ABC News Article and Dr. Brad Wadkins

[Guest guest]

Congratulations to Dr. Wadkins for getting the messege out by Lap-Ban

April 20, 2005 | Get Your Local News and Weather

Search ABC NewsSearch the Web

Home U.S. International Business Technology & Science Health

Entertainment Politics ESPN Sports Travel Local News & Weather Video

& Audio Good Morning America World News Tonight 20/20 Primetime Live

Nightline World News Now This Week ABC News Home > Health Font

SizeSmallMediumLargeExtra Large

Battle of the Bulge: Dietary Challenges after Obesity Surgery

Barrow

April 18

What Is Morbid Obesity and What Can Be Done?

Want to Learn to Eat Right? Work with a Dietician

Health Library:

Select a Health Topic ADD & ADHD Allergy Alternative Medicine

Alzheimer's Disease Arthritis Asthma Body Aches and Pains Breast

Cancer Cancer Awareness Cardio Health Children's Health Colon Cancer

Contraception COPD/Emphysema Dental Health Diabetes Diet & Weight

Loss Elder Care Epilepsy Erectile Dysfunction Eye Care Fertility

Fitness Gastrointestinal Health Glands and Hormones Gynecologic

Health Hair Loss Headache Healthcare Today Healthy Aging Heartburn

HIV and AIDS Infectious Diseases Kidney Health Leukemia Liver Health

Lung Cancer Lymphoma Men's Health Mental Health Multiple Sclerosis

Nutrition Osteoporosis Parkinson's Disease Pregnancy & Childbirth

Prostate Health Sexual Health Skin Health Sleep Disorders Stroke Teen

Health Thyroid Health Urologic Health Vascular Disease Women's Health

Workplace Health If you're morbidly obese and you've made the

decision to have obesity surgery, your journey is far from over.

While this may be a step towards a much healthier life, the lifestyle

changes that you will have to make after surgery must be considered

or you'll be in even worse shape than when you began.

" Gastric surgery is not magic, " says Brad Watkins, MD, FACS, co-

founder of the Northwest Weightloss Center in Kirkland,

Washington. " It's not a panacea, but a very powerful tool to assist

you with your weight loss efforts. "

There are three primary types of obesity surgery: laparoscopic

gastric banding, known as LAP band surgery, gastric bypass and

biliopancreatic diversion (BPD). The goal of these procedures is to

reduce the amount of food your body can absorb, either by making you

feel fuller faster or by removing your body's capacity to absorb

calories.

LAP band is the least invasive of these surgeries; a band is placed

around the opening of your stomach, restricting the amount of food

that can be eaten at a given time. Both gastric bypass and BPD

restructure your digestive system, with gastric bypass minimizing the

size of your stomach and BPD shrinking the stomach and bypassing most

of the small intestine. Both of these surgeries are

called " malabsorptive " ; by detouring parts of the gastrointestinal

system, fewer calories—and nutrients—can be absorbed. These patients

will have to take numerous multivitamins and nutrient supplements for

the rest of their lives.

The rules that will govern your dietary habits after surgery will

differ a lot based on which procedure you undergo. This should be one

of the many major considerations you make when choosing a bariatric

surgery; if you are unable to stick to the eating plan post-

operation, major problems will arise and you may even put on more

weight.

Introducing Your New Stomach

Expect your doctor to have a post-surgical dietary plan that will

ease you into eating solid foods. Post-surgical diets vary from

doctor to doctor, but are generally divided into phases, progressing

slowly from liquids to mushy foods to more solid foods. Before you

eat anything, however, your doctor will examine you after the surgery

to confirm that either the LAP band is correctly in place or that the

sutures from the gastric bypass or BPD are secure.

At first, you'll only be allowed to consume clear liquids including

water, sugar-free juice, clear broth, sugar-free gelatin and flat

soda in small amounts at a time. No other food can be consumed for

one to two weeks after surgery. This will give your body time to

heal. When your body adjusts to these liquids, your doctor will

gradually allow a full-liquid diet, with the major component being a

nutrient-rich protein shake. This liquid diet can last anywhere from

two to six weeks after surgery.

Eventually, you'll begin to eat soft and puréed foods. Baby foods can

be eaten, but be sure that, no matter what, everything you eat is

completely smooth in texture, so you don't rip out a suture. Eggs and

low-fat cheeses are a good option, as are puréed tuna or chicken.

Eventually, you will be allowed to begin to eat soft, solid foods.

Mashed potatoes, oatmeal and cooked vegetables are good options to

help you transition into tougher foods.

Sabotaging Your Own Success

So now that you've made it through the hardest steps, it's time to

transition into a routine eating pattern. This does not mean that you

can go back to your old eating habits, however.

For all patients, every meal needs to be nutrient dense. Some find

that eating five or six small meals throughout the day works better

than eating three larger meals. And since your stomach can only hold

about 1 ounce of food at a time, you'll need to chew your food

thoroughly into a mush before swallowing to aid absorption, and

remember to stop eating when you feel full.

Since a LAP band procedure leaves the stomach completely intact, you

are still able to digest food normally and absorb nutrients—and

calories—as you did prior to surgery. As a result, LAP band patients

only need to take a chewable multivitamin for the few weeks following

surgery. However, many LAP band patients gain weight after gastric

surgery due to " grazing, " or constantly eating throughout the day. If

a LAP Band patient nibbles on food all day, he or she can continue

eating a high-calorie, high-fat diet without ever feeling full and

never lose weight.

For gastric bypass and BPD patients, failure to take all vitamin and

mineral supplements continuously after surgery is by far the biggest

problem. As they begin to heal from surgery and move into a more

routine life, it becomes easy for you to skimp on the expensive pills

that you are supposed to take because, for the most part, you still

feel completely healthy.

" It's not the kind of thing you're going to feel tomorrow or next

week, " says Montgomery, MD, FACS, co-founder of the Northwest

Weightloss Center. " But down the road it'll really effect you. "

Common illnesses after these surgeries include osteoporosis from

calcium deficiency, anemia from iron deficiency and permanent nerve

damage from thiamin deficiency.

Many people find BPD appealing because it eliminates your stomach's

role in the digestive process; food just passes right through, never

making you feel full, but it leaves very few nutrients absorbed in

the process. Some patients think they can just eat and eat and let

the food end up in the toilet. Additionally, the vitamins BPD

patients are given often go undigested because the high amount of

food consumption pushes them through too quickly, without anytime to

dissolve and be absorbed, leading to, as Dr. Watkins put it, " very

expensive diarrhea. "

Protein consumption is especially emphasized in malabsorptive

bariatric surgery patients, as protein is necessary to help you heal

after surgery. But it is also important later on. Proper protein

consumption ensures that the weight you lose is fat, not muscle. LAP

band patients can continue to digest protein normally, so this is

less of a concern. Part of the reason gastric bypass and, especially,

BPD offers the fastest weight loss, is only because these patients do

not get enough protein; their body begins to decompose their muscles,

called " muscle wasting " , to make up for the missing protein, leading

to very rapid weight loss, but also weakness and possibly loss of

mobility from the muscle loss.

Upsetting Your Stomach

If you do not follow the diet plan specified by your doctor, you

probably will experience some discomfort. However, be advised that

not all people tolerate the same foods equally well after surgery.

LAP band patients often have problems digesting rice or white bread;

gastric bypass and BPD patients have problems with sugary foods. As

you experience discomfort, keep notes of the food you ate.

Identifying these trigger foods can help you stay as comfortable as

possible.

Dumping syndrome is probably the most common problem after gastric

bypass or BPD. Because sugar is no longer well digested in the

stomach, it passes straight into the intestine. The sugar then

absorbs water, causing diarrhea that leads to nausea, weakness,

dizziness and a rapid pulse. To prevent this discomfort, sugars and

high-fat foods should always be avoided. If it's too late, and you

begin to experience symptoms of dumping syndrome, lay down to slow

the movement of food to the intestine.

Mental Weight-Loss

In many cases, the hardest lifestyle factor to change is one's

psychological need for food. In many cases, morbidly obese people use

food as a source of comfort, rather than a source of nutrition,

leading to their extreme weight.

" [some patients] have trouble changing their relationship with food, "

Dr. Watkins says. " They ate when they were bored; they ate when they

were depressed, and they just can't do that anymore; they need to

find something else. "

Having a multidisciplinary team set up before you have the obesity

surgery will help you transition both physically and mentally into

your new body. Many women—85 percent of the people who receive weight—

loss surgery-find themselves confused when treated differently by men

and coworkers. A dietician, psychologist and a support group can help

you cope with these changes you may not have expected and give you

new ways to handle stress and find comfort.

No matter what, always follow the dietary plan laid out by your

doctor and consult him or your dietician if you are finding some

aspects of it too difficult; there are always adjustments that can be

made. Keep a positive attitude; the post-surgical road can be a bumpy

one, but by sticking to the plan, it's also the road to a healthier

life.

ding. Heres the article.