You’ve battled with weight loss and dieting all your adult life. Name a diet or food fad – if it exists, you’ve tried it. Yet despite all your efforts it just seems like you just can’t seem to keep the weight off. The weight keeps coming back with a vengeance, each time with a little more than what you started with. It doesn’t help that your GP has been telling you for ages to get “weight-loss surgery”. That stuff sounds scary and expensive! But in your desperation you’re toying with the idea more and more. It sounds almost fail-proof, and the idea that it requires less effort than all your previous attempts makes it super appealing.
But is it really all as fail-proof as it seems? With more and more clients presenting in my office with weight regain post-surgery, it appears that there’s a lot more to understand about the long term efficacy of weight-loss surgery.
In this article I’ll highlight how the surgery works, what the long-term implications are for you, as well as include the all-important checklist of questions to ask yourself to help you decide if this will work for you.
What IS weight–loss surgery?
There are currently three common types of weight-loss surgery available in Australia.
Gastric Band
Mode of action:
- Slows down eating
- Increases the feeling of “full-ness”
The band creates a small pouch where food sits for a longer time. This forces you to slow down when you eat, meaning you are better able to listen to your hunger and satiety cues; and you’re less likely to overeat.
The band also squeezes a nerve around the stomach that sends a signal to your brain that you are no longer hungry. When food passes the band, this squeezes the nerve harder.
Gastric Sleeve
Mode of action:
- Portion restriction
- Hunger reduction
A large portion of the stomach is removed leaving a narrow tube-like “sleeve” structure that can only hold very small amounts of food.
Less grehlin (a hunger hormone) is produced due to removal of a large portion of the stomach.
Gastric Bypass
Mode of action:
- Malabsorption of nutrients
- Portion restriction
- Hunger reduction
A large portion of the stomach is removed leaving a small pouch that can only hold very small amounts of food.
Foods eaten “bypass” or skip the first section of the small intestine, meaning less nutrients (including calories) are absorbed by the body.
Less grehlin (a hunger hormone) is produced due to removal of a large portion of the stomach.
Similar to traditional diets, weight-loss surgery works in the sense that it restricts or reduces the total amount of calories consumed – whether it’s by reducing the size of the stomach, reducing hunger or slowing down your eating. Gastric bypass surgery takes it one step further – it’s also malabsorptive, meaning you cannot absorb nutrients (including calories) from your food intake.
As the restriction is no longer in your direct control (i.e. you cannot decide to “break the diet” and eat large amounts of food, and re-start next Monday), weight-loss surgery tends to work better than traditional diets.
Will it work for me?
Yes – to some degree. When it comes to weight management, weight-loss surgery is just another tool and not a cure. And like all diets, it will definitely lead to weight-loss but the question of whether it keeps the weight off depends entirely on your actions and behaviours in the long-term.
You might probably want to spend some time thinking about what led to weight gain or weight re-gain from your previous attempts at weight loss. Were your efforts focused solely on restricting calories and not much on changing behaviours or the food environment? Did it become harder to stay consistent over time?
We now know from recent research that habits-based interventions are successful in keeping weight off. After all, losing weight isn’t the difficult part when it comes to weight management. It’s keeping the weight off that’s the biggest challenge; and even weight-loss surgery isn’t the silver bullet when it comes to this.
Weight-loss surgery will:
- Reduce your hunger and appetite
- Result in weight loss which may improve your ability to do physical activity
Weight-loss surgery won’t:
- Stop non-hunger related eating e.g. boredom eating, emotional eating, and binge-eating disorders.
- Automatically make you eat healthier food options. In fact, healthier foods may be more difficult due to issues with texture and fibre.
- Give you the skills to stay consistent with healthy eating – such as meal planning, food preparation and organisation, or improving cooking skills.
- Actually make you get off your bum to do physical activity, which is oh-so-important in preserving muscle mass and metabolism. Exercising can also be difficult if you’re suffering from nutritional deficiencies.
Long-term commitment
So you’ve made it through the surgery, and the weeks of gruelling liquid to puree to soft diet that comes after. You’ve now graduated to eating solid foods again. Huzzah! However, contrary to popular belief, weight-loss surgery isn’t just a “set and forget” thing.
Eating a healthy diet is now more important than ever as you’ll be struggling to consume enough nutrients such as protein, vitamins and minerals to keep your body healthy. You’ll also be relying on supplements such as multivitamins for the rest of your life to avoid deficiencies and chronic malnutrition, which could result in extreme fatigue, nerve issues, muscular aches or muscular weakness.
You not only need to follow-up with your surgeon post-op, but also need to build your support team to ensure the best possible results in the long-term. Think of your post-surgery self as a very expensive luxury car – you do not wait for the wheels to fall off, or for smoke to billow out of the engine before you take it in for a service. I have seen too many clients who have waited until they have regained more than half of the weight they have lost before deciding to reach out for help.
Regular follow-up with a dietitian initially post-surgery will help you establish healthy eating skills and habits early on, and then once these are established you might want to touch-base at least annually to ensure consistency and performance.
Have diets failed you in the past? Are you considering bariatric surgery for weight management? We don’t do diets – we look at the long-term habits and skills that build healthy eating. Our team of qualified dietitians can help you with weight management both before and after bariatric surgery.
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