Tips & Reminders: exercise

1. Walking is always okay.
   
2. For the first 6 weeks after surgery no lifting greater than 10 lbs.
   
3. Check with your doctor about when, what type, and how much exercise is appropriate for you.
   

   --Regular and water aerobics can be started at 4 weeks
   

   --Weight lifting and abdominal exercises can be started at 6 weeks
   

4. Exercise will help you lose weight and maintain lean muscle tissue.
   

   
    

Tips & Reminders: vitamins/minerals

1. Protein. Remember your ultimate goal of 60-70 grams for females or more per day (or 70-80 grams for males). Adequate protein is essential to avoid loss of your lean body mass (muscle), hair, and to promote healing. Also, the lack of protein can cause fatigue.
   
2. Take a children's multivitamin/mineral supplement with iron two tablets daily beginning with Stage 2 (full liquid diet). Do not take your multivitamin with iron, concurrently with dairy products, Calcium, Vitamin D, Coffee or Tea as the items hamper absorption.
   
3. Supplement 1500 mg of chewable calcium daily, but don't take your whole daily dose at once. Split it into at least 3 doses (calcium citrate (Citracal) is preferred.
   
4. Pills. Ask your doctor about any medications you must take. If they are large, they may need to be crushed (and mixed with pudding or applesauce) or broken into smaller pieces.
   

Tips & Reminders: Fluids

1. It may be a "full time job" to keep up with your fluid needs. Plan to carry around a big bottle full of water or sugar free beverage.
   
2. Your urine should be clear and frequent.
   
3. Drink fluids between meals only. Keep meals dry. Do not drink with meals. Drinking fluids at meal has the same effect as eating large amounts of foods. It may cause dumping syndrome.
   
4. Avoid the use of straws as the air swallowed with eventually stretch your pouch.
   
5. Avoid sugary foods and drinks. They can lead to "dumping syndrome" (a condition characterized by abdominal cramps, diarrhea, sweating and dizziness shortly after consuming concentrated sweets) and provide extra empty calories.
   
6. You should really try to avoid alcoholic beverages, including beer, wine, and liquor. Alcohol affects your liver very quickly and can lead to serious liver damage if taken in excess. Alcoholic beverages can cause weight gain and result in poor nutrition since they are very high in calories and low in nutrients.
   

 

(Information from WHMC Gastric Bypass Nutritional Guidelines Handbook)

 

 

Recover time from surgery

Walk every day…after surgery

Plan to stay 2-3 days in hospital after surgery

--Hospital stay length varies with each patient

--Lap band: same day surgery or 1 overnight

--Sleeve: 2 overnights

--Gastric Bypass: 2-3 overnights

Plan to take off from work for 3 weeks

--Often patients are able to go back to work in 2 weeks

--You will fatigue easily

--Light duty/activities for 6 weeks

Do not

--Lift greater than 10 lb or do heavy housework for 6 weeks

--Drive for 2 weeks

Walk every day…after surgery

 

 

Follow up appointments

Lap band- every 4-6 weeks for band add/remove fluid

Sleeve & GBP- 2 wk, 1 mo, 3 mo, 6 mo, 1 yr and then annually

Protein

After weight loss surgery the goal is to maintain lean body mass, as well as support successful weight loss. Protein supplementation is essential to health and promotes healing. It is recommended to take in 60-70 grams of protein daily. Also, after the surgery, if your protein status is low, your body will heal more slowly, sometimes very slowly.

WHAT ARE THE SYMPTOMS OF INSUFFICIENT PROTEIN?

The first sign of lack of protein is often fatigue and/or weakness. Not just the feeling that we didn't get enough sleep last night, but deep fatigue….or weakness where it's hard to get through the day.

A second sign is weight loss plateau. When we don't get enough protein, there is increasing evidence that the body tries to store calories rather than burning them. We hear from many patients who do get enough protein that they are successful in reaching their weight loss goal.

A third sign is hair loss, and we believe it is often preventable. While one cause of hair loss following the surgery is the "shock" of the surgery to the body, another leading cause of hair loss in weight loss surgery patients is insufficient intake of protein.

HOW TO GET THAT MUCH PROTEIN?


An ounce of meat (the weight after the shrinkage of cooking) provides about 7 grams of protein.

An egg contains about 7 grams of protein. Milk contains 8 grams of protein per 8 ounce cup

Example: To get 70 grams of protein from meat, you would need to eat 10 ounces of cooked meat each day.

Purchased Protein powder

* This is a general recommendation that of course cannot consider individual patient needs. It does not, and should not, supersede the recommendation of medical professionals who best know the individual patient needs.

 
 

 
 

 
 

Purpose of the 2 week liquid diet

Every patient that has WLS (weight loss surgery) will be put on a 2 week liquid Pre-op diet. This has some important benefits:

1. To shrink the liver- this makes the surgery safer for the patient and allows the surgeon better view to create the new stomach pouch
   
2. Shrink intra-abdominal fat- all the fat that everyone has around their organs, weight loss of 10-20 lbs
   
3. This is the same liquid diet you will be on after surgery while your new digestive system heals
   

**Comments from post-op patients: you will be starving on this liquid diet, you will be irritable, you will want to cheat, it will be hard to stick to the diet, tell friends and family so they can support you, know that after surgery you will not feel hungry on the liquid diet like you did before surgery, your taste may change-what you liked before surgery you may not like after surgery.

Daytime Support Group Today

Come out and join us for the Daytime Support Group
In the General Surgery Clinic @ 1130-1230
No appointment needed - just show up!

YOU ARE THE KEY TO YOUR SUCCESS!

Habits that are the key for long-term success:

• 3 meals plus 2-3 planned snacks
  
• Adequate water (at least 8-9 glasses)
  
• Daily supplements (your vitamins, calcium, B-12)
  
• 7-8 hours of sleep
  
• Regular Exercise
  
• Personal responsibility
  

 

Behaviors that are red flags for Failure:

• Starting to eat sweets                
  
• Eating Fast Food often
  
• Skipping meals
  
• Eating after your stomach is full
  
• Eating rapidly
  
• Grazing mindlessly
  
• Eating when you are bored, upset, angry, or depressed
  
• Clinging to the couch and not exercising
  
• Choosing favorite carbohydrates first
  
• Snacking from vending machines
  

 

The choice is yours.

Best wishes for your continued success!

(Information from WHMC Gastric Bypass Nutritional Guidelines Handbook)

 

Food intolerances

After surgery each patient may have a certain food they say "doesn't agree with me." It is important to recognize that these are usually the very foods which fill up the pouch the fastest! If a bite of chicken fills up your pouch and makes further eating impossible, often it isn't because "the chicken doesn't agree with me", but rather, because that small amount of chicken was enough to fill up your pouch! STOP eating right then and there!

 

To have that "second bite" is often to overeat. Your new restricted stomach can't handle it - even one more bite will distend the pouch and make you feel miserable. When you have an experience like this (most patients do) use it to learn how much of different kinds of food it takes to feel full. Try to train yourself to recognize an adequate amount of food while it is still sitting on the plate, and avoid that "painful full" feeling altogether.

This is a new concept and it will take time to adjust to it. So, go easy on this new eating pattern in the first few months until you know what that new "feeling of fullness" is like. Eating such small amounts of foods seems strange, but it is all you need to be healthy and will promote maximum weight loss.

(Information from WHMC Gastric Bypass Nutritional Guidelines Handbook)

Vitamins and Minerals

Post surgery common deficiencies

    *Iron *    Vitamin B12 * Folate * Thiamin * Calcium * Vitamin D * Vitamins A, E , K * Zinc

Post Surgery Supplementation

Multivitamin with Iron – chewable or liquid, avoid time released or enteric coated

    Choose a complete formula with at least 2/3 of nutrients including folic acid, zinc, iron and selenium

    --Begin 1 day after discharge from hospital

        Gastric Bypass and Lap Band patients need 100% Daily vitamins

        Sleeve patients need 200% Daily vitamins

Calcium citrate with vitamin D – chewable or liquid

**Remember

Calcium and Iron should be taken 2 hours apart

Take Iron with orange juice or water to aid in absorption, never with milk, coffee, tea

 

 

    

    

Exercise after surgery

 

Exercise is just as important as your diet. For successful weight control, you should combine a healthier diet with a consistent exercise program. Exercise is a healthy habit that burns calories, reduces fat, and tones muscles.

 

Immediately after surgery, do not engage in heavy exertion, bending or lifting over 10 pounds. If any activity or position causes pain around your incision, don't do it. Do not sit in one place for long periods without getting up and changing position because inactivity increases the risk of blood clots forming in your lower legs. Another important note, do not engage in any abdominal exercises the first six weeks after surgery.

 

When your surgeon says you are ready, adopt a routine of regular exercise a minimum of 30 minutes, at least four days a week. Studies of people who succeed in reaching their goals after bariatric surgery indicate that over 75% exercise regularly to help maintain weight loss. Not only does regular exercise burn calories, but it also helps you avoid becoming weak and losing muscle mass as your body loses fat.

 

Within four to six weeks after bariatric surgery, it is extremely important to walk as much as you can to speed recovery and regain your strength. Walking promotes wound healing, circulation, bowel function, weight loss, and a healthy heart and lungs.

 

To maximize success, consult an Exercise Therapist to obtain an exercise program designed specifically for you.

 

This information taken from: http://www.bethesda.med.navy.mil/patient/health_care/surgery_services/bariatric_surgery/index.aspx#Handouts

Solid foods vs. soft calories

To maximize weight loss and to maintain nutrition, solid foods are preferred over soft calories. This means that soup, yogurt, and other healthy but soft calories should be minimized.

You should generally eat the same foods as the rest of the family, only in much smaller amounts (e.g. a chicken wing might constitute an entire lunch). The best foods here are meats and vegetables (including salads). Since the quantity of your intake is very limited, it is very important that you eat highly nutritious foods and don't waste valuable space in your new "stomach pouch" with empty calorie, junk foods. This is a great incentive to "eat healthy."

Fruits may also be added during this time, though they do contain natural sugar and should not be a big part of your diet. In the long run fruits are best used sparingly as "dessert."

All meats can now be eaten. The most important things to remember when eating meats are:

-To cut up each piece of meat to the size of the eraser on a wooden pencil.

-To chew up each piece of meat individually, before swallowing.

-Avoid any gristly meats (including Spam) at this time because
gristle tends to get stuck in the pouch.

 

(Information from WHMC Gastric Bypass Nutritional Guidelines Handbook)

 

 

 

Constipation

Constipation is very common after weight loss surgery. Symptoms of constipation are painful bowel movements, difficulty passing stool, and/or when your stool is very hard. Constipation is often times due to narcotic usage after your operation. It can also be due to inadequate water intake or insufficient amount of fiber in your diet.

 

Remember also the amount of food you are eating is much less and therefore you have a lot less material to make stool. For these reasons your surgeons ask you to take supplemental fiber such as over the counter Bene-fiber.

 

Weight loss surgery patients do NOT need to have a bowel movement daily. If you are having bowel movements every 2-4 days, and your stool is soft, brown, and not difficult to push out, then you are normal. In contrast, if your stool is very hard, you are on the toilet a very long time, your bowel movements are painful, your bowel movement makes you bleed, or your stool is difficult to push out, then you are probably experiencing constipation. Things that will improve the regularity of your bowel movements and make them softer are the following:

 

1. Increase your fluid consumption. This includes water or any other zero-calorie liquid such as Crystal Light.
   

   
    

2. Fiber. Increase fiber consumption by regularly taking over the counter fiber supplements such as Benefiber. You can start this when you are eating regular food.
   

   
    

3. Take mineral oil. Take 1-2 teaspoons once or twice daily - this will draw water into your colon and soften your stool
   

   
    

4. Colace. This is available over the counter in a suppository or pill form - it should be initially taken once or twice daily, however can be taken more frequently if necessary.
   

   
    

5. Eat more vegetables.
   

   
    

6. Milk of Magnesia. This is not to be taken regularly, but may be required occasionally.
   

 

You should not hesitate to call the Bariatric Nurse if your problems persist or if the above measures do not help @ 210-292-4303

 

(Information from WHMC Gastric Bypass Nutritional Guidelines Handbook)

 

 

 

Support Group--Tonight

Come out and join us for the Evening Support Group
At the Gateway Club @ 6:30pm to 8:00pm
No appointment needed - just show up!
**Reminder each patient must attend one meeting before surgery


Many pre and post surgical patients attend
Bariatric Surgeons will be there
Guest Speaker: Plastic Surgeon from BAMC

Directions to Gateway Club
Enter Lackland AFB at Main gate (Vistor Center) off Military Dr
Go straight from gate to stop sign club will be catie-corner to you
Questions call (210) 292-4303 during duty hours

From a post surgery pt…

things I wish I had known.. hmm.. well, I knew a lot of stuff from reading on the internet before going in, so I felt pretty prepared already…

I would stress the no carbonation thing.. I know of people that drink it even after the surgery.. bad idea. and the no drinking 30 mins before and after eating.. they should be prepared for their mind to play games with themselves.. they dont do brain surgery when they do stomach surgery.. and you will see something and think you can eat that and you really cant.. then you'll get sick. or your brain will tell you that you are still huge after you've lost weight and you're not so huge anymore.. it affects the self esteem..

and theres the sugar issue.. i know a lot of people don't even try sugar after surgery because of the fear of 'dumping'.. but some of us do try it and discover that it doesn't effect us like that.. which is bad because now we know we can eat sugar and not hurt (yes, I'm one of those) take your vitamins!! cant be stressed enough. im bad about it.. and im low in iron and b12.

and after we lose the weight, we still have to continue with our 'diet' or lifestyle.. we cant just go back to how we used to eat.. we can gain the weight back. i think people tend to forget that after time.

tell them to try a bunch of different protein drinks.. they don't all taste the same. and even if they hate one, try it again after surgery.. your tastes change. I have only found one type i like, and i cant stand the kind my MIL likes.. so it varies with everyone. protein protein protein. need lots of it daily!

the first 6 months after surgery are your 'honeymoon period'.. you lose the weight the fastest.. after that it slows down some. so, during those 6 months, eat the way you should, and do some form of exercise.. even if its just going for walks around the block.

I typed the 6 month date out, printed it, and taped it to the wall in front of my treadmill. I also taped up pics of outfits/styles in magazines I wanted to be able to wear. It gave me a little bit of incentive. ;)

Knowing How Much to Eat

This issue is understandably a source of significant concern for Weight Loss Surgery patients. There is no single answer that fits all patients at all times following surgery, so guidelines are going to be laid out instead of a list of amounts and types of food.

First, during the recovery phase from surgery (1-4 weeks) it is normal to have no appetite. During this time you are likely to consume far less food than you would need over the long haul to stay healthy, but in this recovery period it is OK. Your surgeons want you to be sure you consume adequate fluids (zero-calorie) to stay well hydrated, but they do not want you to force food. At this stage, food should be used to begin to teach yourself new eating habits that will help you feel well and lose weight over the following year.

Next, a few teaching points about knowing when you have eaten enough:

• Don't eat until you feel full. The reason has to do with the fact that the nerves of satiety (feeling of stomach fullness and eating satisfaction) are "slow" nerves. There is a delay of around five minutes from the time your stomach pouch gets comfortably filled to the time that your brain becomes aware of that fact. If you swallow even one additional bite then the pouch will be overfilled and you will experience painful nausea. Realistically, every patient will experience this overfilled feeling at least once or twice, and it will not damage your stomach if it does not become a pattern. The goal is to learn from the experience - remember how much was consumed and what kind of food it was. Next time, use your memory and your eyes to know when to stop eating, before you feel full.
  
• An irritated stomach stays that way for a day or so. If you overeat or if you eat something that does not agree with you, the stomach pouch will be irritated for 12-24 hours. While your stomach is irritated it will be less tolerant of food and liquid than usual, and even small amounts of food can cause the overfull feeling to recur. The lesson here is that if you have an overeating episode, give the stomach pouch a chance to recover by taking only clear liquids for the next meal or two, then slowly add soft foods and eventually transition to solid foods. You can apply this principle to any situation where your stomach pouch is irritated - if medications or an illness makes you feel unable to eat, simply consume liquids alone to maintain your hydration...
  

 

(Information from WHMC Gastric Bypass Nutritional Guidelines Handbook)

 

 

Dining Out: Making better choices

By Staci Stone, RD, CDN

 

For the original article go to http://www.obesityaction.org/magazine/oacnews5/nutrition.php

 

These days, dining out has become the norm rather than the exception. Gone are the days when dining out was a

unique event saved for special occasions with the entire family present. With our hectic lifestyle and busy schedules, dining out is sometimes a necessity, and for many it may mean eating out several times per week and for more than one meal in a day. In addition, having an abundance of eateries available, ranging from breakfast carts to fast food chains to high end restaurants, may make even the most health conscious person feel overwhelmed. Usually, when we eat out we are consuming a lot of extra calories, mainly from fats and large portions, not to mention the extra sodium. While not always easy, it is possible to stay on track with a healthy eating plan while still enjoying the pleasures of dining out.

 

General Tips for Eating Out: This list helps individuals make better choices when eating out.

• Plan ahead; try to read the restaurant menu first. The Web site www.menupages.com has many menus
  

  available from major cities. Or, call the restaurant ahead and ask them to fax or email you the menu.
  

• When choosing a restaurant, try to avoid buffets. The multitude of choices will likely cause you to
  

  consume extra unwanted calories.
  

• Don't arrive to the restaurant starving. You will be too tempted to snack on breads, nuts, etc. which will quickly rack up the calories.
  
• Don't be afraid to ask how something is prepared. Broiled fish is better than fried fish, however if it is
  

  broiled in butter then that is not the best choice.
  

• Request sauces, gravies and dressings on the side. Ask how vegetables are prepared and always order
  

  them steamed. For side dishes, ask to double up on vegetables and omit potatoes, rice or french fries.
  

• Omit high calorie toppings such as sour cream, mayonnaise or tartar sauce. Mustard, tomato sauce and
  

  salsa are all lower fat alternatives where appropriate.
  

• Ask the server to remove the bread basket from the table. Avoid rolls, bagels, croissants and pastries which can add 200-400 calories to your meal. For a sandwich, order it on whole wheat or pita bread.
  
• Avoid these cooking methods: au gratin, fried, cream sauces or soups, "cream of," breaded, alfredo, battered and parmiagiana. Instead, choose healthier preparations: au jus, steamed, poached, grilled, baked, lightly sautéed, barbequed and roasted.
  
• Be careful of mayonnaise based salads such as potato salad, macaroni salad, cole slaw, etc.
  
• Don't waste your calories on drinks. Choose water, diet soda, unsweetened iced tea, etc. Monitor your
  

  servings of alcohol as well.
  

About the Author:Staci Stone, RD, CDN, is a registered dietitian who works for Columbia University in NY with the Center for Advanced Surgery. She specializes in working with the bariatric population, providing nutrition counseling both pre and post surgery.

B-12 Deficiency

B-12 absorption may be altered to some degree after gastric bypass surgery, which can lead to B-12 deficiency and pernicious anemia in some people. Multivitamins typically contain B-12, but this may not prevent B-12 deficiency in all people after surgery. Treatment for B-12 deficiency will likely include B-12 supplemented sublingually or in some cases shots (usually monthly). Your doctor will let you know when you need this.

Prevention:

-Take your vitamins as directed.

-Be sure to come to all your scheduled follow-up appointments for lab tests. (lab tests can detect B-12 deficiency)

-Be sure to have your B-12 levels tested at least yearly after the first year following surgery.

(Information from WHMC Gastric Bypass Nutritional Guidelines Handbook)

 

Daytime Support Group Today

Come out and join us for the Daytime Support Group
In the General Surgery Clinic @ 1130-1230
No appointment needed - just show up!

FOOD FOR THOUGHT

Dr. Cynthia Alexander, in her book, The Emotional First Aid Kit; she reminds patients that weight loss surgery consists of two entirely separate components: The surgery itself, and the lifestyle changes.

She suggests six things patients might do pre-operatively to address lifestyle changes:

1. Prepare your environment.
   
2. Prepare your Support System
   
3. Emphasize activity instead of food
   
4. Begin to learn to structure your eating habits
   
5. Control emotional and recreational eating
   
6. Become more active.
   

By embarking on this journey before surgery, patients avoid the outdated way to thinking; waiting until after the surgery to start lifestyle changes. Alexander believes healthy habits start prior to surgery.

Reference:

Matrix Medical Communications, Bariatric Times. Volume 4, Number 5, June 2007

Jacques, Jacqueline, ND, Protein Basics Bariatric Times, Matrix Medical Communication, Volume 4, Number 4, May 2007.

(Information from WHMC Gastric Bypass Nutritional Guidelines Handbook)

Iron Deficiency

If you don't take in enough iron, you may become iron deficient.

Prevention:

--Be sure to include low fat meats when you are at stages 3 and 4. They are your best food sources of iron.

--Take a multivitamin with iron as instructed.

--Don't take your vitamins or eat your high iron foods with coffee or tea. The coffee and tea can bind iron and prevent absorption.

No one can guarantee you won't develop iron deficiency, even if you follow these guidelines, but you can minimize your risk for iron deficiency.

(Information from WHMC Gastric Bypass Nutritional Guidelines Handbook)

 

 

Agreement expands AF beneficiaries' access to bariatric surgery

Agreement expands AF beneficiaries' access to bariatric surgery


by Sue Campbell
59th Medical Wing Public Affairs

1/7/2009 - LACKLAND AIR FORCE BASE, Texas -- According to the Centers for Disease Control, two-thirds of all Americans are overweight or obese. Thanks to a resource sharing agreement between the Nix Health Care System and the 59th Medical Wing, Wilford Hall Medical Center doctors are providing increased services to bariatric patients.

An agreement was initially implemented in 2007, allowing Wilford Hall providers to perform surgeries in Nix operating rooms, using Nix equipment and support staff. In December 2008 the agreement was modified to include bariatric surgeries. 

Read this article at the link above or cut and paste the following url 

http://www.whmc.af.mil/news/story.asp?id=123130372

Recipes for High-Protein supplements

High-Protein Milk

Instructions: In a blender, mix:

1 cup skim milk

2 scoops (1 ounce) Carb Solutions or other protein powder

Sugar substitute

Vanilla or flavoring

--This recipe provides: ..190 calories..28 grams protein..2 grams fat..1 gram fiber

Variations:

• Chocolate milk: Add unsweetened cocoa powder to the recipe before mixing.

• Hot chocolate, heat the chocolate milk. Sip slowly.

 

High-Protein Fruit Punch

Instructions: In a blender, mix:

6 ounces sugar-free powdered fruit drink (such as Crystal Light or sugar-free Kool Aid)

2 scoops (1 ounce) protein powder

4 ice cubes

--This recipe provides: ..110 calories..20 grams protein..4 grams carbohydrate.. 2 grams fat

 

High-Protein Cream Soup

Eat soup when it is lukewarm.

Instructions: Mix well:

1 cup nonfat dry milk powder

1 teaspoon chicken or beef bouillon

3 tablespoons protein powder

Add enough hot water to equal 1 cup.

--This recipe provides: ..200 calories..24 grams protein..20 grams carbohydrate..2 grams fat

 

**Choosing Liquid Protein Supplements from the Pharmacy or Grocery Store**

 

Read labels. Look for supplements with:

• At least 15 grams (g) of protein per 8-ounce (1 cup) serving

• Less than 20 grams Total Carbohydrate per 8-ounce serving

• Less than 5 grams fat per 8-ounce serving

 

Do not choose any of the following supplements. They are too high in carbohydrates:

• Regular Carnation Instant Breakfast

• Ensure

• Slim-Fast

• Boost

 

**Tips for Protein Shakes**

• Non-fat plain yogurt can be added to shakes to increase protein and creaminess
  
• Freeze skim milk in ice cube trays. Blend these "milk cubes" with your shake to make it cold and slushy. This also adds protein without diluting your shake.
  
• Turn an ordinary protein shake into a vanilla or mocha latte by adding 1 teaspoon of decaffeinated instant coffee to a vanilla or chocolate shake. Or add 1 serving Sunrise Orange Crystal Light® to a vanilla shake for a dreamsicle flavor.
  
• If you find that you do not tolerate milk, you can use fat free Lactaid milk or soy milk to add protein to your shake. Avoid flavored soy milk (i.e. vanilla, chocolate, almond) as it contains a large amount of added sugar.

Hydrate!!!!

Patients who have had bariatric surgery are at greater risk of dehydration. Dehydration is one of the common reasons to be admitted into the hospital after surgery. After bariatric surgery you should be drinking at least 6-8 cups (48-64 oz) of fluid every day. Fluid combination should be ½ clear fluids and ½ protein drinks. Drinking this much fluid is more challenging after surgery because you cannot drink as much at one time. To avoid stretching your stomach, slowly sip beverages. Initially it should take you 10-15 minutes to drink 1 ounce of fluid. Avoid fluids during meals, by drinking 30 minutes before or after eating.

Sign of dehydration:

• Dry mouth or skin
  
• Headache
  
• Dark urine or little urine output
  

**if you experience any of these increase your fluid intake

Why is it required to have a psychological evaluation prior to weight-loss surgery?

By David Engstrom, PhD, ABPP

All of this content is from: http://www.obesityaction.org/magazine/oacnews4/healthqanda.php

If you become a candidate for bariatric surgery, you will likely be referred for evaluation and consultation with a psychologist. Although this may seem surprising to you, it has become a routine part of your preparation for surgery. Your follow-up care will be provided by a team of professionals and each of them, including a dietitian, exercise therapist and psychologist, will need to become more familiar with you and your individual situation and needs.

People sometimes say, "Why do I have to see a psychologist?"
There are two very good reasons for this evaluation. First, many insurance companies realize its importance and require a psychological evaluation before they will approve bariatric surgery. More importantly, your entire surgery team of physicians, nurses and dietitians want you to maximize your success – to lose excess body weight, become a healthier person and improve the quality your life to the greatest possible extent.

The psychological evaluation can help identify your strengths, such as a strong motivation to exercise as your weight is coming off, a complete understanding of the effects of surgery or a supportive marital relationship. It can also help find areas where you might need support after surgery, such as depression or mood swings, lack of family support or triggers for past emotional eating.

The thought enters some people's minds, "Do they think I'm crazy?"
It is important for you to understand that people with obesity are usually psychologically normal and do not fit any specific psychological profile. The psychologist's main purpose is not to find underlying problems and conflicts that might have caused you to become obese. Most psychologists who perform these evaluations specialize in health psychology, and as such, are looking for ways to help you prevent disease and promote health in the future. The psychologist's purpose is never to "fail" people and exclude them from surgery. In fact, studies have shown that a very small number (perhaps four percent) of individuals are found to be poor candidates based on their psychological evaluation results.

Weight-loss surgery is by far the most successful treatment method for people with morbid obesity, where the body mass index (BMI) approaches 40 or greater. There is really no specific personality pattern that predicts success or failure after surgery. Many studies have examined depression, bipolar illness, history of childhood sexual abuse and even severe mental illness or eating disorder as potential predictors of failure to reach weight-loss goals after surgery.

Results have shown no clear-cut predictors of failure. As an example, about 40 percent of candidates for bariatric surgery have a history of depression. Often, the depression is being treated with medication and/or counseling and is well controlled. This situation almost never presents a problem after surgery.

There are, however, behavior patterns which suggest greater need for follow-up after your surgery. For example, grazing, or non-mindful snacking and nibbling on high-calorie foods between meals can be a problem if not identified and stopped once you have had surgery. It is a pattern that significantly reduces your chances of success.

Your evaluation will probably include psychological testing, such as personality tests, mood inventories and other questionnaires. This paperwork is often completed before meeting with the psychologist. You will also have a face-to-face interview, usually scheduled for about an hour.

It is often suggested that you bring a family member or close friend along to the interview if possible, since it is important to know that you have good family and social support. Results of the testing are usually discussed during this time, and the psychologist will want to know about your family and social history, any medical or psychological concerns you may have and your reasons and motivation for seeking the surgery. You will also be asked about your past and present eating patterns, your level of activity and exercise and your current family and social situation.

The psychologist can often answer questions you might have. For instance, some people are fearful of the surgery itself and may be able to benefit from stress management techniques. There is evidence that people who are relaxed prior to many types of surgery not only heal faster, but also have less post-operative pain. The psychologist may be able to guide you toward techniques which may help with this.

Others may be concerned about future feelings of "deprivation," such as not being able to eat their favorite rich, high-calorie foods after surgery. The psychologist will help you to understand that these feelings, if they occur at all, will usually be short-lived. And, if you feel the need for a referral for counseling, please feel free to ask. Just remember, the psychologist is part of your "safety net" after your surgery whose primary focus is your ultimate success.

About the Author:
David Engstrom, PhD, ABPP, is a clinical health psychologist, board certified in Clinical Psychology. He practices in Scottsdale, Arizona and is a psychologist at Scottsdale Bariatric Center. An active member of the American Society for Bariatric Surgery and is a specialist in applying mindfulness techniques to long-term weight management. Dr. Engstrom currently serves on the OAC Advisory Board.

Eating Behaviors to start before surgery

Prior to surgery is the best time to start your new nutrition and lifestyle changes that you will need to incorporate into the rest of your life.

 

• Slow rate of eating
  
• Slow rate of drinking – sip fluid, do not gulp
  
• Do NOT use straws – cause you to swallow a lot of air, causing gas
  
• Drink liquids separate from meals – 30 minutes before or after meals
  
• Do not drink carbonated (bubbly) drinks – bubbles may cause gas/bloating, and stretch the stomach pouch
  
• Avoid caffeine – it irritates your stomach and causes dehydration
  
• Avoid alcohol – contributes to dehydration and has no nutrients
  
• Eliminate high calorie drinks – like milkshakes, regular soft drinks, sports drinks, juice, sweet tea; switch to sugar free and low fat beverages
  
• Drink 8-10, 8 ounce glasses of water daily
  
• Break the "sweet tooth" – no sweets or desserts with regular sugar
  
• Limit high-fat and fried foods – breading, high fat sauces, high fat meats, junk food and sweets
  
• Practice decreasing portion sizes – use a salad plate and infant spoons
  
• Eat 5-6 small meals daily – make a schedule if needed; stop eating at first sign of fullness
  
• Chew your food to applesauce consistency
  

Co-morbidity Reduction After Bariatric Surgery

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Support Group

Next support group
Daytime- 19 Nov 2010 in the General Surgery Clinic from 11:30 to 12:30
Evening- 2 Dec 2010 at the Gateway Club on Lackland from 6:30pm to 8:00

**Reminder: all patients must attend at least one Support Group meeting before surgery, remember to sign in.