How do I know if I am a good candidate for weight loss surgery?
What types of weight loss procedures are offered at Houston Methodist Willowbrook?
What is the LAP–BAND system?
What is Roux–en–Y gastric bypass?
What is the Sleeve Gastrectomy?
What are the risks associated with weight loss surgery?
What are other benefits of weight loss surgery?
What can I expect following a weight loss procedure?
How will my diet change after weight loss surgery?
How will the consumption of fluids change following weight loss surgery?
How will protein in my diet change following weight loss surgery?
Will it be necessary to take supplements after weight loss surgery?
What if my insurance company requires a presurgical diet program?
What happens during the pre–surgery visit?
Weight loss surgery could be for you if you:
Houston Methodist Willowbrook Surgical Weight Loss Center provides a specially trained staff of nutritionists, dieticians and counselors for ongoing support to bariatric patients both before and after weight loss surgery. There are several Houston Methodist available for the surgical treatment of obesity. We specialize in laparocopic weight–loss surgeries including adjustable gastric lap banding, the LAP–BAND®, as well as the Roux-en-Y Gastric Bypass (RYGB) and the Sleeve Gastrectomy.
Among the less invasive weight loss surgeries currently available, the LAP–BAND® procedure, also known as adjustable gastric banding, is designed to restrict food intake by placing an adjustable silicone band around the upper portion of the stomach, creating a small pouch able to hold approximately two ounces of food.
A restrictive procedure, the LAP–BAND® system does not involve stapling or the surgical manipulation of the gastrointestinal tract. Under local anesthesia, the procedure is performed laparoscopically through small incisions. An adjustable silicone band, or ring, is safely placed around the upper portion of the stomach, creating a small "pocket" at the top of the stomach that limits the amount of food that can be consumed. Additionally, a tube connected to an access port and placed beneath the skin during surgery allows your surgeon to modify the size of the ring in order to ensure successful weight loss. These adjustments are also referred to as "fills."
The Roux–en–Y Gastric Bypass (RYGB) is among the most frequently performed weight loss procedures in the United States and one of the weight loss surgeries offered at the Methodist Willowbrook Surgical Weight Loss Center. Named after Swiss surgeon César Roux, who first began using the Y–shaped loop technique in gastrointestinal surgeries in 1892, the RYGB is a malabsorptive, restrictive procedure designed to redirect food to a pouch surgically created in the stomach, bypassing part of the small intestine.
The first part of RYGB entails the creation of a small pouch in the stomach, restricting the amount of food that can be consumed. The larger part of the stomach is then separated from the pouch though not removed. The small intestine just below the duodenum is divided, the jejunum portion is then brought up and connected to the newly created pouch and the duodenum is reconnected to the new intestinal limb – forming a "Y" shape. Bypassing the duodenum prevents the absorption of calories and nutrients, which results in weight loss.
The Sleeve Gastrectomy, or Gastric Sleeve, is a minimally invasive laparoscopic procedure that promotes weight loss by permanently removing two–thirds of the stomach (the new stomach looks like a "sleeve," or tube), while preserving the pylorus. The pylorus is the valve that regulates the emptying of the stomach. Retaining the pylorus allows food to trickle slowly out and causes patients to feel full with a small amount of food.
Once the large portion of the stomach is surgically removed following the greater curvature of the stomach, the open edges are attached with staples to form a "sleeve" or tube – permanently reducing the size of the stomach. The stomach is reduced by 85 percent, holding approximately two to five ounces of food and lowering daily caloric intake. Since there is no modification to the bowel, Dumping Syndrome is not as common and there is less nutrient malabsorption after surgery. The elimination of the majority of the stomach also results in the reduction of hunger-causing hormones produced within the stomach.
Performed under local anesthesia, the Sleeve Gastrectomy entails approximately five small incisions and takes about an hour to perform. There is no nasogastric tube or drain, allowing patients to return to work and daily activities in about two weeks following the surgery.
The minimally invasive laproscopic Sleeve Gastrectomy is a good weight loss option for patients with less weight to lose. It may also be performed to initiate weight loss and help less stable morbidly obese patients achieve a healthier state before a more extensive procedure can safely be performed.
Patients with a high Body Mass Index may require follow up surgery in order to reach their weight loss goals. Complications from stomach stapling may occur. Other risks and complications may include; deep vein thrombosis, ulcers, gastric leakage and fistula, pulmonary embolus, ulcers & dyspepsia.
Following adjustable gastric banding, patients consume a liquid–only diet and gradually resume consumption of solid foods according to their specific weight management plan. The first fill is not made until the stomach heals from surgery, approximately six weeks following surgery. Adjustments to the gastric band are made four to six times in the first year, in order to ensure optimal fit and encourage continued weight loss. Band adjustments are painless and generally made during a regular office visit. Weight loss associated with the LAP–BAND® is more gradual than with some other weight loss surgeries, about five to 10 pounds a month.
As with an surgery, there are operative and long-term complications and risks associated with weight-loss surgical procedures that should be discussed with your doctor. Possible risks include, but are not limited to, leaks from staple line breakdown, deep vein thrombosis, bleeding, complications due to anesthesia and medications, dehiscence, infections, marginal ulcers, spleen injury and stenosis. Prior to the weight loss procedure, your surgeon will thoroughly discuss all risks and concerns as well as the precautions that are taken to minimize them.
Aside from reducing risk of life-threatening obesity–related conditions, weight loss surgery patients also report increased energy and resumption of physical activity, a more positive outlook and improved self image. Weight loss surgery combined with a life–long commitment to a healthier, more active lifestyle will improve overall quality of life.
The actual weight a patient will lose after the procedure is dependent on several factors, including:
The weight loss team at The Methodist Willowbrook Surgical Weight Loss Center work to educate patients on the best diet for optimal results. Patients undergoing the LAP–BAND® procedure can expect in the first year a gradual weight loss of between one to three pounds per week. Those undergoing the Roux–en–Y Gastric Bypass (RYGB) generally experience more rapid weight loss in the first six months to a year following surgery. Those undergoing a Sleeve Gastrectomy can expect to lose 30 to 50 percent of their excess weight the first year following the procedure.
Long–term results depend on the ongoing commitment bariatric patients make to diet and lifestyle modifications. A maintained weight loss of 50 to 60 percent of excess weight is possible.
It is important that weight loss patients remember that eating behaviors must permanently change in order to sustain the loss. Despite the procedure, it is possible to regain weight lost if a nutritional diet, smaller portions and consistent exercise program are not sustained. There are many behavioral issues that impact one’s food and lifestyle choices, and the weight loss team at The Methodist Willowbrook Surgical Weight Loss Center is available to help put these issues into proper perspective. The monthly support groups are caring and compassionate health professionals working in the fields of nursing, mental health, nutrition and physical fitness.
Following weight loss surgery, the quality of your diet will change. Weight loss surgery patients are encouraged to consume a nutritional diet that is low in fat and sugar and high in protein. Resumption of solid food is gradual. Patients generally begin with clear liquids and build slowly to a regular, low-–fat diet as tolerated. This progression reduces post surgical complications and builds gastrointestinal tolerance and a successful recovery.
Immediately following the weight loss procedure, patients will sip approximately one to two ounces of clear liquids every hour. This may include water, flavored broth, sugar–free fruit–flavored beverages and decaffeinated, non–carbonated drinks. During the first month, bariatric patients slowly progress to semi–solid, low–fiber foods – building to a regular diet of smaller proportions.
While portions at each stage of recovery will increase, they should always remain relatively small – approximately eight ounces, or one cup, per meal. Gastrointestinal tolerance and food sensitivities following weight loss surgery will vary among individuals. Patients are encouraged to slowly resume foods eaten prior to weight loss surgery, in order to assess how well they are tolerated following the procedure.
A clinical dietitian will meet prior to surgery in order to discuss post surgery and ongoing dietary changes, as well as review nutrition education handouts designed specifically for bariatric patients.
Following weight loss surgery, fluids should no longer be consumed with food. Fluids should be consumed between meals, approximately 30 to 60 minutes before and after – as drinking fluids with meals may cause uncomfortable side effects by expanding the stomach pouch or forcing foods through the intestine at a more rapid rate resulting in Dumping Syndrome and/or vomiting.
Fluids should consist of water, broth, or sugar-free beverages (e.g., Crystal Light®), sugar–free gelatin and popsicles (no fruit pieces), milk and soy milk. Caffeinated and carbonated beverages should be avoided. Caffeine is an appetite stimulant and a diuretic. It can also interfere with mineral absorption such as calcium. Carbonation can cause the stomach pouch to expand and result in discomfort. Alcohol is also discouraged as caloric intake is reduced following weight loss surgery and those contained in alcohol are considered "empty" calories. The calories consumed should be of the highest nutritional value possible. Weight loss surgery patients are also encouraged to keep a water bottle during the day, drinking frequently though slowly.
Since all weight loss procedures restrict caloric intake, it is important to choose quality calories and foods and fluids rich in nutrients and protein. Weight loss surgery patients are encouraged to eat a low–fat, high-protein diet, consuming approximately 70 grams of protein per day from foods and fluids. While protein intake is limited by the restricted diet immediately following surgery and during initial recovery, it should be prevalent in the fluids and solid foods incorporated over time. Protein can be found in abundance in meat, poultry, fish, beans and legumes, low–fat cheese, low–fat tofu, and light yogurt. Grains and vegetables contain a smaller amount of protein though are rich in other important vitamins and minerals. Meals can also be supplemented with protein powders (e.g., 100% whey protein isolate, soy protein isolate) or protein drinks (e.g., Isopure® and "no sugar added" Carnation Instant Breakfast®). The clinical dietitians at The Methodist Willowbrook Surgical Weight Loss Center are available to consult on high protein supplements and food sources. They will educate and assist both you and your family in following the postoperative dietary guidelines.
Bariatric surgery patients are at risk for malnutrition. Vitamin supplements may be required as part of an ongoing, lifelong nutritional program, as weight loss surgery restricts caloric intake and changes food tolerances, inhibiting absorption of important vitamins and minerals required daily. In order to permit weight loss and sustain optimal health, vitamin and protein supplementation may be recommended.
The weight loss team of licensed dieticians and surgeons at The Methodist Willowbrook Surgical Weight Loss Center, along with the type of surgical procedure performed, will determine which type of supplement program should be incorporated into your diet after assessing your specific health goals and nutritional needs.
Some insurance companies may require a pre-surgical diet program as part of the criteria that must be met before qualifying for weight loss surgery. This may entail a three to six–month program that includes consulting with a registered dietitian on healthy eating and the type of lifestyle changes required following weight loss surgery. The program focuses on exercise, healthy food selection and meal planning as well as behavior modification.
The pre–surgical diet program is intended to:
Your bariatric surgeon may also order a pre–surgical nutrition program if weight loss is required prior to surgery – time frame and/or weight loss goals determined by the surgeon and based on each patient’s particular situation.
A pre–surgical diet program can be scheduled by calling the Weight Management Center at 832-667-LOSE (5673).
Bariatric patients meet with a physician and the weight loss team prior to surgery in order to confirm that weight loss surgery is the best option and that the risks and diet and lifestyle modifications that accompany bariatric surgery are well understood. Among the evaluations performed is a psychological evaluation, which includes an interview with the psychotherapist, who will examine psychosocial history and coping skills – important factors in dealing with lifestyle changes following bariatric surgery. A nutritional evaluation is also performed by a clinical dietitian and entails a review of nutritional history, current dietary and lifestyle habits, and post–surgery expectations.
At this visit, patients receive a bariatric surgery guide outlining nutritional parameters, as well as information on the pre-surgical diet program if it is required by your insurance or physician. Patients are also required to attend a 90–minute comprehensive nutrition class covering diet after bariatric surgery. The class schedule is given at the evaluation session.
The bariatric program nurse will then check blood pressure and anthropometrics (e.g., weight, height), as well as administer an H. Pylori (Helicobacter pylori) breath test if requested by the surgeon. This helps determine the presence of bacteria that can cause stomach and duodenal (small intestine) ulcers in some individuals; it has also been linked to certain stomach cancers. The H. Pylori breath test is an important test to perform prior to weight loss surgery, as once the stomach is stapled shut, H. pylori is difficult to treat. The breath test is performed on an empty stomach (no food or drink including no water and chewing gum for one hour prior to the test).
The nurse should be notified prior to the appointment if any of the following drugs have been taken:
A pre–surgery photograph is also taken during this visit.