During the beginning of November I went to a weight loss center for one of my rotations. This was a very interesting rotation because when I think of weight loss centers I think of helping people make modifications to their diet and exercise regimen. This center definitely did this, plus more. This center offers Bariatric Surgeries to those that need it. These patients can be referred to them for multiple reasons. Many of the patients have tried dieting to no avail. This can be a result from numerous reasons; genetics, hormones, medications, and other morbidities as a result from obesity. To qualify for one of these surgeries you must have a BMI of 40 or greater, or a BMI of 35 with at least 3 other co morbidities. Some examples of co morbidities are hypertension, sleep apnea, uncontrolled diabetes mellitus, and obesity related physical and functional impairment that interfere with activities of daily living (ADL’s).
To be a candidate for the surgery the patient must get pulmonary clearance as well as cardiac clearance to make sure they are safe for surgery. The patient must also get psychological clearance to make sure that they are ready emotionally. This is a huge lifestyle change and patients must be prepared as possible.
There are three types of bariatric surgeries that work in different ways. There is a restrictive procedure, malabsorptive procedure, and combination procedure. The weight loss center I interned at does not do any malabsorptive procedured (ex. bilopancreatic diversion BPD). There are a variety of bariatric surgeries but this center specializes in three. There is the lap band, the roux-en- y gastric bypass, and the gastric sleeve. The sleeve and the Roux-en-Y are a combination of being restrictive and malabsorptive procedures and the Lap band is just restrictive.
With the Sleeve Gastrectomy approximately 60-80% of the stomach is removed. It leaves the stomach in more of a banana shape which is not as big as an average stomach. There is also a decline in the production of a hormone known as grehlin, which causes a person to feel hungry. With the decrease in size and grehlin, there is a decrease in food intake.
The lap band creates a small pouch that causes the individual to feel full quickly and will eat less. The band can be tightened or loosened by adding or taking saline solution out of the band through the port on the inside of the skin on the abdomen. The tighter the band is, the longer the food remains in the pouch increasing the duration of satiety. Because such a small amount of food may be consumed, nutrient deficiencies are possible.
The Roux-en-y is the most common bariatric surgery which also creates a small pouch. It not only does that, but also bypasses the entire duodenum and a short section of the jejunum. Because of this, deficiencies may also occur if supplementation and a healthy diet are not consumed. An advantage of the gastric sleeve surgery over the Rouxen-Y is that there seems to be less malabsorption, and dumping syndrome doesn’t occur as easily.
Before any type of bariatric surgery, most patients are required to see a Dietitian at least once if not multiple times. Pre- surgery goals are determined in these sessions, which will ultimately improve nutritional status of patient if goals are met. The patients must also try to adapt to not drinking soda or smoking pre-surgery.
The Dietitian plays a critical role in helping ensure the patients can be successful. Just because this is a weight loss surgery, does not mean that the patient doesn’t have to make life style changes. If anything, it is more critical that they do make these changes to ensure better health and better results.