Weight Loss Surgery Group Education Session

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Weight Loss SurgeryGroup Education Session
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Introductions
Cara Barnes Bariatric Nurse
Specialist
Julie Thompson Specialist Bariatric
Dietitian

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Introduce you to the types of surgery and the
service offered
What is the purpose of today?
Provide you with information on diet and
lifestyles to enable you to start preparing now
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Types of surgery
Whats the right operation for you
Preparing for surgery
What well cover
Time for questions
Changing eating before surgery
The pathway
Impact of surgery on your life
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ITS NOT THE EASY OPTION!!!!
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Gastric band
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Gastric band
Benefits
Complications

• Occur much later
• Slippage
• Erosion
• Leakage
• Infection
• 0.3 mortality risk

• Slightly less major operation
• Control over restriction
• Effective for volume eaters

Implications

• Takes up to 2 years to get to goal weight
• Eat small amount
• Lots of chewing
• Certain foods can be problematic
• Reliant on will power with snacking
• 20 band failure rate
• Lose 40-50 excess body weight

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Gastric Bypass
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Gastric Bypass
Benefits
Complications

• Rapid weight loss
• 1-2 st / month for 3/12
• ½-1st/ month next 3/12
• 70-80 excess weight loss
• Complications early on
• Effective for snackers/sweet eaters
• Improves diabetes

• Anastomotic leak - 4
• Anastomotic stenosis
• Hernia
• Some hair loss
• 1 mortality risk

Implications
Implications

• Rapid weight loss- 9 months to 1 year
• Lots of chewing
• Small portions
• Life long vitamins and minerals
• Dumping syndrome

• Regular blood tests
• Risk of malnutrition
• Not reversible
• Still have emotional hunger
• Certain foods can be problematic

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Sleeve Gastrectomy
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Gastric Sleeve
Benefits
Complications

• Leakage of stomach acid
• Weight regain

• Less invasive than bypass
• Reduced stomach volume (by 60 85)
• Restriction over volume eaten

Implications

• Completely irreversible
• Average wt loss 60 70 of excess
• (limited data on long term maintenance)
• Smaller portions
• chewing

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SURGICAL COMPLICATIONS

• Bleeding
• DVT
• PE
• Infection - chest
• - wound
• Scarring

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The long walk to theatre
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After Surgery

• Tired
• Vomiting
• Exercise
• Mood swings
• Hair loss
• Hernias
• Diarrhoea/Constipation
• Dumping
• Excess skin

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Body Mass Index (BMI)

• Is a ratio of your weight for your height.
• The healthy range is between 20-25kg/m2

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EXCESS BODY WEIGHT

• Is
• THE WEIGHT YOU ARE NOW minus
• THE WEIGHT YOU SHOULD BE

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So If you weigh 25st (159kg), and your ideal
weight (at BMI 25) is 11st 11lb (75kg), your
excess body weight is 13st 3lb (84kg).
Band Loss of 40-50 of excess weight 5st
4lb 6st 9lb (33.6 - 42kg) New wt 18st 6lb -
19st 10lb (117 125.4kg) BMI 39 42kg/m2)
Bypass Loss of 70-80 of excess weight 9st
3lb 10½st (58.5 - 67kg) New wt 14½st 15st
10lb (92 - 100kg) BMI 31 - 33.5kg/m2)
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How quick?
How much weight to lose?
Other co-morbidities?
Ability to alter eating habits
Am I prepared for surgery risk?
Key questions
Binge eater?
Committed to follow up?
Sweet eater/ snacker
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Which option is right for me?

• BYPASS
• If you
• have a lot of weight to lose
• have poorly controlled diabetes
• have lots of resolvable health problems
• like snacking/sweets

• BAND
• If you
• eat large meals
• are only a few stones overweight
• are happy to lose weight slowly over 2 years

• Balloon
• If you
• have a BMI over 60kg/m2
• have lots of health problems that mean you
  cannot have surgery

• Gastric Sleeve
• If
• a band is not appropriate and a bypass is not
  safe
• Not a primary procedure

With all procedures, you must be willing to sign
up to commitment with dietitian the team
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What is my eating really like?
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Overeating and then starving
Emotional / comfort eating
Putting others first
Grazing cravings / bored
Types of over eating
Food as reward
Binge eating out of control of eating
Picky eater / grazer
Eat large portions
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Should I lose weight before bariatric surgery?
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Decreases liver size (fat)
Helps develop good habits
Weight loss before surgery
Demonstrates motivation commitment
Reduces operation time
Possible shorter Length of hospital stay
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3 regular meals a day
No longer than 5 hours without food
Breakfast is the most important meal of
the day
Healthy Eating starts here
Wait 2 hours until having a snack IF youre hungry
Include small amounts of treats
Monitor your food intake
If you are not hungry outside mealtimes, do not
eat
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Pre-Op Diet / Liver Shrinkage
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A large liver
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Pre-Op Diet / Liver Reduction Diet
Diet sheet given out at first dietetic appointment
Strict diet you need to follow for 3 weeks before
surgery
1000kcal/dlow fat and low carbohydrate

• Caution with diabetic control your diabetes
  nurse needs to monitor you

Should lose 6kg (1 stone)
Shrinks the liver
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Eating after surgery
What can I eat afterwards?
How is my eating going to change?
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Immediate post-surgery dietary rules
Stage Texture Duration
Stage 1 Pureed (smooth textures, no lumps) 4-6 weeks
Stage 2 Soft/moist/mashable 2 - 4 weeks
Stage 3 Normal Weeks 8 -10 onwards
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Dietary Principles
Texture
Eat very slowly chew each mouthful 25 times
Stop eating as soon as you start to feel full
Not drinking with eating (wait 30 mins either
side)
Regular meals
Volume / portion control Use small plates bowls
Healthy Eatingie. low fat, low sugar, moderate
protein, rich in micronutrients
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Things to avoid
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Progression Through Textures

• Puree Diet (smooth, no lumps or bits,
  yoghurt-consistency, too thick to suck up through
  a straw) - 4-6 weeks
• First few days will only manage teaspoons.
  Stop eating as soon as you start to feel full.
• Over first 2 weeks will build up to 3-4
  tablespoons
• During this time you will need 3 meals and 3
  snacks, all pureed, and low fat and sugar, and
  high in protein
• When you feel you can manage more than 3-4
  tablespoons, do have a little more but start
  reducing the snacks between meals. Eventually
  you should be on 3 small meals a day (some people
  manage better with 4).
• Soft Mashable Diet 2-4 weeks
• Then you can move on to a soft, mashable diet
• ie. anything that can be mashed with a fork. You
  may need additional low fat, low sugar
  sauces/gravy to help with this. No hard lumps,
  gristle or stringy vegetables.
• Normal Textures
• Then you can move on to a normal textured diet,
  although you may struggle with some foods (eg.
  bread, tough meats, stringy vegetables, pithy
  fruit (eg. citrus) but you may be able to manage
  them after a few months.
• NB Some people may progress a little slower or a
  little faster than the above

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Alternatives
Potential Problem Foods
Bread
Crackers or toast
Pasta
Use small shapes for soup
Tough/dry/gristly meat
Small pieces / mince Slow cooked / stewed
Rice
Risotto
Stringy/hard vegetables
Overcook Cauliflower, broccoli, carrots
Fruit pips, seeds, skins pithy fruit
Peel fruit / purée or stew Tinned fruit in juice
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Iron
Calcium
Zinc
Vitamin D
Thiamine
Therefore, lifelong supplementation of
multivitamins minerals, with additional iron
and calcium, with potential for further
supplementation dependent on your blood results
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Pathway to surgery
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Pathway after surgery
Operation
Band 2-3 day stay
Bypass 2-3 day stay
Seen by team daily
Seen by dietitian and nurse specialist before
discharge
1st Outpatient Appointment at 6 weeks
1st band fill6 weeks
2nd Outpatient Appointment at 12 weeks
Band fills as required for 2yrs
Reviews at 6, 12, 18 and 24 months, then
discharged back to GP