Bariatric surgery post op


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Bariatric surgery post op

  1. 1. Life after Bariatric Surgery Pouya Shafipour, MD Wellesley Medical Los Angeles, CA
  2. 2. First the Good News!  At the end of this presentation you will have a clear understanding of the following:  You will lose excess weight in a healthy way and reach your ideal weight fairly rapidly post-op  You will feel better than you have in a long time  You can do this through safe and effective dietary changes  You will learn how to maintain your weight Wellesley Medical
  3. 3. In this talk we will cover: The Problem The Causes The Solution Wellesley Medical
  4. 4. An example of the Good news! • TJ 40 y/o F • 5’ 2” • 130 pounds overweight • Size 18 • Frequent Headaches • Nausea • Insomnia • Chronic Fatigue • Diabetic •6 months later • 70 pounds loss •Size 8 •headaches gone •nausea gone •Dizzy spells gone •Diabetes cured •Great sleep •Lots of energy! Wellesley Medical
  5. 5. Now the Bad News! • When it comes to Dieting and Weight loss in the US, We are confused • Our current weight problem is not a result of lack of effort by the American Public. • With over 6000 diets available and the contradictory “scientific evidence”, it would be a miracle if Americans were not confused • Following the wrong plan, no matter how hard you try, will get poor results. Wellesley Medical
  6. 6. The Problem America is Overweight and Obese According to the CDC 1 out of 4 people Are either Pre-Diabetic or Diabetic?  Oct 2010 CDC Estimates  By 2050 up to a third of the population diabetic  57 Million Americans Pre-Diabetic.  24 Million Americans Diabetic.  7th cause of Death in 2007
  7. 7. More Statistics  Over 400,000 Deaths from Obesity year.  74% of Adult Americans are Overweight/Obese  Since 1980 number of Overweight Americans has doubled
  8. 8. The Epidemic  Over the next 24 hours  2200 diabetics will be diagnosed  512 diabetics will die  66 diabetics will go blind  77 diabetics will develop end stage kidney disease  153 will have diabetes related amputations
  9. 9. Overweight and Obesity CancerStats in U.S.  90,000 Cancer Deaths  14% of all Male Cancer  20% of Female Cancers  American Cancer Society* *estimates excess weight contributes to 33-50% of women! Heart Disease in U.S. Since 1984 more female deaths, than male. 512,000 female Deaths 447,000 male Deaths 10,000 women under 50
  10. 10. Health Effects of Being Overweight/Obese • Type II Diabetes • Heart disease • High B.P., Heart Attack • Stroke, Arthritis • Pancreatitis • Infertility, Birth Defects • Carpal T.S., Low Back Pain • Impaired Immune Response • Impaired Resp. Disorders • Fatigue, Fatigue and more... • Gall Bladder D., Gout • Menstrual disorders • Menopausal hot flashes • Insomnia, Sleep Apnea • Depression, Reflux • Surgical Complications • Pain, Urinary Incontinence • Chronic Ven. Insufficiency
  11. 11. Cancers and Obesity  Esophagus  Pancreas  Colon and rectum  Breast (after menopause)  Endometrium (lining of the uterus)  Kidney  Thyroid  Gallbladder
  12. 12. These Statistics Represent:  Quantity & Quality of Human Life Severely Diminished by this one condition  Meaning Quantity in Years Lost  Quality of Life 24 hours, 7 days a week
  13. 13. Why is There an Epidemic of Diabetes and Obesity? Falsehoods Exposed “Its in my genes – I am doomed to get it” “It is out of my control”. Wellesley Medical
  14. 14. Causes of Diabetes & Obesity • Unhealthy Eating Habits • Excessive Weight (Abdominal Fat) • Lack of Adequate Nutrients • Lack of Exercise
  15. 15. Changes in Our Eating Habits  Sugar intake 1900, 2-4 lbs. of Sugar/person/year  Sugar intake 1999, 158 lbs./person/year  Refined Grain intake from late 1970’s thru 2000 has increased by 60 lbs. per year
  16. 16. French vs American Diet Late 20th Century French Diet was higher in fat, had equal amounts of meat and fish, 4X's as much butter and cheese, and they had 60% less Heart Disease than the US.
  17. 17. More About Fats  From the mid 1980’s to mid 1990’s, the % of daily calories from Fat in the American Diet, decreased from 40% to 33%, while obesity in increased significantly  From 1910 to 1970, Heart Disease escalated from almost non-existent to # 1 cause of death. During this time the intake of Animal & Butter fat significantly decreased, dietary cholesterol did not increase, while sugar intake increased dramatically
  18. 18. How do we Gain FAT? Let’s look at the common scenario of fat gaining that takes place, slowly but surely over time, from too many carbs, too many “empty calories”.
  19. 19. When blood sugar exceeds a certain level the body converts it to fat and stores it. High Carb Meal Fat Storage Fat Storage Fat Storage Fat Storage Low Blood sugar Symptoms Next Carb Fix Next Carb Fix Next Carb Fix Next Carb Fix
  20. 20. Insulin and Glucagon Insulin • lowers elevated blood sugar. • shifts our metabolism into storage mode • removes dietary fat from blood and transports it into fat cells. • Increases body's production of cholesterol • causes the kidneys to retain fluid • stimulates the release of eicosanoids. (proinflammatory Signaling Molecules) Glucagon • shifts metabolism into burning mode • turns fat into blood sugar for energy use. • Decreases body’s production of cholesterol • causes the kidneys to release excess fluid. • stimulates the release of eicosanoids. (antiinflammatory signaling molecules)
  21. 21. The Eicosanoids Insulin • Promotes platelet aggregation • Promotes vasoconstriction • Depresses Immune Response • Is Pro-Inflammatory • Increases Pain Transmission Glucagon • Inhibits platelet aggregation • Promotes vessel opening • Stimulates Immune Response • is Anti-Inflammatory • Decreases Pain Transmission
  22. 22. Where Does the Sugar come From?
  23. 23. Think about the foods you love? Are they healthy choices?
  24. 24. Refined Sugar Sodium Saturated Fat Minerals, Vitamins, & anti-oxidants Probiotics Omega-3
  25. 25. Out of Control Portion Size Hamburger 2.8oz – 4.30oz 50% inc in calories French Fries 2.4oz – 7.00oz, 10x inc in calories Chocolate Bar 2.0oz – 7.00oz, 3x inc in calories Coca Cola 6.5oz – 16.0oz, 2x inc in calories Popcorn 3cups – 21cups, 10x inc in calories
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  28. 28. “If there is one thing that could bankrupt America, it’s health care. And it’s out of control!” David Walker, GAO – Presidential Forum on Aging
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  30. 30. The Status Quo Not Sustainable. 33% Diabetic - CDC!
  31. 31. So, How do We Solve this Problem? The Bad News is: There is No Magic Pill to solve this problem.
  32. 32. What Does not Work • Natural Stimulants”, i.e. Ephedra and the many other “Fat Blockers”, “Carb Blockers”, “sleep your way to weight Loss, dont change your lifestyle” products. • Prescription Medications for Weight Loss, remember Fen, Phen? • Lastly,“it is not the fault of your Genes”. When we take care of the body in the way it is designed to be cared for, it performs wonderfully and loses weight steadily.
  33. 33. Really Good News Gastric Bypass Cures Diabetes and most diseases associated with Obesity
  34. 34. This Challenge is: Following a plan that focuses on:  Fat Loss  Preservation and increase in muscle mass  Long-term sustainable weight loss and avoids weight regain.
  35. 35. It is not about a Diet It is about a system! A System Structured for Success
  36. 36. What a typical diet lacks:  Proper nutrients.  Proper protein content.  Adequate unsaturated “good” fat
  37. 37. Long term Post-op Program • Abdominal Fat Loss • Develop Healthy Food Habits • Nutritional Deficiencies Supported • Exercise
  38. 38. Abdominal Fat Reversal  Establish a Bio-chemical State to Target: ABDOMINAL FAT Abdominal Fat = Development of Insulin Resistance & Tumor Formation
  39. 39. Abdominal Fat Study Excess body weight in combination with physical inactivity is a major determinant for the development of insulin resistance with associated hyperglycaemia and hyperinsulinaemia and further leads to tumour development.” Arch Physiol Biochem. 2009 May;115(2):86-96. Obesity related hyperinsulinaemia and hyperglycaemia and cancer development. Becker S, Dossus L, Kaaks R.
  40. 40. Healthy Food Habits • Understand Food Habit Impact on Blood Sugar • Make the 20/80 Flip • Minimize Foods that Induce Allergies/Sensitivities • Ensure Adequate Intake of Protein with Meals (60 grams/day minimum) • Maintain 3 Meals a Day – Never Miss Breakfast • Healthy Snack Between Meals
  41. 41. Nutritional Deficiencies • Typical post-op Mineral and Vitamin Deficiencies • Chromium, Magnesium, Zinc, EFA, Selenium, CoQ-10, alpha lipoic acid, calcium with vitamin D, iron and vitamin B12
  42. 42. Exercise • Daily 30 minutes of movement for Heart Health • 60 minutes of exercise for weight maintenance • Family Exercise very important to prevent childhood obesity • Non-Exercise Activity Thermogenesis (NEAT)
  43. 43. Summary • Gastric Bypass is an effective procedure to cure diabetes and cause dramatic weight loss. • Caloric intake, nutritional deficiencies and Protein intake need to be monitored post- operatively and for the rest of one’s life. • 60-80 grams of Protein/day is necessary to avoid muscle loss and maintain one’s weight.
  44. 44. Conclusion  Have 4-6 small meals a day. You can not eat large amounts of food and your meals will not last as long as they did before, so eat more frequently.  Drink at least 64 ounces of water daily. Drink at least 30 minutes before eating. This "water loading" will make you feel fuller before you eat.
  45. 45. Simple Action Steps  Chew your food very well- 20 times before swallowing. It slows down your eating and also breaks down the food to allow the food to go down easier  Keep a food diary and plan your meals. If you fail to plan, you plan to fail.  Don't rely on what is nearby for food. Fast food will slow you down. Never skip breakfast. Eat like a queen for breakfast, princess for lunch and pauper for dinner.
  46. 46. Simple Actions  Avoid foods high in sugar (more than 20 grams per serving) or high in fat (more 30%).  Bread does not grow on Trees! So Avoid Carbohydrates as much as possible  Be careful with liquids like juices, smoothies, or lattes. These have calories and you will not have the feedback or solids telling you that you are full.  Avoid snacking. Grazing on food will add weight. Stick to your set meal times.
  47. 47. Concluding Remarks  Don't give up. Weight loss and weight maintenance is a life long process. If you over indulge one day, make up for it the next day. Keep working to make yourself better each in every day in each and every way.  Find time for yourself. If you are stressed at work or home your body will know it and not like it. Take care of yourself or you can't take care of others.
  48. 48. For more information please visit us at Or Call us at (310) 400-5565