Many patients believe that the weight-loss process begins and ends on the day of surgery. But that is decidedly not the case. In fact, obesity is a lifelong struggle, surgery or not, and the real work begins after surgery. This is why we encourage patients not to think of the surgical option as the easy way out. After surgery, there are several phases of post-bariatric life, beginning with early recovery. This includes the 6-to-12-week period immediately after surgery, during which patients must follow their post-bariatric plan very closely.
The patients are actively encouraged to walk at around 4 hours from surgery and also started on their breathing exercises. Following a sleeve gastrectomy, most patients go home the very next day, in case of gastric bypass, patients usually go home on the second post-operative day. Patients are allowed to walk, walk stairs, and do breathing exercises (incentive spirometry). Regular exercise is essential to maximise weight loss and to maintain weight loss.
Exercise in a gym or strenuous exercise can be started four weeks after laparoscopic surgery. An ideal exercise regime is one that includes cardio exercise and a little bit of weight training. Driving is allowed four to five days after surgery, provided patients are comfortable and not on narcotic medications. Most often patients return to work after a week of the surgery.
Patients are allowed sugar-free liquids for the first two weeks after surgery, and then pureed solids for the next two weeks thereafter. Since most bariatric surgeries cause a reduction in the reservoir capacity of the stomach, patients are advised to drink small quantities of liquids at regular intervals. After four weeks patients are allowed to go back to normal diet but encouraged to chew well and eat slowly.
Patients are counselled pre-operatively about the changes in dietary habits that are entailed in the surgery. Proper vitamin and mineral consumption are a critical part of a post-bariatric life. Following a sleeve gastrectomy, patients will generally require a daily multivitamin for the rest of their lives with the possibility of or individual vitamin or supplementation, depending on the circumstance. Gastric bypass patients will require more significant supplementation due to the malabsorptive component of the procedure. Most commonly, we find that patients have the greatest risk of deficiencies in vitamin D, calcium, vitamin B12, and iron. Of course, each of these vitamins and nutrients can be boosted easily using oral or even injectable supplements.
Protein is an important part of life after bariatric surgery, and it plays a key role in both early recovery and longer-term weight loss and maintenance. In the long term, protein is essential for the development of muscle mass and its maintenance.
Why we stress so much on muscle mass is because of the fact that it improves the caloric burn at rest. In the early postoperative period, food alone may not be able to give an adequate amount of proteins. Hence supplements like protein shakes may be needed.
Following up after bariatric surgery is a critical part of the postoperative process. Patients are asked to follow up every three months in 1st year, every six months in the 2nd year, and once a year thereafter. A good follow-up regimen is one where patients are well prepared. They are encouraged to keep a log of the liquids consumed, foods are eaten and exercises that are performed on a daily basis.
Unfortunately, weight regain is a possibility after bariatric surgery. Most patients maintain significant weight loss for the rest of their lives. However, we need to remember that bariatric surgery is not a magic wand, and a lot of success is dependent on the patient.
Bariatric surgery can truly be a life-changing experience for the better. Surgery with good aftercare and moderate lifestyle changes can give wonderful long-term results for health and weight.
The writer is Chief Consultant, Department of General, Minimal Access & Bariatric Surgery
Manipal Hospitals, Palam Vihar, Gurgaon.
