Obesity is a major problem across the world. In India, fast foods and an unhealthy lifestyle have led to widespread obesity as well. While following a proper diet and leading a healthy life can help manage obesity and weight gain in most cases, severely obese people require surgeries to lose weight.

Weight loss surgery, known as bariatric surgery, aims to reduce hunger and appetite in extremely obese people. However, simply undergoing surgery does not guarantee positive results. In fact, the lifestyle changes post-surgery is the most important factor to keep the extra weight off your body.

Recovery post bariatric surgery:

If you undergo a bariatric surgery, your lifestyle changes will depend on the procedure of the surgery. For instance, in laparoscopic bariatric surgery, the recovery period is short. In this surgery, the doctor will make 5-6 very small incisions on your stomach. He will then insert a tube-like equipment with a camera in your stomach and carry out the surgery.

Since very small incisions are made instead of a large cut, you will be discharged within a week. Furthermore, you can return to your normal routine within a month.

Lifestyle changes to follow:

1. Eating healthy: Post the surgery, you will need to follow a low sugar and low-fat diet. If this is a break from your usual diet then you need to get used to this diet, since you will need to stick to it for a long time. Immediately after the surgery, you will need to stick to a liquid diet, so that your stomach can adjust to the food.

Once your stomach starts adjusting to the sudden change, consume soft proteins. You will be able to return to solid foods around six months after your surgery. In the initial six months, it is essential to avoid foods such as white bread, pasta, and potatoes. Furthermore, you need to consult your doctor before consuming certain medicines such as painkillers.

2. Exercise daily:

Exercise becomes vital in your long-term goal of losing excess weight after the surgery. Your doctor will first need to clear you to take part in light activities, which will help enhance your body s metabolism. Joining a gym is helpful in this regard   you will have access to trainers and training equipment to help you exercise correctly. However, make sure to inform your instructor of your surgery before beginning an exercise regimen.

Most people fail to understand that you do not magically lose weight after bariatric surgery. You will need to maintain a healthy lifestyle if you want to achieve an ideal body mass and stay in shape. Therefore, you need to be committed to the procedure for the rest of your life.

Lifestyle After Bariatric Surgery!

Abdominoplasty, also known as  tummy tuck  is a surgical procedure aimed at removing excessive skin from the abdomen. This surgery removes the extra fat and skin, thus making the abdomen flatter, resulting in tighter muscles near the walls or border of your abdomen. You should consult your doctor and strictly follow prescribed procedures before and after the surgical process. It must not be confused with liposuction i.e. the cosmetic surgery which removes excessive fat deposits in the body. 

Abdominoplasty or tummy tuck is beneficial to you, 

If you possess good physical health. 
If you are a non-smoker or have recently quit smoking. 
If you have a stable health and realistic expectations about the outcome of the surgery. 
If you have been pregnant previously and now need to lose weight and fat deposits. 
The surgery is not suitable for the following cases: 

If you are planning to get pregnant, then it is recommended to perform the surgery after delivery. This is due to the fact that your muscles can be stretched again after the surgery. 
If the appearance of scars after tummy tuck is a problem, consult your doctor about the scar replacement procedure. 
If you still smoke or are absolutely unable to quit. 
Types: 

There are two procedures of tummy tuck. These are decided by the surgeon during your consultation and some pre-surgery medical tests. The procedures are: a) Complete Abdominoplasty and b) Partial or mini abdominoplasty. 

In Complete Abdominoplasty, the surgeon cuts the abdomen from hipbone to hipbone and your skin, tissue and muscle will be operated. In the case of partial or mini abdominoplasty procedure, the fat deposits are usually located below the navel region and the surgeon may not move your belly button. The entire procedure may take around two to three hours. 

Aftercare: 
Proper nutrition and healthy meals are required for this surgery. You must follow a balanced diet and focus on post-operative care.

Tummy Tuck Surgery - Abdominoplasty!

Looking good and feeling good are sometimes one and the same thing which can be achieved with good skin and a fit body. One can turn to many measures to achieve the same, including cosmetic procedures. Cosmetic surgery like liposuction is generally used to remove the excess fat in the body which cannot be treated with normal exercise or diet control measures. This surgery is conducted by a plastic surgeon. Here is everything you need to know about liposuction.

About: Liposuction is a cosmetic procedure. It removes the excess fat present in one s body with the help of a procedure known as body contouring. This kind of contouring may be carried out in various parts of the body including the calves, knees, buttocks, hips, abdomen, upper arms, breasts and even the neck and chin area. These are the areas that generally end up accumulating excessive fat which does not go away easily. For some people, persistent diet control and exercising may help. But for severe and chronic cases, one will have to make use of measures like liposuction.

Types of Liposuction: Depending on your case as well as the individual system of the patient, one can go in for one of the various types of liposuction. The fluid injection based liposuction is the most popular and common form where a large dose of medicated solution is injected with a local anaesthesia blended into it. This helps in contracting the blood vessels so that the fat can be suctioned out. The next type is the super wet liposuction where the amount of liquid solution injected is the same as the amount of fat that has to be removed. Ultrasound assisted liposuction uses ultrasonic waves in order to transform the fat cells into liquid which can be vacuumed out later. Further, laser assisted liposuction makes use of laser pulses and beams in order to make the fat cells liquid before they are vacuumed out of the system.

The procedure: The plastic surgeon will make use of a special liposuction machine and cannulas or special instruments, so that the surgery may be carried out in a proper manner. Also, depending on the type of procedure you are going in for, you will require local or general anaesthesia. A small incision is made so that the tube may be inserted for the liquefaction process to begin. After this, the fat that has been dislodged will be vacuumed away through the same suction tube. Small drainage tubes will be inserted to remove blood and fluid from the deflated areas and in some rare cases, blood transfusion or fluid replacement may also be required. High blood pressure and cardiovascular cases should not use this option.

Liposuction - How It Can Help You?

When dieting and exercising fail to help an obese person manage their weight, bariatric surgery may be suggested. One of the most popular types of bariatric surgery is a gastric sleeve surgery or sleeve gastrectomy. The main aim of this surgery is to reduce the amount of food that can be consumed in one sitting. It does not affect the amount of nutrients and fats absorbed from the food that has been eaten. A majority of the weight loss resulting from this surgery happens within 12-18 months.

A gastric sleeve surgery is a relatively safe, straightforward and short surgery. Prior to surgery, few patients would have been given a special diet.  This surgery is always  performed laparoscopically popularly known as keyhole route. More than half the outer side of the stomach is removed. The remaining part of the stomach takes the form of a tube. 

Though recovery from any surgery varies from person to person, most patients are able to walk and allowed sips of water by evening. Though certain amount of pain and discomfort is expected, this remains in bearable range with pain killers. Usually liquid diet is advised for 2 weeks followed by soft foods for 4 weeks.

You will notice that you feel fuller much faster and are able to consume a very limited portion of your normal food intake. It is essential to drink plenty of water to remain adequately hydrated and to prevent constipation.

On an average, this surgery can help people lose up to 70% - 100%% of their excess body weight. However, this depends largely on your understanding and compliance of post operative dietary changes. A dietician can also help you make right food choices, decide meal portions and address the right number of meals needed by your body. For long term weight maintenance it is important not to fall back to your earlier lifestyle and to maintain a positive attitude.

Gastric Sleeve Surgery - What Is The Process Of It?

Is there a relation between weight loss surgery and type 2 diabetes? Yes, there is and a very promising one. Many diabetics may not know this but a key hole procedure called metabolic/ bariatric surgery can help resolve type 2 diabetes.

It s scientifically proven that these surgeries can normalize blood sugar levels and control diabetes in most patients. This means that you may not need any medicines post such a surgery. One long-term study which tracked 400 people with type 2 diabetes showed that six years after bariatric surgery, 62% diabetics showed normal blood sugar levels. Apart from this, they also showed better blood pressure, cholesterol and blood triglyceride levels that can cause heart disease.

Should you get a metabolic/bariatric surgery done? You are a fit candidate for bariatric surgery if your:

BMI is 27.5 or higher
And if are finding it difficult to maintain blood sugar with medicines & lifestyle changes.
Your doctor will give you a physical exam to check whether you are fit for a major surgery and if you are emotionally ready to commit to necessary lifestyle changes like eating healthy and exercising regularly.

Types of weight loss/diabetes surgery:

The most popular type of weight loss surgery is one in which the size of your stomach is reduced so that you feel full even after small meals. Other types of bariatric surgeries change the way your body absorbs calories and nutrients and vitamins. A few other types of bariatric surgeries do both.

Gastric Bypass: In this surgery, your surgeon makes a small stomach pouch by dividing the top of the stomach from the rest. This small pouch is connected to intestine so other part of stomach is bypassed. So, when you eat, food goes into this small pouch, which makes you feel full faster and also makes it possible for your body to absorb fewer calories. This is a very promising type of bariatric surgery for diabetics as up to 80% of people have normal blood sugar after it. And they also lose 60% to 80% of their extra weight on an average.
Gastric Sleeve: In this surgery, your surgeon will remove a major part of your stomach. When your stomach is small, you will feel full faster. It also reduces hunger pangs. This type of surgery is also very effective in reducing diabetes and losing weight.
Adjustable Gastric Band: In this surgery, your surgeon puts an inflatable band around the top of your stomach. This forms a small pouch which makes you feel full faster. The good point is that your stomach is not cut and your intestines are not shifted. There are thus lesser complications. It also helps in controlling diabetes. The con is that you lose less weight in this type of surgery.
Biliopancreatic Diversion: This is an uncommon surgery but most effective for diabetics. In this the doctor removes a large part of your stomach and also changes the way the food goes to your intestines. This helps in losing weight but also affects digestion long term.
As with any major operation, all bariatric surgeries come with potential risks of bleeding, infection, and leaks in the digestive system. It is necessary to change lifestyle to avoid weight regain.

Is There A Relation Between Weight Loss Surgery & Type 2 Diabetes?

Bariatric surgery is unlike other surgeries, as its effects are not instant but gradual and are seen over the months. Like any other surgery, it is not without complication. But again unlike all other surgeries, the complication rate can be negligible if a strict protocol is followed. Moreover, the factors like technology advancements, development in the field of advanced laparoscopy, enhanced skillset of the bariatric surgeon, dedicated management of bariatric and metabolic surgeries by bariatric surgeons, play a vital role in the reduction of complication rate which eventually results in safe surgery.

As the procedure is done laparoscopically, the pain is just for a day and is minimally managed by analgesics.

The fear of increasing incidence of incisional hernias while operating an obese patient is so negligible or nil, as the procedure is performed through tiny key holes and all precautions are taken to suture the sheath through which the ports are put to perform the surgery.

Reduced hospital stay and early resuming to work is one of the biggest benefits of this laparoscopic bariatric procedure.

Sometimes, problems that may be faced are:- 

Post-operative bleeding: Normally, this a nearly bloodless surgery involving 5 to 10ml loss of blood. However bleeding from the staple edges is known, but this can be managed well by the surgeon, by choosing the right size of the cartridge as well the right technique of application of the cartridge.

Dehydration: We are normally accustomed to drinking water at long intervals (a few hours) as we can consume nearly 200 to 400ml at one go. Following bariatric surgery, gulping or drinking water in one go is not possible in the first 2 to 4 weeks, due to reduced capacity of the gastric pouch. Hence, care needs to be taken to drink small quantities of water at frequent intervals to avoid dehydration. This is possible only if the patient is counselled about this prior to surgery and is fully aware of this. Also, the patient needs to be given good and clear post operative instructions regarding the quantity and frequency of liquid consumption, not forgetting the type of liquids. Coffee taken frequently could be another cause for dehydration. Family members and colleagues and friends at work play a major role in reminding tthe patient about consuming water frequently. Special care needs to be taken in people who are not accustomed to consuming adequate quantities of water prior to surgery as a general habit.

Vomiting/Fullness/ Discomfort/Indigestion: Following bariatric surgery, soft food is introduced in the diet in the third week, after the first 2 weeks of taking liquids. Due to the reduced capacity of the gastric pouch, the morsel size is significantly reduced and one has to chew the morsel well and eat slowly, giving a gap of 40 to 50 seconds between the morsels. This prevents distension or overdistension of the gastric pouch and thus avoids vomiting. This again requires good counselling prior to the surgery and on the follow up visit too before stating soft food. There is a subjective difference when we say small morsels and we cannot reach a standardization as the morsels size of each individual varies prior to the surgery itself. The best way to avoid this confusion is to make the person have the first soft food meal before you where in you can physically show the way food is expected to be eaten. However, by mistake, there is a chance that one can have a regular sized morsel as over years one is used to eating in that manner. If this happens, the person will vomit , and this will be a reminder to gauge the morsel size the next time the person eats. Following the vomiting, there could be a burning sensation in the stomach which will subside afer taking an antacid. If one follows the instructions of small morsel size, chewing properly and eating slowly, there is no chance that there will be vomiting. Another reason for vomiting could be keeping the stomach empty for a longer duration or having sicy food on an empty stomach. Avoid nuts, seeds, fried foods and processed foods. Very rarely vomiting could be due to reduced size of the joint between the gastric pouch and the small intestine. This could require an Endoscopy and necessary treatment.

Vitamin and mineral deficiency: It is seen that many of the obese patients are seen to have vitamin B12, vitamin D, iron and protein deficiencies in their blood tests that are done prior to surgery. With the significant reduction in the amount of food consumed after bariatric surgery, the existing deficiencies are bound to increase. Hence, it is necessary to do these tests, before surgery and rectify the deficit prior to the surgery.  

Gall bladder stones: Significant weight loss which is consistant over a short duration could lead to the formation of gall bladder stones, be it with or with out surgery in a small percentage of patients. To avoid this there are two schools of thought, one is have a prophylactic removal of the gall bladder along with the bariatric surgery and another is to put the patient on ursodeoxycholic acid (a tablet) for the first few months after surgery during which there is significant weight loss.

Skin sagging: In the morbidly obese, when the skin is overstretched beyond a certain point, it tends to sag once significant weight is lost. This sagging is influenced by a number of factors like age of the patient, the BMI, pre existing sagging, pre-existing muscle tone and protein supplements taken during weight loss and exercises done during the weight loss period. Skin sagging is less if the age is less than 45, BMI less than 45, good protein intake during weight loss and good toning exercises done during the weight loss period.

Hairfall: Significant weight loss either by diet and exercise, aerobics, bariatric surgery, will entail hair loss. But this can be minimised to a greater extent by ensuring good protein intake during the weight loss period and adequate supplements in terms of vitamins and minerals.

Dumping syndrome: With a reduced size of the stomach, the food moves from the stomach into the smaller intestine much faster. This causes the pancreas to release excessive amount of insulin, leading to very low blood sugar levels , producing various symptoms like abdominal cramps, bloating, diarrhoea, sweating, dizziness, nausea, weakness, and anxiety. This is managed by eating less amount of sugars and fats and spacing out the meals through the day, having four to five small meals compared to  2 to 3 large meals. Having a high protein diet and avoiding liquids during meals is also an option.

Bariatric Surgery - Know Problems Of It!

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