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Post-operatively, exercise is always a good idea, especially if it’s tailored, fun and effective. If you’re thinking about having bariatric surgery such as a gastric sleeve or gastric bypass, you may have heard that your weight “melts off,” especially in the early days. It is true, that for some people (not all) the anatomical restriction and then the metabolic changes which occur in the months following surgery can lead to rapid weight loss. So why do we recommend that you exercise?
We get it, for many of you, exercise might seem like the last thing you want to do. Risk of injury; embarrassment; lack of motivation or low fitness level can all make working out seem like a daunting task. So if you’re going to lose weight anyway, why would we recommend starting an exercise program? What benefit does exercising have for your weight loss surgery journey? In this article, written just in time for Exercise Right Week, we look at when, how and why exercise is crucial to your success in the months, and indeed years, after weight loss surgery.
Weight loss surgery is major surgery, and we recommend you take it easy in the weeks following, in the same way, that you start gently with your diet. First up, you’ll want to take short walks. In the days after surgery, this will probably be around 10-15 minutes at a modest pace. You can increase this as you feel able to do so. Regular movement will help to get your blood flowing, reducing the risk of blood clots and encouraging normal bowel function. As the majority of bariatric surgery is performed laparoscopically, you should be ready to hit the streets and start exercising in earnest, a couple of weeks after surgery. Check with your surgeon to be sure. Taking it easy, whilst still moving, is the aim of the game in the days after surgery.
Once your wounds have healed, and you get clearance from your surgeon, you can increase your level of movement at a rate to suit you. Incorporating plenty of incidental activity (activity in normal daily movement) is a great place to start.
You may also be able to incorporate gentle exercise like swimming activities or walking. Swimming is also great in the early days, because it alleviates the load on your joints, reducing the risk of injury while you exercise.
One of the earliest appointments we’d like you to make before surgery (apart from seeing your Dietitian) is to book in with an Accredited Exercise Physiologist. Why? For prehab rather than rehab! Getting the right information to exercise safely and effectively is essential. A cookie-cutter exercise routine is futile in the early days. Sure, standard routines might be great for some (and one day you – we promise!) but to start with, you need expert help. Slogging it out at the gym trying to keep up with people half your age (and weight) is not the answer. Expecting to suddenly become Jamie-Lee Curtis (or Arnie) overnight is going to at best lead to disappointment. At worst, it could lead to injury.
Everybody is different. What an Exercise Physio has, is a unique way of determining what is going to work best for you and your body for right now. Taking into consideration all of those things that might have held you back in the past. They can identify and work with past injuries, anatomical structure, and your current weight and muscle tone. They also work with your own personal preferences when it comes to exercise style and even your own limiting ‘self-talk.’ Then, they can build you a personalised workout plan which ticks all the boxes for you.
“Come on, I’m losing weight anyway, do I really need it?” you ask. Yes, you may lose a lot of weight without even putting on your exercise shoes in the first 12 months after surgery. But you will also lose muscle and bone mass along with it. In fact in postmenopausal women, following weight loss surgery, there is a 7% chance of a long bone fracture due to osteoporosis/ osteopaenia. Being able to counter-balance that loss by incorporating weight-bearing exercise (also called resistance training) is a very good idea. It really is a case of “use it or lose it.” Increased muscle mass encourages a faster metabolic output so that you can burn more calories. Muscle tissue is the powerhouse of the body. And if you’re finding the weight is not ‘falling off’ for you, building that muscle is a great way to encourage weight loss.
If you have comorbidities, exercise is an even faster way to health. Exercise helps to reduce the risk of chronic diseases like diabetes and heart disease. As well, you can increase bone density and even support changes to your biomechanics and encourage joint stability. It also has a really positive effect on mood due to the release of endorphins when you exercise.
Most of all, exercising after weight loss surgery is about forming healthy habits which give you every chance at lasting weight loss and health. There is growing research into how exercise can support long-term health after bariatric surgery. In modern surgical practice, we recognise that adopting crucial healthy lifestyle changes can enhance bariatric surgery in distinct ways.
Exercise Right Week is brought to you by Exercise & Sports Science Australia (ESSA). This body accredits our wonderful Exercise Physiologists. This year’s theme is Movement is Medicine, and we encourage you to have a look at some of the ideas ESSA has for getting moving. Follow the hashtags #ExerciseRight2020 and #MovementisMedicine for all the ideas.
So be sure to embrace exercise and the wonderful benefits for you post-surgery, but don’t go it alone in the early days. If you have access to a great Exercise Physiologist, and your surgeon has a modern approach, then the process will be safe, fun and achievable! It is our sincere hope that the experience will inspire you to reach for goals you never imagined possible.
Why not head to our patient information area, to get all the facts.
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If you’ve thought about surgery, you may have wondered what the bariatric diet stages are that you must adhere to. You may also want to know why it’s important to progress with reintroducing foods after surgery. And even wonder, “is this staged differently depending on the procedure I opt for?” These questions are natural and common questions for a prospective patient to ask, and we try to answer these as best we can in the information below.
Firstly, let us preface this information by telling you that every patient is different. What’s right for one person may be very different for someone else. But it can be reassuring to know what to expect in a general sense. With that in mind, here’s a general overview of the different bariatric diet stages, and why these might be important for you to adhere to after weight loss surgery. If you have actually had surgery, the best protocol is the one given by your surgeon or dietitian who actually knows you and your unique needs.
In general, no. We use the same 2/2/2 rule for all procedures. That is 2 weeks liquids, then 2 weeks puree, then 2 weeks soft, before transitioning to “normal” food. The bariatric diet stages may differ in timing depending on how you tolerate them. We make the 2 weeks liquid mandatory but there is some leeway with the puree and soft phases. Either way it will be six weeks before you start on normal food, albeit in very, very reduced quantities. We don’t typically see much difference in the way patients, post sleeve versus post bypass, tolerate the diet.
After the surgery, you will be undergoing a complete change in the way you eat, and how you approach it. What doesn’t differ, is your need for optimal nutrition and hydration. A dietitian is best equipped to help you navigate nutrition and hydration to ensure you are meeting all of your needs. A bariatric dietitian will also be invaluable in providing tips and tricks to thrive on a weight loss surgery diet at every stage. We recommend a protein based diet, along with some healthy fats, and minimal carbohydrates, especially the Roux-en-Y where carbs can lead to dumping syndrome.
There are 4 phases to post-surgery diet and there is also a pre-surgery protocol which you need to follow. This timing is very important for your health and safety and is evidence-based. For post-surgery care, we need to ensure that the normal swelling and oedema you would expect after surgery has subsided. Your stomach needs to be healed before reintroducing solid foods. You may feel well, but adhering to your surgeon’s recommendations will reduce the likelihood of complications.
We may ask you to follow a very low-calorie diet (VLCD) for about 1-4 weeks before you are due to have surgery. This varies depending on your BMI. This is to help reduce the size of your liver and help make it more pliable by reducing the amount of fat in it (fatty liver/ hepatosteatosis/ steatohepatitis). This ensures a safer operation. Generally, your preoperative diet will consist of a protein shake/ soup meal replacement such as Formulite or similar liquid diet. We recommend Formulite as weight per volume it has up to 50% more protein and 50% less sugars than other replacement meal shakes and soups. Protein keeps your hunger at bay for longer. The reduced sugar contents helps wean off sugary foods. It also has fibre and macrobiotics essential for gut health. Meal replacement shakes are NOT meant to be fun!! They are NOT the same as a milkshake. They should be palatable, sure, but primarily they are to provide adequate calories and micronutrients for the preoperative weight loss phase of your journey. Most people tolerate Formulite. If not you can talk with our dietitians about a suitable alternative.
Right after surgery, we need to go very slowly. You will need to sip, sip, sip. Liquids such as plain water, protein water, protein shakes (including those from VLCD phase), clear broths and soups, decaf tea or coffee, sugar-free jelly or flavoured water. The length of this stage is 14 days. You will find each day you can drink just that little bit more as the swelling settles. You need to get AT LEAST 1000 mL each day to avoid dehydration. Sip, sip, sip is the way. Usually around the second post op week you can start on your multivitamin, which you will take indefinitely. If you’re struggling to meet fluid and/or protein requirements contact your surgeon or dietitian.
Stage 3 is the purees stage. and can be likened to the way we introduce food to babies. This is food pureed to a smooth consistency, with a view to providing a gentle introduction back to solid food. Your dietitian will provide recommendations here. Stage 3 is generally 1-2 weeks after stage 1 is completed.
Just as with babies, stage 3 is about incorporating more solid (but still soft) foods and an overall protein-based, moderate healthy fats, low card diet. Your dietitian will guide you in eating small meals consisting of protein and vegetables at this stage. This diet will progress to stage 4 depending on your tolerance. generally 3-4 weeks after stage 2. It continues till around week 6 post op.
Over time, you will find your tolerance for solid foods will grow, as will the amount you can eat at each meal. Your goals are to eat for optimal nutrition and of course, enjoyment. For most patients, you will feel full after very small meals. But you will still ENJOY them. The metabolic/ neurohumoral aspect of the surgery tricks your brain- you will feel full, satisfied and content after just a small amount of food. Interestingly your tastes may change. Every patient is different. Some say their tastes gravitate towards healthier options, and foods which are lower in sugar and fat.
As a weight loss surgery patient, you will need to monitor your diet and nutrient levels for life. But it will definitely get easier over time. We recommend seeing your dietitian regularly, especially in the first 12 months. This will help cement the important lifestyle changes you need for lasting weight loss, while the metabolic effects of surgery are in motion. You should also follow-up with your surgeon who will monitor your nutrition and overall wellbeing.
You should check in with your team (surgeon, bariatric G.P, dietitian, psychologist, exercise physio) whenever you feel that you’re steering off course. This happens to the best of us, and your team will quickly help get you back on track. This can be any time in the years after your surgery.
You can chat to a weight loss surgeon in the strictest confidence about the risks and benefits of each procedure as well as check whether you qualify for surgery. Arming yourself with the right information will help you to make an informed decision that’s the right one for you. Find out where you can book in for a no-obligation consultation.
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If you’ve been thinking about weight loss surgery, you’ll know that finding good information can be a minefield. You start thinking and talking about surgery and suddenly everyone is an expert on it. You’re not sure what to believe. Some stories might have some truth to them. Some are completely unfounded, or relevant only for that person. We break down 7 of the most common weight loss surgery myths that need to be debunked. So when it comes to this important decision, you can separate fact from fiction.
The idea that surgery is a vanity decision is medically and psychologically incorrect. Being slim, or looking better can be a side effect of surgery, and albeit it is a welcome one for many patients. But, in our experience, it is not the biggest reason patients choose to have surgery.
Overwhelmingly the decision is around health.
Being obese, is one of the leading causes of premature death. It increases the risk of diabetes mellitus, high blood pressure, heart disease, stroke and at last count 11 cancers. Obesity can also lead to obstructive sleep apnoea (shorts periods where a person stops breathing while sleeping). People can also experience back and joint problems and depression.
Losing weight, getting smaller and looking fitter is a good goal, and monitoring this for patients is a great way of keeping on track after surgery. But this is not about how the body looks, but what the body can do.
Getting off medication, sleeping better, becoming more active, reducing the risk of co-morbid disease and just generally having a better chance at life, that’s where the real wins are.
If you ask them, most of the time our patients will tell you that at the heart of their decision, was a desire for a better quality of life and to be around longer for those they love.
The stigma attached to weight loss surgery as somehow being a quick fix or a lazy option is untrue. This myth proposes that weight loss surgery patients are taking the easy option when it comes to their health and weight. In reality, recommendations for weight loss surgery are only made after a patient has tried in vain to lose weight through diet and exercise alone. This is a requirement we need to comply with as health professionals.
In reality, most patients have tried their entire lives to lose weight through diet and exercise alone.
Weight loss surgery in broad terms is about a lifelong commitment to health and wellbeing. The surgery itself is a tool to kick start a new healthy lifestyle which incorporates diet, exercise and mindset growth. Some patients find this transition easy. But most, find that change is hard work on not only a physical level but emotional too. For others to downplay this hard work can be soul-crushing, especially when it comes from friends and family.
Supporting bariatric patients and recognising their challenges and achievements is something everyone can and should do more of.
Bariatric surgery is not dangerous in the hands of an experienced and qualified surgeon. But it does carry risk, as with all surgeries. There’s risk around the surgery itself, including the anaesthetic administered. There are also risks of complications following surgery. Each surgery will have its own unique risk profile, and surgeons should explain the benefits and risks of each thoroughly to you.
But the procedures are not considered ‘high risk’ or ‘dangerous’ especially if performed laparoscopically (keyhole surgery). The risk profile is comparable with procedures like laparoscopic removal of the gallbladder, laparoscopic hysterectomy and hip replacement.
Despite this, complications can occur. We operate in select hospitals with 2 surgeons at each operation It means we are confident in the team and their expertise and one of us can be on hand within minutes should complications arise.
It is important to debunk the misconception that a ‘one size fits all’ approach works. Some people due to their medical history and or anatomy are unsuitable for a particular procedure, despite its efficacy rate. Likewise, following surgery your nutritional requirements, exercise regimen and support needs will be as individual as you are. These needs are a delicate balance that must be managed to ensure your physical and mental health are on track.
That’s why the support of your surgeon, general practitioner, dietitian, exercise physio or trainer and your psychologist are so important after surgery. We’re all in this with you for the long term.
After surgery, when it comes to the tips and advice from others, it’s important to be open but cautious. While it’s great to investigate the different approaches you come across, ultimately you should discuss the merits with your trusted team before adopting changes yourself. This is especially important when it comes to nutritional supplements, dietary advice and exercise regimes. What worked for someone else might actually be very wrong for you.
Some patients experience rapid weight loss in the first 12 months due to the metabolic and anatomical changes which occur following surgery. It is tempting to assume this exempts you from exercise. But nothing could be further from the truth. In fact, this myth about bariatric surgery can be dangerous. Rapid weight loss can lead to muscle mass loss. Counteracting that with regular exercise and including weight-bearing exercise at a level to suit you is imperative. It is the case of “use it or lose it.”
Maintaining muscle mass also promotes fat loss, so it really is important. As well, developing habits around exercise will help you to maintain your weight loss as the metabolic effect stabilises after the first 12 months or so after surgery.
If you have had surgery somewhere where follow up was not given the importance it deserves, you may feel that the surgeon’s job is done once you lose weight. In a way that’s true, if the surgeon’s only role was to perform the surgery. But if your surgeon and allied health team take on the role of ensuring your long term health and wellness, and ability to maintain your weight loss, then follow up is a big part of the equation.
Because skinny doesn’t always mean you’re healthy, especially for the bariatric patient. Following up can allow us to prevent or address complications, monitor your nutritional health and help to keep you on track to maintain your weight loss for the long term.
Have you been thinking about weight loss surgery for a while, but feel you need to be bigger? This is a common myth that is not often discussed. Psychologically, those at the lower end of the qualifying criteria may feel they need to be bigger to have bariatric surgery. This is absolutely fine if they are trying again with diet and exercise. But often, we see people go away and put on more weight before coming back to have surgery.
There are various reasons for this thinking, some have to do with personal and psychological reasons which are all perfectly acceptable. Really, when you’re ready you’re ready and when you’re not you’re not. It is always okay. But sometimes it comes from being influenced by the bariatric myths and stigmas we have addressed here.
Anatomically, being at the lower end of the spectrum is helpful. Apart from having less weight to lose, you also have less impact on your joints, so you can get moving faster. As long as you meet the criteria, wholeheartedly understand what you’re up for, and are serious about changing your lifestyle as well, then wanting a healthier life is always justifiable.
We would be happy to answer any and all of your questions as they impact you and your unique circumstances
Why not make a time to come and see a surgeon near you, and get the real deal on your health.
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Fibre is essential for a healthy diet, and this is especially true if you have had bariatric surgery. With your new smaller stomach, you may find it a little more of a challenge getting enough fibre into your meals. They say that food is medicine, and for someone who has undergone gastric sleeve, gastric bypass or other procedures this is never more true. Empty calories just have no place in your new bariatric diet and working to achieve the right balance is the goal.
When it comes to fibre, we have high needs. In this article, we explain why fibre is important, and which foods are fibre rich.
We also include some tips especially for you if you’ve had bariatric surgery, to help choose the right fibre-rich foods for you unique needs.
Dietary fibre is found in plant foods such as fruit, vegetables, whole grains and legumes. If you guessed that most Australians are not averaging enough fibre each day, you are right. So why is it so important?
Fibre is the indigestible portion of whole plant foods. Why do our bodies benefit from these indigestible components so greatly? Well, there are three main types of fibre which work well to keep us healthy:
The sweet spot for fibre intake is about 25-30 grams of fibre per day. A study examining the data of 185 observational studies, and 58 clinical trials found that people who had more fibre in their diet were 15-30 percent less likely to die prematurely from any cause or a cardiovascular condition.
While these symptoms don’t all mean you have inadequate fibre intake, they just might, especially when combined. Symptoms of not enough fibre can include:
It is important to remember that everyone is different and you also will have different tolerances and needs at each stage post-surgery. Keeping a dialogue and regular follow up appointments with your surgeon and dietitian will ensure you aren’t missing out on important nutrients like fibre.
If you aren’t getting enough fibre, your dietitian can help you navigate the decision to supplement. This means deciding on the right supplement for you – containing the appropriate types of fibre. As well, working out the correct amounts in your specific case to maintain a healthy digestive system. We would never recommend supplementing anything without having a conversation with your surgeon/dietitian first. Please remember, that everybody is different. Even if a fellow bariatric patient has had success, this may not mean it is right for you.
The good news is, if you’re able to increase your intake of good quality fibre, it can have a positive impact on your gut microbiome. This in turn will have a positive impact on your weight loss. Another great reason to be proactive.
If you’re curious, you are most welcome to reach out to us to have a confidential chat with a surgeon about your options. Contact one of our surgeons near you for a no-obligation consultation.
Image Credit: Trainer Academy
Check out our more tips on navigating diet after bariatric surgery.
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What are non scale victories? Why should I focus on them after bariatric surgery? We explain the importance of NSV and how focusing on them can help you make great progress towards achieving your weight loss goals.
When you’re trying to lose weight, it can be really tempting to keep a laser beam focus on the number on the scales. While how much you weigh is important to track, it’s not nearly as important as other success measurements. For the weight loss surgery patient, preoccupation with the scales can be counter-productive and sometimes destructive.
Enter the non scale victories. Non scale victories (NSV) are a group of success measurements that indicate progress even when the scales do not change that week or month. Because sometimes, they just don’t.
How much we weigh can be a really abstract thing. NSV are rooted in what we do and are easier to attach to a habit we’ve changed or an action we’ve taken. That’s why we love them. When the numbers don’t reduce, we need to know that there are other ways to pat ourselves on the back. To be able to find a new reason to keep putting one foot in front of the other and to keep striving. Because success is made every day, in the little steps.
Non scale victories prove that it is not all about the scales. Here are some other really important indicators you are on the right track. Make a note of changes you experience in a journal you can refer back to. These wins will encourage you when you feel down. And keep you moving forward.
Has your diabetes gone into remission? Is your medication reduced? Is your blood pressure lower, or resting heart rate better? Are you sleeping better? These are all extremely important milestones to take stock of. As doctors, we love this NSV. It means you are on the road to a healthier longer life.
Maybe the scales are saying you’re the same weight. But if you measure your waist and you’ve lost centimetres then you are winning! Time to celebrate.
Can you get in and out of the car much easier? Do you climb the stairs without running out of breath? Are your joints better and is getting around much easier now? These are not things to take lightly! If you are able to move more freely than you used to, then you have every reason to congratulate yourself.
If you are making and exceeding the exercise goals you or your physio set, then this is a great NSV to focus on. If you can exercise for longer, or if you can do more reps in the time you are doing really well. If you’re getting stronger and can lift more, then you are building muscle mass and this will have a great result for you.
Are you feeling more able to give things a go? Less worried about weight-related issues holding you back? This will look different for everyone. Some people say they no longer fear having to sit next to someone on a bus or on a flight. Or it might be something like confidently going to the beach or park with the kids.
We don’t always want to focus on outward appearance, it’s true. But some days you just have to high-five yourself for how much healthier you look. When pants are too big. When dress and shoe sizes reduce. Or when you catch your new frame in a photo and you feel happy about the new you that’s emerging.
Have you got a certain ‘Joie de Vivre’ that you didn’t have before? If you feel happier within yourself most of the time, then this is a great thing to take note of. This is not to say that weight loss surgery is by any means an easy journey. There are ups and downs – especially when you are undergoing such significant lifestyle changes. But if you are generally happier with your new lifestyle, then this is a great reason to celebrate.
There are so many little ways you can feel victorious. You might have:
It’s the little things that make up a life, and a successful weight loss result.
We hope that there are a few NSV that you can take note of. If you’ve had surgery, we hope that there are a few here you can claim as your own. Whatever they are, hold them close. Through the tough times (and there may be tough times) these will gently remind you of your progress, and that you’ve got this!
See why comprehensive support gives you ever chance at long term success.