2023-07-28 11:18:59
What is bariatric surgery?
Bariatric surgery, also called obesity surgeryis an intervention aimed at modifying the anatomy of the digestive system with the aim of decrease the amount of food eaten or limit their assimilation.
When used as part of the treatment of obesity, the objective is lasting weight loss and an improvement in the quality of life of the patients concerned.
In France, the number of bariatric surgery operations has tripled in ten years and is now estimated at more than 50,000 operations per year.
The different techniques
Different techniques can be used depending on the patient’s profile, the expected results and the operative risks.
- The adjustable gastric band : a ring is placed around the upper part of the stomach thus creating a small pocket. This technique makes it possible to trigger early satiety, thus reducing the quantity of food ingested and caloric intake. A loss of 40 to 60% of excess weight is estimated. Weight regain is common following band removal.
- Sleeve gastrectomy : a large part of the stomach is resected, which restricts the gastric volume by two-thirds without interrupting digestive continuity. In the same way as for the gastric band, early satiety is triggered and the quantities of food ingested decrease. A loss of 45 to 65% of excess weight is expected. This is the most common operation and offers the best results.
- gastric bypass : a short-circuit of a part of the stomach and the intestine is carried out allowing to decrease the volume of the stomach and therefore the quantity of food ingested as well as the assimilation of nutrients. It is a restrictive and malabsorptive method that allows you to lose 70 to 75% of excess weight.
Who is bariatric surgery for?
To qualify for bariatric surgery, several conditions must be met:
- you have to have an IBody Mass Index (BMI) greater than 40 kg/m2 or greater than 35 kg/m2 with at least one severe comorbidity factor such as arterial hypertension, type 2 diabetes, non-alcoholic steatohepatitis, osteoarticular disease, etc.,
- surgery should be done following failure of medical, dietary and psychotherapeutic treatment well driven for 6-12 months without sufficient weight loss,
- the patient must have been well informed and have benefited from multidisciplinary preoperative care,
- he must not have any contraindications to surgery and general anesthesia.
Bariatric surgery, on the other hand, is contraindicated in the event of severe cognitive or mental disorders, unstabilized eating disorders, dependence on alcohol and psychoactive substances, the patient’s inability to participate in prolonged medical follow-up, illnesses involving the vital prognosis at short and medium term and in case of contraindication to general anesthesia.
Bariatric surgery: what are the benefits? Are there any risks?
Bariatric surgery allows significant weight loss and thus a reduction in the risk of cardiovascular, respiratory and metabolic diseases. This weight loss can considerably improve the quality of daily life: less difficulty moving around, less joint pain, less shortness of breath…
Nevertheless, this is not not a trivial operation. It carries risks of complications related to the surgical intervention. The medium-term effects such as the risk of weight gain and vitamin deficiencies should not be overlooked either.
The operation can have significant psychological impacts on some patients with, for example, the development of eating disorders such as anorexia nervosa and dysmorphophobia. Audrey Raturas, dietitian-nutritionist.
This loss of identity and this rapid physical change can be destabilizing and difficult for some people to live with. In addition, “there is a real risk of cutting oneself off from society because the constraints are significant”.
Post-operative multidisciplinary follow-up is one of the keys to the success of the operation.
How to eat following bariatric surgery: the post-operative refeeding phase
During the procedure, the body, and in particular the stomach, undergoes significant stress. The replenishment must therefore be done gently with a gradual adaptation of the textures.
Each institution and each surgeon has its own refeeding protocolhere is an example :
- First phase : the food will be smooth to avoid irritating the stomach which has already been sensitized by the operation. We will favor foods such as broth, compote and yogurt for 2 to 3 days.
- Second phase : the food will be mixed and divided into 3 main meals and 2 to 3 snacks during the day to cover the needs and avoid the loss of muscle mass. Proteins should be consumed first, then starches, and finally vegetables which are not a priority at the beginning because they are low in energy. “We advise our patients to mix the foods separately and not mix everything on the plate to be able to prioritize the proteins”, explains Anthonin Bermond, dietitian-nutritionist. It is also important to eat slowly and chew food well. This phase lasts regarding 2 weeks.
- Third phase : it will be necessary to favor a soft diet, which can be crushed under the fork for regarding 1 week. We also try to increase the quantities a little more during meals and we can eliminate a snack if we eat enough during meals. Proteins will still need to be prioritized.
- At the end of the first month, you can start eating normally once more and have 3 meals a day and 1 snack. “During a sleeve, part of the stomach containing ghrelin, the hunger hormone, is resected. The patient therefore feels less hunger at first. To avoid undernutrition, it is important to eat at a fixed time even if you are not hungry,” insists Audrey Raturas.
What dietary changes should be put in place in the long term following a sleeve or a bypass?
The composition of the meals
“The most important thing is to have a varied and balanced diet, avoiding snacking and sugary drinks for the operation to be useful. It will be necessary to pay attention to the rich products apart from the meals which support dumping syndrome “, explains Audrey Raturas. Dumping syndrome is a very unpleasant feeling of discomfort that occurs when fatty or sugary foods arrive too quickly in the small intestine. It may take a few hours.
Meals should include a source of protein, a portion of preferably wholegrain starches and a portion of vegetables. We will favor complex carbohydrates rather than simple carbohydrates which are more satiating.
After the operation, there may be changes in food preferences and sensory alterations.
Some people can no longer eat red meat. They find it difficult to chew and digest which causes a feeling of disgust. Anthony Bermond, dietitian-nutritionist
More globally, protein sources such as meat, fish or eggs can be difficult for some people to eat for the first few months. This can be problematic because consuming a source of protein with every meal is essential to prevent loss of muscle mass. In this case, we can favor dairy products and vegetable proteins such as legumes. Dietary monitoring will be necessary to ensure good coverage of protein needs.
The meals being less substantial, the rrisk of vitamin and mineral deficiencies is important following bariatric surgery. Supplementation is sometimes necessary especially for vitamin B12, vitamin D and calcium. In the case of a bypass, lifelong supplementation is essential
How many meals per day?
The number of meals per day will be adapted according to the quantities that the patient is able to eat during meals. Some people will find it difficult to eat large volumes and will split their meals over 5 to 6 intakes over the day when others will eat 4 meals to cover their needs. These elements will also be adapted according to weight loss.
What foods to avoid following bariatric surgery?
THE soft drinks and the chewing-gums are strictly prohibited because they promote aerophagia likely to cause fistulas and, in the long term, to dilate the stomach impacting the effectiveness of the surgery. Alcohol is also strongly discouraged.
Hydration
After bariatric surgery, the recommendations remain the same: it is important to drink at least 1.5 liters of water a day. “You have to drink in small sips throughout the day and not during meals to avoid vomiting. We avoid drinking just before the meal so as not to spoil our appetite and we wait at least 30 minutes following the meal”, explains Anthonin Bermond.
After the operation, some people may to be disgusted by water without being able to explain it. Tea, herbal teas or water with infused fruits can facilitate water consumption. On the other hand, it is preferable to avoid syrups which are very sweet.
How to recognize that we have eaten too much during a meal?
After a meal that is too large, very strong abdominal pain or even vomiting appear. “Normally you should feel a pleasant sensation at the end of the meal. If abdominal pain appears, it means that we have gone beyond satiety,” explains Anthonin Bermond. With time and experience, it is easier to recognize it.
What to do in case of frustration?
After bariatric surgery, the frustration can be significant and thee food pleasure difficult to find. Hunger is less present, the quantities are reduced.
The work done before the operation is once more essential to manage the frustration. We learn to indulge ourselves with taste, by choosing quality products, rather than quantity. The psychological follow-up is also very important with work of acceptance to be carried out. Audrey Raturas, dietitian-nutritionist
The quantities can also be increased slightly and gradually to limit frustration.
Can we practice physical activity?
After the operation, walking is recommended to limit the loss of muscle mass but we avoid carrying heavy loads for a month. After one month, the resumption of suitable and regular physical activity is encouraged.
What does the post-operative follow-up consist of? Is it important ?
The pre-operative follow-up lasts 6 to 12 months and is an essential element in the success of the operation. “The more the patient is prepared for what awaits him, the better the post-operative follow-up will go,” explains Audrey Raturas. Pre-operative consultations and therapeutic education workshops on various themes are essential: balanced diet, false beliefs, listening to bodily sensations, recognition of hunger and satiety…
And post-operative follow-up regular and multidisciplinary involving the surgeon, a psychologist, a dietician and a teacher in adapted physical activity is also necessary. Even if the appointments can be spaced out over time, the follow-up must last a lifetime.
Many patients stop coming for appointments once they are better and have lost weight. ” Nevertheless, this follow-up is very important to maintain weight loss and avoid operation failure. We must not forget that obesity is a chronic disease, lifelong follow-up is essential,” insists Audrey Raturas.
Financially, it is not always easy to observe the follow-up. Some consultations are not reimbursed by health insurance, such as dietary and psychological consultations, but more and more mutual funds are covering them. There are also fully supported clinic or hospital pathways. You can inquire with your doctor.
How many pounds and over how long can you lose weight? Is there a risk of weight regain?
“It’s very hard to say and it really depends on the patient, their efforts and their physiology. Generally there is a rapid weight loss immediately following the operation, then the loss becomes slower and stabilizes following a few months. »
« And rrisk of weight regain is very real, it is not a miracle operation. Hygieno-dietary advice must be followed and regular snacking eliminated,” adds Audrey Raturas.
In the case of severe obesity, bariatric surgery can be a valuable aid that saves lives. It is an operation to be taken seriously, which must be carefully considered, being aware of the impact on daily life and the changes to be made even before the intervention. It is essential to be well surrounded and to have regular medical follow-up.
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