Frank Parsons had been dieting for what seemed to be his entire adult life. All this time he had been telling himself, “I’ve got to get rid of this fat,” and in his mind he had been imagining the fat melting away as he ate lettuce leaves and rice cakes. That is, he thought that way until his specialist, Dr. Jacob, gave him a dose of reality: Frank is stuck with the same fat cells he was born with,(1) and all the comfort eating he did in his teens actually caused his fat cells to expand so much that they split to produce more new fat cells. Even worse, fat cells cannot be removed by any diet currently available. For some lucky people, however, appropriate dieting will cause the fat cells to shrink.
Frank is not one of those lucky people. All the dieting in the world has not made much difference in the size of his 62-inch waist, so he agreed to consider a gastric bypass operation.
Dr. Jacob explained that there are several types of bariatric surgery. Each approach reduces the amount of space available in the stomach and intestines. The good news is that Frank will not be able to eat as much as he did in the past. The challenge is that Frank’s body will lose some of its ability to absorb the nutrients that it needs on a daily basis.
But the operation is not the end of the story for Frank, or for anyone else seeking this solution to excess weight. Weight loss surgery patients cannot expect the fat cells to shrink without some very significant lifestyle changes. These lifestyle changes will allow them to live long and healthy lives.
In addition to eating less, which the operation addresses, patients like Frank will need to become more physically active. This will require some dedication, especially for those who have not engaged in significant physical activity for years. They will also need to pay particular attention to wise eating. (2) If patients fail to carefully monitor their protein and vitamin intake, they can easily slide into a state of malnutrition, which may show itself in many ways. Excessive sweating and hair loss are mild side effects of malnutrition compared with the more serious conditions that may result, including anemia, calcium deficiency, nausea, vomiting, and diarrhea. (3)
Surgery is not a quick fix to achieve the body the media portrays as desirable. Instead, it requires significant behavioral changes. There will be an increased risk of significant and life-threatening side effects, such as wound infection, hernia, ulcers, blood clots in the lungs, and even death, for any patient failing to follow the strict dietary and exercise regimen demanded by bariatric professionals.
People who have carried excess weight for many years are at a disadvantage when it comes time for recovery. Their hearts have been under a high degree of stress for years, working hard to supply oxygenated blood to body tissues. Lung capacity may also be impaired; less oxygen is getting into the blood, and less blood is being supplied to the wounds caused by the operation. The mechanism of wound healing requires a healthy supply of oxygenated blood. However, wound healing also demands adequate supplies of proteins, carbohydrates, vitamins. and minerals (4)-the very substances that gastric bypass limits in the body. If a patient’s food choices remain unchanged, the food he or she eats may not be rich enough in the constituents that the healing body requires, especially since food quantity will be limited by the reduced stomach capacity.
For the first twelve weeks after the operation, patients have no option. The first few days, when the stomach is no bigger than an egg and holds only an ounce or two of food, will be dedicated to intake of liquids only; (5) patients then progress to pureed foods, a bit like baby food with no chunks so they cause no digestive problems for inflamed and healing stomachs and intestines. After three weeks, patients may be able to manage soft foods like ground meats, cooked vegetables, and fresh fruit. After eight weeks of soft-food, in consultation with their surgeons, patients can start introducing regular foods into their diets.
Throughout his life, Frank has struggled to achieve the self-discipline to eat smart. Now, that self-discipline is precisely what is necessary for him to recover from the operation and to live with his new stomach. For fast and effective healing, Frank, like all other bypass patients, must eat easily-digestible protein-rich foods like cottage cheese, egg substitute, cheese, chicken and other poultry. While this high-protein diet may be limiting, it does not need to be unvaried. Patients may consume fish, shellfish, tofu, milk, soymilk, texturized vegetable protein, and a whole range of sugar- and fat-free commercial protein supplements. (5)
The only problem with most of the protein sources mentioned is that the proteins arrive in a patient’s tender post-operative stomach as very large molecules that are normally broken down by the acids and enzymes in the stomach in a process called hydrolysis. However, the post-operative stomach will no longer be able to break down foods the way it did before surgery, so it makes sense to eat foods that are already hydrolyzed to some degree. Some protein supplements (6) are made from a blend of hydrolyzed proteins that have been reduced to amino acids or peptides without changing their natural, biologically-active structure. These peptides are very small in size and can be absorbed into the body very rapidly.
Other challenges patients will face when selecting a protein supplement are serving size and taste. Some protein supplements are too large for a postoperative patient’s small digestive system. It may take hours to consume a 16- or 20-ounce protein beverage. Too-large protein bars and drinks may also over-extend the reduced stomach. That can, by itself, cause serious side effects. Taste is perhaps the most important factor of all, especially if protein supplementation becomes part of a patient’s daily routine. If a patient must trickle-feed a two ounce meal over a period as long as sixty minutes, that meal should at least taste good.
Keeping high protein intake through this critical phase will not only assist in the healing process, it will also prevent muscle wastage, provide energy, and fuel the metabolic changes necessary to promote weight loss.
If a patient neglects protein as a main constituent of the recovery regimen, he or she will almost certainly experience the plateau effect, when the weight loss initially achieved as a result of the operation comes to a mysterious halt. This can happen even if the patient is eating smaller portions less frequently and is avoiding sweet and fatty foods. (4)
Foods high in sugar and fat-like soda, candy, cookies, honey, potato chips, ice cream, hot dogs, and doughnuts-can also cause a particular stomach discomfort called dumping syndrome. (4) This occurs when food in the stomach moves too quickly into the intestine and causes a range of side-effects, including diarrhea and dehydration, leading to muscle cramps, sweating, dizziness, headaches, and general weakness.
Working together with Dr. Jacobs, Frank aims to get into a routine of three healthy meals each day, along with small snacks, and to stop the grazing behavior that is a sure recipe for weight gain with or without gastric bypass surgery. The gastric bypass operation is only the first step on the road to a healthier, happier lifestyle. The journey to full health and consistent weight loss depends almost entirely on following all of the steps spelled out by concerned and competent surgeons like Dr. Jacobs. As for Frank, he will have to learn to avoid all of the food and self-discipline demons that got him and those pesky fat cells into trouble in the first place.