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Diet, Nutrition & Exercise:

Will I need to follow a post-operative diet after surgery? If so, for how long?

We will provide you with a post-operative diet and meal plan to follow for four weeks after your surgery. The diet will help decrease the initial irritation and inflammation around the stomach and allow your band to "settle" into place. At first, you will have only liquids in small amounts. Gradually, you will progress from liquids to soft foods, eventually introducing solid foods back into your diet. The transition to solids is slow and varies among patients. Eating must be done slowly and should be stopped when you feel full. Only small portions at intervals throughout the day are recommended. Eating too much at one sitting can cause discomfort and/or vomiting. Our surgeon will meet with you before and after the surgery to discuss the specific post-operative dietary restrictions and recommendations in greater detail.

Will my eating habits change after surgery?

Yes, your eating habits will change following surgery. You will find that you become full or satisfied after consuming a much smaller portion of food than you did prior to surgery. It is important that you stop eating once you feel full, as overeating can trigger pain and/or nausea. In addition, we recommend that you eat slowly and chew your food carefully.

Are there any specific foods or beverages that I should not eat post-operatively?

Before and after surgery, our nutritionist will review with you in detail the post-operative diet you should follow as well as additional dietary recommendations and restrictions, including: Food:  Patients should NOT eat any dried fruits, as they can swell in the stomach pouch and become stuck. It is also recommended that patients avoid "fibrous" foods after surgery as they can also get lodged in the small opening of the stomach pouch. Such foods include, but are not limited to: asparagus, pineapple, rhubarb, corn (especially popcorn) and grapes. Furthermore, nuts and seeds (walnuts, whole peanuts, almonds) appear to be hard to digest for many patients. (Note: in general, LAP-BAND® patients improve their digestion if they learn to chew their food well, particularly meats.) Beverages: Most liquids are fine, but patients should try to avoid carbonated beverages as they can cause distension of the stomach pouch. In addition, patients can help avoid feeling nauseated during the first 6 weeks post-operatively if they avoid acidic juices (e.g., orange, grapefruit, lemon). Otherwise, we recommend you eat a wide variety of foods and drink ten glasses of water every day.

How many grams of protein should I consume post-operatively?

You should consume approximately 20-35 grams a day. (Gastric bypass patients need more protein to promote healing from the major surgery.)

What nutritional supplements will I need to take post-operatively?

We recommend that our patients take a multivitamin with iron every day. In addition, we suggest that our female patients also take a daily calcium supplement. The volume of the food you eat will decrease, however, so you will need to be sure to follow a nutritionally balanced meal plan.

Will I get sick from eating sugar, natural or otherwise?

There are no problems with "dumping syndrome" after your procedure because your stomach and intestines have not been bypassed or significantly altered. Gastric bypass patients, on the other hand, are instructed to avoid refined sugar, which can cause dumping: an unpleasant experience which can include sudden rapid heart rate, abdominal pain, cramps, sweating and diarrhea.

Will I be able to drink alcohol after surgery?

Alcohol has a high number of calories and it breaks down vitamins. But an occasional glass of wine or other alcoholic beverage is not considered harmful to weight loss.

What type of exercise do you recommend post-operatively?

Walking is great exercise to start out with following your surgery. After 6 weeks you may do any exercise you would like - aerobics, bicycling, running, strength conditioning, etc. Exercise is an important part of your post-surgery regimen, as it will facilitate weight loss and contribute to your overall health and well-being.

Post-Operative Results, Adjustments & Follow-Up Care

How much weight should I expect to lose and how fast?

The amount of weight you lose and the rate at which you lose it is dependent on a number of factors such as: your starting weight, your post-operative diet, the amount of exercise you do, etc. On average, however, patients have lost about 50% of their excess weight within the first year of surgery. Most patients find they are losing between 5-10 pounds a month, depending on their individual diet and exercise regimens. In general, it is not safe to lose weight too quickly; a weight loss of 2 to 3 pounds a week in the first year after the operation is possible, but 1½ pounds a week is more likely. Remember that your primary goal is to have a weight loss that prevents, improves, and/or resolves health problems associated with severe obesity.

Will I still get hungry following surgery?

The surgery works best with solid foods to decrease hunger. Solid foods tend to stay in the stomach pouch longer, giving you a greater sense of fullness and satisfaction. Following surgery, you will begin by eating/drinking only liquid foods. Therefore during this time you may feel hungry. However, most patients find that they feel less hungry and more satisfied if they eat/drink the foods the recommended number of times throughout the day. Once you begin to eat solid foods you should feel very satisfied with significantly less food than you were consuming before surgery. If you are a Lap-Band patient, after 6-8 weeks post-operatively, if your weight loss slows down to less than 1 pound a week, you may need to have a LAP-BAND® Adjustment to tighten the band.

What kind of post-operative medical care will I require and for how long?

You will be seen as often as necessary, of course, but we generally schedule you for a post-operative follow-up appointment at the Center two weeks after surgery. Then you will see the surgeon at 1 month, 3 months, 6 months and 1 year post-operatively. In addition, based on your rate of weight loss and your personal weight loss goals, your band may require that you come in for band adjustments. Finally, we will have an optional support group for patients dealing with emotional and psychological issues relating to body image, stress coping strategies, addictive behaviors, etc.

Will there be any medications that I can no longer take post-operatively or that I will be unable to absorb properly?

No, you will be able to take any medication necessary. Unlike other bariatric surgeries, the LAP-BAND® will not affect your absorption so the effectiveness of medication will not be diminished and/or affected.

How is the LAP-BAND® adjusted?

It is a quick and relatively painless outpatient procedure. You will be x-rayed during the procedure so that the band reservoir or "port" can be seen clearly. Then, a fine needle is passed through the skin into the port to add or remove saline. Adding saline tightens the band, further restricting the amount of food you can eat before you feel full and satisfied. Local anesthesia is used.

How many LAP-BAND® adjustments will I need?

The number of adjustments (fills) you may need cannot be determined in advance of your surgery. Some patients need one adjustment, while others need two or three in the first year depending upon their individual response to the band and the degree of weight loss desired. Generally, adjustments are not performed until at least 6 weeks after your surgery.

Are adjustments covered by my insurance company?

No, currently most insurance policies do not pay for band adjustments. If your insurance policy does not provide coverage for band adjustments, you will need to pay for this procedure yourself. For our cash-pay patients, the first year of adjustments are free, however, for all other patients, adjustments are $250 each. Individuals who have had their surgery elsewhere will be charged $500.00 for each adjustment.

How long will it take to have an adjustment?

The adjustment usually takes only a few minutes and you will be able to leave the Center immediately following the procedure. You will be placed back on a liquid diet for a few days following the adjustment in order to give your stomach some time to adapt to the change.

Will I be able to get pregnant after LAP-BAND® surgery?

During the first year after surgery: A fast rate of weight loss during pregnancy is thought to be harmful to the developing baby. Therefore, we would like for you to use some form of contraception to avoid pregnancy during the first year following surgery. If you become pregnant, however, during this first year, we will leave your LAP-BAND® in place without saline in order to ensure adequate nutrition for the baby's growth. After the first year: Many women find it easier to conceive following substantial weight loss. Your menstrual cycle may become more regular. If you need to eat more while you are pregnant, the band can be loosened. After the pregnancy, the band can be made tighter again and you can go back to losing weight.

Potential Side Effects, Risks & Complications:

What are the risks and complications involved with the LAP-BAND® procedure?

Any gastric operation for obesity is major surgery and carries with it the risks associated with any complex operation. And although the LAP-BAND® procedure is minimally invasive surgery, it is not without its own risks (laparoscopic surgery risks include: complications from general anesthesia, spleen or liver damage, damage to major blood vessels, lung problems, blood clots, rupture of the wound, esophagus/stomach perforation ).

In rare cases, the LAP-BAND® surgery cannot be performed using the less invasive laparoscopic approach. For example, if unforeseen problems arise while attempting to position the band, surgeons may have to switch to an open method. In addition, there can be serious complications that may warrant the removal of the LAP-BAND® including:

·         Slippage of additional stomach tissue under the band

·         Erosion of the band into the stomach

·         Infection and/or breakage of the injection port (rare)

·         Gastric symptoms

While removal of the band can often be done laparoscopically, in some cases it may require open surgery. Serious problems such as peritonitis, infection, leaks, and long-term nutrition problems such as iron and vitamin deficiencies that are seen with gastric bypass surgery do not occur with the LAP-BAND®. Re-operation rates for gastric bypass are significantly higher due to leaks, bowel blockages, outlet scarring, ulcers, and bleeding.

can often be done laparoscopically, in some cases it may require open surgery. Serious problems such as peritonitis, infection, leaks, and long-term nutrition problems such as iron and vitamin deficiencies that are seen with gastric bypass surgery do not occur with the LAP-BAND®. Re-operation rates for gastric bypass are significantly higher due to leaks, bowel blockages, outlet scarring, ulcers, and bleeding.

The surgeon will review the potential surgical and/or LAP-BAND® complications in greater detail with you during your consultation. In the meantime, visit the LAP-BAND® manufacturer's Website for additional discussion of the risks and complications.

What is the mortality rate for the LAP-BAND® procedure?

The mortality rate is extrem

Have you ever had any patients die?

No, none of our patients have died.

Will I need to have a blood transfusion during surgery?

No, most of the time blood loss is minimal.

Will I have any problems with gas post-operatively?

Gas is common during the first post-operative week; some patients complain of "needing to burp, but nothing comes up". This problem can usually be alleviated by walking and drinking fluids as soon as you can after surgery.

Are there risk involved with gereral anesthesia?

Serious side effects of general anesthesia are uncommon in people who are otherwise healthy. However, because general anesthesia affects the whole body, it is more likely to cause side effects than local or regional anesthesia. Also obese patients are considered at a higher level of risk because of health problems and body mass index. Our team considers as many factors of complications when medically clearing you for surgery which includes the administration of general anesthesia. Fortunately, most side effects of general anesthesia are minor and can be easily managed but like in any surgery there are normal anesthesia risks involved.

How will reflux / heartburn affect me after the surgery?ely low for LAP-BAND® surgery, less than 0.1%.

 

 

In recent studies, patient's reflux problems have improved after LAP-BAND® surgery. However, some patients may experience reflux during the early stages of their recovery.

Will I suffer from constipation?

There may be some reduction in the volume of your stools. This is normal after a decrease in food consumption, because you are eating less fiber. This should not cause severe problems. If difficulties do arise, however, the doctor may suggest that you take a mild laxative and drink plenty of water for a while. Drinking plenty of water is recommended, anyway. Your needs will vary, but you should drink at least 6-8 glasses of water a day.

 

Will I need plastic surgery for the extra skin after I have lost a lot of weight?

 

Plastic surgery is not always necessary - sometimes the skin will readjust and mold itself around the new reduced body tissue. You should give your skin the time it needs to adjust - at least a year or two - before you decide to have more surgery.

What will happen to me if I become ill?

One of the major advantages of the LAP-BAND® system is that it is adjustable. If your illness requires you to eat more, the band can be loosened by removing saline from it (it can also be removed if it cannot be loosened enough). Once you have recovered from your illness and want to start losing weight again, the band can be tightened again.

Administrative

 

What is the first thing I need to do if I am interested in the program?

 

The first step is to schedule a consultation with our office. If you are approved for surgery after your initial consultation, and you have been medically cleared by the physician, your surgery date will be scheduled. Please note that the timing for the completion of these steps and the scheduling of surgery varies from patient to patient based on whether or not you are paying for the operation yourself (approximately 2 weeks).

How do I pay for the surgery?

You can either pay for the operation yourself upfront (self-pay), or you can try to get the procedure covered by your health insurance plan. If you decide to self-pay for the surgery, we have several financing options to help you manage the costs (please call our office at (866)992-6443, and we will be happy to give you this information). If you want to have your insurance company pay for your surgery, you will need to call our office at (866)992-6443, and we will be more than happy to file your paperwork for you. Please feel free to contact us to discuss either payment option.

How quickly can I get the surgery?

Self-pay patients have about 8 days from the date of their initial surgical consultation to the date of their surgery. Patients seeking insurance coverage for the procedure, however, generally wait about 3 weeks between the consultation and their surgery date due to the length of the insurance company's approval process.

Frequently Asked Questions About Teens and Adolescents
Which weight loss procedure works best?
Is there anything other than surgery?
How does obesity affect teenagers?
Is obesity surgery safe for teenagers
How does surgery help the teenager?
What will the Lap Band ® do?
What will the bypass do?
How does surgery help a teenager?
Is surgery all that’s needed?
If diet and exercise are part of the surgery, why do surgery at all?
Which weight loss procedure works best?

You will read a lot in this website about customized weight loss plans for each individual.  Since every person is different it is important to choose a physician that performs all three major weight loss procedures and performs them well.  Many physicians will offer the LAPBAND or the Gastric Bypass.  You will hear them say that one procedure is better than another and every person they speak with is an appropriate candidate.  This is simply not the case!  There are particular medical conditions or behavioral tendencies that would either exclude you from a particular surgery or provide better opportunities for success.  Every weight loss surgery is different and has a different result for each person.  Let me be clear; I want what’s best for you. 

The Gastric Bypass has the longest track record in the USA and It is a great operation. Folks can expect to lose about 60-77% of their excess body weight. This means if you are carrying 100 extra pounds, you can lose 60-77 pounds in 1-2 years.

The Lap Band is a wonderful operation. An easily adjustable weight loss belt surgically placed around the top of the stomach. Patients can lose 50-60% of their excess body weight. If you have 100 pounds to lose, you can lose 50-60 pounds over 1-2 years.

The Gastric Sleeve is another great surgery. It has been around since the 1960’s but not used very often. Recently it has become very popular. Folks can lose 65-70% of their excess weight over 1-2 years. This means for 100 pounds of excess weight they can lose 65-70 pounds.

Is there anything other than surgery?
There are programs that combine nutrition, exercise, individual counseling with the teenager and group counseling with the entire family. It is always a good idea to try this type of program before thinking about surgery. Of course it is important that a complete physical evaluation be completed to make sure there is no medical condition that may be contributing to the obesity. If there is no medical condition present other than obesity and obesity related conditions, going ahead with a non-surgical program is a good idea. But if the adolescent and the parents have tried this type of program and have not succeeded, it’s time to talk about surgery.

How does obesity affect teenagers?
The concern is that obese teenagers may go on to become obese adults. Obesity can produce adult medical conditions in teenagers like diabetes, high blood pressure and sleep apnea. These are problems that come up for obese adults. When these problems show up during the teenage years, they have a head start to produces more severe medical conditions at an earlier age.

Is obesity surgery safe for teenagers?
The answer to that is yes. If you are a teenager or a parent and want to find out about surgery to help treat obesity, please read through this whole section. Scientific studies taking place in the United States where teenagers are having obesity surgery show that surgery is safe. These studies are looking at the Lap Band and the Gastric Bypass to treat obesity.
The answer no one has is what happens for a teenager 10, 20 or 30 years after having obesity surgery.

How does surgery help the teenager?
The purpose of any obesity surgery is to reduce the amount of food that can be eaten at one setting. That means less food is taken in at each meal. This is a start. Lap Band® and Gastric Bypass have different effects. But mainly by reducing the amount of food that can be eaten at each serving, helps reduce the total calories a teenager can eat in a day. The bypass also changes the body’s response to high calorie, high sugar foods. The bypass also produces changes in hormones that help move the teenager towards good health and lose weight. These hormone changes do not take place without surgery. That is why surgery is a powerful tool.

What will the bypass do?
The bypass will do 4 things.
1. Reduce the amount of food that can be eaten at each meal, usually about 1 cup or less.
2. Help take away hunger and cravings for certain foods.
3. Help patient stay away from high calorie foods.
4. Make good hormone changes .
All of these help the patient lose weight and become healthy.

How does surgery help a teenager?
The purpose of any obesity surgery is to reduce the amount of food that can be eaten at one setting. That means less food is taken in at each meal. This is a start. Lap Band® and Gastric Bypass have different effects. But mainly by reducing the amount of food that can be eaten at each serving, helps reduce the total calories a teenager can eat in a day. The bypass also changes the body’s response to high calorie, high sugar foods. The bypass also produces changes in hormones that help move the teenager towards good health and lose weight. These hormone changes do not take place without surgery. That is why surgery is a powerful tool.

Is surgery all that’s needed?
No. Good nutrition is an important tool to make the surgery successful. A program of progressive aerobic exercise move the patient to good health. A family program where the parents and siblings participate in helping the teenager keep on track with their nutrition and exercise, makes the entire family a team to help the teenager succeed. Dr Dirk will meet with the  teenager and parents to explain the program, surgery and to discuss expectations.

If diet and exercise are part of the surgery, why do surgery at all?
Good nutrition and exercise help surgery patients be successful. Any plan that tries to help patients lose weight always includes good nutrition and exercise. Surgery produces important changes in the body. Helping reduce the total daily calorie intake is important and the surgery helps the patient stick to the plan. Surgery produces internal hormone changes that will not happen with a diet and exercise program alone. Surgery is a powerful tool that helps move the body to good health and to lose weight.



Our Patients' Tips

The following helpful tips were all provided by our patients who have undergone obesity surgery. Patients from Dallas, Plano, Lewiston, Carrollton, and other Texas communities have offered these tips to help others successfully achieve their weight-loss goals. If you have a tip that you think would help others, please let us know!

We also encourage you to attend our support group meetings, First Saturday Walks, and other events. They are a great way to keep your weight loss efforts on track and to meet others who have undergone bariatric surgery. For more information, check our Calendar of Events — we keep it regularly updated with fun and interesting happenings.

Eat Slowly

• Chew your food thoroughly.
• When you think you have chewed enough, chew some more.
• Use smaller eating utensils, such as a pickle fork or children's utensils.
• Eat with the opposite hand — your left hand if you are right-handed, or your right hand if you are left-handed.
• Start conversations and become the conversationalist in your family at mealtimes.
• Read something interesting or do a crossword puzzle between bites.
• Creatively arrange the food on your plate.

Portion Control

• Don't forget that your meals should not exceed one cup total.
• Use a one-ounce shot glass or a measuring cup to measure your food portions.
• Use a small plate to make portions look larger.

Beverages

• Sip your beverages; don't drink quickly or gulp liquids.
• Stick to zero-calorie liquids. Skim milk and fruit juice are ok when they are counted as part of your meal.
• Beverages should be enjoyed between meals; don't drink with your meal.
• Stay away from carbonated beverages.

Foods

• Eat your protein source first at each meal.
• You can digest ripe bananas easily.
• Your stomach can tolerate bread much better when it is toasted.
• Make your own freezer pops with Crystal Light® or sugar-free Kool-AID®: Freeze the drinks in ice cube trays or freezer-pop molds (available in most variety stores) with a spoon or wooden stick positioned as a handle. These freezer pops are delicious and refreshing!

Weight Gain

• If you gain a few pounds, you can easily lose them by returning to the post- obesity-surgery stage-one liquid diet for however long you choose.

In addition to excellent tips for succeeding in your LAP-BAND® or REALIZE™ Band System weight loss program, our patients have provided us with testimonials so that you can read the stories of real people who have undergone obesity surgery. If you are ready to join our patients who have successfully lost significant weight and are now enjoying active, productive lives, contact us today. We look forward to posting your tips or testimonial on our website!

The 10 Golden Rules for Success after Obesity Surgery

In addition to offering tips from our patients to help you successfully maintain weight loss after your obesity surgery at the Baylor Medical Center or Dallas Surgery Center, we provide the "10 Golden Rules" for eating, drinking, and exercise after the LAP-BAND® or REALIZE™ Band Adjustable Gastric Band procedure. These rules are designed help you achieve the best possible results from your surgery. Keep in mind that the ultimate success of your obesity surgery is based on Dr. Veninga's skill in placing the gastric band and your willingness to make significant changes to your eating habits.

Rule 1: Eat only three small meals each day.

Obesity surgery with the LAP-BAND® and REALIZE™ Band System creates a small region at the top of your stomach. If you eat beyond the capacity of the region and it becomes a true "pouch," you can become nauseous. If you repeatedly eat too much, you can stretch the pouch and cancel out the effects of the obesity surgery. The best policy is to learn how change your behavior to live with your band appropriately.

Rule 2: Chew completely and slowly.

Obesity surgery with the LAP-BAND® and REALIZE™ Band Adjustable Gastric Band restricts the size of food that is able to pass through the stoma (outlet) of your new stomach. For this reason, you must chew thoroughly to ensure that the food is "chopped" into very small pieces. Chewing slowly helps you make sure that your food will be the ideal size for digestion, and it will help you reach satiety (fullness) during your meal.

Rule 3: When you feel full, stop eating.

Your stomach sends a neural signal to your brain when it senses that enough food has been eaten. This signal can take time to reach the brain, however, and this can lead you to eat more than is good for you. The result can be nausea and vomiting. Chew your food slowly and take time eating your meal. When you feel the first signs of fullness, stop eating immediately.

Rule 4: Don't drink with your meals.

Obesity surgery with the LAP-BAND® and REALIZE™ Band Adjustable Gastric Band only produces results with solid food. If you drink beverages while you eat, the effect of the band is greatly reduced. The best policy is not to drink anything for one to two hours after eating. This will also help you maintain a feeling of fullness.

Rule 5: Don't eat between meals.

One of the main reasons that obesity surgery fails is because patients snack between meals. It is critical to your long-term success that you do not eat anything between meals. Once you have finished a meal, stay away from the kitchen or any area where you might be tempted to reach for a snack.

Rule 6: Only eat fresh food.

You can only eat a little after you undergo obesity surgery with the LAP-BAND® or REALIZE™ Band System. For this reason, you must eat foods that are healthy and nutritional. Fresh vegetables and fruit, as well as meat and cereals, are recommended because they are high in protein and vitamins. Avoid foods that are high in fat and sugar. Apples and oranges are good, but stay away from orange juice and apple juice in cartons or bottles. We will provide you a list of approved foods and recommendations for vitamins and protein supplements.

Rule 7: Avoid foods rich in fiber.

Foods with a high fiber content can block the stoma (outlet) of your new stomach. Chewing and your saliva cannot break down fiber-rich foods sufficiently. If you just have to have a high-fiber food such as asparagus once in a while, be sure to cut the food into small pieces and chew thoroughly.

Rule 8: Drink plenty of liquids during the day.

As you lose weight, your body must excrete through urination the waste products that result from the breakdown of your body's fat. For this reason, you must drink large quantities of liquids every day. However, keep in mind that you should only drink low- or zero-calorie liquids, and you should not drink with meals.

Rule 9: Drink only zero-calorie or low-calorie liquids.

The LAP-BAND® and REALIZE™ Band Adjustable Gastric Band restricts the passage of food through the stoma. However, liquids can pass through easily. If you consume high-calorie drinks, you'll undermine the purpose of your obesity surgery, and you won't lose much, if any, weight. Stick with low- or zero-calorie beverages for optimal results. Water, mineral water, and tea or coffee without milk or sugar are good. Many of our patients also like zero-calorie, non-carbonated soft drinks such as Crystal Light® and sugar-free Kool-AID®.

Rule 10: Exercise 30 minutes or more every day.

For your obesity surgery to be successful, it is very important that you maintain a daily exercise schedule. Physical exercise will consume energy and calories, and it will improve your physical and psychological health. At first, your weight may be an impediment to getting sufficient exercise. As you lose weight, however, you will find that exercising becomes easier and progressively more enjoyable. You can start with simple exercises such as walking and swimming. As your fitness level increases, you can add more strenuous forms of exercise such as cycling, jogging, and aerobics.