Dietitians Dish: Bariatric surgery right choice for some

By Lindsay Adams
April 2, 2013 at midnight
Updated April 1, 2013 at 11:02 p.m.

Obesity is a serious medical condition that can contribute to a number of other health issues such as diabetes, high blood pressure, sleep apnea, heart problems, certain types of cancer and joint pain, to name a few.

Obesity can also have an emotional toll on individuals, contributing to depression and low self-esteem. As rates of obesity continue to rise in the United States, so do the efforts to find effective methods of weight loss. Bariatric surgery is becoming increasingly popular as a way to combat obesity.

Bariatric surgery is the term used to identify various procedures aimed at weight loss, including Roux-en-Y gastric bypass, vertical sleeve gastrectomy, adjustable gastric banding and biliopancreatic diversion with or without duodenal switch.

Although bariatric surgery is not right for everyone, it is suggested to be the most effective and long-term treatment for individuals with morbid obesity and often resolves many of the conditions associated with obesity.

One way to classify obesity is using Body Mass Index, which is an index that expresses adult weight in relation to height. To qualify for bariatric surgery, you must have a BMI of 40 or greater or have a BMI between 35-40 along with at least one other serious medical condition such as diabetes, high blood pressure or asthma.

Some facilities will perform adjustable gastric banding, one of the less invasive procedures, with a BMI of just 30. Most health insurance plans also cover the costs of bariatric surgery if you meet the appropriate criteria.

Although some physiological changes occur with the different types of bariatric procedures that contribute to weight loss, the effectiveness in these procedures can be attributed largely to the restriction of the amount of food you can eat.

Society often thinks of bariatric surgery as the easy way out, and while surgery can be thought of as portion control, success is still dependent on diet and exercise. Below are some of the basic principles of a healthy lifestyle after bariatric surgery.

First, eating three meals a day with no snacks is generally recommended. Snacking leads to unnecessary consumption of excess calories that can often prevent weight loss or lead to weight regain. If you make appropriate choices at your meal, you should stay full until the next meal time.

You must also take several different vitamin supplements after surgery to help prevent deficiencies that may occur as a result of the decrease in portion size and some malabsorption. Your surgeon will guide you on which supplements you need to take.

The importance of protein intake is also increased after surgery. Protein is needed to maintain lean body mass and to prevent loss of muscle mass. Since your portions will be much smaller after surgery, protein should be eaten first at meals to make sure you get it in before you get full.

You should also avoid all high-sugar and high-calorie beverages such as sodas and juice, which have minimal to no nutritional benefits. You should also avoid liquid meals, which will not give you the feeling of satiety like solid foods do.

There are several behavioral changes that are important after surgery, too, including eating meals over 20-30 minute duration to prevent overeating, taking small bites of food and chewing foods very well.

Adequate fluid consumption is extremely important to prevent dehydration, and both cardiovascular and resistance exercise is crucial for weight loss success and to help maintain lean body mass and decrease excess skin after surgery.

So if you meet the BMI criteria for surgery and have tried other avenues for weight loss without success, bariatric surgery may be an option for you.

It never hurts to visit with a bariatric surgeon to determine if surgery is appropriate for you. It may be just what you need to lose weight, keep it off and improve your physical and mental health.

Lindsay Adams is a registered dietitian with DeTar Health Systems. Send questions or comments to



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