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Updated 17 February 2016

Bariatric surgery Part II – the negative aspects

Morbidly obese patients can greatly benefit from bariatric surgery, but like any surgery, it is not without risk of negative side-effects.

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In Part I of this series on bariatric surgery we discussed the many positive results that morbidly obese patients can achieve with surgical interventions.

No surgery is however without risks and in some cases it can also be associated with long-term negative side-effects. bariatric procedures are no exception.

A Danish study published last month highlighted the problems that some obese patients have to cope with after a well-known procedure called Roux-en-Y gastric bypass (RYGB) surgery.

Problems of bariatric surgery

RYGB surgery basically entails stapling the top of the stomach to prevent food from entering, and connecting the section of remaining stomach (which is about the size of an egg) to the intestine, thus bypassing the stomach and restricting the amount of food the patient can ingest at a given meal without discomfort to a very small quantity.

Read: Gastric band versus bypass – benefits and risks

According to Mahan and her co-authors, a RYGB bypass can cause so-called “dumping syndrome”, because the food empties too rapidly into the intestine. Symptoms of dumping syndrome include rapid heartbeats (tachycardia), sweating and pain. Such symptoms tend to make the patient eat very small portions and thus lose weight.

Danish Study

In January 2016, Dr Sigrid Bjerge Gribsholt of Aarhus University Hospital, Aarhus, Denmark, and a team of researchers studied 1,429 patients who had undergone RYGB surgery for the purpose of weight loss between January 2006 and December 2011, in order to determine what negative effects the surgery had on quality of life. A group of 89 matched patients, who had not undergone RYGB surgery, were included as a control group.

The following effects were reported by the RYGB surgery patients:

  • Encouragingly, 87% of the RYGB surgery patients reported improved well-being and only 8% reported reduced well-being.
  • Of the patients reporting reduced well-being, 89% reported 1 or more symptoms approximately 5 years after surgery.
  • 29%, or nearly one third of the RYGB surgery patients, had to be hospitalised for their symptoms, compared to 7% of the control group.

Symptoms reported by patients up to 5 years after RYGB surgery were:

  •   34% – abdominal pain
  •   34% – fatigue
  •   28% – anaemia
  •   16% – gallstones

Women, patients younger than 35 years, smokers, unemployed persons and individuals who had surgical symptoms before undergoing RYGB surgery, had a higher risk of developing negative symptoms after their gastric bypass surgery.

Read: Weight-loss surgeries increase demand for cosmetic ops

As would be expected, the more symptoms patients had, the lower their quality of life. Dr Gribsholt points out that these patients may be inclined to depression and has made calls for solutions to improve gastric bypass surgery.

Dietary intake after gastric bypass surgery

According to Mahan and her co-authors (2012), the following dietary progression should be used after a gastric bypass:

a) Liquid diet:

After a gastric bypass most patients should use a liquid diet for 1-2 days. Not more than ½ cup of the following liquids should be taken in total at a time: plain and flavoured water (use only still water), clear broth, unsweetened juices, diet gelatine or jelly, non-carbonated diet drinks (avoid drinks with bubbles), pureed and strained milk soups.

b) Semisolids and pureed diet:

This type of food should be used from day 3 for 3 weeks. No more than ½ to ¾ cup in total per meal should be eaten. Increase the quantity from ½ cup to ¾ cup gradually, 1 teaspoon at a time. Most cooked foods can be blended, such as soft meats, fish, chicken, turkey, fruit and cooked vegetables. Warm cereals cooked in milk, and yoghurt can be included.

c) Soft foods:

These soft foods can be eaten from week 3 to week 6. The patient should gradually increase the quantity from ¾ cup to 1 cup (not more) per meal. Any foods that can be mashed with a fork such as minced, cooked meat, canned or soft fresh fruit and cooked vegetables, soft cooked cereals with milk, yoghurt and soft scrambled egg, can be used.

d) Standard small meals and healthy, non-fattening snacks:

These foods can be eaten from week 6 and thereafter. No more than 1 cup in total per meal, and less per snack. Meat should not exceed 60 g. Foods that no longer need to be pureed or blended can now also be eaten. Avoid foods such as popcorn, nuts, meat gristle and fat, dried fruits, tough fruits and vegetables, carbonated sweetened drinks, bread, crunchy breakfast cereals and muesli (the latter may contain nuts, dried fruit etc., which can cause diarrhoea).

Read: Diarrhoea cure could save millions

Because each patient is an individual and may have food preferences and aversions, it is essential that the post-operative diet adaptation should be monitored by your dietitian. The dietitian will also advise you about the use of liquid meal supplements, multivitamins and mineral preparations and amino acid supplements. If your surgeon has not referred you to a registered dietitian, please ask them to do so. The dietitian will guide you through this adaptation period and help you sort out potential problems.

Pitfalls of bariatric surgery

Some patients who undergo bariatric surgery for morbid obesity sabotage their own success by working out a variety of tricks to ingest more food and energy (kJ) and thus slow down or prevent weight loss. For example, even patients who have hardly any stomach capacity will start drinking small quantities of high-energy drinks or eating high-energy soft foods all day long. This is a recipe for disaster.

If you have undergone the discomfort and risks of anaesthesia and surgery to lose weight, don’t sabotage your own progress by over-feeding. At end of the day, it is your body and your health that lose out, and all the expense and suffering will have been in vain.

Read: Anaesthesia fit?

The general conclusion is that bariatric surgery can be very successful and help morbidly obese patients achieve dramatic weight loss and reduced risk profiles. It must, however, always be kept in mind that any surgical intervention may have negative side-effects and that the post-operative guidance of a dietitian regarding the types of food and quantities patients can eat, is an important factor in long-term success.

Read more:

Bariatric surgery Part I – the positive aspects

Bariatric surgery substantially reduces the risk of diabetes

White Americans more likely to have bariatric surgery

Sources:

Gribsholt SB et al, 2016. Prevalence of self-reported symptoms after gastric bypass surgery for obesity. JAMA Surg. 2016 Jan 6: 1-9. doi: 10.1001.

Mahan K L et al (2012). Krause’s Food & the Nutrition Care Process. Elsevier Publishers, USA.

Dr Ingrid van Heerden is a registered dietician and holds a doctoral degree in Nutrition and Biochemistry. She believes that "we are what we eat" and offers free nutrition and weight loss advice via her DietDoc service on Health24.com. Read more of her articles.

 
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