Frequently Asked Questions
1: Why do blood clots sometimes occur after surgery?
2: What if I can't eat a few days after surgery?
3: What do I do if I want to eat in a fancy restaurant?
4: Can I eat fast food?
5: What about exercise?
6: What is a Bariatrician?
7: How Prevalent is Obesity?
8: What about childhood obesity?
9: What are the Health Risks of Obesity?
10: How is a Patients BMI Related Health Risk Determined?
11: What happens after the surgery?
12: What should I eat after surgery?
Q1: Why do blood clots sometimes occur after surgery?
A: Blood clots form because of pooling of the blood in the large veins in the legs. This occurs when patients move their legs less, such as either during surgery or when spending a time in bed recovering after surgery. Stress, such as from surgery or injury, causes the blood to clot in these pools to clot more easily. Combine these changes with thickening of the blood that can occur after surgery due to mild dehydration, and the result is an overall increased risk of blood clots forming in the legs. Your doctors will use early ambulation, automatic compression stockings, and blood thinners to prevent these clots from forming. Be sure to do what you can to help, by getting up as much as is practical, and by putting your compression stockings back on when you get back into your hospital bed, and your risk of forming blood clots will stay low, hopefully just a few percent or less. Back
Q2: What if I can't eat a few days after surgery?
A: It is hard to eat much 5 days, or even a week or 2 after surgery. Your small stomach pouch, and the opening between the pouch and your intestine are swollen and almost closed off. You also are recovering from major surgery, and don't feel like eating much. Concentrate on taking liquids so you don't become dehydrated, and eat simple pureed and soft foods as you are able to. The problem up till now has been too many nutrients. You probably have great nutritional reserves, and can go for some time without depleting your stores. As you feel better and the swelling goes down, and you learn what agrees with you, you will take more. As you begin to take more, try to lean toward high protein foods and supplements, bearing in mind that some people can't take dairy products or dairy based supplements. Do let your doctors know how you are doing, especially if you have diabetes, so that they can adjust your medicines as your intake goes up and down. Back
Q3: What do I do if I want to eat in a fancy restaurant?
A: The rule of thumb is always eat protein. Most will gladly grill or roast a piece of chicken, fish or steak. Even if not mentioned on the menu restaurant's menu most willingly makes substitutions of permitted vegetables spinach, green beans etc., instead of potatoes or rice. If the restaurant simply will not prepare a dish which you are permitted to have order something with fish, poultry or steak and a separate plate. Take the protein and scrape off the offending sauce, breading, etc. and place it along with any permissible vegetables on your "keeper" plate and give the "Fattening Stuff" back to the waiter (you don't need the temptation to sneak a taste and no-one in your party needs extra fat or calories). If there is one food you can eat with impunity it is protein. At the dinner party load up on salad and protein (push the gravy or sauce to the other side of your dish) and dig in! Although you may not be following the program 100% it won't be too bad or hurt your progress that much. Back
Q4: Can I eat fast food?
A: Many patients worry about where they can get meals in fast food chains or restaurants. It is very easy to get the types of food you need at many of the fast food chains such as Burger King, Wendy's, or McDonald's. (These are good choices to make even if you have not had the surgery.) All three offer salads that are low in calories and fat. Both Wendy's and Burger King offer Chunky Chicken Salads. Unfortunately, Long John Silver's offers fish and chicken entree's which are both fine (remember no rice, cole slaw or bread sticks) and they will be happy to substitute a salad for the starches you are not permitted to have. Hardee's offers a grilled chicken sandwich, which will be permissible for lunch if you eat only one slice of bread and request it without mayonnaise. Arby's offers the only turkey sandwich in the fast food circuit, which is fine with only 1 slice of the bread. Mrs. Winner's offers broiled chicken with green beans. Remember the old standby at any of these fast food places. You can always order a garden salad and a hamburger pattie with mustard. This is a quick meal that is available at all the fast food chains. Back
Q5: What about exercise?
A: It's important to exercise while trying to lose weight. Walking is the key. The bike manufacturers and gym owners would like you to think that heavy exercise is the key, but, research is recommending less vigorous and stressful physical activities for those of us who wish to lose or control our weight. Most patients have adequate amounts of lean body mass. In many overweight individuals this mass will be very close to or exceed their ideal weight range. This means that they do not need additional muscle and need to lose fat. Remember you cannot exercise fat and can only exercise muscle. Our body responds to exercise by increasing muscle size and thereby increasing lean body mass. Adding additional lean body mass to an individual who is trying to loose fat undermines the whole process. It is quite likely that you will gain weight if you exercise extensively. This will be more pronounced if your protein intake is increased while dieting. Back
Q6: What is a Bariatrician?
A: A Bariatrician is a licensed physician (Doctor of Medicine [M.D.] or Doctor of Osteopathy (D.O.) who, as a member of the American Society of Bariatric Physicians (ASBP), has received special training in bariatric medicine the medical treatment of overweight and obesity and its associated conditions. Bariatricians address the obese patient with a comprehensive program of diet and nutrition, exercise, lifestyle changes and, when indicated, the prescription of appetite suppressants and other appropriate medications. (The word bariatric stems from the Greek word barros, which translates as heavy or large.) Back
Q7: How Prevalent is Obesity?
A: Obesity is a chronic, debilitating and potentially fatal disease that requires treatment by a physician trained in bariatric medicine. It is marked by an excess accumulation of body fat sufficient to endanger health. The United States is currently suffering an obesity epidemic contributing to the premature death, sickness and suffering of millions of Americans. Back
Q8: What about childhood obesity?
A: Approximately one in five children in the US between the ages of 6 and 17 is overweight. The number of overweight children in the US has more than doubled in the past 30 years. The number of overweight children (age 6-17) has doubled within three decades. Obesity in children is a chronic disease that overshadows all others in frequency in the pediatric population. Changes in the Western lifestyle have led to significant reductions in energy expenditure of children and have encouraged "super-sizing" of calorie-dense, high-fat foods and snacks. Physical inactivity, "junk" food diets (including high calorie soft drinks and fruit beverages), increased television watching accompanied by snacking, increased time playing video and computer games all contribute to increased obesity among the young. When we think of the major problems facing pediatrics in the next millennium, the disturbing trend toward obesity has to be among the most serious, with all the adverse health implications that obesity carries. (Pediatric Alert, March 27, 1997) Back
Q9: What are the Health Implications of Obesity?
A: Obesity has been established as a major risk factor for diabetes, hypertension, cardiovascular disease and some cancers in both men and women. Other co morbid conditions include sleep apnea, osteoarthritis, infertility, idiopathic intracranial hypertension, lower extremity venous stasis disease, gastro-esophageal reflux and urinary stress incontinence. Obesity-related medical conditions contribute to 300,000 deaths each year, second only to smoking as a cause of preventable death. Back
Q10: How is a Patients BMI Related Health Risk Determined?
||BMI >= 27 kg/m2
(approximately 20% above ideal weight)
||BMI >= 30 kg/m2
(approximately 30% above ideal weight)
Q11: What happens after the surgery?
A: After your Gastric Bypass surgery, you will begin to awaken in the post-op recovery room, in what may seem like just an instant. Many patients will have little or no recollection of being there, a normal side effect of the medicine given to you during anesthesia. Ordinarily, your breathing tube is removed from your throat as you begin awakening usually before you are aware of it being there. You will be started on pain medication by the nurses in recovery as soon as you need it. The IV line for fluids and medications that was started in the operating room will remain with you for your entire stay in the hospital and will take care of your required fluid intake. Although you won't be allowed to drink water for the next day or so, you will be allowed to suck on ice chips after the first day if your mouth is dry. About 4 hours after surgery, the nurses will ask you to sit up again, only this time, you will dangle your legs off the side of the bed and put your feet on the ground. We check to see that your vital signs are ok, your pain medication is ok and that you are recovering normally in preparation for your first walk. The nurses will get you up again in preparation for your first walk about 5 hours after surgery. Along with your deep breathing and coughing exercise, walking is essential to your recovery. For your entire stay in the hospital, the nurses will get you up and make you walk around the floor about every 2 hours. As your recovery continues, we monitor your pulse, your temperature, and your blood count carefully. If you are showing good medical progress, we start you on swallows of water, followed by Jell-O and broth your meals for the next few days. Don't worry about finishing your meals. When you feel full or just don't feel like eating stop. Depending on the patient, on the second or third day you will be instructed in preparation for leaving the hospital. If you are taking fluids well, can tolerate Jell-O and broth, don't have a fever and are breathing and walking well, we will send you home. Back
Q12: What should I eat after surgery?
A: Follow these four simple rules faithfully and the weight will come off and stay off. Break these rules continually and long term you will gain weight. Your surgery is a tool to be used with these four rules and experience shows that unless you follow them, we cannot predict any weight loss results. When patients reach a 'plateau' and stop losing weight, it is usually because they are not following these simple but very important rules!
Protein first every meal: Eat the protein portion of your meal first, very meal! One to three meals per day. Eating protein helps the body to feel 'full' and sends a signal to stop eating. Protein is very important to building tissue in the body muscle, your organs, your brain everything is built with proteins. Now, the body does not need three meals a day, so listen to your hunger cues and don't worry about the clock. It the beginning - after you can tolerate solid food - most patients only eat one or two meals a day.
No snacking between meals: Eating anything flavorful or containing calories in between meals is considered snacking. Do not eat between meals at all! If you absolutely have to snack, the only snack that is acceptable is protein. In the beginning, turkey jerky is a good protein and you must work at it a little to eat it! Later on, after 6 months, beef or venison jerky is acceptable but only if you just have to eat something. The main problem with snacking on flavorful food is that it contains glucose or some other sugar. We feel good when we eat sugar and when that sugar is gone one to three hours later our brain sends a message to snack again! Snacking actually makes us hungrier! Do not open the door to snacking. Snacking will slow down or even stop your weight loss! And depending on how much or how often you snack, you can actually gain weight! Not good! You can get this big again. Remember, the surgery has only changed your digestive system and not your eating habits. Your commitment to a change in lifestyle is the key to making the surgery work for you for the rest of your life.
Drink water: Drink water, drink water, drink water! Especially in the beginning, when you can only tolerate a mouthful at a time, it is so important to continually sip water all day - and make sure you drink 48 to 64 oz. a day minimum - that's 2 to 3 quarts per day. Eventually, you will able to drink 2 to 4 oz. at one time. No tea, soda (with or without sugar), coffee, or juice are allowed. There are a couple of problems with drinking flavorful liquids in between meals. First and most importantly, it encourages snacking not good! Second, flavored drinks with any sugar can cause dumping making you very sick!
Exercise: Exercise every day for at least 30 minutes. Walking is fantastic exercise and is probably the easiest way to get started exercising. We understand that in the beginning you may struggle with a simple walk down the hall and that your energy level can be very low. Your job is to move your body a little more every day. At 4 to 8 weeks (everyone is different) you will mostly feel back to normal. After you have been cleared by your physician, you may begin other forms of exercise. Eventually, incorporating both aerobic and resistance training into your daily exercise routine will help you remain healthy - at a healthy weight - for the rest of your life. Back
| After Surgery
|Patients will be on a clear liquid diet for the first few days immediately following gastric bypass surgery, and then advance to a pureed diet. These foods will be very soft, so as to pass through the small, newly formed pouch and stoma. One of the main issues during this period will be adequate fluid intake, and dehydration can be a problem for patients recovering from this surgery. We will ask patients to take in at least 32 ounces of liquid a day before leaving the Gastric Bypass Surgery Center.
Approximately one month after the gastric bypass surgery the patients can expect to advance to a transitional diet. They begin to take more regular table foods, but will often still go back to eating the pureed foods that they have tolerated well. They will still be learning how to eat right, including chewing food carefully, learning to drink most of their liquids between rather than with meals, and learning that eating the wrong foods, such as sweets or fatty foods, can make them ill.
Patients experience the most rapid weight loss during this period. They are often thrilled to see the weight coming off, sometimes at the rate of 20 pounds a month, but it is not an easy time. Patients feel the loss of calories taken in, and are sometimes low in energy. Their small pouch will make them uncomfortable when they eat too much or too fast. They may have diarrhea, which can usually be controlled by avoiding certain foods or by taking medication. They may experience hair loss, though the hair usually begins to grow back within a few months. click here for more information