What is Bariatric Surgery?

Bariatric surgery is a combination of different types of weight loss surgeries, such as gastric bypass etc. These are surgical procedures that make changes in our GI tract (gastrointestinal tract. In extremely obese people, when diet and exercise do not make any change, bariatric surgery is an effective option. It is a process of long-term commitment which also requires permanent lifestyle changes such as eating patterns and regular exercise etc.

 

Bariatric Surgery on NHS

Bariatric surgery is offered to people on NHS in the UK under the following conditions:

• Inability to lose required weight with diet, exercise or both
• BMI above 40 or having BMI more than 35 with other life-threatening conditions such as stroke, heart issues, and diabetes
• A better understanding of post-surgery risks
• Committed to making long-term lifestyle changes

 Risks and Benefits of Bariatric Surgery

1. Risk Factors:

As we know, it's a complete surgical process that comes with many risks and complications. Common risk factors include:

• Nausea
• Diarrhoea
• Weakness
• Fatigue
• Loss of appetite
• Faintness

 Along with these, some other serious complications can also occur such as:

• Delayed wound healing
• Wound infection
• Abdominal hernia
• Malnutrition 
• Deficiency of vitamins such as Vitamin D

2. Benefits of Bariatric Surgery:

There are many health benefits of going through weight loss surgery:

• Rapid weight loss will occur for 2 years which helps in acquiring desired weight
• Quality of life will improve
• Blood lipid levels will improve results in better health
• Hypertensive patients will see improvement in a few months
• Insulin sensitivity will also improve

Types of Bariatric Surgery

There are different types of bariatric procedures, some of them are the following:

Gastric Banding

It is a reversible procedure in which a silicon band is tied around the upper portion of the stomach, which leads to reduced stomach size. It helps in lower food intake with the prolonged feeling of fullness.

  Advantages:

• Reversible procedure
• The risk of complication is less
• Required less hospital stay
• Helps in weight loss
• Minimum nutritional deficiencies are reported
• Intake of food decreases as you feel full after taking a small amount

Disadvantages:

• Weight loss is happening, but the rate is slower compared to other types 
• The band needs to be adjusted again and again 
• The band is a foreign body; sometimes, it can lead to rejection by the body, and inflammation occurs at the site.
• Risk of band erosion
• The rate of operating again is high

Sleeve Gastrectomy

In this procedure, most of the stomach part is removed and it becomes banana-shaped. It decreases the production of ghrelin (hunger hormone) and results in significant weight loss by reducing appetite.

Advantages:

• It has more effect on long-term weight loss
• Fast process 
• Less hospital stay time
• Rapid weight loss happened
• Reduces hunger 

Disadvantages

• Irreversible procedure
• Leads to certain nutritional deficiencies for a longer time
• More risk of complications

Gastric Bypass

In this surgery top portion of the stomach is cut into a pouch and then directly connected to 2nd portion of the intestine. In this way, food bypasses most of the stomach and a small portion of the intestine.

Advantages:

• Decrease consumption of food
• Helps in weight loss for longer periods
• Low hunger hormone production
• Reduces appetite and increases satiety
• Health conditions such as diabetes, cardiovascular issues, and hypertension start to improve

Disadvantages:

• The procedure is more complex and technical as compared to other
• Increased risk of dumping syndrome (this is a condition in which food moves from the stomach to the intestines rapidly. This happens when high-sugar foods are taken more often)
• The rate of Gastro Intestinal tract issues such as ulcers, small bowel syndrome (a condition in which essential nutrients are not absorbed properly) etc increases
• Patient's hospital stay increases
• The risk of nutritional deficiencies is more as compared to other procedures.

Nutritional Importance after Surgery

After the surgical procedure, food is restricted for a few days to allow the healing process. The patients are given a liquid diet for the first few weeks and then transitioned to soft foods that can be easily tolerated. However, malnutrition can also occur during this transition phase if proper bariatric supplements and diet plans are not given to patients. For this reason, patients strictly need to follow their recommended plans. Their Dietitians carefully cater to their post-operative needs in these plans. 

Risk of Malnutrition

The patients have gone through several changes in their gastrointestinal anatomy. Two types of malnutrition can occur. One of them is PEM (protein energy malnutrition) and the other is different nutritional deficiencies such as iron, calcium folate etc. The severity of it depends on the type of procedure and intake of food before the operation. Proper intake of nutrients is necessary to prevent this complication.

Importance of Protein

Protein is the building block of our body. It is present in almost every cell. Their building and breakdown happen side by side through the process of anabolism and catabolism. When our body goes through some infection or any surgical procedure, the rate of catabolism automatically increases which also means more protein breakdown. Our body starts muscle breakdown to replenish this requirement. But we need muscle mass for a healthy body. So, the protein requirement increases which can be fulfilled through proper diet and supplements. Protein plays a significant role in our body. Some of them are discussed below. 

Helps in Wound Healing

Rapid healing of the wound is very important after bariatric surgery. It helps to repair tissues at the site of the wound and regenerate new cells.

Reduces Inflammation

After surgery, our body goes through some inflammation as a response to the procedure by releasing some inflammatory markers in the blood. This inflammation can prolong the healing process by increasing the protein demand to start the anti-inflammatory process in the body. Research has shown that the intake of dietary proteins such as plant-based proteins, can help reduce inflammation. This demand can be fulfilled by taking a good amount of protein.

Retain Muscles Mass

Our body loses rapid weight with weight loss surgery. This happens not only because of fat loss but also due to muscle loss. To keep the body healthy, muscle mass should be retained. This can be achieved by taking the proper amount of protein in our diet.

Improves Skin, Hair & Nails

When we talk about the role of protein, it is also an integral part of our hair, nails, and skin. After a few months of surgery, you can notice rapid hair fall along with thinning of hair. Your skin can be dull and flaky, and your nails can lose their shine. This all can be avoided by having a good amount of protein in your diet.

 Daily Goal of Protein

You should take a minimum of 60 to 80 grams of protein in your diet. This can be done by having protein sources in your daily food, or you can also supplement your requirement with protein powder as recommended by your medical practitioner.

Sources of Protein

• Eggs
• Black beans 
• Lima beans
• Lentils
• Salmon
• Potatoes
• Beef
• Chicken
• Tuna
• Lamb
• Turkey

Important Role of Vitamins after Surgery

Vitamins are included in essential nutrients as they have a particular role in the maintenance of our body. Our metabolism depends on them. They do not produce energy but they are used in metabolizing carbohydrates and proteins. Many B vitamins help in the regulation of the metabolism. They also play a role in boosting immunity. Our body gets most of the vitamins and minerals through the food we eat. They get absorbed through the digestive tract in the body. They are part of many co-enzymes that play a part in many chemical reactions in our body. 

After surgery, many changes occur in our gastrointestinal tract, which results in the malabsorption of certain minerals and vitamins. Vitamins are present in small quantities in our food, and their availability depends on the amount of food we have eaten. In these patients, as the functionality of GI is compromised and less food is eaten, very few or negligible amounts of vitamins have been absorbed in the body. In this situation, taking multivitamins is not a choice; it is compulsory for a better quality of life.

 Post-operative Nutritional complications

• Anaemia as a result of deficiency of Iron and Vitamin B12
• Neurobiological effects due to deficiency of B12
• Bone disease due to alteration in the absorption of Calcium and vitamin D 

To avoid these complications, nutritional supplements are of the utmost necessity. Special bariatric supplements are designed to avoid these deficiencies. They are particularly prescribed by a doctor according to their patient's requirements.

 

How to identify a nutritional deficiency in a bariatric patient?

The type of procedure or surgery is an indication of nutritional deficiencies that can occur post-operatively. They are also indicated by proper laboratory blood testing. These patients are carefully monitored before and after the operation to avoid such risks. Complete blood tests are performed. If signs and symptoms of any deficiency appear, their labs are done thoroughly.

 

General Guidelines for taking Multivitamins

It is better to take multivitamins either in liquid or chewable form within a few weeks after the surgical procedure. Multivitamins in the form of gummies should be avoided. If you need to take more than one multivitamin, it is better to take them at different times. You can opt to take one in the morning and one in the evening. Always check the label for taking supplements either empty stomach or after food.

 

B Vitamins:

B vitamins are essential for the proper functioning of the body. After weight loss surgery, vitamin B12 deficiency occurs due to improper absorption which leads to anaemia. To avoid this situation, it is better to take B12 as a supplement. Along with this, other B vitamins such as B6 is important to keep normal lipid and sugar level in the blood and to avoid a spike in blood glucose level.

 

Calcium:

Calcium supplement is also important post-surgery. A daily dose of 1200-1500mg calcium is required. You can add calcium-rich sources to your diet as well. Supplemental calcium is also necessary. Try to take calcium along with a meal for better absorption or as recommended by your healthcare practitioner.

 

Vitamin D:

Vitamin D deficiency is also very common in bariatric surgery. It is essential to take 3000IU of vitamin D daily in supplemental form. It is also necessary for Calcium absorption in our body. Take along with meals for better absorption.

 

Bariatric supplements available in the market

Multivitamin:

They should contain 200% daily value of iron and other minerals. If you are taking a good multivitamin, you don't need to take vitamin D and B12 separately. Few examples are mentioned below:

• Bariatric Advantage 
• Celebrate one 45
• Celebrate multi-complete 60
• OPURITY bariatric multi chewable
• ProCare health 
• Biomaximo complete multivitamin
• Biomaximo vitamin B12 complex

They are high in vitamin D and B12, so there is no need to take them separately unless your healthcare practitioner recommends them.

Calcium Citrate:

• Bariatric Advantages calcium chewable and calcium chewy bites
• Celebrate calcium plus 500
• Solgar (liquid)
• Bariatric Advantage powder mix calcium

 Protein Powder: 

• Whey protein powder chocolate flavour 
• Whey protein powder vanilla flavour 
• Mealtime vanilla flavour shake 
• Mealtime chocolate flavour shake 

In Conclusion

Bariatric surgery is beneficial for obese people with having BMI of more than 40 and at high risk of life-threatening conditions such as diabetes and stroke. These surgical procedures improve the quality of life and severity of metabolic conditions as well. However, a person needs to make lifelong commitments to dietary changes and exercise. Regular checks up and follow-ups are mandatory to improve their health. Screenings and blood tests regularly are also essential. A healthy diet and regular intake of a multivitamin will not only help them in recovery but also make their life better. It is not just a procedure but a lifestyle modification necessary to keep things going.