To recognize when it’s time to adjust a gastric band – REALIZE or Lap Band - you need to understand how gastric band surgery helps you lose weight. In short, gastric band surgery works by restricting you from eating large portions of food at a time. The REALIZE and Lap Bands only work on the amount of food you intake; they do not have sensors to prevent you from eating high calorie or unhealthy foods such as ice cream or fast foods. It also does not prevent you from ingesting liquid calories - soda, juices, vitamin water, etc., which slip through the band’s restriction around the top of the stomach with ease. Lastly, eating multiple meals per day, or grazing, will hamper weight loss as the total calorie count per day will go up with multiple meals. It’s key for gastric band patients – REALIZE or Lap Band - to aim for three meals per day with 30 minutes spent on each meal.
During the first year after surgery, you will require approximately three to five REALZIE or Lap Band adjustments to achieve your goal weight. The band adjustments are done either in your surgeon’s office or under fluoroscopy (X-ray) at hospital or surgery center. There is no right or wrong way to perform band adjustments. At the New Jersey Bariatric Center, we routinely perform band adjustments (more than 99%) in the office. There is no need for local anesthesia with adjustments, they usually take five to 10 minutes, and are less painful than getting blood drawn.
On average, the goal is to lose one to two pounds per week after REALIZE or Lap Band surgery. Band adjustments are performed approximately every four to six weeks when one is either no longer able to achieve a one to two pound weight loss per week while eating healthy or feels hungry between meals to the point that it’s distracting you from normal daily activity. The key is finding the level of restriction that decreases your food intake without making you uncomfortable or hungry all the time. It’s important to be patient with yourself in the beginning, you will be getting use to a new way of eating and may face the inability to tolerate certain hard foods that you use to eat prior to surgery.
I hear different gastric band myths from patients all the time. Some of the most common to consider prior to band adjustment include:
1. The tighter the band, the faster the weight loss. When the band is too tight it often leads to cheating. When it’s so tight that you’re at the point where you can’t tolerate solid foods, you will often compensate by eating high-calorie liquid calories [soda, juices] or soft foods [ice cream]. In this scenario, you may have a tighter band, but you can actually gain weight. Another way to cheat is to graze, eating smaller meals all day long. This can backfire too by increasing an individual’s calorie intake. And finally, patients whose bands are too tight often will “lubricate” it with sauces and creams to get the food through the opening, once again increasing the calorie intake and gaining weight, instead of losing it.
2. The more adjustments one gets, the faster the weight loss. Making to frequent adjustments will only lead to a very tight band, leaving you unsatisfied, which often leads to cheating.
3. You can lose the same amount of weight per week as one does with gastric bypass surgery. Gastric bypass surgery restricts your food intake like gastric band surgery, however it also involves malabsorption of food which increases weight loss. Therefore, you will not lose weight at the same rate as a gastric bypass patient.
If you feel off track and aren’t happy with your weight loss, I suggest you participate in a small one to two week calorie count assignment to help determine why you’re not losing the weight. The assignment starts by recording everything you eat daily in order to calculate the total calories taken in each day. Two sites I recommend to help with the calculations are www.FitDay.com or www.thecaloriecounter.com. I find that patients who aren’t happy with their weight loss, tend to take in more calories per day then they realize, particularly the liquid calories which I mentioned earlier that can slip through the band quite easily, but also eating multiple meals a day and continuing to eat fast food can put you off course. Charting your calorie intake will help you determine if you fall in this category. Remember, to lose weight with the band, you need to take in no more than 1200 calories per day and perform cardio exercise at least 30min three times per week to be successful. Some additional tips to maximizing weight loss include weighing yourself on a weekly basis, regular monthly appointments with your bariatric surgeon to evaluate progress and regular calorie counting to keep you on track.
New Jersey Bariatric Center
The New Jersey Bariatric Center, led by Dr. Ajay Goyal, has offices in Union and Hoboken, New Jersey. Dr. Goyal’s approach to patient care has resulted in zero mortality to date and a complication rate that is lower than the national average. These surgical results stand out as some of the best in New Jersey. If you or someone you love is considering bariatric surgery – gastric bypass, REALIZE band or lap band procedure - please join us for one of our free educational seminars. To register, visit us at www.njbaritriccenter.com.
###
New Jersey Bariatric Center
700 Rahway Avenue
Union, NJ 07083
Phone: (908) 378-1779 (Business hours)
Phone: (201) 461-1915 (Service)
Fax: (908) 688-8861
www.njbariatriccenter.com
Monday, June 30, 2008
Friday, May 16, 2008
Five tips to friends and family members so they can help bariatric surgery patients achieve their goal weight loss
Bariatric surgery – gastric bypass, Lap Band and REALIZE Band procedures - is recognized by the National Institute of Health as a safe and effective way for morbidly obese patients to lose weight. But surgery is only a tool, it’s still up to the patients to adhere to healthy diet and exercise program. With the food the center of many family activities, the New Jersey Bariatric Center finds that patients with strong family support and encouragement can increase weight loss success. Family support keeps patients on track as well as losing and maintaining their weight throughout their life.
“From the simplest everyday family dinner to the large family holiday celebrations, food and family are closely linked,” says Dr. Ajay Goyal, surgeon, New Jersey Bariatric Center. “While the ultimate success of weight loss surgery lies with the patients and their adherence to a healthy diet and exercise program, with family present during the majority of times when patients interact with food, their support and encouragement plays a significant role in a patient’s weight loss success.”
New Jersey Bariatric Center patient Dawn Rodriguez credits her husband and daughter’s support to her weight loss success. Rodriguez says while it wasn’t always easy on her family, “we had a lot of issues come up, even just sitting down to eat as a family became an issue because of what and how I had to eat compared with what and how they ate,” no matter what the issues were or how difficult it was at any given moment, her family never failed to support and be happy for her. “Even though losing weight is my accomplishment, if it wasn’t for them, I don’t think I would have gotten as far as I have or had the success that I’ve achieved.”
Five Tips for Family Members
Dr. Goyal offers five tips to friends and family members so they can help bariatric surgery patients achieve their goal weight loss after gastric bypass, Lap Band and REALIZE Band surgery.
1. Learn About the Surgical Procedure: Just as patients research and learn about what changes their bodies will undergo, it’s important for family members to do the same. Understanding the journey your family member is about to take will help you guide, coach and offer support throughout the process.
2. Respect Patients New Eating Habits: Your family member’s eating habits are going to change drastically immediately after weight loss surgery. Be respectful of their weight loss goal, don’t bring “treats” to the hospital after surgery, don’t encourage them to finish their plate when their full and try to refrain from tempting them with food - “a little bite won’t hurt you” - or inadvertently sabotaging their efforts, i.e. giving them a box of chocolates as a gift.
3. Don’t Blame the Patient: Over and over again patients remark that many of the toughest times during weight loss is when the family sits together at the dinner table. In many cases, the person who’s in charge of feeding the family is the patient, and the family overall sees a difference in the type of food now served that can be frustrating for family members. Fried chicken becomes grilled chicken, an ice cream treat is not a fruit treat. These little changes can cause bickering, squabbling and even heated debates at the dinner table. Try to stay away from responses such as “You chose this not me” or ‘Don’t punish me for your decisions,” stay calm, count to 10 before you respond, and find a solution that works for both parties.
4. Prepare for the Dynamics of the Relationship to Change: Was this your friend who you always went out for ice cream sundaes with when times got tough? Was your family member always a little shy due to her/his weight causing them to shrink from attention? As the weight comes off, prepare for the dynamics of the relationship to change. Instead of bonding over food or taking your joint frustrations out with food, find a new activity to enjoy together that doesn’t involve food – join a gym, take a class or start a book club. And understand your family member is still the person you’ve always known and loved, they’re not changing on you – you’re seeing a new confident side of them that’s always been there but that they were uncomfortable expressing when they were carrying the extra weight.
5. Compliment Success, Offer Encouragement During Setbacks: And finally, don’t forget to compliment your family member on the successes they’ve achieved, and offer encouragement during the more challenging times.
“From the simplest everyday family dinner to the large family holiday celebrations, food and family are closely linked,” says Dr. Ajay Goyal, surgeon, New Jersey Bariatric Center. “While the ultimate success of weight loss surgery lies with the patients and their adherence to a healthy diet and exercise program, with family present during the majority of times when patients interact with food, their support and encouragement plays a significant role in a patient’s weight loss success.”
New Jersey Bariatric Center patient Dawn Rodriguez credits her husband and daughter’s support to her weight loss success. Rodriguez says while it wasn’t always easy on her family, “we had a lot of issues come up, even just sitting down to eat as a family became an issue because of what and how I had to eat compared with what and how they ate,” no matter what the issues were or how difficult it was at any given moment, her family never failed to support and be happy for her. “Even though losing weight is my accomplishment, if it wasn’t for them, I don’t think I would have gotten as far as I have or had the success that I’ve achieved.”
Five Tips for Family Members
Dr. Goyal offers five tips to friends and family members so they can help bariatric surgery patients achieve their goal weight loss after gastric bypass, Lap Band and REALIZE Band surgery.
1. Learn About the Surgical Procedure: Just as patients research and learn about what changes their bodies will undergo, it’s important for family members to do the same. Understanding the journey your family member is about to take will help you guide, coach and offer support throughout the process.
2. Respect Patients New Eating Habits: Your family member’s eating habits are going to change drastically immediately after weight loss surgery. Be respectful of their weight loss goal, don’t bring “treats” to the hospital after surgery, don’t encourage them to finish their plate when their full and try to refrain from tempting them with food - “a little bite won’t hurt you” - or inadvertently sabotaging their efforts, i.e. giving them a box of chocolates as a gift.
3. Don’t Blame the Patient: Over and over again patients remark that many of the toughest times during weight loss is when the family sits together at the dinner table. In many cases, the person who’s in charge of feeding the family is the patient, and the family overall sees a difference in the type of food now served that can be frustrating for family members. Fried chicken becomes grilled chicken, an ice cream treat is not a fruit treat. These little changes can cause bickering, squabbling and even heated debates at the dinner table. Try to stay away from responses such as “You chose this not me” or ‘Don’t punish me for your decisions,” stay calm, count to 10 before you respond, and find a solution that works for both parties.
4. Prepare for the Dynamics of the Relationship to Change: Was this your friend who you always went out for ice cream sundaes with when times got tough? Was your family member always a little shy due to her/his weight causing them to shrink from attention? As the weight comes off, prepare for the dynamics of the relationship to change. Instead of bonding over food or taking your joint frustrations out with food, find a new activity to enjoy together that doesn’t involve food – join a gym, take a class or start a book club. And understand your family member is still the person you’ve always known and loved, they’re not changing on you – you’re seeing a new confident side of them that’s always been there but that they were uncomfortable expressing when they were carrying the extra weight.
5. Compliment Success, Offer Encouragement During Setbacks: And finally, don’t forget to compliment your family member on the successes they’ve achieved, and offer encouragement during the more challenging times.
Gastric Bypass, Lap Band or REALIZE Band – A Nutritionist’s Perspective
Frequently when I meet with patients contemplating weight loss surgery at the New Jersey Bariatric Center they’re still debating which surgery – gastric bypass, Lap Band or REALIZE Band – is right for them. Often, they ask for my opinion from a nutritional standpoint, regarding which one they should pick, or which one is “better.” These are decisions that can only be made by patients, together with their doctor, based on their weight, lifestyle, and medical history. However, what I can do is explain the nutritional differences between the surgeries to arm patients with the nutritional side of what life will be like post- gastric bypass, Lap Band or REALIZE Band surgery to factor into their decision.
One of the first considerations to look at nutritionally regarding weight loss surgery is vitamin and protein maintenance. While all three procedures require a multi-vitamin, a calcium supplement and a diet high in protein, Lap Band and REALIZE Band surgery requires less vitamin and protein maintenance than the gastric bypass. When bypassing the stomach and initial section of the small intestine as one does in gastric bypass surgery, you also bypass the area where B12, a key nutrient, is prepped [it binds with a stomach enzyme] to be absorbed in the small intestine. It’s therefore very important that gastric bypass patients take a daily supplement of B12, which is placed under the tongue so it can be absorbed directly into the bloodstream.
Protein supplements are also an important part of a weight loss surgery patient’s diet. It’s important for a Lap Band and REALIZE Band patients to supplement protein for the first two weeks after their surgery while they’re on a full liquid diet, and for gastric bypass patients to take a protein supplement for the rest of their life. The mal-absorptive nature of gastric bypass results in not only preventing the absorption of part of the calories one eats, but also the absorption of the proteins and nutrients one needs to survive. That’s why gastric bypass patients will need to supplement proteins and vitamins (Iron, Calcium, Vitamin B12) for the rest of their lives. To ensure you’re getting the nutrients you need to stay healthy, your doctor will perform annual blood check to see if you are adequately talking these vitamins and minerals. [Note - the side effects of not regularly taking supplemental proteins and multivitamins can take years to develop in some cases and by then it can be too late to replete the body of these essential building blocks so it’s essential you follow the supplement regimen your doctor prescribes.]
So, now it seems like the decision is simple – the Lap Band or REALIZE Band is the way to go, less vitamin and protein supplements to deal with, therefore it must be easier. It’s actually the opposite, Lap Band and REALIZE Band patients must be more vigilant about what they eat than gastric bypass patients.
Here’s why, let’s use liquids as an example- specifically liquid calories such as juices, sodas and fancy coffee drinks. For weight loss in general, it’s recommended to avoid all liquid calories. It’s even more important with weight loss surgery. Due to the mal-absorptive component of gastric bypass, liquid calories that are sweet will cause a patient to experience dumping syndrome (nausea, sweating, increased heart rate). Dumping syndrome is unpleasant, and experiencing it once often prevents patients from consuming these high calorie beverages again. This side effect, while unpleasant, helps curb a patient’s desire for unhealthy foods such as sweets. However, Lap Band or REALIZE Band patients can consume liquid calories without experiencing dumping syndrome. The absence of the mal-absorptive nature of the Lap Band or REALIZE Band doesn’t give their body the signal that these beverages are not good for them, thus making compliance with dietary restrictions more rigorous.
All surgeries – gastric bypass, Lap Band or REALIZE Band - have their pros and cons from a nutritional stand point, and choosing one is an individual decision based on your doctor’s counsel, your lifestyle and your tolerance to the different restrictive natures of both procedures. Regardless of which procedure you decide to move forward with, adopting an overall healthy lifestyle with proper nutrition and exercise is the key to success.
By Karen Kelly, RD, New Jersey Bariatric Center
One of the first considerations to look at nutritionally regarding weight loss surgery is vitamin and protein maintenance. While all three procedures require a multi-vitamin, a calcium supplement and a diet high in protein, Lap Band and REALIZE Band surgery requires less vitamin and protein maintenance than the gastric bypass. When bypassing the stomach and initial section of the small intestine as one does in gastric bypass surgery, you also bypass the area where B12, a key nutrient, is prepped [it binds with a stomach enzyme] to be absorbed in the small intestine. It’s therefore very important that gastric bypass patients take a daily supplement of B12, which is placed under the tongue so it can be absorbed directly into the bloodstream.
Protein supplements are also an important part of a weight loss surgery patient’s diet. It’s important for a Lap Band and REALIZE Band patients to supplement protein for the first two weeks after their surgery while they’re on a full liquid diet, and for gastric bypass patients to take a protein supplement for the rest of their life. The mal-absorptive nature of gastric bypass results in not only preventing the absorption of part of the calories one eats, but also the absorption of the proteins and nutrients one needs to survive. That’s why gastric bypass patients will need to supplement proteins and vitamins (Iron, Calcium, Vitamin B12) for the rest of their lives. To ensure you’re getting the nutrients you need to stay healthy, your doctor will perform annual blood check to see if you are adequately talking these vitamins and minerals. [Note - the side effects of not regularly taking supplemental proteins and multivitamins can take years to develop in some cases and by then it can be too late to replete the body of these essential building blocks so it’s essential you follow the supplement regimen your doctor prescribes.]
So, now it seems like the decision is simple – the Lap Band or REALIZE Band is the way to go, less vitamin and protein supplements to deal with, therefore it must be easier. It’s actually the opposite, Lap Band and REALIZE Band patients must be more vigilant about what they eat than gastric bypass patients.
Here’s why, let’s use liquids as an example- specifically liquid calories such as juices, sodas and fancy coffee drinks. For weight loss in general, it’s recommended to avoid all liquid calories. It’s even more important with weight loss surgery. Due to the mal-absorptive component of gastric bypass, liquid calories that are sweet will cause a patient to experience dumping syndrome (nausea, sweating, increased heart rate). Dumping syndrome is unpleasant, and experiencing it once often prevents patients from consuming these high calorie beverages again. This side effect, while unpleasant, helps curb a patient’s desire for unhealthy foods such as sweets. However, Lap Band or REALIZE Band patients can consume liquid calories without experiencing dumping syndrome. The absence of the mal-absorptive nature of the Lap Band or REALIZE Band doesn’t give their body the signal that these beverages are not good for them, thus making compliance with dietary restrictions more rigorous.
All surgeries – gastric bypass, Lap Band or REALIZE Band - have their pros and cons from a nutritional stand point, and choosing one is an individual decision based on your doctor’s counsel, your lifestyle and your tolerance to the different restrictive natures of both procedures. Regardless of which procedure you decide to move forward with, adopting an overall healthy lifestyle with proper nutrition and exercise is the key to success.
By Karen Kelly, RD, New Jersey Bariatric Center
Monday, March 10, 2008
PREGNANCY AND WEIGHT LOSS SURGERY
Gastric Bypass & Band Surgery (Lap Band & Realize Band) Increases Fertility
One of the first questions many of my female patients in their twenties and thirties ask me when contemplating gastric bypass or lap band surgery is how the procedures will affect their ability to get pregnant. Many have tried to conceive in the past, and have been unsuccessful. The good news is that in addition to improving ones overall health, both procedures can have a positive effect on fertility. While they can’t overcome serious fertility issues, research shows both gastric bypass and lap band surgery can improve many factors related to infertility for those who are obese.
Obesity’s Toll on Fertility and Pregnancy
Obesity takes a toll on the body, as many people know it’s often the cause of diabetes, heart disease, high blood pressure and sleep apnea. What many don’t realize is the toll carries over to fertility too. Being seriously overweight causes an increase in the level of two key hormones related to fertility – estrogen and testosterone. While an increase in these two hormones result in excess body hair and risk in breast and uterine cancer, it’s also directly related to infertility, causing irregular or heavy periods. Weight loss after gastric bypass or lap band surgery results in normalization of estrogen and testosterone, and a return to normal menstrual cycle and improved fertility.
For those who are able to conceive, obesity also takes a toll on the pregnancy increasing the risk for gestational diabetes, hypertension and spontaneous abortions. There is also an increased rate of cesarean sections due to large weight fetus that results from gestational diabetes. Weight loss surgery prior to pregnancy can help resolve the pregnancy-related medical conditions obese woman are at risk for, often resulting in a safe and healthier birth.
Pregnancy after Gastric Bypass or Lap Band Surgery
After patients learn about the benefits to weight loss on fertility, they quickly ask how gastric bypass or lap band surgery will affect pregnancy. Is pregnancy safe after surgery? Will I be able to take in enough nutrients for both me and the baby? Multiple studies show that pregnancy is safe after bariatric surgery provided you follow a couple of key guidelines. To start, for your safety and the safety of the baby it’s very important to avoid becoming pregnant for one year after gastric bypass surgery as this is the time where one’s weight loss will be most significant. Contraception is a must for the first year after both procedures, and for gastric bypass in particular oral contraceptives (OCP) might not be adequately absorbed after the procedure so it’s important to use an additional form of contraception.
With lap band surgery, one can safely conceive six months after the procedure but might not have lost enough weight yet to avoid pregnancy related health conditions.
As with any patients who have had weight loss surgery, nutritional supplements need to be taken religiously before, during and after pregnancy. This is because gastric bypass surgery is both a restrictive and mal-absorptive procedure. It results not only in a decreased intake of food – four to six ounces of food per meal - but it also decreases the absorption of calories and nutrients you have consumed.
Lap band and the new Realize band surgery is a restrictive procedure, resulting in only decreased amount of solid food one can consume at one setting. The decrease in calories, means a decrease of nutrients you take in, so it’s important to add nutritional supplements to your diet.
Key supplements to increase include iron to form new red blood cells, calcium for mineralization of fetal skeleton, folic acid to prevent birth defects, vitamin B1 (thiamine), vitamin B12 and vitamin A. Women should also take protein supplements in the form of protein shakes (Table1) or protein bars as one cannot take the recommended daily allowance of 60 grams of proteins per day from foods. I recommend taking at least half or 30 grams in supplements and the rest from foods rich in proteins. (Table 2)
For women who have undergone gastric bypass or lap band procedure pregnancy can be safe for them and even healthier for the baby with regular follow-up visits to your bariatric surgeon and obstetrician. Below are ten guidelines to help you along the way.
Ten Guidelines to follow for a safe pregnancy:
1. Avoid pregnancy for one year after weight loss surgery
2. Take multivitamins (Vitamin A, B1, B12, Iron, Folic Acid)
3. Make regular appointments with your bariatric surgeon and obstetrician
4. Obtain regular blood test to check for vitamin deficiency
5. Eat multiple small meals a day (at least four meals per day) and spend 30
minutes to eat each meal
6. Eat high-protein, low-carbohydrates and a low fat diet
7. Take 30 grams of proteins in supplements
8. Drink plenty of water (40 – 60 ounces per day)
9. Continue regular low impact exercise for both body and mind
10. For lap band or realize band patients, one can remove the restriction by an
adjustment if patients develop pregnancy related nausea.
Table 1 High-protein and low-carbohydrates shakes
Protein supplement shakes are best mixed with skim milk or lactaid milk as lactose intolerances can occur after surgery. Another option is to mix in the blender the protein powder with sugar-free yogurt or sugar-free beverages. You may split your protein shake into 2 or 3 servings, as long as you take 30 -40 grams of protein in 100-150 calories. Suggested supplements include:
• Designer Protein (90kcal/17.5g pro per scoop)
• Isopure (210kcal/50g pro per 2 scoops)
• Pro-stat 64 (15g proteins and 1g Carbohydrate per2 tablespoon)
• ISS Whey Protein (96kcal/17g pro per scoop)
• Twinlabs Triple Whey Fuel (100kcal/21g pro per scoop)
Table 2 Foods Rich in Protein
Our bodies need the amino acids and other nutrients found in protein-rich foods. Protein builds and repairs muscle, and is the fuel that gives our body energy. Patients should attempt to get at least 60 grams of protein a day. Good sources of protein include:
• Turkey, chicken, or beef - purchase 97% lean meat
• Baked, broiled, or BBQ skinless chicken, white turkey meat, or fish
• Ground or chopped chicken or turkey (white meat) for salads (use nonfat, non- dairy based dressing)
• Water packed tuna (1/4 cup = 1 oz meat)
• Egg whites or egg substitute. (Yolk has all the cholesterol and fat, whites
are pure protein)
• Nonfat yogurt
• Cereals: oatmeal or cream of wheat with nonfat milk
• Kidney beans, navy beans, lima beans, pinto beans
• Baked potato
• Nonfat cottage cheese (great on a baked potato)
• Cereals (read labels for those high in protein and fat free or low fat)
• Fish baked or broiled
One of the first questions many of my female patients in their twenties and thirties ask me when contemplating gastric bypass or lap band surgery is how the procedures will affect their ability to get pregnant. Many have tried to conceive in the past, and have been unsuccessful. The good news is that in addition to improving ones overall health, both procedures can have a positive effect on fertility. While they can’t overcome serious fertility issues, research shows both gastric bypass and lap band surgery can improve many factors related to infertility for those who are obese.
Obesity’s Toll on Fertility and Pregnancy
Obesity takes a toll on the body, as many people know it’s often the cause of diabetes, heart disease, high blood pressure and sleep apnea. What many don’t realize is the toll carries over to fertility too. Being seriously overweight causes an increase in the level of two key hormones related to fertility – estrogen and testosterone. While an increase in these two hormones result in excess body hair and risk in breast and uterine cancer, it’s also directly related to infertility, causing irregular or heavy periods. Weight loss after gastric bypass or lap band surgery results in normalization of estrogen and testosterone, and a return to normal menstrual cycle and improved fertility.
For those who are able to conceive, obesity also takes a toll on the pregnancy increasing the risk for gestational diabetes, hypertension and spontaneous abortions. There is also an increased rate of cesarean sections due to large weight fetus that results from gestational diabetes. Weight loss surgery prior to pregnancy can help resolve the pregnancy-related medical conditions obese woman are at risk for, often resulting in a safe and healthier birth.
Pregnancy after Gastric Bypass or Lap Band Surgery
After patients learn about the benefits to weight loss on fertility, they quickly ask how gastric bypass or lap band surgery will affect pregnancy. Is pregnancy safe after surgery? Will I be able to take in enough nutrients for both me and the baby? Multiple studies show that pregnancy is safe after bariatric surgery provided you follow a couple of key guidelines. To start, for your safety and the safety of the baby it’s very important to avoid becoming pregnant for one year after gastric bypass surgery as this is the time where one’s weight loss will be most significant. Contraception is a must for the first year after both procedures, and for gastric bypass in particular oral contraceptives (OCP) might not be adequately absorbed after the procedure so it’s important to use an additional form of contraception.
With lap band surgery, one can safely conceive six months after the procedure but might not have lost enough weight yet to avoid pregnancy related health conditions.
As with any patients who have had weight loss surgery, nutritional supplements need to be taken religiously before, during and after pregnancy. This is because gastric bypass surgery is both a restrictive and mal-absorptive procedure. It results not only in a decreased intake of food – four to six ounces of food per meal - but it also decreases the absorption of calories and nutrients you have consumed.
Lap band and the new Realize band surgery is a restrictive procedure, resulting in only decreased amount of solid food one can consume at one setting. The decrease in calories, means a decrease of nutrients you take in, so it’s important to add nutritional supplements to your diet.
Key supplements to increase include iron to form new red blood cells, calcium for mineralization of fetal skeleton, folic acid to prevent birth defects, vitamin B1 (thiamine), vitamin B12 and vitamin A. Women should also take protein supplements in the form of protein shakes (Table1) or protein bars as one cannot take the recommended daily allowance of 60 grams of proteins per day from foods. I recommend taking at least half or 30 grams in supplements and the rest from foods rich in proteins. (Table 2)
For women who have undergone gastric bypass or lap band procedure pregnancy can be safe for them and even healthier for the baby with regular follow-up visits to your bariatric surgeon and obstetrician. Below are ten guidelines to help you along the way.
Ten Guidelines to follow for a safe pregnancy:
1. Avoid pregnancy for one year after weight loss surgery
2. Take multivitamins (Vitamin A, B1, B12, Iron, Folic Acid)
3. Make regular appointments with your bariatric surgeon and obstetrician
4. Obtain regular blood test to check for vitamin deficiency
5. Eat multiple small meals a day (at least four meals per day) and spend 30
minutes to eat each meal
6. Eat high-protein, low-carbohydrates and a low fat diet
7. Take 30 grams of proteins in supplements
8. Drink plenty of water (40 – 60 ounces per day)
9. Continue regular low impact exercise for both body and mind
10. For lap band or realize band patients, one can remove the restriction by an
adjustment if patients develop pregnancy related nausea.
Table 1 High-protein and low-carbohydrates shakes
Protein supplement shakes are best mixed with skim milk or lactaid milk as lactose intolerances can occur after surgery. Another option is to mix in the blender the protein powder with sugar-free yogurt or sugar-free beverages. You may split your protein shake into 2 or 3 servings, as long as you take 30 -40 grams of protein in 100-150 calories. Suggested supplements include:
• Designer Protein (90kcal/17.5g pro per scoop)
• Isopure (210kcal/50g pro per 2 scoops)
• Pro-stat 64 (15g proteins and 1g Carbohydrate per2 tablespoon)
• ISS Whey Protein (96kcal/17g pro per scoop)
• Twinlabs Triple Whey Fuel (100kcal/21g pro per scoop)
Table 2 Foods Rich in Protein
Our bodies need the amino acids and other nutrients found in protein-rich foods. Protein builds and repairs muscle, and is the fuel that gives our body energy. Patients should attempt to get at least 60 grams of protein a day. Good sources of protein include:
• Turkey, chicken, or beef - purchase 97% lean meat
• Baked, broiled, or BBQ skinless chicken, white turkey meat, or fish
• Ground or chopped chicken or turkey (white meat) for salads (use nonfat, non- dairy based dressing)
• Water packed tuna (1/4 cup = 1 oz meat)
• Egg whites or egg substitute. (Yolk has all the cholesterol and fat, whites
are pure protein)
• Nonfat yogurt
• Cereals: oatmeal or cream of wheat with nonfat milk
• Kidney beans, navy beans, lima beans, pinto beans
• Baked potato
• Nonfat cottage cheese (great on a baked potato)
• Cereals (read labels for those high in protein and fat free or low fat)
• Fish baked or broiled
Saturday, March 8, 2008
Choosing a Procedure
Lap Band vs. Gastric Bypass: Choosing the Right Procedure
Patients considering weight loss surgery often ask “which procedure is right for me?” At the New Jersey Bariatric Center both surgical weight loss procedures -- gastric bypass or lap band -- result in successful weight loss. The best way to make the decision regarding which procedure is best for you is to consider several factors: loss of pounds, reversibility, diet requirements and risk, and compare the pros and cons of them against your personal goals.
Weight loss:
Initial weight loss with the gastric bypass is approximately 3lbs to 5lbs per week for the first three to six months. Over 18 months the gastric bypass procedure results in approximately 60 to 70 percent excess weight loss. However, gastric bypass is both a restrictive (restricts the intake of food) and mal-absorptive (less absorption of calories you take in) procedure resulting in weight loss from both decreased food intake and decrease calorie absorption. With the lap band procedure weight loss is slower, about 1lbs to 2lbs a week. Over an18 months it will approximately result in a 50-60% excess weight loss. Since the Lap Band is only restrictive, and not mal-absorptive, it requires much more personal will power to avoid high calories and snacking. In addition, Lap Band requires significant and consistent follow up for the first year to adjust the band. Keep in mind, that a slower weight loss does not necessarily mean less ‘hanging skin,’ nor does faster weight loss result in more ‘hanging skin’ problems. These issues are a factor of the amount of weight loss and your age, not the amount of time it takes to lose the weight.
Reversible:
Unlike the gastric bypass, the lap band procedure is reversible. At any time, you can choose to have the band removed. Keep in mind, patients who typically have the band removed often gain the weight back over a short time period.
Diet:
Regardless of the procedure, patients are required to eat healthy and exercise to maintain the weight loss. However, when comparing the procedures, the gastric bypass requires less dietary compliance as it combines both the restrictive and mal-absorptive components. With the bypass you simply can’t intake the same amount of food, high caloric food or eat to quickly without getting physically ill (dumping syndrome). However, due to the mal-absorption component of the bypass, patients must take protein and vitamin supplements for life. Dumping syndrome can occur after gastric bypass surgery resulting in dizziness and heart palpitations. It occurs 15 to 30 minutes after a high carbohydrate meal, especially one that's rich in sugars such as sucrose (table sugar) or fructose (fruit sugar). Some people also experience low blood sugar (hypoglycemia), related to excessive levels of insulin delivered to the bloodstream as part of the syndrome. Insulin influences your tissues to take up the sugar present in your bloodstream.
Risk: Link
To date, at the New Jersey Bariatric Center we have no mortality and below average complications for both procedures. However, when comparing the two procedures and looking at the national statistics the lap band has a significantly lower risk of death than the gastric bypass procedure since it is less invasive.
Making the decision:
Ultimately, the decision to have the procedure is entirely up to you. After reviewing all the information and attending one of the free educational seminars at New Jersey Bariatric Center, you must decide if the benefits outweigh the side effects and potential complications. This surgery is only a tool. Your ultimate success depends on strict adherence to the recommended dietary, exercise and lifestyle changes. While most patients enjoy an improvement in obesity-related health conditions (such as diabetes, heart disease, mobility, self-image and self-esteem) after the successful results of weight loss surgery, these results should not be the overriding motivation for having the procedure. The goal is to live better, healthier and longer. The key is not to be pressured to pick a procedure by anyone, including your medical doctor, your family or a friend. Do the research yourself and learn the pros and cons of both the procedures. In the end, the decision is yours, it’s your life and you will need to be comfortable with what you choose.
Patients considering weight loss surgery often ask “which procedure is right for me?” At the New Jersey Bariatric Center both surgical weight loss procedures -- gastric bypass or lap band -- result in successful weight loss. The best way to make the decision regarding which procedure is best for you is to consider several factors: loss of pounds, reversibility, diet requirements and risk, and compare the pros and cons of them against your personal goals.
Weight loss:
Initial weight loss with the gastric bypass is approximately 3lbs to 5lbs per week for the first three to six months. Over 18 months the gastric bypass procedure results in approximately 60 to 70 percent excess weight loss. However, gastric bypass is both a restrictive (restricts the intake of food) and mal-absorptive (less absorption of calories you take in) procedure resulting in weight loss from both decreased food intake and decrease calorie absorption. With the lap band procedure weight loss is slower, about 1lbs to 2lbs a week. Over an18 months it will approximately result in a 50-60% excess weight loss. Since the Lap Band is only restrictive, and not mal-absorptive, it requires much more personal will power to avoid high calories and snacking. In addition, Lap Band requires significant and consistent follow up for the first year to adjust the band. Keep in mind, that a slower weight loss does not necessarily mean less ‘hanging skin,’ nor does faster weight loss result in more ‘hanging skin’ problems. These issues are a factor of the amount of weight loss and your age, not the amount of time it takes to lose the weight.
Reversible:
Unlike the gastric bypass, the lap band procedure is reversible. At any time, you can choose to have the band removed. Keep in mind, patients who typically have the band removed often gain the weight back over a short time period.
Diet:
Regardless of the procedure, patients are required to eat healthy and exercise to maintain the weight loss. However, when comparing the procedures, the gastric bypass requires less dietary compliance as it combines both the restrictive and mal-absorptive components. With the bypass you simply can’t intake the same amount of food, high caloric food or eat to quickly without getting physically ill (dumping syndrome). However, due to the mal-absorption component of the bypass, patients must take protein and vitamin supplements for life. Dumping syndrome can occur after gastric bypass surgery resulting in dizziness and heart palpitations. It occurs 15 to 30 minutes after a high carbohydrate meal, especially one that's rich in sugars such as sucrose (table sugar) or fructose (fruit sugar). Some people also experience low blood sugar (hypoglycemia), related to excessive levels of insulin delivered to the bloodstream as part of the syndrome. Insulin influences your tissues to take up the sugar present in your bloodstream.
Risk: Link
To date, at the New Jersey Bariatric Center we have no mortality and below average complications for both procedures. However, when comparing the two procedures and looking at the national statistics the lap band has a significantly lower risk of death than the gastric bypass procedure since it is less invasive.
Making the decision:
Ultimately, the decision to have the procedure is entirely up to you. After reviewing all the information and attending one of the free educational seminars at New Jersey Bariatric Center, you must decide if the benefits outweigh the side effects and potential complications. This surgery is only a tool. Your ultimate success depends on strict adherence to the recommended dietary, exercise and lifestyle changes. While most patients enjoy an improvement in obesity-related health conditions (such as diabetes, heart disease, mobility, self-image and self-esteem) after the successful results of weight loss surgery, these results should not be the overriding motivation for having the procedure. The goal is to live better, healthier and longer. The key is not to be pressured to pick a procedure by anyone, including your medical doctor, your family or a friend. Do the research yourself and learn the pros and cons of both the procedures. In the end, the decision is yours, it’s your life and you will need to be comfortable with what you choose.
Finding Your Inner Athlete
Weight loss surgery is a wonderful tool in leading a healthy lifestyle, helping people to control portion size and food choices and enabling a successful weight loss journey. It’s not the only tool, however, and following a regular exercise plan is another necessary component for a successful lifestyle change. Whether you’re new to an exercise plan or looking to energize your current plan, the tips in this issue will help you to find your inner athlete, that person who loves exercise.
Starting Out with the Right Environment: We all have different exercise styles: Some of us prefer to work out at home, while others enjoy the energy and camaraderie of a gym environment. If you prefer to work out alone and want to stay in the privacy of your own home, make sure you designate a space and set it up with the right equipment. You’re unlikely to use that elliptical if you have to move a couch or a stack of books to get to it, so make exercise a priority in the home. This could be as simple as finding a good comfy exercise mat, a jump rope, and a set of resistance bands. If you like the motivation of working out with others, a gym might be a better solution. Keep in mind that different gyms have very different atmospheres. Some are more family- oriented with lots of classes, others cater to the individual exerciser. All can be intimidating to a novice so ask around for recommendations, read the online reviews, and go visit. When you visit, ask any of the questions that might be holding you back—are there weight limits on the cardio machines? When are the least crowded times of day? Can a trainer teach you how to use the machines? Choosing the right gym for you can make a huge difference in your motivation to work out— so don’t just settle for the first one you visit!
Getting Help From the Experts: Don’t be reluctant to ask for help, whether from the staff at the gym, a friend whose fitness plan you admire, or by hiring a personal trainer or exercise physiologist to devise a plan for your specific needs. An expert can help you to refine your fitness goals, make your workouts more effective, and help to motivate you to achieve. We work closely with Stephen Kelly, MPT to help you develop an exercise program that is right for you.
Setting Goals and Measuring Success: Keeping track of your pounds lost is only one way of measuring the success of your exercise plan. Start to notice other ways in which exercise can enhance your life: by improving energy and mood, creating flattering shape and definition in your physical appearance, keeping your heart healthy and strong, and improving your sense of achievement. One great way to see your success and increase your motivation is to set attainable and written goals. For example, if you start with an initial goal of working out three or four times per week, and write down in a calendar or notebook each time you complete a workout, at the end of a month you will be able to see your progress and feel incredibly proud of making exercise a habit in your life. Depending on what exercises you prefer, you might set goals such as a particular distance or amount of time walking or running.
Thinking Outside the Treadmill: More advanced exercisers know that once you get set in the routine of an exercise plan, you can start to feel that your results slow and you become less excited about the same old routine. For these reason, it’s important to “think outside the treadmill” and find activities that you enjoy and that also help you to move your body. At any level, incorporating different exercises and activities ensures that you vary your exercise from day to day so that your body doesn’t become too accustomed to one thing. Maybe there’s an activity that you’ve always wanted to try—perhaps salsa dancing or kayaking or tennis. Now’s the time to take up that new activity!
Think outside the treadmill
Q: How can I “think outside the treadmill”? Outside of a regular workout, what activities should I try?
A: Yoga is excellent for both mind and body. It is intimidating to start a class, especially if you are inflexible. But once you start doing it, the activity is truly enjoyable. Pilates is another good activity to strengthen the core muscles of the pelvis and abdominal region. Any of the activities that you can do in a group or that are scheduled at a certain time are great. They make you put it in your schedule and it eventually becomes part of a routine. Attending activities with other people just makes the activity more social and enjoyable.
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