A: Obesity is a chronic, debilitating and potentially fatal disease that requires treatment by a physician trained in bariatric medicine. It is marked by an excess accumulation of body fat sufficient to endanger health. The United States is currently suffering an obesity epidemic contributing to the premature death, sickness and suffering of millions of Americans.

A: Obesity has been established as a major risk factor for diabetes, hypertension, cardiovascular disease and some cancers in both men and women. Other co-morbid conditions include sleep apnea, osteoarthritis, infertility, idiopathic intracranial hypertension, lower extremity venous stasis disease, gastro-esophageal reflux and urinary stress incontinence. Obesity-related medical conditions contribute to 300,000 deaths each year, second only to smoking as a cause of preventable death. 

A: Approximately one in five children in the US between the ages of six and 17 is overweight. The number has more than doubled in the past 30 years. Significant changes in the Western lifestyle that contribute to a high-calorie, low-activity lifestyle are the major culprit.  “Super-sizing” of high-calorie-high fat foods, “junk food” diets (including high calorie soft drinks and fruit beverages), increased TV watching, increased time spent playing video and computer games (often while snacking) all contribute to obesity among the young. With all the health implications that obesity carries, this trend toward obesity is perhaps one of the most serious problems our children’s generation will face.

A: The word “bariatric” stems from the Greek word barros, which translates as heavy or large. A Bariatrician is a licensed physician – a Doctor of Medicine (M.D.) or Doctor of Osteopathy (D.O.) -  who, as a member of the American Society of Bariatric Physicians (ASBP), has received special training in bariatric medicine the medical treatment of overweight and obesity and its associated conditions. Bariatricians address the obese patient with a comprehensive program of diet and nutrition, exercise, lifestyle changes and, when indicated, the prescription of appetite suppressants and other appropriate medications.

A: After your Gastric Bypass surgery, you will awaken in the post-op recovery room (many patients will have little or no recollection of being there, a normal side effect of the anesthesia used during surgery). Ordinarily, your breathing tube is removed from your throat as you begin awakening — usually before you are aware of it being there. You will be started on pain medication as soon as you need it. The IV line for fluids and medications that was started in the operating room will remain with you for your entire stay in the hospital. Although you won't be allowed to drink water for the next day or so, the IV will give you your necessary fluids and you will be allowed to suck on ice chips after the first day if your mouth is dry.

About four hours after surgery, the nurses will ask you to sit up, dangle your legs off the side of the bed and put your feet on the ground. They’ll check that your vital signs and pain medication are OK and that you are recovering normally.  An hour later, they’ll get you up again for your first walk. Along with your deep breathing and coughing exercise, walking is essential to your recovery. For your entire stay the nurses will get you up to walk about every two hours.

As your recovery continues, your pulse, temperature and blood count will be monitored carefully. If you are showing good medical progress, you may begin to take swallows of water, followed by Jell-O and broth.  These will be your meals for the next few days. Don't worry about finishing —when you feel full or just don't feel like eating, stop. When you are ready, typically on the second or third day, you will be given instructions for your discharge from the hospital. If you are taking fluids well, can tolerate Jell-O and broth, don't have a fever and are breathing and walking well, we will send you home!

A: Blood clots form when blood pools in the large veins of the legs, which often occurs during surgery or recovery when patients move their legs less frequently. Surgery can cause mild dehydration, which thickens the blood, and the stress of surgery itself can cause the blood in these pools to clot more easily. To significantly reduce your risk, your physician will encourage you go get up as much as possible, wear compression stockings to stimulate blood flow and may prescribe blood thinners.

A: Your surgery is a tool that must be used in conjunction with long-term lifestyle changes in order to achieve weight loss results. Follow these four simple rules faithfully and the weight will come off and stay off. Break these rules continually, and over time you will gain weight. When patients reach a 'plateau' and stop losing weight, it is usually because they have not followed these rules.

RULE # 1: PROTEIN FIRST AT EVERY MEAL
Eat one to three meals per day and always eat the protein portion of your meal first! Protein is very important to building tissue and nearly everything in the body – muscles, organs, brains – is built with it.  Eating protein also helps the body to feel 'full' and sends a signal to stop eating. Remember that your body does not need three meals a day, so listen to your hunger cues and don't worry about the clock. In the beginning, after being able to tolerate solid food, most patients eat only one or two meals a day.

RULE #2: NO SNACKING BETWEEN MEALS
The problem is that the flavorful foods we snack on usually contain glucose or some other sugar.  We feel good when we eat it, but just one to three hours later, the sugar is gone and our brain sends the message to snack again. So, snacking actually makes us hungrier! Its best to not even open the door, as snacking can slow down or stop your weight loss, and even make you gain weight.

Remember, the surgery has changed only your digestive system – not your eating habits.  Your commitment to a lifestyle change is key to making the surgery work for you the rest of your lir.e. While you should never eat in between meals, if you absolutely must, the only acceptable snack is protein. In the beginning, turkey jerky is a good option — and you must work at it a little to eat it! You can graduate to beef or venison jerky after about six months, but again, only if you must eat something.

RULE #3: DRINK WATER
Drink water, drink water, drink water! Especially in the beginning, when you can only tolerate a mouthful at a time, it is important to continually sip water all day.  Make sure to drink 48 to 64 ounces (two to three quarts) a day minimum. Eventually, you will able to drink two to four ounces at one time. Do not drink tea, soda (with or without sugar), coffee or juice. Flavorful liquids in between meals encourage snacking and flavored drinks with any sugar can cause “dumping,” an intolerance to sugar and carbohydrates which can make you very sick.

RULE #4: EXERCISE
Exercise every day for at least 30 minutes. Walking is fantastic exercise and is probably the easiest way to get started. In the beginning you may struggle with a simple walk down the hall and your energy level may be very low. Your job is to move your body a little more every day. Each patient is different, but at four to eight weeks most will feel back to normal. After you have been cleared by your physician, you may begin other forms of exercise. Eventually, incorporating both aerobic and resistance training into your daily exercise routine will help you remain at a healthy weight for the rest of your life.

A: Many fast food restaurants are now offering a wide variety of low-fat, low-calorie options.  Stick with salads and chicken and fish entrees with either no bread or one slice only, and no mayo, rice or coleslaw.  Most establishments will be happy to substitute a salad for the starches you are not permitted to have.  And remember the old standby – a garden salad and a hamburger patty with mustard, available at nearly all fast food restaurants!

A: The rule of thumb is always eat protein. Even if it is not on the menu, most restaurants will gladly grill or roast a piece of chicken, fish or steak and willingly substitute permitted vegetables for potatoes or rice. If the restaurant is unwilling to help, order something with fish, poultry or steak and ask for a separate plate. Scrape off any offending sauce, breading, etc. from the protein and place the protein on your "keeper" plate along with any permissible vegetables.  Give the "fattening stuff" back to the waiter (you don't need the temptation to sneak a taste and no-one in your party needs extra fat or calories). At a dinner party, load up on salad and protein, push the gravy or sauce to the other side of your dish, and dig in! Don’t get discouraged if you don’t hit your goals 100% of the time; a backslide here and there won’t hurt your progress too much, but always do your best.

A: It is important to exercise while trying to lose weight, but the type of exercise you do is critical to your success.  While gym owners would like you to believe that heavy exercise is the key, research suggests that moderate exercise is best for losing and controlling weight.  Heavy exercise increases muscle size, which increases lean body mass. Most patients’ lean body mass is already close to their ideal weight range; they do not need to add muscle, they need to lose fat! By adding lean body mass, heavy exercise may actually lead to weight gain, especially since you are increasing the protein in your diet.  For patients trying to maintain weight after bariatric surgery, walking is the key.