Weight Loss SurgeryGroup Education Session

Introductions

Julie Thompson – Specialist Bariatric Dietitian

Cara Barnes – Bariatric Nurse Specialist

What is the purpose of

today?

Introduce you to the types of surgery and the service offered

Provide you with information on diet and lifestyles to enable you to start preparing now

What we’ll cover

Changing eating before

surgery

Types of surgery

What’s the right operation for you

Preparing for surgery

Impact of surgery on your

life

The pathway

Time for questions

IT’S NOT THE EASY OPTION…!!!!

Gastric band

Gastric bandBenefitsBenefits

•Slightly less major operation

•Control over restriction

•Effective for volume eaters

ComplicationsComplications•Occur much later

•Slippage

•Erosion

•Leakage

•Infection

•0.3% mortality risk

ImplicationsImplications•Takes up to 2 years to get to goal weight

•Eat small amount

•Lots of chewing

•Certain foods can be problematic

•Reliant on will power with snacking

•20% band failure rate

•Lose 40-50% excess body weight

Gastric Bypass

Gastric BypassBenefitsBenefits ComplicationsComplications

ImplicationsImplications

•Rapid weight loss

•1-2 st / month for 3/12

•½-1st/ month next 3/12

•70-80% excess weight loss

•Complications early on

•Effective for snackers/sweet eaters

•Improves diabetes

•Anastomotic leak - 4%

•Anastomotic stenosis

• Hernia

•Some hair loss

•1% mortality risk

•Rapid weight loss- 9 months to 1 year

•Lots of chewing

•Small portions

•Life long vitamins and minerals

•“Dumping” syndrome

ImplicationsImplications

•Regular blood tests

•Risk of malnutrition

•Not reversible

•Still have emotional hunger

•Certain foods can be problematic

Sleeve Gastrectomy

Gastric SleeveBenefitsBenefits

• Less invasive than bypass

• Reduced stomach volume (by 60 – 85%)

• Restriction over volume eaten

ComplicationsComplications

• Leakage of stomach acid

• Weight regain

ImplicationsImplications

• Completely irreversible

• Average wt loss: 60 – 70% of excess

• (limited data on long term maintenance)

• Smaller portions

• ++ chewing

SURGICAL COMPLICATIONS

• Bleeding

• DVT

• PE

• Infection - chest

- wound

• Scarring

The long walk to theatre

After Surgery

• Tired• Vomiting• Exercise• Mood swings• Hair loss• Hernias• Diarrhoea/Constipation• Dumping• Excess skin

Body Mass Index (BMI)• Is a ratio of your weight for your height.• The healthy range is between 20-25kg/m2

EXCESS BODY WEIGHT

Is …

THE WEIGHT YOU ARE NOW minus

THE WEIGHT YOU SHOULD BE

So…

If you weigh 25st (159kg), and your ideal weight (at BMI 25) is 11st 11lb (75kg), your excess body weight is 13st 3lb (84kg).

Band:

Loss of 40-50% of excess weight

= 5st 4lb – 6st 9lb (33.6 - 42kg)

New wt = 18st 6lb - 19st 10lb (117 – 125.4kg)

BMI: 39 – 42kg/m2)

Bypass:

Loss of 70-80% of excess weight

= 9st 3lb – 10½st (58.5 - 67kg)

New wt = 14½st – 15st 10lb (92 - 100kg)

BMI: 31 - 33.5kg/m2)

Key questions

How much weight to lose?

How quick?

Other co-morbidities?

Committed to follow up?

Ability to alter eating habits Am I prepared

for surgery risk?

Sweet eater/

snacker

Binge eater?

Which option is right for me?BANDIf you:

• eat large meals

• are only a few stones overweight

• are happy to lose weight slowly over 2 years

BYPASS

If you:

• have a lot of weight to lose

• have poorly controlled diabetes

• have lots of resolvable health problems

•like snacking/sweets

Balloon

If you:

• have a BMI over 60kg/m2

• have lots of health problems that mean you

cannot have surgery

With all procedures, you must be willing to sign up to commitment with dietitian & the team

Gastric Sleeve

If:

• a band is not appropriate and a bypass is not safe

Not a primary procedure

What is my

eating really like?

Types of over eating

Binge eatingBinge eating

“out of control of eating”

GrazingGrazing

“cravings / bored”

Emotional / Emotional / comfort comfort eatingeating

Overeating Overeating and then and then starvingstarving Putting Putting

others firstothers first

Food as Food as rewardreward

Picky Picky eater / eater / grazergrazerEat large Eat large

portionsportions

“Should I lose weight

before bariatric surgery?”

Weight lossbefore surgery

Decreases liver size

(fat)

Demonstrates motivation

& commitment Possible shorter Length of

hospital stay

Reduces operation time

Helps develop good habits

Healthy Eating

starts here

3 regular meals a day

No longer than 5 hours without

food

Wait 2 hours until having a snack IF

you’re hungry

Include small amounts of treats

Breakfast is the most important meal of

the day

Monitor your food intake

If you are not hungry outside mealtimes, do not eat

Pre-Op Diet / Liver Shrinkage

A large liver

Pre-Op Diet / Liver Reduction Diet

Diet sheet given out at first dietetic appointment

1000kcal/d:low fat and

low carbohydrate

Shrinks the liverShould lose 6kg

(1 stone)

Caution with diabetic control – your diabetes nurse needs to monitor

you

Strict diet you need to follow for 3 weeks

before surgery

Eating after surgery

How is my eating going to

change?

What can I eat afterwards?

Stage Texture Duration

Stage 1 Pureed (smooth textures, no lumps)

4-6 weeks

Stage 2 Soft/moist/mashable

2 - 4 weeks

Stage 3 Normal Weeks 8 -10 onwards

Immediate post-surgery dietary rules

Dietary Principles

Healthy Eatingie. low fat, low sugar, moderate protein, rich in micronutrients

Regular meals

Texture

Eat very slowly – chew each mouthful 25 times

Stop eating as soon as you start to feel full

Not drinking with eating (wait 30 mins either side)

Volume / portion controlUse small plates & bowls

Things to avoid

Progression Through TexturesPuree Diet (smooth, no lumps or bits, yoghurt-consistency, too thick to suck up through a

straw) - 4-6 weeks• First few days – will only manage teaspoons. Stop eating as soon as you start to feel full.• Over first 2 weeks – will build up to 3-4 tablespoons• During this time you will need 3 meals and 3 snacks, all pureed, and low fat and sugar,

and high in protein• When you feel you can manage more than 3-4 tablespoons, do have a little more but start

reducing the snacks between meals. Eventually you should be on 3 small meals a day (some people manage better with 4).

Soft Mashable Diet – 2-4 weeks• Then you can move on to a soft, mashable diet• ie. anything that can be mashed with a fork. You may need additional low fat, low sugar

sauces/gravy to help with this. No hard lumps, gristle or stringy vegetables.Normal Textures• Then you can move on to a normal textured diet, although you may struggle with some

foods (eg. bread, tough meats, stringy vegetables, pithy fruit (eg. citrus) but you may be able to manage them after a few months.

NB Some people may progress a little slower or a little faster than the above

Bread

Pasta

Potential Problem Foods

Crackers or toast

Tough/dry/gristly meat

Rice

Stringy/hard vegetables

Fruit pips, seeds, skins & pithy fruit

Use small shapes for soup

Small pieces / minceSlow cooked / stewed

Risotto

Overcook:Cauliflower, broccoli, carrots

Peel fruit / purée or stewTinned fruit in juice*

Alternatives

Vitamin DThiamine

Zinc

Calcium

Iron

Therefore, lifelong supplementation of multivitamins & minerals, with additional iron and calcium, with potential for further supplementation dependent on your blood results

Pathway to surgery

Referral From GP

Group education session Support Group

Meeting with Consultant

Health Assessment

Return to see doctor for results & put on waiting list for surgery

Pre-assessmentLiver shrinkage diet for 3 weeks

Surgery

Psychologicalassessment

Respiratory Cardiology EndocrineMedical

Management

Funding agreed by PCT

Endoscopy Sleep apnoea test

Dietitian

MDT

Pathway after surgery

Operation

Band – 2-3 day stay Bypass – 2-3 day stay

Seen by team daily

1st Outpatient Appointment at 6 weeks

Seen by dietitian and nurse specialist before discharge

2nd Outpatient Appointment at 12 weeks

1st band fill~6 weeks

Band fills as required for 2yrs

Reviews at 6, 12, 18 and 24 months, then discharged back to GP