements and Your Upcoming Surgery 15 Bariatric Post-Op Diet Progression 16 Discharge Home Instructions 17 Post-Op Emotions 18 Liquid Diets Explained 19-20 Soft Foods Explained 21 Guidelines for Food Choices 22 Protein Requirements After Surgery 24-25 Tips for Eating After Surgery 26 Portion Control for Weight Loss 27-29 High Protein Recipes 30 2 Tips for Dining Out 31 Frequently Asked Questions After Surgery 32-34 Life After Your Bariatric Surgery 35-36 Possible Complications of Bariatric Surgery 37-38 Ten Commandments of Bariatric Surgery Patients 39 Helpful Hints for Ongoing Weight Loss 40 Aquatic Weight Loss Program 41 Are You an Emotional Eater? 42 Vitamin and Mineral Supplements 43-44 Vitamin B12 45-46 Vitamin B1 (Thiamin) 47 Zinc 48-49 Vitamin A 50-51 Biotin 52 Calcium 53-56 Vitamin D 57-58 Medications Not to be Taken After Surgery 59-60 Body Mass Index 61 We're Here for You 62 Bariatric Post-Op Appointments 63 Helpful Resources 64 3 Welcome to My New Beginning My New Beginning, the bariatric program at Doctors Hospital at White Rock Lake, is committed to relieving the suffering resulting from clinically-severe obesity by providing multidisciplinary bariatric care.

Our goal is to improve health by achieving weight loss that reduces life threatening risk factors, improves self-esteem, and enhances all aspects of daily living.

We are pleased that you have chosen to participate in Doctors Hospital at White Rock Lake's longterm, weight loss surgical program. Your input, motivation and participation are required for your program to be successful. Your commitment to long-term follow-up, including support group attendance, is essential for your success. We will partner with you to help you achieve your goals of long-term weight loss and maintaining your new life!

This Handbook

–  –  –

What is Obesity?

Obesity is no longer considered a cosmetic issue that is caused by overeating and a lack of selfcontrol. The World Health Organization (W.H.O.), along with National and International medical and scientific societies, now recognizes obesity as a chronic progressive disease resulting from multiple environmental and genetic factors.

The disease of obesity is extremely costly not only in terms of economics, but also in terms of individual and societal health, longevity, and psychological well-being. Due to its progressive nature, obesity requires life-long treatment and control.

An epidemic in the United States, morbid obesity, or clinically severe obesity, is a serious disease.

This medical condition can often be misunderstood and mistreated. As a result of popular misconceptions, obese people often endure ridicule, discrimination and misunderstanding.

Here are some obesity related facts:

 Worldwide, at least 2.8 million people die each year as a result of being overweight or obese.

 In all regions worldwide, women were more likely to be obese than men.

 Between 1980 and 2008, the prevalence of obesity nearly doubled.

Studies suggest that bariatric surgery may lower death rates for patients with severe obesity. Obesity is a complex disease characterized by storage of excessive body fat. There are several factors that play a role in the development of obesity. Evidence proves that genetic, biochemical and physiological factors contribute to obesity. Certain biological factors such as environmental, cultural, socioeconomic and psychological issues also contribute to the development of obesity.

Genetic factors play a role in the development of this disease. Many obese people do not need to consume as many calories to maintain weight as non-obese people. Obese patients usually have

other associated conditions called co-morbidities. These conditions include but are not limited to:

 Hypertension  Diabetes  Heart disease  Elevated cholesterol/triglycerides  Respiratory disease-sleep apnea  Shortness of breath with exertion  Heartburn (reflux disease)  Degenerative arthritis  Depression 5  Stress incontinence  Increased risk for cancer  Premature death

There are also non-hereditary factors that contribute to obesity. These factors include:

 Calories consumed - food and beverages  Calories burned - burned by body through normal activities and exercise  Amounts of fat, carbohydrates, and protein in diet  Frequency and duration of physical activity People who are at least 100 pounds above their ideal body weight not only suffer from medical health risks, but they often suffer from psychological aspects of the disease.

There are solutions to the obesity epidemic. Doctors Hospital at White Rock Lake offers effective surgical options for the treatment of morbidly obese people.

Do I qualify for bariatric surgery?

Your bariatric surgeon will discuss whether or not you are a good candidate for surgery. Common

selection criteria for bariatric surgical treatment programs include:

 100 pounds over ideal body weight  Body Mass Index (BMI) of 40 or more  BMI of 35 with serious co-morbidities Bariatric Surgery is not a “miracle cure” for morbid obesity. It is simply one part of the My New Beginning Bariatric Program. Successful weight loss after undergoing bariatric surgery depends upon your participation as a patient. The most important factor in your program is realizing that your commitment and dedication must be life-long. The key to your success is your personal dedication to the lifestyle changes in eating and exercise habits. Successful treatment will include calorie restriction, calorie reduction, and changes in the amounts of fat, carbohydrates and proteins that you consume. Exercise and long-term follow-up are also essential portions of this weight loss program.

We want you to be successful in reaching and maintaining your weight loss goal. We are here to help.

6 Now that you’ve made the decision to have bariatric surgery, you will want to explore some common weight loss surgery options offered at Doctors Hospital at White Rock Lake.

Bariatric Surgery Options:

1. Adjustable Gastric Banding (AGB or Lap-Band®)

Potential Advantages:

 Low mortality rate  Minimally-invasive surgery  Body parts remain intact – no cutting or stapling  Adjustable  Reversible  Low complication rate  Low malnutrition risk

Potential Disadvantages:

 Slow initial weight loss  Regular follow-up for band adjustments  Requires strict dietary compliance for success  Band or stomach slippage  Band erosion  Port leakage – may require additional surgery  Infection at port site  Device malfunction

2. Roux-en-Y Gastric Bypass (RYGB or Gastric Bypass)

Potential Advantages:

 Rapid weight loss  Minimally-invasive approach or open abdominal incision options  Higher weight loss than with other methods, except BPD (Biliary Pancreatic Diversion)  Long, successful results in the U.S.

 Patients have improved or resolved co-morbidities

Potential Disadvantages:

–  –  –

 Higher mortality and complication rates than with VBG (Vertical banded Gastroplasty) and Band

3. Sleeve Gastrectomy (Laparoscopic Sleeve Gastrectomy if Laparoscopic)

Potential Advantages:

 Restricts the amount of food the stomach can hold  Induces rapid and significant weight loss that comparative studies find similar to that of the Roux-en-Y gastric bypass. For example: weight loss of 50% for 3-5+ year data, and weight loss comparable to that of the bypass with maintenance of 50%  Requires no foreign objects (AGB), and no bypass or re-routing of the food stream (RYGB)  Involves a relatively short hospital stay of approximately 2 days  Causes favorable changes in gut hormones that suppress hunger, reduce appetite and improve satiety

Potential Disadvantages:

 Is a non-reversible procedure  Has the potential for long-term vitamin deficiencies  Has a higher early complication rate than the AGB

4. Biliopancreatic Diversion with Duodenal Switch (BPD/DS) Gastric Bypass

Potential Advantages:

 Results in greater weight loss than RYGB, LSG, or AGB  Allows patients to eventually eat more average meals  Reduces the absorption of fat by 70% or more  Causes favorable changes in gut hormones to reduce appetite and improve satiety  Is the most effective against diabetes, as compared to RYGB, LSG, and AGB

Potential Disadvantages:

 Requires a longer hospital stay than the AGB or LSG  Has higher complication rates and risk of mortality than the AGB, LSG, and RYGB  Has a greater potential to cause protein deficiencies and long-term deficiencies in a number of vitamin and minerals such as iron, calcium, zinc and fat-soluble vitamins such as vitamin D  Compliance with follow-up visits and strict adherence to dietary and vitamin supplementation guidelines are critical for avoiding serious complications from protein and vitamin deficiencies For more information visit: http://asmbs.org/patients/bariatric-surgery-procedures.

Bariatric surgery is designed for those with a body mass index equal to or greater than 40, or equal to or greater than 35 with serious co-morbidities.

–  –  –

Your Obligations as a Bariatric Patient To ensure you reach your weight loss goals and achieve the success that you desire in the My New Beginning program, it is important that you understand your responsibilities.

The following are the obligations that you are accepting as a part of the bariatric program:

 I will be sure to get necessary pre-op work done before surgery  I will see my surgeon for follow-up visits after surgery  I will visit my bariatric coordinator for follow-up visits after surgery, as needed  I will contact my bariatric coordinator if I have any other procedures, tests, ER visits, hospital stays or surgeries  I understand I must take my vitamin and mineral supplements for the rest of my life  I understand I must take Vitamin B12. Vitamin B12 may be taken by nasal spray, sublingually, or injection per the instructions of your physician or nurse coordinator.

 I know I must follow the prescribed diet for the rest of my life  I will attend a support group after surgery to help me achieve my goals

–  –  –

Preparing for Your Bariatric Surgery Preparation for your surgery will involve several important steps to ensure proper preparation and

optimal outcome of your bariatric surgery including:

 Initial medical consultation – find out if you are a good candidate for bariatric surgery, get information about different kinds of surgery, ask questions of your physician  Medical clearance – fitness exam to be cleared for surgery including: physical examination, EKG, chest X-ray, blood work, gallbladder ultrasound, EGD and pulmonary function tests  Psychological screening – evaluates any issues that would compromise your chances for a successful recovery and for achieving long-term weight loss, as well as to determine if you have adequate support after your bariatric surgery  Nutritional consultation with a registered dietitian – ◦ nutritional information and guidelines for eating before and after bariatric surgery ◦ information on new, healthy eating habits and how to make good food choices ◦ information on the different stages of post-op diet progression

–  –  –

Checklist for My New Beginning Program Before Surgery Before you have your gastric bypass surgery, there are a few things you need to do. This list will make your admission to the hospital a smooth and easy process.

 10 days before surgery – stop taking any aspirin or NASAIDS which can cause an increase in blood loss during surgery and check with your surgeon if you are taking any nutritional supplements or herbal remedies. Let your doctor know if you are taking blood thinner such as Warfarin® (Coumadin®) or other blood thinners.

 7 days before surgery – have pre-op testing done. It is your responsibility to schedule and complete the tests. Tests include: EKG, chest X-rays – if applicable, labs – blood work and pregnancy test, if applicable.

 7 days before surgery – go grocery shopping and get items listed on the “Shopping List before Surgery” on pages 13-14, including adult chewable vitamins and protein powder supplements.

Start taking vitamins.

 2 days before surgery – start eating soft foods such as: mashed potatoes, soups, rice, pasta, pudding, etc. If you are a diabetic, please talk to your surgeon about managing your diabetes while on soft and clear liquid diets. You may have to closely monitor your diabetes during this pre-op phase.

 1 day before surgery – start your clear liquid diet (liquids you can see through) such as:

gelatin, Popsicles®, chicken broth, etc.

 The night before surgery – do not eat or drink anything after midnight the night before surgery.

(No gum, no mints, no water, no coffee, etc.)  The morning of surgery – take medications only if instructed to do so by your surgeon, otherwise no eating, drinking or swallowing water when brushing teeth.

Day of Surgery  Arrive at the hospital three hours before your surgery is scheduled, unless told otherwise by the hospital staff.

 Bring: any pertinent papers that the surgeon’s office gave you, your driver’s license, insurance card and list of current medications, lip balm.

–  –  –

 Wear comfortable clothes to the hospital (clothes that won’t rub your incision) if you plan on wearing these clothes home after you are discharged.

 The nurse will start an IV and if you are a diabetic, your blood sugar will be checked.

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