May 6, 2022 - Weight Loss Surgery: What Can I Expect After Bariatric Surgery?

For this Bariatric Friday, Kemal Erkan, Chairman of American Surgery Center, and Dr. Irgau of Christiana Institute of Advanced Surgery (CHRIAS) are sitting down to continue their discussion from last week. CHRIAS is the top weight loss surgery center in the State of Delaware. The weight loss program the center offers is top notch, and it has been designated as providing the most advanced and unsurpassed care in Delaware and the surrounding tristate area.

The pair reflect on a prior conversation with an insurance provider. There is a stigma against individuals who are obese. “Even when it comes to treating any type of illness, there is data that shows that healthcare professionals spend less time when patients are obese when taking care of them,“ Dr. Irgau states. Some insurance companies exclude bariatric surgery from their covered services. Dr. Irgau presents a likely, yet hypothetical, situation: A mother who has a body mass index (BMI) of 58 works for a large company, but the insurance provided to her via the company does not cover bariatric surgery. This woman then must pay out of her own pocket if she elects to go through with the procedure that has the probability to, not only enhance, but save her life. Bariatric surgery is not seen as a necessity to many; however, the weight loss in individuals who suffer from obesity could be life changing. For instance, if this same woman had cancer, another life-threatening disease, the insurance companies would cover the treatments. Dr. Irgau elaborates on how deep the stigma is in society. Erkan explains how problems need to be addressed and that a stigma cannot prevent people from getting the help that they need and deserve. Dr. Irgau goes on to explain, “Obesity is the fastest growing epidemic in society right now. Wee have reached a stage in which a third of the population of the United States is obese, which means they have a BMI greater than 30.” With obesity, the likelihood of developing sleep apnea, type 2 diabetes, and high blood pressure increases; therefore, it is important to address the root of the problem, obesity. Dr. Irgau states how this is “a responsibility of healthcare workers and health plans to provide adequate coverage.” For example, Erkan explains that Wal-Mart does not provide this sort of adequate coverage for their employees. Wal-Mart has a revenue of approximately $572 billion, and yet, is lacking in the area providing appropriate healthcare coverage for their workers.

Dr. Irgau and Erkan then transition into the larger topic of discussion for this Bariatric Friday, which is what a patient can anticipate after undergoing bariatric surgery. Erkan begins by presenting Dr. Irgau with the demographics of two hypothetical patients named Katrina and Samantha. “Katrina is 37 with a BMI of 47, and she does not have diabetes… what can she expect immediately after bariatric surgery?” Dr. Irgau explains that this is a common scenario. To compare Katrina’s situation with getting a gastric sleeve to Samantha, a 62-year-old with a BMI of 42 and heartburn who is receiving a gastric bypass, for both “overall, life is going to be so much better, there is going to be fairly rapid weight loss soon after surgery that they are going to actually feel it, and that will have an impact in a beneficial way.” Within the first four weeks after surgery, regarding diet, the patients will follow a structured diet progression provided to them by CHRIAS’ program. The first two weeks consist of a strict liquid diet to aid in the healing process of the digestive system. Liquids, anything capable of being consumed via a straw, is the easiest to digest. The main goal of this stage is to keep the individual hydrated and proactively prevent thirst. Dr. Irgau tells his patients, “If you are not asleep, if you are not talking, you are sipping water.” By always having some type of fluid with them, they prevent dehydration. The following two weeks the patient begins a diet of pureed foods; this is defined as any food that does not require chewing. The chances of the patient swallowing food that has not been chewed well enough is extremely high and can cause detriment to the stomach which can lead to leaks, a profound danger to the body. It is imperative that the patient follows these dietary restrictions. Following the period of pureed food, the individual can introduce chewable foods gradually. By this stage in the process, the patient’s appetite and hunger has decreased

immensely. Dr. Irgau explains, “There are some challenges at this stage; for instance, one of the things that happens because of bariatric surgery is there is a change in the sense of taste and smell”. Dr. Irgau continues, “patients will find that certain smells or tastes of foods will be different.” This can alter the individual’s likes and dislikes of specific foods, but this is temporary. The first four weeks require considerable mental preparation. To aid the patient in staying on track with this diet, they will visit the office two weeks post-surgery. At this two-week mark, the doctor will help the patient transition from the liquid diet into the puree diet.

Erkan mentions that because of bariatric surgery, 83% of patients have resolution of diabetes, 82% have resolution of cardiovascular issues, approximately 72-98% have reduced occurrence or complete resolution in their acid reflux, and about 74-98% have reduction or complete cessation of their sleep apnea. He then asks when Katrina and Samantha could expect to see changes in their corresponding conditions that come with obesity. Dr. Irgau responds by beginning with breaking down type 2 diabetes and blood pressure in patients, “both conditions will show marked improvement very early after surgery… with the drastic weight loss there is massive improvement in those comorbidities.” In the instance of patients on blood pressure medication, their blood pressure could improve so much that they need to dial back on the amount of medication they are taking. Regarding patients with type 2 diabetes who receive a gastric bypass, “there are some patients who experience total resolution of type 2 diabetes immediately after surgery.” It may not happen for everyone; however, it happens in enough patients to demonstrate how powerful this surgery is.

Erkan then inquires on the hypothetical patients’ behalf about continuing to see a nutritionist. Dr. Irgau explains that it is important that they continue to see the nutritionist, “even when we talk about the progression of diet… there is going to be a priority of foods that we want patients to have.” The patient should be consuming mainly protein, followed by fruits and vegetables, and lastly carbohydrates in regulated amounts. The quantity consumed by the patient is extremely reduced; however, the balance of foods by food group should still meet the minimum requirements to keep the body running properly. Therefore, a dietitian or nutritionist is very important in the patient’s weight loss journey.

Erkan references a NASA study that shows there are 13 types of cancer associated with obesity. “There is a very high association between many types of cancers and obesity; we don’t quite understand the causal relationship, but the association is there,” Dr. Irgau states, “which means the higher the body mass index of the person, the higher the risk for certain cancers, and by reducing the body mass index… we’re automatically reducing their risk for getting certain cancers.” This message is important to relay to patients, as well as it is very important to continue research.

Circling back to Katrina and Samantha, Erkan asks about their weight loss and BMI after six months of following the program. Dr. Irgau explains, “a fair amount of the weight loss will have actually happened… generally after gastric bypass we would see weight loss of about 75% of the excess weight.” This equates to a loss of 75 pounds if the patient had 100 pounds over their ideal weight. “For gastric sleeves, it is a little bit lower at 65% of their excess body weight,” he mentions. Success in the long term is defined as the patient maintaining at least 50% of their excess weight loss. “We are not looking purely at the weight of the person, we are looking at the burden of the diseases that are associated with the weight as well,” Dr. Irgau states. The resolution of comorbidities is extremely important and accompanies the success of the surgery.

“Why would we prevent someone who is able to lose 75% of their excess weight in six months” from doing so, Erkan questions while referencing the presentation from the insurance provider that the two experienced. He states how he aims to touch patients’ lives by being able to aid in

getting the help they need and deserve. Dr. Irgau explains, “we are specialists, but we are also passionate… when you see a patient who comes back to you… who is truly liberated after they have lost a substantial amount of weight, and they are a healthier person… that is what makes bariatric surgery such a wonderful area of medicine to be in.”