Quotes & Sayings

Weight loss surgery is not an event with a finish line or a goal weight -- it is the beginning of a new way of life   ~Susan Maria Leach

The Do's and Don'ts for a Successful Exercise Program

by Julia Karlstad, MEd, CSCS

Original content: http://www.obesityaction.org/magazine/ywm20/fitnessandwls.php

If you're considering weight-loss surgery or have already had weight-loss surgery, your commitment to adopting a physically active lifestyle along with sustaining healthy eating habits are critical to your long-term success.

Having worked with hundreds of weight-loss surgery clientele, I have seen some phenomenal success stories and I can say without hesitation that the successful weight-loss surgery patient has incorporated regular exercise into their daily lives. The important thing for you to recognize is how to exercise in order to compliment your weight-loss efforts and in turn sustain your fitness regimen injury free!

Combating Excess Body Weight

Excess body weight often restricts your ability to be physically active and it is important for you to understand how to work around these mobility limitations. The excess body weight as a whole is the biggest obstacle when determining an appropriate exercise program. Weight-loss will always be your number one objective initially since decreasing weight allows more mobility and puts less stress on your joints. Not to mention, the number one reason you had weight-loss surgery was to lose weight and increase your health, thus your exercise program should complement the effects of the surgery.

If you are an obese person or a fitness professional working with an obese client (body mass index greater than 30) follow these physical activity recommendations:

• Increase daily activity. For example, wash the dishes by hand, clean the house, park further away, try using the stairs, etc.
  
• Start slow and gradually progress until you're exercising 60 minutes a day, six days/week.
  
• If your BMI is greater than 35, make every effort to avoid exercises that would create greater stress on your joints. Avoid activities such as jogging, jumping and competitive contact sports.
  
• Do aerobic exercise that is low to moderate in intensity. This is best for weight-loss.
  
• Emphasize duration over intensity in your exercise.
  
• Select a modality of exercise that works around any physical or medical limitation.
  
• Strength training should consist of two to three sets of 12-15 repetitions. Use light to moderately heavy weights. The goal is to maintain your lean muscle through the weight-loss phase, not to bulk up.
  
• Focus on doing a total body strength training workout. Strength train anywhere from one to three times per week (a minimum of once per week), and be sure to leave at least 48 hours between strength training sessions.
  
• Always remember that joint pain is not healthy pain. If the exercise causes pain, modify the exercise to alleviate the pain.
  
• If you have major joint limitations in your lower extremities, try to perform most of your strength exercises from a seated position.
  
• Always change up your exercise routine (i.e., flexibility, cardio and strength training) every four to six weeks.
  

Exercise Guidelines for Each Stage of Weight-loss Surgery

The best thing a weight-loss surgery candidate can do to prepare themselves for both before and after surgery is to increase their level of fitness. The better cardiovascular condition before surgery, the fewer complications they'll experience during and after surgery. The following guidelines should prove helpful:

Preoperative Stage

• Make weight-loss a primary goal of your exercise program. Excess fat can make the weight-loss surgery operation itself more challenging. In fact, most surgeons require that their patient lose a certain amount of weight before they will operate.
  
• Focus on cardiovascular exercise to improve heart health, decrease body weight and help lose body fat before surgery.
  
• Follow the exercise guidelines discussed above.
  

Post-operative Stage

If there are any postoperative complications, that is physical problems following the weight-loss surgery, schedule an appointment with your bariatric surgeon and follow the surgeon's recommendations for an exercise program.
For the first four weeks after surgery, focus on flexibility exercises, deep breathing and getting back into performing normal daily activities.

Gradually incorporate low-intensity aerobic exercise (i.e. walking, biking or swimming).
If the surgery was laparoscopic, it is generally safe to start exercising up to your pain threshold two weeks after surgery, but it is best to consult with your surgeon before starting any exercise program.
If the surgery was "open," it may take a few more weeks to recover. Here are some tips for those that underwent "open" procedures:

• During the first six weeks after surgery, do not lift any more than 15 lbs; otherwise, exercise up to pain threshold.
  
• Avoid abdominal exercises for the first eight to 12 weeks (allow the incision to heal). This helps alleviate abdominal hernias near or around the incision.
  
• Significantly reduce caloric intake. During the first few weeks to months after surgery, patients should consume less than 500 calories a day (the surgeon will give specific instructions). This significant decrease in calories may initially cause some fatigue. Therefore, do not perform high-intensity exercise. As weight is lost and the level of fitness is improved, you will be able to take in a few more calories as well as exercise at higher levels of intensity. Follow the surgeon's dietary recommendations.
  

Caloric Intake

The bariatric surgeon may increase the caloric intake to 1,200-1,400 calories six to 12 months after surgery, particularly if their patient has lost a large percentage of their excess weight. Follow the surgeon's and/or dietitian's recommendations on food intake. Regularly monitor and assess your exercise program to ensure continued compliance and continued weight-loss which ultimately leads to weight maintenance.

Conclusion

A lifelong exercise program is critical to a weight-loss surgery patient's long-term success. Bariatric surgery is a valuable tool for rapid weight-loss; however, in two to three years, if a physically active lifestyle has not been adopted, the weight returns.

Exercise is insurance for long-term weight-loss. If you can stick to this advice, you'll be at a healthy weight and in good physical condition for years after your weight-loss surgery.

About the Author:
Julia Karlstad, MEd, CSCS, is the president of JKFITNESS, LLC. Julia has worked in the fitness industry and specifically the medical wellness community for several years. Previous to owning her own business, Julia personally developed and directed an exercise physiology program that consisted of two bariatric hospitals and three medically supervised weight-loss clinics. For more information on Julia, please visit www.juliakarlstad.com or www.jk-fit.com.

Foods to avoid after surgery

The following foods should be carefully limited or eliminated for the rest of your life:

Cakes        Candy Bars    Candy         Chewing gum        Cookies

Custard    Granola    Honey        Ice Cream        Jam and Jelly

Molasses    Pastries    Pies        Sugar            Sweet Rolls

Sugar coated cereals        Syrup        Sweetened Fruit    

Sweetened Condensed Milk

 

Severely restrict:

Regular soft drinks     regular fruit drinks     sweetened seltzer water     Ensure

Ultra Slim Fast or any sweetened beverages (unless sweetened with saccharin

NutraSweet     acesulfame-K or Splenda (surcalose)        aspartame

 

(Information from WHMC Gastric Bypass Nutritional Guidelines Handbook)

WHMC Bariatric Weight Loss Surgery (WLS) Program

Step 1: Referral from Primary Care Manager (PCM)

Step 2: Attend Initial Informational Briefing

Step 3: Attend Surgery Specific Briefing-enrollment in program

Step 4: Complete Pre Surgery Checklist

Step 5: Notify clinic checklist complete @ 292-4303

Step 6: Pre-Operative Appointment

Step 7: Surgery

Step 8: Follow up appointments

Protein powder

The following recipes can be found at the original link http://www.unjury.com/using/weight_loss_surgery_protein.shtml

 

Quick Ways to Use Each UNJURY Flavor

Chocolate

Mix in 8 oz. skim milk or soy milk. Customers say, "Tastes like chocolate milk!" Mix in 8 oz. warm coffee (about 130○ F, not hotter). Makes a mocha!

Vanilla

Mix in 8 oz. skim milk or soy milk. For an old fashioned custard taste Mix in 8 oz. warm coffee (about 130○ F , not hotter) Rich creamier taste Mix in 8 oz. orange beverage (example Crystal Light). Makes a dreamsicle!

Strawberry Sorbet

Mix in 8 oz. cold water. Fresh light strawberry taste Mix in 8 oz. sugar free lemonade. Strawberry lemonade!

Chicken Soup flavor

Mix in 8 oz. warm water (about 130○ F, not hotter). Tastes like cup-of-soup!

Unflavored

Mix in 8 oz. Crystal Light – Fruit Flavored such as Orange or Raspberry or Fruit Punch.

  Tips and Tricks

• Grab-and-Go: Mix up your favorite UNJURY drink the night before and leave in the fridge. Grab it on your way out the door for a healthy breakfast.
  
• Eating Out: Have a packet with you when you go out to eat. Order your beverage – milk, cold water, iced coffee – and an extra glass for mixing.
  
• Know your Microwave for Chicken Soup flavor: See how many seconds it takes your microwave to get water up to 130○ F. Then you know the time to get the water just right.
  
• Lunch at Work: Faster than a trip to the lunch counter, and probably more protein. Keep UNJURY handy, and there's always time for lunch.
  
• Milk Ice Cubes: For richer frosty-cold drink, substitute frozen skim milk ice cubes (from milk ice cubes frozen in your ice cube tray) for some of the milk. For example, use ½ cup of frozen cubes and ½ cup milk in your recipe. Blend in blender until smooth.
  

 
 

 
 

 
 

Support Group Daytime today

Come out and join us for the Daytime Support Group
At the General Surgery/Bariatric Clinic (WHMC) on Lackland AFB

11:30am to12:30pm (1130-1230)

No appointment needed - just show up!

No need to check in at counter, just have a seat in the waiting room and one the Clinic Nurse/Technicians will come out and call attendees to the conference room at 11:30.
**Reminder each patient must attend one meeting before surgery

Bariatric Surgeons will be there
Topic is selected and presented by the clinic Nurses'

Questions call (210) 292-4303 during duty hours

Gastric Bypass Post Operative Complaints

 

Complaint	First Try	Then…
Nausea	Eating different foods, eat slower, a little fluid with bites of food, luke warm fluids instead of very hot or very cold foods, look at the food label and make sure the carbohydrate content is not too high, smaller bites of food	See physician or dietitian (bring food log)
Vomiting	Eat slower, smaller bites, smaller more frequent meals, practice good food sanitation, go back to a Stage 1 or 2 for a few days	See the physician about a swallow study
Dumping Syndrome (Nausea, Vomiting, Cramping)	Don't eat "problem causing" foods, eat less carbohydrate and fat	See dietitian or physician if this becomes a problem
Diarrhea	Eat enough fiber (use supplement if necessary-see below)	If it lasts for longer than 3 days and is causing discomfort, see the physician
Constipation	Increase fluid intake, increase fiber with Citrucel or Benefiber—Metamucil can cause gas	Increase exercise if possible, increase Citrucel or Benefiber as directed by a dietitian or physician
Lethargy (feeling tired)	Increase exercise, take a multivitamin, protein powder and enough fluid	Get vitamin B12 and iron studies, possibly pre-albumin
Hair Falling Out	Increase protein intake. Take a multivitamin, may need gel cap vitamin	Get tocopheral, retinol, zinc studies. May need additional supplementation as appropriate
"Food Caught in Chest" Feeling	Drink a little fluid with food to wash it down	Consider swallowing study
Blood in Vomit or Stool	Call physician immediately	----------------------------
Fever	Call physician immediately	----------------------------
Lactose Intolerance	Use Lactaid, soy milk, and/or lactase pills	----------------------------
Gas	Try Beano, Gas-X or Simethicone drops	Begin a lactose free diet, see lactose intolerance above.

 

(Information from WHMC Gastric Bypass Nutritional Guidelines Handbook)