How To Qualify for Bariatric Surgery

Bariatrics is the branch of medicine that deals with the control and treatment of obesity. Bariatric surgery is simply another term for weight loss surgery. In order to qualify for bariatric surgery, you must be classified as morbidly obese. In other words, if you have been looking for a way to shed those fifty pounds that have been plaguing you for most of your life, bariatric surgery is not the option for you. Bariatric surgery is a surgery of last resort for those who are classified as morbidly obese. Here are the criteria that you must meet in order to qualify for bariatric surgery:

1. You must have a Body Mass Index (BMI) of 40 or higher. The body mass index is a system used to establish standards for what is considered overweight, obese, and morbidly obese. The BMI is calculated by dividing the person's weight in kilograms by the square of the person's height in meters. Keep in mind that there are 2.2 pounds per kilogram and 39.37 inches per meter. If your math skills are not quite up to the gymnastics required for this calculation, then you can use the BMI calculator provided by the National Heart Lung and Blood Institute here at its website. If your BMI is 25 or more, you are considered overweight; 30 or more, obese; and 40 or more, morbidly obese. An approximate measure of morbid obesity is being 100 pounds or more overweight.
   OR
2. You must have a BMI of 35 or higher with at least one co-morbidity. A list of co-morbidities includes:
   • Diabetes
   • Cardiovascular disease
   • High blood pressure
   • Sleep apnea
   • Asthma
   • Hypercholesterolemia
   • Degenerative Joint Disease
   • Gastroesophageal Reflux Disease
   • Incontinence
   • Psychosocial Problems
   • Reproductive Problems/Infertility
3. You must have tried lifestyle changes that include healthful eating habits and regular exercise. Most bariatric surgeons believe that weight loss surgeries work best in conjunction with behavioral and dietary changes. There is also a correlation between the patient's motivation levels and the success of the surgery so surgeons prefer to work with patients whom they feel will be able to manage the post-operative requirements, which include significant dietary and behavioral modifications.

Remember that even if you qualify for bariatric surgery, the surgery itself is risky, and has long-term consequences such as requiring vitamin supplementation and regular follow-up (usually including blood work) for the rest of your life. You can read more about how to choose the weight loss surgery that is appropriate for you here: How To Choose Weight Loss Surgery.

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How To Choose Weight Loss Surgery

There are several different types of weight loss surgery and it is important to understand the differences among them. In order to qualify for weight loss surgery, you must have a Body Mass Index (BMI) of 40 or higher or a BMI of 35 or higher with at least one co-morbidity. Common comorbidities include diabetes, sleep apnea, high blood pressure, joint problems and incontinence. Anyone who qualifies for weight loss surgery qualifies for any of the weight loss surgery options listed below. Here is an overview of the three primary types of weight loss surgery available today:

1. Lap Band. In lap band surgery, a laparoscopic donut-shaped rigid silicone band is put around your stomach and connected to a port just under the skin in the wall of the stomach. (A tube comes off of the band and leads to the port.) Doctors inject saline into the port to adjust the lap band, making it tighter or looser.
   Lap band surgery is purely restrictive: It basically creates a small pouch at the top part of your stomach, which affects both how much food will fit into your stomach and through your stoma (or the opening at the bottom of the pouch). Of the major weight loss surgeries available, lap band is the least invasive of the surgeries, requires the shortest time under anesthesia and enables people to return to work within a couple of days. However, keep in mind the following consequences of lap band surgery:
   • Immediately after surgery, patients are allowed only clear liquids, and the progression to solids is slow. (You start out with only eight teaspoons of food!)
   • People with lap bands must eat slowly, chew their food thoroughly and stop when they feel full; only three small portions three times per day are allowed.
   • People with lap bands must have regular check-ups and follow-up care to ensure that the band is adjusted properly.
   • Some people have trouble getting their bands adjusted correctly - too loose and they don't lose weight, too tight and they throw up frequently.
   Lap band recipients average a loss of 60% of their excess weight. Lap band surgery is easy to sabotage if you drink a lot of high-calorie liquids such as milkshakes, which can cause regain.
2. Roux-En-Y Gastric Bypass. This surgery is named after the intestinal limb created by the sugery, which is known as the Roux-En-Y intestinal limb. In this gastric bypass surgery, surgeons create a tiny pouch at the top of your stomach (usually by stapling it off) and leave the rest of the stomach in your body. Your pouch (your new stomach) is very small, traditionally only ½ to one ounce. Food no longer travels to the bottom part of the stomach that has been stapled off but that part of the stomach continues to produce stomach acids. The small intestine is connected directly to the reduced stomach, with a small hole between the two known as a stoma. Because food bypasses the lower stomach, the first segment of the small intestine (the duodenum), and the first portion of the the second segment of the small intestine (the jejunum), the amount of calories and nutrients the body absorbs is greatly reduced (this is called malabsorption).
   Because food passes from the stomach directly into the intestine minus the usual regulating influence of the pyloric valve, there are several possible complications involving the stoma.
   • If a large chunk of food becomes trapped in the stoma instead of passing through into the small intestine, you can end up vomiting until it comes out or having to have it removed by a doctor.
   • Food, especially sugar, sometimes passes directly from the stomach into the small intestine too quickly, a process known as "dumping." The results of dumping syndrome can be severe, including experiencing lightheadedness and the shakes, sweating, nausea, weakness, fainting, and diarrhea shortly after eating. Approximately 60% of gastric bypass patients experience dumping syndrome to some degree.
   In addition to the possible complications involving the stoma, there are other consequences to consider:
   • Between 5-15% of the time, the connection between the stomach and the intestine narrows, causing nausea and vomiting after eating.
   • Immediately after surgery, you will be on a clear liquid diet. You will then advance to a diet of pureed foods. One month after surgery, you will be allowed to advance to more regular foods, though some people return to pureed foods because they are more easily tolerated.
   • You can not eat large portions of food at one time (an average portion is approximately 1/2 cup).
   • An iron and vitamin B₁₂ deficiency occurs more than 30% of the time, and about half of those people with an iron deficiency develop anemia.
   • Ulcers, hernias, and an enlargement of the bypassed stomach are additional possible complications.
   • You are also no longer able to take non-steroidal anti-inflammatory drugs (NSAIDS).
   Approximately 30% of gastric bypass patients experience a significant weight regain but successful gastric bypass patients lose 60-75% of their excess weight.
3. Duodenal Switch is named after the duodenum, which is the first segment of the small intestine. Duodenal switch is a relative newcomer to the weight loss surgery options, having been around since the late eighties. Duodenum is a more invasive surgery and is a difficult surgery to learn and to perform, yet duodenal switch surgery does seem to address many of the long-term issues presented by other weight loss surgery options.
In duodenal switch surgery, the entire small intestine is measured, then divided in a 60/40 ratio. The lower portion of the intestine is the forty percent and it is brought up and connected just below the pyloric valve of the stomach, creating the enteric limb through which food passes. The sixty percent remaining stays connected to the liver and pancreas so that bile and pancreatic fluids continue to flow through that part of the intestine, which then connects to the enteric limb at approximately 100 cm from the large intestine. Since bile and pancreatic fluid are required in order to digest fats, you digest fats for only the last 100 cm of your intestine, or approximately 18 percent of the fat that you would normally digest. Proteins and carbohydrates are also absorbed at a 60 percent ratio, but sugar is absorbed at 100 percent. Thus someone undergoing this type of surgery needs to be willing to reduce their sugar intake significantly.
Along with the intestinal surgery, a partial vertical sleeve gastrectomy is performed on the stomach, in which the outer curvature of stomach is removed (reducing the overall stomach by approximately 75-90 percent). The remaining stomach still functions normally and is usually anywhere from 3-6 ounces. Because vertical sleeve gastrectomy still allows the stomach to function normally, patients can still take NSAIDS. Typically, the gall bladder and appendix are also removed. A common misconception is that intestine is removed in this surgery but this is not the case-no intestine is removed in duodenal switch surgery.
Possible complications from duodenal switch surgery include the possibility of malnutrition due to malabsorption of nutrients. In order to avoid this, you must take a multivitamin every day and 1500-2000 mg of calcium daily. You must also follow up regularly with your surgeon and have regular blood work to ensure that you have no vitamin deficiencies. Because you only absorb 60% of the protein you consume, you need to eat at least 60-80 grams of protein per day.
A recent ten-year study of duodenal switch surgery patients showed a loss of 80% of excess weight maintained over a ten-year period.

Risks common to all weight loss surgeries include the risk of being under anesthesia (which is higher for those who are obese). Keep in mind the day to day quality of your life as you decide on the weight loss surgery that is appropriate for you.

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How Do Fats Get Digested After Your Gallbladder Is Removed?

It is estimated that 20 million Americans suffer from gallstones -- calcified cholesterol pebbles that form in the gallbladder -- but up to 80 percent will not experience any symptoms, according to Johns Hopkins Medicine. Physicians commonly recommend gallbladder removal if you experience severe pain and inflammation related to gallbladder disease. Once your gallbladder is removed, your body can still digest fats from your diet, just not as efficiently.

Gallbladder Function

• The gallbladder is a small sac located on the right side of your body below your liver. It holds bile, a substance that helps your body digest fat from the foods you eat. When you consume foods that contain fat, your gallbladder contracts, releasing the bile into your intestines. If you have gallbladder issues, you can experience sharp pains in your side as a result of eating fatty foods.

Gallbladder Removal

• Your liver actually produces the bile, but when your gallbladder is removed there is no place to store the bile. Your liver continues producing bile in the absence of a gallbladder, but instead of being stored in a concentrated form, it drips slowly from your liver into your small intestine. When you eat a fatty meal, the bile that is already in your intestines helps break down the fat.

Fat Digestion After Surgery

• When the gallbladder is present and functioning, it releases bile in one big gush in response to a meal that contains fat. Without your gallbladder, there is a smaller amount of bile in the intestines. This means that while you can still consume fat, you may not be able to consume large fatty meals because there is only a small amount of bile in your intestines at a given time.

Gallbladder Removal Diet

• While there isn't a specific diet to follow after gallbladder removal, physicians and dietitians typically make general recommendations to avoid problems after someone has undergone a gallbladder removal. Because your body can only break down small amounts of fat at a time, avoid high-fat, fried and greasy foods. MayoClinic.com recommends eating smaller, more frequent meals. Consuming smaller meals helps assure a better mix of available bile. In addition, you should also gradually increase your fiber intake to help reduce constipation.

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How to Remove Belly Fat Without Surgery

Achieving a flat stomach is a goal for many people because many people may be prone to accumulating fat in the belly due to heredity, poor diet or inactivity. Diet and exercise are the biggest factors in removing excess belly fat. Belly fat accumulates on some people due to excessive calories from the wrong types of food as well. There are lifestyle changes you can make that can remove belly fat without surgery.

Things You'll Need

• Water
• Dairy foods
• Fruits
• Vegetables
• Weights
• Aerobic exercise

Step 1:

Stop eating junk food and empty carbohydrates. Junk food is very high in fat, calories and empty carbohydrates. The sugar in junk food is basically a carbohydrate, which turns to fat and often accumulates in the belly. In addition, eliminate soda from your diet. It has no nutritional value and can be high in calories. Drink more water and less sugary drinks and juices.

Step 2:

Eat more fruits and vegetables every day, at least five servings. Fruits and vegetables are low in calories and have fiber and bulk that will help you feel full., and therefore you may feel the need to eat less. Include more calcium-rich foods in your diet. In studies done by the National Dairy Council, people that eat more calcium-rich foods have lower body fat levels.

Step 3:

Stop drinking alcohol. Alcohol, especially beer, is high in calories. Since alcohol is in the form of a liquid, you are able to consume larger amounts than if it was a solid food--therefore consuming more calories at one time. Alcohol contains no nutritional value and the entire amount is stored as fat (hence the phrase "beer belly").

Step 4:

Build muscle by lifting weights to boost your metabolism and burn belly fat. Muscle on your body burns more calories than fat on your body. Do three weight-lifting sessions a week to build up your lower body, upper body and core muscles. According to the American Council on Exercise, weight lifting can turn your body into a fat-burning machine, and in addition, muscles can continue to burn calories even while your body is at rest. While lifting weights, do abdominal and core strengthening exercises to tighten your midsection.

Step 5:

Engage in aerobic exercise 4 to 6 days a week. Each hour of exercise you do burns approximately 400 to 600 calories; this can equal a 1 pound loss of fat per week. Aerobic exercise is important to burn calories, which will remove belly fat. Do low-impact exercise, such as walking, aerobics, cycling, hiking or swimming, at first, and increase your intensity as you lose weight and get stronger.

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How to Lose Weight After Surgery

Losing weight after surgery can be very difficult. It is hard to lose weight when there is not the ability to be as active as you typically are.

Tips For You

1. One way to make sure that you are losing weight is to closely monitor what you are eating and how you are being active. Being as active as possible without the possibility of being injured is always a good idea as there is no reason to become injured after surgery.
2. A good note is that any movement or activity that causes pain in the area or the area directly surrounding where you had surgery is not a good sign and should be discontinued. Just eat green leafy vegetables everyday if you find it hard to exercise or move around in the house.
3. Another good thing to do is to watch your intake and calorie consumption.
4. It is important to really watch what you are eating and to monitor that you are eating the right types of food for being less active. This typically means higher levels of fiber and less starches.

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