weight loss surgery group education session. introductions julie thompson – specialist bariatric...
TRANSCRIPT
Weight Loss SurgeryGroup Education Session
Introductions
Julie Thompson – Specialist Bariatric Dietitian
Cara Barnes – Bariatric Nurse Specialist
What is the purpose of
today?
Introduce you to the types of surgery and the service offered
Provide you with information on diet and lifestyles to enable you to start preparing now
What we’ll cover
Changing eating before
surgery
Types of surgery
What’s the right operation for you
Preparing for surgery
Impact of surgery on your
life
The pathway
Time for questions
IT’S NOT THE EASY OPTION…!!!!
Gastric band
Gastric bandBenefitsBenefits
•Slightly less major operation
•Control over restriction
•Effective for volume eaters
ComplicationsComplications•Occur much later
•Slippage
•Erosion
•Leakage
•Infection
•0.3% mortality risk
ImplicationsImplications•Takes up to 2 years to get to goal weight
•Eat small amount
•Lots of chewing
•Certain foods can be problematic
•Reliant on will power with snacking
•20% band failure rate
•Lose 40-50% excess body weight
Gastric Bypass
Gastric BypassBenefitsBenefits ComplicationsComplications
ImplicationsImplications
•Rapid weight loss
•1-2 st / month for 3/12
•½-1st/ month next 3/12
•70-80% excess weight loss
•Complications early on
•Effective for snackers/sweet eaters
•Improves diabetes
•Anastomotic leak - 4%
•Anastomotic stenosis
• Hernia
•Some hair loss
•1% mortality risk
•Rapid weight loss- 9 months to 1 year
•Lots of chewing
•Small portions
•Life long vitamins and minerals
•“Dumping” syndrome
ImplicationsImplications
•Regular blood tests
•Risk of malnutrition
•Not reversible
•Still have emotional hunger
•Certain foods can be problematic
Sleeve Gastrectomy
Gastric SleeveBenefitsBenefits
• Less invasive than bypass
• Reduced stomach volume (by 60 – 85%)
• Restriction over volume eaten
ComplicationsComplications
• Leakage of stomach acid
• Weight regain
ImplicationsImplications
• Completely irreversible
• Average wt loss: 60 – 70% of excess
• (limited data on long term maintenance)
• Smaller portions
• ++ chewing
SURGICAL COMPLICATIONS
• Bleeding
• DVT
• PE
• Infection - chest
- wound
• Scarring
The long walk to theatre
After Surgery
• Tired• Vomiting• Exercise• Mood swings• Hair loss• Hernias• Diarrhoea/Constipation• Dumping• Excess skin
Body Mass Index (BMI)• Is a ratio of your weight for your height.• The healthy range is between 20-25kg/m2
EXCESS BODY WEIGHT
Is …
THE WEIGHT YOU ARE NOW minus
THE WEIGHT YOU SHOULD BE
So…
If you weigh 25st (159kg), and your ideal weight (at BMI 25) is 11st 11lb (75kg), your excess body weight is 13st 3lb (84kg).
Band:
Loss of 40-50% of excess weight
= 5st 4lb – 6st 9lb (33.6 - 42kg)
New wt = 18st 6lb - 19st 10lb (117 – 125.4kg)
BMI: 39 – 42kg/m2)
Bypass:
Loss of 70-80% of excess weight
= 9st 3lb – 10½st (58.5 - 67kg)
New wt = 14½st – 15st 10lb (92 - 100kg)
BMI: 31 - 33.5kg/m2)
Key questions
How much weight to lose?
How quick?
Other co-morbidities?
Committed to follow up?
Ability to alter eating habits Am I prepared
for surgery risk?
Sweet eater/
snacker
Binge eater?
Which option is right for me?BANDIf you:
• eat large meals
• are only a few stones overweight
• are happy to lose weight slowly over 2 years
BYPASS
If you:
• have a lot of weight to lose
• have poorly controlled diabetes
• have lots of resolvable health problems
•like snacking/sweets
Balloon
If you:
• have a BMI over 60kg/m2
• have lots of health problems that mean you
cannot have surgery
With all procedures, you must be willing to sign up to commitment with dietitian & the team
Gastric Sleeve
If:
• a band is not appropriate and a bypass is not safe
Not a primary procedure
What is my
eating really like?
Types of over eating
Binge eatingBinge eating
“out of control of eating”
GrazingGrazing
“cravings / bored”
Emotional / Emotional / comfort comfort eatingeating
Overeating Overeating and then and then starvingstarving Putting Putting
others firstothers first
Food as Food as rewardreward
Picky Picky eater / eater / grazergrazerEat large Eat large
portionsportions
“Should I lose weight
before bariatric surgery?”
Weight lossbefore surgery
Decreases liver size
(fat)
Demonstrates motivation
& commitment Possible shorter Length of
hospital stay
Reduces operation time
Helps develop good habits
Healthy Eating
starts here
3 regular meals a day
No longer than 5 hours without
food
Wait 2 hours until having a snack IF
you’re hungry
Include small amounts of treats
Breakfast is the most important meal of
the day
Monitor your food intake
If you are not hungry outside mealtimes, do not eat
Pre-Op Diet / Liver Shrinkage
A large liver
Pre-Op Diet / Liver Reduction Diet
Diet sheet given out at first dietetic appointment
1000kcal/d:low fat and
low carbohydrate
Shrinks the liverShould lose 6kg
(1 stone)
Caution with diabetic control – your diabetes nurse needs to monitor
you
Strict diet you need to follow for 3 weeks
before surgery
Eating after surgery
How is my eating going to
change?
What can I eat afterwards?
Stage Texture Duration
Stage 1 Pureed (smooth textures, no lumps)
4-6 weeks
Stage 2 Soft/moist/mashable
2 - 4 weeks
Stage 3 Normal Weeks 8 -10 onwards
Immediate post-surgery dietary rules
Dietary Principles
Healthy Eatingie. low fat, low sugar, moderate protein, rich in micronutrients
Regular meals
Texture
Eat very slowly – chew each mouthful 25 times
Stop eating as soon as you start to feel full
Not drinking with eating (wait 30 mins either side)
Volume / portion controlUse small plates & bowls
Things to avoid
Progression Through TexturesPuree Diet (smooth, no lumps or bits, yoghurt-consistency, too thick to suck up through a
straw) - 4-6 weeks• First few days – will only manage teaspoons. Stop eating as soon as you start to feel full.• Over first 2 weeks – will build up to 3-4 tablespoons• During this time you will need 3 meals and 3 snacks, all pureed, and low fat and sugar,
and high in protein• When you feel you can manage more than 3-4 tablespoons, do have a little more but start
reducing the snacks between meals. Eventually you should be on 3 small meals a day (some people manage better with 4).
Soft Mashable Diet – 2-4 weeks• Then you can move on to a soft, mashable diet• ie. anything that can be mashed with a fork. You may need additional low fat, low sugar
sauces/gravy to help with this. No hard lumps, gristle or stringy vegetables.Normal Textures• Then you can move on to a normal textured diet, although you may struggle with some
foods (eg. bread, tough meats, stringy vegetables, pithy fruit (eg. citrus) but you may be able to manage them after a few months.
NB Some people may progress a little slower or a little faster than the above
Bread
Pasta
Potential Problem Foods
Crackers or toast
Tough/dry/gristly meat
Rice
Stringy/hard vegetables
Fruit pips, seeds, skins & pithy fruit
Use small shapes for soup
Small pieces / minceSlow cooked / stewed
Risotto
Overcook:Cauliflower, broccoli, carrots
Peel fruit / purée or stewTinned fruit in juice*
Alternatives
Vitamin DThiamine
Zinc
Calcium
Iron
Therefore, lifelong supplementation of multivitamins & minerals, with additional iron and calcium, with potential for further supplementation dependent on your blood results
Pathway to surgery
Referral From GP
Group education session Support Group
Meeting with Consultant
Health Assessment
Return to see doctor for results & put on waiting list for surgery
Pre-assessmentLiver shrinkage diet for 3 weeks
Surgery
Psychologicalassessment
Respiratory Cardiology EndocrineMedical
Management
Funding agreed by PCT
Endoscopy Sleep apnoea test
Dietitian
MDT
Pathway after surgery
Operation
Band – 2-3 day stay Bypass – 2-3 day stay
Seen by team daily
1st Outpatient Appointment at 6 weeks
Seen by dietitian and nurse specialist before discharge
2nd Outpatient Appointment at 12 weeks
1st band fill~6 weeks
Band fills as required for 2yrs
Reviews at 6, 12, 18 and 24 months, then discharged back to GP