Weight Loss Surgery: Maintaining Weight after Bariatric Surgery

Aug. 19, 2022 - Weight Loss Surgery: Maintaining Weight after Bariatric Surgery

This Bariatric Friday, Kemal Erkan, Chairman of American Surgery Center, is joined by Dr. Isaias Irgau, President of Christiana Institute of Advanced Surgery (CHRIAS). Dr. Irgau specializes in bariatric surgery, also known as weight loss surgery. Bariatric surgery is known as the most effective way of treating morbid obesity. A person is classified as morbidly obese when their weight is at least one hundred pounds higher than their ideal body weight and have a body mass index (BMI) of 40. When a person has a BMI of 40, they are eligible for bariatric surgery. An individual with a BMI of 35 can also be considered a candidate for bariatric surgery if they have developed illnesses related to morbid obesity such as high blood pressure, type 2 diabetes, or sleep apnea.

Last week, a new journey began with a new set of patients undergoing the bariatric surgery process; the names of the patients illustrated are not real, but the situations are. Every week’s session will highlight what the patients are going through at that time. First, we have Denise; she is 32 years old with a BMI of 43. It was decided that she should receive a gastric sleeve. The next patient is Patrick; he is 30 years old with a BMI of 50. He is still undecided on his surgery type, but it appears likely that he will be getting a gastric sleeve. The third patient is Karen. Karen is 52 years old with a BMI of 41; she initially came to the office requesting a gastric sleeve, but after listening to the advice of Erkan and Dr. Irgau, she will be undergoing a gastric bypass.

Today, the pair will discuss how these individuals can maintain weight loss after bariatric surgery. Dr. Irgau explains, “Denise, Patrick, and Karen are going to have weight loss surgery, this is a very important treatment that will help them lose the weight, and also it will help them reduce the medical problems that they currently suffer from.” Weight maintenance is discussed early in consultations with patients; the patients want to ensure that they will lose weight and not regain what they have lost. If the patient is not careful and diligent, it is possible for them to regain weight. Bariatric surgery is a powerful tool to lose weight; however, the patient has to be mindful in their eating habits following the surgery as well.

In the case of a gastric sleeve procedure, the size of the stomach is physically reduced. Over time, this can be reversed if the patient overeats past the amount the stomach can handle. Dr. Irgau stated communicating each patient that, “one of the very important things that you need to learn is to be mindful when you eat and to try to understand when you feel full.” Physical hunger and an emotional urge to eat are two completely different things. Dr. Irgau explains, “physical hunger, generally, is something that builds up gradually, you know it’s coming, whereas an emotional urge to eat is something sudden, something that is triggered by an emotional event, and we look for food to try to make us feel better”. Substituting the emotional urge to grab food with a productive activity, such as a walk, is a great way to avoid overeating. Overeating, over time, will contribute to weight gain even after bariatric surgery. The best way to get support and stay on track is to make sure the patient continues to go to their followup appointments. Being able to check in with the doctor and address any concerns or questions is extremely beneficial. Support groups are another option; CHRIAS offers a virtual support group on the first Tuesday of every month. During these meetings, patients can exchange stories and tips on how to overcome obstacles faced following bariatric surgery.

Erkan asks Dr. Irgau to explain how bariatric surgery aids the patient as a tool. “What the surgery does is it breaks that cycle,” Dr. Irgau says, “we make our body think as if it has a lot of storage, and it utilizes that, and we are less hungry.” The biology of the human body causes it to store as much energy, in the form of fat, as it can. This is why it is much easier to regain weight than it is to lose it. With bariatric surgery, the body has an added layer of protection. Emotional

urges and mindless eating should be prevented. When a person feels unpleasant emotions, the brain triggers that person to seek food as a form of comfort. Once the original moment of urge passes, a person can typically overcome that feeling and need to eat.

Dr. Irgau goes on to explain, “the other important portion of all the weight maintenance that we have to talk about is physical activity. Physical activity does not mean you have to go to the gym everyday… moving is the key word here because every time we are moving, we are not sedentary, so the trade-off is critically important.” Dr. Irgau expresses, “walking is the foundation of all movement, as creatures and humans we are made to walk, and when we walk, we move all of the muscles in our body”. Erkan mentions how he records his walking every day and how simple it is to track to achieve a goal. Dr. Irgau relates a very simplistic example, “if in the past your most important task was to find the parking spot that is closest to the store or to the office, now your task would be to find the one which is the furthest, so you can add more steps.” Dr. Irgau remarks, “those are the mindsets that we have to have in order for us to change from a sedentary to a movement-based life. If people can go to the gym and also add strength exercises, this is very important, so the activity is not only good because of the maintenance of the weight loss, but it is important to maintain your muscle mass, it’s important to maintain the integrity of the bone, but it is also good for your mind and your emotion as well.” This conversation should be had at one of the first consultations; making short steps in frequent intervals is a great way to introduce activity into one’s life if they are not used to working out or do not go to the gym. “We want them to start that at the beginning, even when they have the first consultation with us, so as they are going through the program, they increase their activity level, and by the time they are recovered from surgery, activity and movement becomes part of their life,” Dr. Irgau emphasizes.

Erkan summarizes the discussion and explains steps that he is taking in his life even though he does not suffer from morbid obesity. These actions can be simply integrated into one’s life. Dr. Irgau responds by saying, “it is very important for people to understand that when we are offering bariatric surgery, we are offering a longer lasting solution for the problem, so we want them to lose weight, we want them to stay healthy… providing the surgery is a very important step in that respect, but providing the information, as well as the support system for them to succeed in the long term is important, that’s why we consider patients in our practice as patients for life because we want to continue to see them for the rest of their life to be there to support them and to provide them with the tools that they need… the support group is very important, as I said, the CHRIAS, American Surgery Center, and Saint Francis Hospital Program support group meets the first Tuesday of every month, and I encourage all patients to participate in that because support groups are a way for you to really invigorate yourself, to get back to the basics, to start again when you feel like you are going backwards.” No one should have to struggle silently when there are programs in place to help