Archive for Aftercare
Bariatric surgery leads to significant weight loss in the obese patient. Exercise has been shown to improve weight loss and body composition in non-surgical weight loss programmes. The role of exercise to improve weight loss following bariatric surgery is unclear. The objective of this review is to systematically appraise the evidence regarding exercise for weight loss in the treatment of obesity in bariatric surgery patients.
MEDLINE, AMED, CINAHL, EBM Reviews (Cochrane Database, Cochrane Clinical Trials Register) were searched, obesity-related journals were hand-searched and reference lists checked. Studies containing post-surgical patients and exercise were included with the primary outcome of interest being weight loss. A literature search identified 17 publications exploring exercise in bariatric surgery patients. All studies were observational; there were no intervention studies found. The most commonly used instruments to measure activity level were questionnaires followed by telephone interview, surgeon reporting and clinical notes.
There was a positive relationship between increased exercise and weight loss after surgery in 15 studies. Meta-analysis demonstrated in patients participating in exercise a standardised mean of 3.62 kg (CI?=?1.28, 5.96) greater weight loss compared to the minimal exercise groups. Observational studies suggest that exercise is associated with greater weight loss following bariatric surgery. Randomised controlled trials are required to further examine this relationship.
Find out more about the Support Groups and schedules at Central Baptist Surgical Weight Loss Center. Click here to find out more.
After weight loss surgery, you will need a new nutrition plan. Discuss this in detail with your surgeon and/or dietitian as they can help you learn about and get used to the changes in lifestyle and eating habits you need to make.
It is very important to follow the eating and drinking instructions starting right after the operation to allow the new stomach structure to heal completely and in the right position. This may take a month or more. It is also important, especially in the early weeks, not to stretch the small stomach pouch above the band. Vomiting can stretch it, so it is important not to vomit. Vomiting can increase the chance of stomach tissue slipping through the band.
The First Few Days Post-Surgery
Right after the operation you can take an occasional sip of water or suck on an ice cube. You shouldn’t drink more than this. The day after the operation, you can take a little more fluid but only a small amount at a time. Besides water, you should also choose clear liquids that have an adequate number of calories. To prevent nausea and vomiting, do not drink too much.
Liquid Diet (1-2 weeks post-op)
The goal during this early post-operative period is to protect the small stomach pouch. Only thin liquids can be tolerated at this time. It is also important to keep hydrated with lots of water. Other liquids recommended during this phase include:
- clear broth or soup (with no vegetables or meat and not creamy)
- skim milk
- fruit juice
- no-sugar-added popsicles
Pureed Foods (3-4 weeks post-op)
During this phase you may start having slightly textured foods. Aim for the consistency of baby foods. This will help you transition to more solid foods later. Because protein is so important to help you maintain muscle while you are losing weight, eat protein-rich foods first, and then move on to fruits and vegetables. Foods in this stage may include:
- pureed skinless chicken or fish
- mashed potatoes
- low-fat yogurt or pudding
In the first few weeks you may be able to eat foods that might not be allowed in your diet later as these foods may contain too many calories. It is more important in the first few weeks to let your stomach adjust to the LAP-BAND ® System than it is to lose weight. Also, your timing and progression into each dietary phase may vary. In general, you should follow the advice of your surgeon and/or dietitian about nutrition.
Soft Foods (5 weeks post-op)
Your meals can now include tender cooked foods like fish and ground turkey. Now that you can chew, make it a habit to chew foods well. If you have dentures, be sure to cut your food into small pieces and chew it thoroughly. If you don’t follow these precautions, you may experience vomiting, stomach irritation and swelling. You could also have stoma obstruction.
If solid foods cause nausea and vomiting,go back to the liquid diet you had earlier. Then you can slowly add soft foods and eventually transition to solid foods. Always ask for advice from your doctor or dietitian that is specific to your situation. Vomiting may increase the incidence of band slippage, stomach slippage, or stretching of the small stomach pouch above the band.
Your New Nutrition Plan
When you can eat solid foods without problems you will need to pay close attention to your diet. Liquids will pass through the reduced stomach pouch quickly and will not make you feel full. The LAP-BAND ® System was designed to restrict solids, not liquids. Drinking liquids during or immediately after meals tends to flush food through the pouch and you will not get the prolonged feeling of satiety needed to help you eat less.
Staying hydrated throughout the day is important. Drink at least 6-8 cups of water per day and make sure you consume them between meals.
Many patients have a difficult time with solid foods during the morning hours. If this is the case for you, you can open up your LAP-BAND ® System by starting with a couple of glasses of liquids before your first meal.
Too much food or big chunks of food can block the stomach pouch outlet. You can avoid this problem by chewing food welland eating small bits at a time. It is important to remember that your new stoma opening is approximately the size of a dime. Chew your food adequately so that it can easily fit through the opening.
Eat only three small meals a day and make sure that these meals contain adequate nutrients. Your stomach can only hold about1/4 cup of food or 2 oz. at a time. Stop eating when your hunger is gone or when you feel comfortable.
You may find that the small stomach pouch makes digestion of high-fiber, high-fat and dry foods more difficult. Tolerance will vary from person to person. Ask your surgeon and/or dietitian about your food choices. The general guide below can help you create good and healthy meals that contain adequate nutrients but little sugar and fat.
Good Food Choices
1. Fruits and vegetables
- 1 to 2 servings of fresh fruit daily
- 2 to 3 servings of fresh vegetables daily
2. Breads and cereals
- 1 small portion of low-sugar cold or hot cereal
- 1/2 to 1 slice of toasted whole wheat or rye bread each day.
Note: some patients have difficulty eating bread.
3. Meat, fish, poultry, eggs
1 oz. to 2 oz. of meat, fish, or poultry or one egg each day. (Remove all visible fat from the meat. Remove the skin from poultry. Prepare the meat in ways that need very little fat. Grilling, steaming, microwaving, or boiling are all good ways to do this.) Note: some patients have difficulty eating meat.
4. Dairy products
Milk and yogurt are calories in liquid form. However, these types of food have calcium, which makes them an important part of a healthy daily diet, so choose a maximum of 2 cups of skimmed milk or low-fat yogurt and 1 oz. of cheese a day.
Restrict the use of fat to 3 to 4 teaspoons of margarine, butter, or oil per day. You can have low-fat salad dressings and mayonnaise in moderation.
Drink as many calorie-free liquids per day as you wish (though not with meals).Suitable drinks are:
- tea or coffee (black) with low-calorie sweetener
- non-carbonated beverages containing few or no calories
Some doctors have reported that carbonated beverages may contribute to enlargement of the small pouch and recommend they be avoided.
Foods to Avoid
Some foods have a concentrated supply of calories with little nutritional value and should be avoided as much as possible. They include foods such as:
Alcoholic drinks should also be consumed in moderation, for example a glass of wine per day.
Common Problem Foods
Some foods have difficulty passing through the opening of the stoma and may cause blockage. These include foods such as:
- dry meat
- untoasted or doughy bread
- peanut butter
- dried fruit
- fibrous vegetables like corn,asparagus and celery
- greasy or fried food
- seeds and skins of fruits and vegetables
- membrane of citrus fruits
Introduce these foods slowly and individually to see if they are tolerated. Always be careful, chew well, and follow your surgeon’s or dietitian’s advice.
Incorporating regular physical activity into your daily routine is as important as your nutrition plan. Often patients have been sedentary due to decreased activity tolerance, psychological constraints, and in some cases, physical disabilities. After LAP-BAND ® System surgery, aerobic activities—particularly walking and swimming—are generally best tolerated. Consult your surgeon and weight management team to find out which activity is right for you.
Get all the information on your health after weight loss surgery by speaking to the professionals at Central Baptist Surgical Weight Loss Center. Call us today if you need additional information.
Losing weight is not rocket science. It requires no special diet, no special foods and no special exercise program. All we need to do is eat less calories than we burn. Despite this, as well as an ever growing number of diets and weight control plans, obesity continues to grow. And the vast majority of dieters find it almost impossible to lose weight without regaining everything within a matter of months. Why is this? Answer: because we don’t get enough support.
Get Proper Help To Lose Weight
Our greatest need when dieting is encouragement. We need people to cheer our successes and help us overcome our disasters. Amazingly, most online weight loss programs fail to address this need. Instead, they focus on what we should eat, how many calories we should consume, and what exercise we should take. And while this advice is useful, it’s not critical. Because most of us know this stuff already. What we have difficulty with, is motivation. We know what to do in order to lose weight, but we can’t sustain it. Maybe we lack a strong incentive, or perhaps our family situation interferes with our weight loss plans, or maybe we hate cooking and eat out too often. Whatever difficulty we have, it’s not likely to involve food or exercise. It’s much more likely to be a motivational or lifestyle problem. Yet as I say, most online programs don’t offer motivational or lifestyle support. And even when they do, their advice can often be expensive and quite uninspiring!
Survey Of Dieters
The value of proper support was highlighted in a recent survey of members of Anne Collins online weight loss program. The program includes a 24/7 community forum specializing in motivation and lifestyle support, with several thousand topics and approximately 100,000 posts. Subjects were asked to assess the personal benefit they had obtained from the forum. A total of 1,348 subjects responded, of whom 81 percent rated the program’s community forum as “important” or “very important” in helping them to lose weight, while less than 5 percent said it “made no difference.” While in no way conclusive, the results indicate the practical value of a “community” approach to weight management.
Weight Loss Meetings
For urban dieters, Weight Watchers is probably the best option. Their meetings are specially designed to help dieters overcome difficulties, but even Weight Watchers has its limitations. First, it’s not cheap to join. Secondly, members typically attend only once a week. So if your diet-wagon loses a wheel on Saturday night, you may have to wait several days for the next meeting to help you out. Like eDiets, Weight Watchers now offers an online service, but again – at something like $250-300 a year – it’s not cheap.
Not Easy To Change Habits
Changing our eating habits is no easy matter. Sure, it helps to know that a cup of fat-free milk contains 40 percent fewer calories and 16 times less fat than whole milk, or that lean ground steak contains half the calories and 4 times less fat than regular cheddar cheese, but how does this help us to say No to a second helping of pizza? How does it quench our desire for a double cheeseburger and fries? It doesn’t. Because facing down temptation requires a change of attitude, a change of priorities. And in my experience, this takes time and as much encouragement as we can get. We need to hear from people like us who have managed to change their attitude and eating habits, and who can explain how to overcome the problems involved. Above all, we need a safety-net if we fail. We need shoulders to cry on and “tough love” to help us win through. In short, we need the support of a real community.
Join An Online Community Forum
In my experience, dieters who join a good online community forum can expect to lose 400-500 percent more weight than those who go solo. In addition, if they maintain their community membership after achieving their goals, they have an excellent chance of maintaining their weight loss indefinitely. This is because an online community can provide a number of specific benefits. First, as stated, it offers personal advice and encouragement. Secondly, it offers members the opportunity to help other people – something that typically works wonders for their self-esteem and understanding. Thirdly, most community forums are self-run. Members may progress to become moderators or resident experts. This too is a real confidence booster as well as a great incentive to maintain weight lost. But by far the major benefit is the fact that online forums are in action 24 hours a day, 7 days a week. So support and human warmth is available whenever you need it. They are real 24/7 safety nets, especially Anne Collins forum which has members from all time zones of the world.
Features To Look For
The best forums are active, well-managed and provide quality advice and support. Activity is best judged by checking the number of “active” members, rather than total membership. And the greater the number of recent threads (topics) and posts (messages), the better. Assessing the management and quality of the forum is a bit more difficult. To do this, open a recent thread, scan the posts and look for the following. First, how quickly do members and/or moderators reply to questions asked? Second, are the questions and answers reasonably serious, or more frivolous? Generally, a well-managed forum will have a higher percentage of serious posts. Other questions to ask yourself include: how “personal” does the forum appear to be? Do you feel a sense of warmth and caring? What age-groups are most active? Take a good look around, and don’t hurry. Finding the right forum for yourself is crucial to your weight loss success.
Summary: Focus On What Matters
The secret of successful weight loss is to focus on what matters. So don’t waste too much time or money trying to find the “perfect” diet. I mean no disrespect to any dietitian or nutritionist but, for most people, a diet is a diet is a diet. As long as it’s reasonably balanced and includes a reasonable number of calories, it’ll do fine. What really matters is support – to help you cope with temptation and disruption during your journey. An excellent option is to join an online weight loss forum and be part of a real community. Because when you have tons of friendly people cheering you on, you can move mountains.
Sleep apnea, a known symptomatic companion to obesity, is an expanding health concern in Kentucky. And the different types of clinics for weight loss surgery in Lexington have to become safer and more numerous every year. While obesity is a common source of this condition, the relationship between obesity and sleep apnea is relatively complex. Additional weight gain is a symptom of sleep apnea. The two are viciously intertwined; sleep apnea can be caused by obesity, and can result in weight gain. For those interested in the lap band, Lexington has some of the most qualified clinics in the country – among them, Bariatric Surgery at Central Baptist Hospital in Lexington. Also called the laparoscopic adjustable gastric band, it is an inflatable silicone device placed around the top of the stomach.
Weight loss has long been associated with improved this condition. Even modest weight reduction can help get the condition under control, according to experts.
Basically, sleep apnea causes the airway to become obstructed during sleep. The result is often loud snoring, the condition’s most benign symptom. But, this can also stop breathing altogether and cause cardiac arrhythmias. The condition can be terminal. Chronic interrupted sleep is part of the sufferer’s life, and can lead to fatigue during waking hours, as well as decreased mental and motor function. But these unfortunate outcomes are avoidable according to the team of Weight Loss Surgery at Central Baptist Hospital – bariatric surgery Lexington can depend on.
According to a recent study in the “British Medical Journal,” obese males with more severe cases of apnea who followed a specialized diet and lost a substantial amount of body mass improved their symptoms greatly.
Researchers from the Karolinska Institute in Stockholm assessed whether early improvements in obstructive sleep apnea after a very low energy diet and subsequent weight loss persisted a year after initial findings, in males ages 30 to 65. Participants had to have been diagnosed with severe obstructive sleep apnea. They also had to have a body mass index of at least 30.
They underwent a 365-day weight loss program which included a nine-week, low-energy diet. Most of the participants completed the weight loss maintenance program. Using the apnea hypopnea index, researchers measured severity of sleep apnea.
Researchers recorded results at the one year point. At least 10 percent of the participants exhibited complete and total remission, and 48 percent no longer needed continuous airway assistance during sleep. Follow-up assessments showed a significant correlation between weight loss and the apnea-hypopnea index.
Diagnosing sleep apnea is fairly simple. Sleep studies can be performed at sleep labs, where patients spend the night sleeping with oxygen saturation monitors and apnea monitors to observe sleep structure. Those suffering from sleep related issues and obesity should reach out to a weight loss specialist and have a personal consultation to see if they qualify for weight loss surgery.
Author: Dr. G. Derek Weiss, MD, FACS, FASMBS, Director of Weight Loss Surgery at CBH in Lexington, Ky.
Contact us today to get information on weight loss and it’s health benefits to you.
After bariatric surgery, you will need to significantly adapt your diet and lifestyle to achieve maximum success. You will be losing weight rapidly and proper nutrition is essential to maintain lean body mass, hydration, and skin elasticity, as well as to minimize hair loss.
The post-bariatric surgery meal plan requires a significant change in meal planning for most people. We recommend that you begin adapting your current meal plan now to prepare for this change.
The primary nutrition goals after surgery are as follows:
- Learn proper eating habits that will promote weight loss while maintaining health at a reduced weight
- Consume adequate amounts of protein to minimize loss of lean body mass and facilitate healing
- Take adequate amounts of fluid to maintain hydration
- Obtain adequate nutrients for optimal health through vitamin and mineral supplementation
Post-Weight Loss Surgery Meal Planning Guide
Most weight loss surgery patients will be discharged from the hospital on a liquid-only meal plan for two to three weeks. After three weeks the diet is usually advanced to soft foods for the next six to eight weeks with a gradual transition to regular consistency foods over the next six to nine months.
Depending on your medical history and surgical procedure, it will be recommended that you take a multivitamin with iron, calcium, and — with some procedures — vitamin B12, additional iron, and/or vitamins A, D, E, and K.
Included here are suggestions for making this a safe and uncomplicated transition.
- Stage 2: Modified Full Liquids
- Stage 3: Soft Foods
- Stage 4: Solid Foods
- How to Make Your Transition to Solid Food a Success
Starting on the day you go home from the hospital, you should drink two ounces, (60 ml), or 1/4 cup of a high-protein liquid nutrition supplement every hour, on the hour, while you are awake. This must be a nutritionally complete liquid that would pass through a standard strainer.
In addition to the nutritionally complete liquid, you should strive to consume two ounces of non-carbonated, non-caffeinated, low- or no-calorie liquid every 15 minutes after the hour for a total of eight fluid ounces each hour.
Your first priority is to drink enough fluid to prevent dehydration; protein is a secondary priority. You should drink a total of six to eight cups of fluid each day to avoid getting dehydrated.
It is not uncommon to feel a sensation of fullness from liquids after surgery. This sensation may limit your ability or desire to take the goal volumes in the first several days after surgery. As you progress from surgery you should find it easier to meet the daily goals.
For best tolerance, do not use straws, take small sips, and start with room temperature liquids.
The liquid-only diet is prescribed for three weeks. Please do not start solid foods until your three week follow up visit with your surgeon and dietitian.
Sample Meal Schedule
8:00 a.m. — 2 oz. Boost High Protein
8:15 a.m. — 2 oz. water
8:30 a.m. — 2 oz. broth
8:45 a.m. — 2 oz. diluted juice
Choose a high protein liquid nutrition supplement with no more than 15-20 grams of sugar and at least 13 grams of protein in an eight ounce serving.
Protein is essential to aid in healing and maintaining muscle mass after weight loss surgery. It may also help avoid (but not necessarily prevent) hair loss associated with rapid weight loss. Try to consume at least 40-60 grams of protein per day.
Examples of Stage 2: Modified Full Liquids
- No sugar added Carnation Instant Breakfast and skim or 1 percent milk
- Eight ounces skim milk with 1/3 cup nonfat dry milk powder (16 total grams of protein)
- Boost High Protein or Ensure High Protein, available at grocery stores
- Whey or soy protein (Carb solutions, Spiru-tein, Designer Whey)
- EAS high protein drinks
- Ensure or Boost (Glucerna or Boost Glucose Control), available at grocery stores
- Isopure, available at nutrition specialty stores
- Crystal Light
- Sugar-free Kool-Aid/Wyler’s drink mix
- Unsweetened decaffeinated tea
- Decaffeinated coffee
- Clear juice diluted 50/50 with water
- Sugar-free popsicles
- Propel Fitness Water
Three weeks after surgery you will follow up with your surgeon in clinic and have a diet advancement class with the program dietitian. In this class you will learn how to successfully incorporate soft solid foods back into your meal plan.
Please do not start solid foods until after your three week clinic visit!
Soft foods will be added gradually to your meal plan over the next six to eight weeks. While on the soft diet you must continue to focus on high protein foods and avoid foods that are high in fat, sugar, or fiber.
You may still need to get some of your protein from supplements until you are able to eat enough solid food to meet your nutritional needs (see the list of protein supplements above).
Consuming adequate protein in your diet will help you maintain muscle mass and heal as you lose weight. Because you will not be able to eat a large volume of food at one time you should plan to eat a small meal four to six times each day.
At meal times it is important to focus on high protein foods, making sure you eat them first. You will be instructed to add only one new food at a time to establish tolerance to foods slowly. If you do not tolerate a food well, the problem may be with the food itself, how it was prepared, or the way it was consumed.
Learn to recognize when you are full. Indications of fullness may be a pressure, tightness, or heaviness in the center of your abdomen just below the breast bone. Feelings of nausea, regurgitation, or heartburn are indications that too much has been eaten or the meal was eaten to rapidly.
Nausea, abdominal pain, or discomfort is most often the result of eating inappropriately and rarely a complication of surgery. Common eating-related causes of discomfort are: eating too fast, not chewing food well, eating too much food at once, eating solid foods too soon after surgery, or drinking liquids either with meals or right after meals.
Following are lists of foods allowed and those to be avoided while on the soft diet. The foods on the avoid list are there because most patients do not tolerate them for the first two to three months after surgery. Some patients do tolerate these foods, but it is best to start with the foods on the recommended list.
Once you have learned how to eat with your new gastric anatomy and have healed from surgery, you can start to add other foods one at a time over the next few months. If you follow these suggestions, your transition to solid foods and weight loss will be a success.
Recommended Food for Stage 3: Soft Foods
- Eggs (cooked with minimal fat)
- Light or low-fat yogurt
- Low-fat cottage cheese
- Soft fish (baked, broiled, grilled)
- Small or baby shrimp, scallops, crab
- Tuna fish (fat-free mayo is okay)
- Tender cooked or ground poultry
- Tender cooked or ground beef or pork
- Bean and lentil dishes and soups
- Fat free refried beans
- Low-fat luncheon meats (turkey, roast beef, sliced thin)
- Shredded or soft low-fat cheeses
- Tofu (soy) mixed in soup or vegetables
- Oatmeal, cream of wheat, grits (thinned)
- Softened cold cereal
- Cooked, soft vegetables
- Soft fruits without skin or canned in natural juices
- Crackers and pretzels chewed well
- Low-fat soups
- Very dry toast
- Soft lettuce (green leaf or Boston Bibb)
Soft foods to avoid:
- Sticky foods
- Bread (may tolerate if toasted)
- Sticky rice
- Pasta (especially overcooked or large noodles)
- Melted stringy cheese
- Macaroni and cheese
- Peanut butter
Crunchy fibrous foods:
- Raw vegetables
- Fruit and vegetable skins
- Iceberg lettuce
Tough or rubbery foods:
- Tough meat (steak, pork chops, ham, hot dogs)
- Butter, margarine, oils
- Sour cream
- Cream cheese
- Fat back, bacon
- Whole milk
- Salad dressing
- Hard cheeses
- Fried foods
- Bologna, salami
It is now 10-12 weeks post surgery and you are ready to progress from soft solids to regular consistency foods. Eventually, you will probably be able to eat most of what you were eating before surgery, only in much smaller amounts.
Overall you should be making healthy food choices including lean meat or vegetable protein, low-fat dairy, incorporating fruit and vegetables as you are able, and avoiding empty calorie or “junk” foods as they are typically high in fat and sugar.
Long term, patients must choose foods with good nutritional value. Each meal should have at least three ounces of protein. Learn to read food labels and limit fat and sugar intake, choose low-fat (five grams or less per serving), low-sugar (five grams or less per serving), and lean protein foods.
The volume you can tolerate will always be limited so choose foods wisely to avoid filling up on foods with little nutritional value.
- Eat slowly and be aware of when you feel full. When you feel full, stop eating! If you continue to eat, you may develop intense chest pain and vomit.
- Chew, chew, chew! You need to make sure you chew your food very well before you swallow it. This makes it easier to digest and pass from your gastric pouch into your small intestine.
- Avoid drinking fluids 30 minutes before and with your meals. If you fill up your small gastric pouch with liquid, you won’t have room for your food. Furthermore, the liquids may accelerate passage of the solid food out of the stomach and possibly cause some discomfort.
- Drink enough fluid between meals to meet your fluid requirements. You need six to eight cups of fluid per day to prevent dehydration.
- Avoid food and beverages high in sugar. High sugar foods can cause “dumping syndrome.” After gastric bypass surgery, some people feel light-headed, sweaty, or faint soon after consuming concentrated sugar.
- Limit high fat foods. These foods may make you feel nauseated. They are also high in calories and will slow down your weight loss. Using a low-fat, reduced-fat, or light version of a product is okay.
Need to know more about your diet after weight loss surgery? Give Central Baptist Hospital Surgical Weight Loss Center a call today and speak with one of our knowledgeable staff members.
After weight loss surgery, many post-ops find themselves trading the addiction that they once had to food for something even more dangerous: alcohol. I haven’t witnessed it firsthand (hopefully never will…) but I keep reading about others who have gone down the path of either alcohol, drugs or gambling, because they can’t fill the void that food filled in the good old days. It would be beneficial for pre-ops to understand this, and have some sort of plan in place for their addictive personalities. You need SOMETHING to do. After the initial flood of weight loss excitement wears off – what do you do? Start tipping the bottle? Go to the casino? What can YOU do? Alcoholism after weight loss surgery is a very real problem and a very dangerous one.
Source: ABC News
“After a five-year boom in gastric bypass surgery, many people who lost hundreds of pounds find they’ve now gained something else — an alcohol or drug problem.
Have they traded one addiction for another?
Patty Worrells and Jeannine Narowitz both had gastric bypass surgery, then found themselves battling alcoholism.
It’s a common problem for people in substance-abuse treatment. Psychologists call the phenomenon of swapping one compulsive behavior for another “addiction transfer.”
New Social Life, New Problems
Worrells, 5 feet, 4 inches, weighed 265 pounds. Narowitz, a mother of seven, weighed 274 pounds. Both women suffered from health problems because of their weight.
Worrells said she used food as “comfort,” while Narowitz believed she had a food addiction. Before her surgery, Narowitz said she would often consume up to 4,000 calories a day out of boredom and depression.
“I woke up thinking about food. I went to bed thinking about food,” Narowitz said. “I used it to solve many problems.”
After undergoing gastric bypass surgery, both women lost about 130 pounds. They met and became friends in a support group for people who had lost a great deal of weight.
Worrells said the group met weekly and often got together socially for parties, camping and other events.
“We started doing things together,” she said. “We were no longer someone who had to hide.”
Because gastric bypass surgery shrinks the size of the stomach, alcohol hits drinkers much faster. Worrells said that at one point she was drinking 12 or more tequila shots at a sitting.
“I was able to accomplish in 10 months with alcohol what some people took 10 years to accomplish in a drinking career,” she said.
Both women said they knew they had developed a new problem. Narowitz said she once woke up with a black eye and wasn’t sure how she got it. Her teenage son was mortified, she said, and poured out all the liquor in the house, replacing it with water.
Addressing Emotional Problems
About 140,000 people have weight-loss surgery each year, and it is estimated that somewhere between 5 and 30 percent of them pick up new addictive behaviors afterward.
Dr. Keith Ablow, a psychiatrist and addiction specialist, said it’s common for people to switch from one addiction to another. People who quit drinking may begin smoking, or they might take up some other compulsive behavior like gambling, shopping or exercise.
Ablow said there is usually an emotional problem at the root of addictive behaviors that needs to be addressed.
“Until people address the underlying emotional turmoil that makes them have to seek comfort from food or have to have 15, 20 shots in a sitting, they are not going to be able to overcome it,” Ablow said. “You have to face your pain, not anesthetize it with shopping, food, gambling.”
Gastric bypass surgery does not lead to alcohol abuse, but Ablow said that people who undergo the surgery need to be aware of and deal with emotional issues behind their weight gain.
Worrells and Narowitz said they continue to confront those emotional issues. Worrells has been sober for two years; Narowitz said she drinks occasionally but only has one or two drinks.
“If you’re going to take a step to deal with addictive behaviors,” Ablow said, “you need to get to the why of why you’re doing it.”
From Beyond Change:
Recommendations on the Use of Alcohol After Surgery
A 32-year old male 5 months out from gastric bypass surgery was issued a DUI after attending his brother’s wedding reception. According to the patient, he had only consumed 2 glasses of champagne, although his blood alcohol levels were above the legal limits to operate a motor vehicle.
A female patient, 50 years of age and one-year post-gastric bypass hit and killed a pedestrian with her automobile after having less than 2 glasses of wine. When police arrived she had difficulty with her coordination, slurred her words and seemed somewhat confused, although her alcohol test suggested that her blood alcohol levels were shy of the legal limit.
Were these patients telling the truth about the amount of alcohol they had consumed or did their surgery affect the way the body absorbs or metabolizes alcohol?
A recent study reported in the British Journal of Clinical Pharmacology (1) found that the gastric bypass procedure significantly affects alcohol absorption and its inebriating influence. According to the study protocol, a group of gastric bypass patients, three years post-surgery, and their non-surgical controls consumed an alcoholic drink after an overnight fast, and blood alcohol levels were examined over a period of time. The data showed that blood alcohol levels of the gastric bypass patients were higher and required much less time to peak than those of the non-surgical controls.
The more rapid absorption of alcohol and heightened blood alcohol levels would cause the bariatric patient to have a more pronounced feeling of inebriation during and shortly after drinking. And, such effects could have serious ramifications with regard to driving an automobile or performing other skilled tasks such as operating heavy machinery, piloting a plane or any other task that may influence the safety of the individual or that of others.
Why would alcohol absorption be higher for someone who has had a gastric bypass (or other surgical procedure that reduces the size of the stomach, i.e. biliopancreatic diversion with or without the duodenal switch, gastrectomy)? With the gastric bypass procedure, more than 95% of the stomach is bypassed. Alcohol passes directly from the stomach pouch, usually without restriction, into the intestines where, due to the large surface area of the intestines, alcohol is rapidly absorbed.
In addition to anatomical changes that influence alcohol absorption, the bariatric surgical patient may be more sensitive to the effects of alcohol because of low calorie intake. Several studies found that alcohol absorption is more rapid and blood levels higher if alcohol is consumed on an empty stomach than if provided with a meal or drank soon thereafter (2-3). During the first several months following bariatric surgery, total daily calorie intake is quite low. Drinking alcohol, even small amounts, at this time, would increase significantly an individual’s risk for intoxication.
Metabolic changes that occur with rapid weight loss, as well as the morbidly obese condition, can also alter the rate that the liver is capable of clearing alcohol from the body by the liver’s primary pathway for alcohol metabolism. Reduced clearance of alcohol by this pathway may further increase blood alcohol levels and the risk for intoxication and alcohol toxicity (4-6). Metabolic changes that occur with massive and rapid weight loss may also increase the clearance of alcohol by a secondary pathway of alcohol metabolism that substantially increases the risk for liver damage while, at the same time, makes an individual more sensitive to the toxic and cancer-promoting effects of pollutants in the air, industrial solvents (such as those in household cleaners), and certain drugs (4-6).
Alcohol use can also cause brain damage, a loss of consciousness or even death by reducing the supply of sugar (glucose) to the brain. Muscle, heart, liver and other tissues use fat and sugar (glucose) for fuel. The brain, however, needs sugar to function. To avoid a depletion of sugar, the body stores sugar in the form of glycogen. Glycogen stores, however, can be depleted in a short period of time with prolonged work or exercise, fasting or a diet low in carbohydrate. Furthermore, alcohol reduces the process that allows sugar to be stored as glycogen (7).
The bariatric patient, particularly in the rapid weight loss period and if on a low carbohydrate diet, may have low amounts of stored sugar (glycogen). Drinking alcohol could deplete those stores and cause blood sugar levels to decline. The body, however, has another mechanism to maintain appropriate amounts of sugar in the body. This process is known as gluconeogenesis and is a chemical pathway that converts certain components of protein, lactic acid and other substances into sugar. However, alcohol reduces the production of sugar by this process (4-7) and can, thereby, cause hypoglycemia (low blood sugar).
Usually when blood sugar levels fall, there are certain hormones produced that restore blood sugar levels to normal. However, when someone drinks alcohol, the response of these hormones to low blood sugar is blunted. To make matters worse, hormone responses to low blood sugar are also blunted or depressed in postoperative bariatric patients (8). The bariatric patient, therefore, would have a much higher risk of becoming hypoglycemic (having low blood sugar) than someone who drinks that has not had the surgery, particularly if the patient drinks alcohol during the rapid weight loss period.
Since the brain and nervous system need sugar for fuel, low blood levels could adversely affect neuromuscular and cognitive functions, causing a loss of coordination and balance, slurred speech, poor vision, and confusion. These are all conditions that mimic those associated with intoxication. The patient described earlier, who appeared extremely intoxicated even though her blood alcohol levels were not high, may have been hypoglycemic. Low blood sugar, over a period of time, can result in a ‘black out’ or loss of consciousness, brain and nerve damage, and even death.
The use of alcohol after surgery could also cause irreversible brain and nerve damage, coma and possible death by inhibiting the absorption of important vitamins, including B-complex vitamins such as thiamin (B1) or vitamin B12. Alcohol inhibits the absorption of thiamin and other B-complex vitamins, reduces activation of certain vitamins, and stimulates the breakdown of vitamin A, pyridoxine, and folate (4-6). These vitamins may already be deficient in bariatric patients because of nutrient restriction, malabsorption or impartial digestion of foods produced by the prospective surgery. Alcohol use, then, would compound the negative effects that bariatric surgery has on vitamin/mineral status and increase the risk for associated health problems, including nerve and brain damage, defects in metabolism, a decrease in the ability of the body to heal, low immunity, fatigue and more.
Alcohol has numerous other toxic effects in the body. Not only does alcohol cause liver disease but also negatively affects other tissues. Alcohol’s influence on the heart inflammation (myocarditis), a loss of heart tissue (cardiomyopathy), and irregular heart beats (arrthymias) that can lead to sudden death. Skeletal muscle is particularly susceptible to alcohol with loss of skeletal muscle fibers and strength. Alcohol also causes inflammation of the intestinal tract, gastritis, pancreatic, acid reflux disease and increased risk for gastric and esophageal cancer. And, alcohol causes damage, often irreversible, to the brain and nervous system.
In addition to the numerous health problems that drinking alcohol after surgery may cause, the bariatric patient should also be cautious of alcohol addiction. The prevalence of food addiction and associated eating abnormalities, i.e. binge eating, carbohydrate cravings, are high among individuals with morbid obesity. With bariatric surgery, the addictive tendency for food and aberrant eating behavior are considerably improved. However, individuals with addictions often transfer their addiction to yet another substance, such as alcohol. According to the findings of Austrian psychologist, Dr. Elisabeth Ardelt, addiction transfer may occur in as many as 25% to 30% of bariatric patients.
Drinking alcohol after surgery may also reduce maximal weight loss success. Alcohol has no nutrient benefits and contains high numbers of calories that may cause weight gain or prevent weight loss. One 12-ounce can of beer, for instance, contains 150 calories; 3.5 ounces of wine contains 70 calories; 1.5 ounces of gin, rum, vodka or whiskey contains between 97 and 124 calories; and 1.5 ounces of liquer contains 160 calories.
Are there guidelines for using alcohol after surgery? Presently, there are no official guidelines that have been established pertaining to the use of alcohol after having bariatric surgery. However, based upon knowledge of changes in the absorption and metabolism of alcohol, coupled with the metabolic state of the bariatric patient at various stages postoperatively (4), the following suggestions are recommended
- Do NOT drink alcohol during the rapid weight loss period.
- When drinking, remember that small amounts of alcohol can cause intoxication or can result in low blood glucose with serious consequences.
- Do not drive or operate heavy equipment after drinking alcohol, even small amounts.
- Eat if you plan to have a drink.
- Make certain to take your bariatric vitamin and mineral supplements.
Cynthia Buffington, Ph.D.
Get more information on weight loss programs available to you from the people who care. Contact Central Baptist Surgical Weight Loss Center today.
When you lose weight your body is changing rapidly. These changes will be reflected in your skin, and sometimes not in a good way. You can suffer from stretch marks, as well as acne and breakouts. Let’s look at how you can handle those challenges.
Stretch marks are revealed as you start to lose weight. You may have the silvery marks on your tummy, your thighs, and on your underarms as well. These marks will fade over time.
Acne can be more challenging. Just when you’re starting to lose weight and are looking great and feeling good, you start to get acne.
1. Stretch Marks and Other Skin Care Concerns
As you continue to lose weight, you may find that your skin is more oily, or even more dry. Make sure that you’re drinking plenty of water. The water is essential because as your body burns fat, it releases toxins, which are stored in the fat, into your system. Water will flush your system, and you’ll feel better.
Use cocoa butter and vitamin E oil on your stretch marks each day. Massage the butter and oil mixture into your skin.
2. Acne and Breakouts
Acne and breakouts can be challenging. If you drink enough water, you’ll minimize the chances that you get breakouts.
You should use natural skin care, so that you’re not clogging your pores with chemicals.
If you have acne, use an oatmeal and milk rinse on your face daily. To make the rinse, take a teaspoon of oatmeal, and soak it in a cup of milk overnight. Massage this rinse into your skin and leave it for a few minutes before rinsing it off. This will leave your skin lovely and soft and will dry out breakouts. (Keep the rinse in the refrigerator and use it up within two days.)
3. More Natural Skin Care from Your Kitchen to Help Your Skin as You Lose Weight
Honey is wonderful for your skin at any time, especially when you’re losing weight. Just take a teaspoon of honey and massage it into your skin. Leave the honey for five minutes, and rinse it away. The honey not only cleans your skin, but moisturizes and disinfects it too.
If your skin feels rough, you can use an olive oil and salt mixture as an exfoliant. Mix a tablespoon of olive oil and a tablespoon of salt, then rub this into your skin. You can use the mixture as an all-over exfoliant.
For more information on weight loss programs and your weight loss journey, contact us today.
One reason people lose weight is to feel more comfortable in their own skin. You want healthy, toned skin to improve your overall appearance and flaunt your new body. But many people experience problems with their skin’s elasticity and condition, especially following significant weight loss. Learn how to get your skin in shape during and after major weight loss.
As a person gains weight, the skin can stretch to accommodate overinflated fat cells that are just beneath the skin’s surface. But while skin is very elastic, some find that after weight loss, their skin fails to shrink back to its original shape, leaving unsightly bulges and hanging folds that can mask all that weight loss. To what extent you are left with extra skin depends on your skin’s elasticity, which varies depending on your age and genetics, the amount of weight lost and other factors.
Healthy Weight Loss, Healthy Skin
Weight loss specialists advocate slow, steady weight loss as opposed to crash dieting because it ensures proper nutritional balance. But good nutrition is important for your skin, too, and a proper balance of nutrients will help your skin regenerate more quickly. Aim to lose about 1 to 2 lbs. of fat each week. This will give your skin time to adapt to your new body and will allow you to keep a healthy balance of nutrients that will make your skin glow.
Moisture, Moisture, Moisture
When it comes to your skin, moisture means two things: drinking water and consistently using a good moisturizer. Your body needs to be hydrated to properly regenerate cells, including the cells that make up your skin, so drink up. There is no official recommendation for the amount of water you should be drinking, but a good rule of thumb is eight 8 oz. glasses a day, or enough to keep from feeling thirsty. Also, use a good moisturizer all over your body and use it regularly. You can try lotions that claim to be “skin firming,” but more important is that any product you use keep your skin hydrated throughout the day. Creme moisturizers (they come in a tub, not a bottle) are thicker and provide a strong layer of protective moisture if your skin tends to be very dry.
The Added Value of Exercise
If you added exercise to your daily routine to shed pounds, keep it up. If you didn’t, now is a great time to start. Exercise helps rid your body of toxins and gets oxygen flowing, which is great for your skin. In addition, many dieters tend to lose a significant amount of lean muscle mass in addition to fat, but building muscle gives your skin a firm base, making it look smoother. So add a strength training session to your workouts. Aim for two or three 20- to 30-minute strength training sessions each week.
The Surgical Option
For people who have lost very large amounts of weight, for example after weight loss surgery, cosmetic surgery may be an option to remove large folds of skin. Body contouring is a major surgery involving extensive incisions to essentially cut off the sagging skin of patients. Complete body contouring is often done in stages or multiple surgeries and can include lifting the butt, thighs, abdomen, breasts and arms. Like any major surgery, there are many risks, and body contouring may or may not be covered by your insurance. Talk to your primary care physician and specialists before deciding if a surgical option may be appropriate for you.
For additional information on surgical weight loss visit Central Baptist Hospital Weight Loss Center at bariatric surgery Lexington.
- 3/4 cup shredded mozzarella cheese
- 5 large eggs
- 3 slices 1 lean serving ham
- 1 package broccoli
- 1 cup pieces or slices fresh mushrooms
- Spray 8″ x 10″ pan with cooking spray.
- Layer pan with cooked chopped broccoli, mushrooms (steamed to remove excess), ham, and mozzarella cheese.
- Beat eggs with water and then pour in pan.
- Bake at 350 °F (175 °C) for 20-25 minutes.
Many people these days skip breakfast, we all know about it. People come with seriously, stupid, arguments to why they are not eating breakfast. In matter of fact breakfast is the most important meal of the day (some consider lunch as the most important, I know). Nevertheless, some people say they don’t have enough time, they are trying to lose weight, they are not hungry, they can’t eat when they wake up. There are, solutions for these problems, and there can be even more problems (reasons) than these that I just mentioned. We are going to discuss some of the normal ones, shortly. As the same time I’m going to give you a brief overview over why breakfast is so important. I know that some of you might already eat breakfast properly, then great – I’m really proud of you because I know many people who don’t.
Why is breakfast so important?
The breakfast really literally, makes your day. Studies have shown that people who eat a proper breakfast works better and have more energy (logic – with other words, have a better performance) for the rest of the day. Kids that eat a good breakfast showed to have a much better performance in school too & learned more if they ate breakfast. People think that skipping breakfast is a good way to lose weight – but it’s not. Studies have shown that it’s much more likely that people who avoid breakfast are much more likely to eat things like: candy, snacks & other unhealthy stuff later in the day to fill their “hunger-ness” (yes I made that word up, but it means the rate of being hungry). So eating your breakfast doesn’t just keep you away from unhealthy food, it gives you energy, strength and a better performance for the rest of the day.
Why you shouldn’t skip breakfast to lose weight
Without repeating previously mentioned things, I just wrote something about this above. Another reason is if you don’t eat and keep away from food for longer periods of time, when you do, your body thinks like “Oh, I must save my energy storage because I ain’t getting refilled”. This process slows down your fat-burn (energy consumption) and can make you actually to gain more weight than you wish to lose – since your body is SAVING energy/fat. The best solution to this is to eat more often but less, every 4th hour is what Irecommend. Here is something more to read about regarding weight lose & breakfast.
I can’t eat (breakfast) in the morning
This is actually a common “problem”, the best way to do solve this in my opinion is to split it up, or wait an hour or so. Though, waiting an hour can be a problem if you are in a rush or are about to go to work. If you can’t wake up an hour earlier than you should bring some of the food (breakfast) to work, remember – split it up.
Breakfast is important – it’s important to keep it healthy as well!
Just because you’re eating breakfast everyday – it doesn’t mean you are doing your body a favor. Keep in mind that you must eat a healthy breakfast. Eat lots of fiber, it will make you feel full for a longer time (which can make you less likely to overeat). Eat a fruit or vegetable, or maybe even two. Drink water, juice or tea – or coffee if you prefer that instead. Or some standard basics: egg or bread. Don’t eat things like bacon or pancakes, syrup, fat (I’m thinking of the fat used when frying food). Eat just clean, healthy and unprocessed food. Keep in mind though you can eat things like pancakes (food with more sugar). It’s nothing I recommend in long terms, especially nothing you should eat in large amounts.
Avoiding breakfast is (as mentioned) a normal problem, make yourself a favor and fix that problem if you are one that does not eat breakfast. In a matter of fact I can’t even understand how people manage to avoid this meal. I’m already starving when I wake up. Skipping breakfast is really bad honestly for your health, and you will feel better if you eat breakfast.
Keep in mind, eat breakfast for a better living. If you are out of time – make sure you create that time. We always have time to eat.
Get more information on healthy eating and good nutrition by visiting us at Central Baptist Hospital Surgical Weight Loss Center.
This article courtesy of http://enduranced.wordpress.com/.