Roux-en-Y (Gastric Bypass)
Gastric bypass surgery is when the surgeon makes a small pouch out of the stomach and reconnects it to the small intestine. The stomach remains intact (ie. it is not removed from the body), however there is a small pouch (30-40mls) - the size of an egg, that prevents too much food or fluid being consumed. The new stomach is attached to the middle of the small intestine. This allows some mis-match absorption of foods and restricts the food allowed into the stomach. This leads to greater suppression of hunger and appetite and subsequent weight loss. With less food being absorbed, there is a greater need of vitamin and mineral supplements.
Figure 1: Roux-en-Y Bypass (Gastric Bypass)
Benefits of Gastric Bypass Surgery:
Negatives of Gastric Bypass Surgery:
Gastric Sleeve Surgery
A gastric sleeve is where the surgeon removes 2/3 of the stomach. This procedure also reduces appetite by removing cells that stimulate your hunger. These cells are called ghrelin and leptin. Ghrelin is responsible for driving hunger. Leptin is responsible to keeping hunger cues 'on'. When there is an abundance of fat, leptin - which is stored in the fat cells, become resistant to the hormones that try to switch it off. As a consequence, leptin is on all the time, driving hunger/appetite. This affects weight gain. Removal of these cells is effective to prevent weight regain and promote weight loss.
Figure 1: Gastric Sleeve Surgery Outline: The normal stomach (which is NOT enlarged in obese patients) holds about 1.5 litres of food. The stomach is reduced by removing the larger part of the stomach (see Figure 1). This large part of the stomach is removed completely. This leaves a small sleeve of the stomach that can only hold 150ml (1/2 cup). The stomach capacity is reduced by 70%. This means that you will not be able to eat as much as you used to. This procedure is restrictive and not malabsorptive.
Benefits of the Surgery
Negatives of the Surgery
A gastric band is a plastic device held around the top of the stomach to restrict food that can enter the stomach. The device holds saline solution, which causes the restriction of the stomach. It decreases hunger by causing a stretching of the stomach above the band, which sends a message to the brain telling you that you are full – even if you had a small portion of food.
There is no malabsorption in this procedure. This procedure needs adjustments with saline solution (salt) through the port, to increase or decrease the amount of food that can enter the stomach. If you are gaining weight, the band can be tightened. If you are losing weight too quickly or cannot get food down, the band can be loosened.
Figure 1: Lap-Band Procedure
A gastric band is a surgery that is done laparoscopically (using small incisions in the stomach), a band is introduced into the abdomen and secured around the stomach and sewn in place. It is made of silicon and Silastic. It has a balloon on the inner surface, which is connected to a tube and small port – under the skin. This lies on the top of you abdominal wall. In the port, your doctor will add or remove saline/salt water to increase or decrease the size of the stomach.
The lap-band needs a significant change in your dietary habits. Please ensure that you are well aware of these changes before undergoing the surgery. An accredited practising dietitian will assist you in making these changes.
Weight loss surgery or bariatric surgery is gaining popularity with a 54% increase of procedures being undertaken in one decade(1997-2007). In 2007-2008, 17,000 bariatric surgeries were completed (1).
Bariatric surgery is a tool for weight loss. It is not a ‘quick fix’.
You cannot have this procedure and eat the same foods that led you to the weight you started at. Junk food has no place in your diet after the surgery.
Bariatric surgery has a good success rate. Most patients lose 45-55% of their excess weight within 6-12 months. Excess weight is the weight you are carrying above a BMI of 25.
For example for a person that is 170cm and 170kg, their weight at a BMI of 25 is 72.25kg.
Excess weight = Current weight – weight at a BMI of 25
Excess weight = 170kg – 72.25kg
Excess weight = 97.75kg
For this example, I would suggest that that person’s weight loss would be between 44-64kg within 6-12 months. You wouldn’t get this with a regular diet. This does seem like the answer, however you need to know that there are some nutritional concerns that are important to consider with this surgery – which I will discuss at a later date.
Over the next few weeks, I will highlight the different types of surgeries, how they work and how they allow weight loss to be sustainable and permanent. I will review some elements of eating post-surgery and how to maintain your health/nutrition with these procedures.
As a bariatric dietitian, I have specialised knowledge in this field to advise and assist those that have chosen to use bariatric surgery as their permanent solution to overweight. If you’re keen to learn more or schedule a consult with myself to talk about your issues with diet and bariatric surgery, contact my office.
High Protein Iced Coffee
I’ve been really looking for high protein recipes as of late. I have a population of clients that have undertaken weight loss surgery. It is very important for these individuals to maintain an adequate protein intake, which is difficult with a smaller stomach. I advise a minimum of 60g a day of protein for these individuals.
Most people enjoy an iced coffee. I have made a high protein iced coffee recipe, which I’m sure you would enjoy too.
All you need:
Yep, it’s that easy. You may like to add the ice cubes after you’ve blended (like I did), however if you like a frappe consistency – add the ice cubes.
Let me know any recipes that you would like modified to be high protein! Suraya
Who is Suraya Nikwan?
I’m pleased you’ve stumbled across my blog.
I understand that nutrition can be complicated, however my aim for the blog is to provide you with easy-to-understand nutrition tips and concepts that you can implement into your life.
I thought I’d start my blog with a ‘get to know me’ section. I’ll give you a snapshot of who Suraya Nikwan is.
Nationality: I’m Australian. I was born in Australia (my mother is Australian) and my mixed look comes from my father, who is Malaysian.
Degrees: Master of Nutrition and Dietetics (Research); Bachelor of Biomedical Science; Certificate III and IV in Fitness (Qualified Personal Trainer); Certificate II in Information Technology (means I can use a computer!).
Top Five Favourite Foods? Peanut Butter, Bread, Spinach, Sprinkles and Strawberries. I also like slushies, churros and cinnamon on everything.
List Five Destinations I’ve Travelled to: Africa – (Cape Town, Johannesburg, Zimbabwe), Saudi Arabia, Fiji, Malaysia, Japan – Tokyo.
Favourite Animal? Hippos and Penguins.
Fitness: I’ve run two full half-marathons, with times 2:10 for the Gold Coast Half Marathon and 2:15 for the Sydney Herald Half Marathon.
Like I said, this is just a snapshot of me. If you have any dietary concerns, I’d be more than happy to assist you.
Please contact me for more information.
Quotes make you question certain aspects of your life. Today I came across this quote, which was interesting to ponder on. I hope you find some inspiration and motivation from it too:
“Those who think they have no time for healthy eating, will sooner or later have to find time for illness” – Edward Stanley (1826-1893)
Often, we say that we will get to things tomorrow, I’ll eat better tomorrow or the next meal. I’ll exercise tomorrow. No. You most likely will not do it tomorrow.
Tomorrow is never promised.
Yesterday has finished and is in the past. Tomorrow may not come. You only have the present moment. My biggest aims with all clients is for them to implement healthy lifestyle changes that are consistent. This may include eating more vegetables, walking daily, reducing portion sizes, sleeping earlier, reducing alcohol consumption, having less ‘treat’ foods, avoiding soft drinks or drinking more water. I encourage you all to implement at least one healthy habit that is easy to change and is sustainable. If the habit isn’t sustainable, you’re less likely to continue it. For example, switching soft drink for soda water with lemon/lime juice or slices added. It’s the same type of drink (ie. carbonated) and you get a similar refreshing feeling – only you’re not adding in any additional chemicals or sugar into your diet.
Task for Tonight/Today: Have a look at your current diet and lifestyle habits and make one sustainable change to improve your overall health.
If you have any questions, feel free to contact me.
Suraya Nikwan (APD) provides short, concise and informative nutrition advice specific to bariatric surgery.