Gastric bypass is a lifetime commitment of post-operative care
Who knew it could be so tough after the
surgery?
The hardest part of gastric bypass
surgery is often found to be the lifestyle
and dietary adjustments that are necessary
after the surgery.
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Undergoing surgery is only the beginning
One of the effective methods to combat morbid
obesity is surgery. Bariatric surgery allows the
primary care provider to make a significant
contribution to weight management. Weight management
has to be unique to each individual based on the
patient’s age, baseline weight, overall health
status and the type of procedure performed.
For treatment of morbid obesity, an increasing number of patients
are turning towards surgical procedures like gastric bypass. Morbid
obesity or Clinically Severe Obesity (CSO) is considered to be the
most lethal pathogen. This rather ‘huge’ cause for most of our
diseases is surprisingly resistant to all non surgical
interventions.
In this scenario, bariatric surgery emerges as the only reliable and
sustainable means of shedding those extra pounds of flab. In a
society wherein many members are called obesogenics, this surgery
provides a lifelong care which first identifies and then effectively
manages potential complications.
With the number of clinically severe obese patients opting for this
surgery, it becomes imperative for primary care providers to be
knowledgeable regarding ongoing management of the bariatric surgery
patient.
In 2004, more than 100,000 CSO patients in US underwent bariatric
surgical procedures. Rouxen-Y gastric bypass (RYGBP), a restrictive/malabsorptive
procedure, is one of the most frequently performed weight reduction
surgery in US.
Getting yourself operated upon is not the end, only one battle won
in your war against extreme corpulence. CSO patients who chose
bariatric surgery require lifelong weight loss monitoring. You need
to keep an eye on co-morbidities, metabolic and nutritional status,
dietary and activity behaviors. On the first year after surgery the
patient has to keep a frequent note on these factors. Thereafter an
annual monitoring schedule is necessary.
However, post-operative care and weight management after that will
vary with each patient and the procedure of bariatric surgical
procedure that he has gone through. Each patient’s willingness to
imbibe the prescribed dietary and activity changes and also his or
her adaptation to surgery and its effects will have to be kept in
mind while devising the Patient Management System.
While undergoing post-operative Patient Management System the
patient should be given morale boosters with heavy doses of support,
encouragement and guidance. The clinician has to frequently assess
the patient’s compliance and keep reinforcing the rules whenever
necessary. The idea is to keep the patient focused and motivated to
achieve that necessary level of fitness. For this the patients need
to be given realistic weight-loss expectations. CSO patients after
undergoing a bariatric surgery procedure need to be told that they
are never likely to become thin or achieve the ideal body weight.
Success in keeping a sustained and healthy rate of weight loss is
achieved if you remain committed to maintain 50% of your excess
weight loss (EWL) at least for five years after the surgery is
performed.
Post-operative weight loss varies with every individual due to many
factors. For example those patients with a lower body mass index
(BMI) generally has a higher percentage of EWL and usually come
closer to achieving their ideal body weight and younger persons tend
to achieve higher EWL.
What is however common to all patients, with a deal of commitment
and good Patient Management System, is that post-operative weight
loss is very evident and achieving a fitter lifestyle and a better
personality is possible.
Resources:
Bevoni L. Management of adult obesity. Clinician Reviews. 2003;
13[5]:55-63; and Ferraro
Preparing patients fox bariatric surgery: the clinical
considerations. Clinician Reviews. 2004;14[1]:57-64
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