The Importance of Long Term Team Approach to Weight Management

Following bariatric surgery, many patients start off doing very well in terms of their weight loss goals. However, significant weight regain does occur in about 1/3 people around two to three years post-surgery.

The reasons for the weight gain  are complex but can be due to changes in:

• gastric anatomy (shape and size)
• physiology (function) 
• patient psychology (behavior). 

At Upper GI Surgery, we believe that coaching people during their journey towards a healthier lifestyle will maximise their chances of getting the most out of their surgery and avoid both weight regain and nutritional complications. 

Anatomy 

The anatomy of your surgery will change over time 

Bariatric surgery changes the way the body processes food, but over months the stomach adapts to the surgical changes by stretching slightly and becoming significantly suppler and therefore able to process food faster. This has the effect of lessening your perceptions of restriction and discomfort if you overeat. 

In some cases, this stretching can lead to reflux or other problems but a “loss of restriction”, especially to high calorie and liquid foods, is experienced by everyone after the first few months.

Physiology 

The most significant effect of surgery is suppression of appetite

The majority of patients gaining weight after bariatric surgery do so in the absence of hunger, and while some patients do need more surgical therapies to help them lose hunger this is uncommon. 

Larger operations such as the gastric bypass can drastically change people’s tastes so they begin to dislike the smell and taste of many high calorie foods. 

Surgery can also reduce enjoyment of food so eating for pleasure becomes a thing of the past. While appetite suppression persists in almost all patients, the stronger effects such as taste changes fade after two years and are present in only about 1/3 of patients after this time. Not being hungry is quite different to “being full”. 

A key part of coaching after surgery involves retraining people to eat “enough” rather than eating until they can’t eat any more.

Psychology

People are usually highly motivated before and soon after surgery, but after the first few months the desire to return to old habits returns and they can slip back into their old routines. While most patients still have a significant suppression of appetite, it is common for people to eat in the absence of hunger.  

Over time, after surgery people also learn that eating some foods like meat, chicken, salad and vegetables remains difficult, but having liquid calories (milky coffees, sweet drinks and alcohol) or high carbohydrate and high fat foods becomes easy again.  The change in the feeling of restriction during meals, the gradual disappearance of discomfort when foods are overeaten, and the tendency for people to “graze” and move unconsciously to soft foods that they can eat more of, inevitably leads to people eating more food and being at risk of weight regain.  

Another issue is that the large majority of people with a weight problem have spent many years or decades snacking on high calorie foods and liquids between meals.  While these habits usually disappear in the first few months after surgery, they reappear down the track especially if people go through periods of stress in the future.  

The most common cause of weight regain after any weight loss procedure is not due to patients eating large meals, but due to patients eating between meals or changing from low calorie food to high calorie junk food.  

We support you for the long term

At Upper GI Surgery, our team that supports you during weight loss surgery and the years afterwards includes:

• Your surgeon whose job it is to keep an eye on surgical complications and discuss how surgery affects your body function
• A bariatric medical practitioner who works in the same way that the surgeon does but often with a more in-depth focus on some long term nutritional aspects of surgery
• A dietitian who helps remind patients to keep their eating on track
• A psychologist for people who find that snacking or other eating behaviors and response to stress are difficult to get on top of.
• We’ve recently introduced the Fresh Start program for our post-bariatric surgery patients, which provides a wealth of on-going support for up to two years. 

Post-surgery support

Unless patients come in for a follow-up after surgery, they lose the opportunity to benefit from the advice that we provide. This advice is based on our experience managing many thousands of patients over years and decades.  

Every year after surgery the advice we give patients is different because the difficulties and risks that patients face are different during the first year, second year, third year and out to five years post-surgery. After about five or six years we feel that most patients have the knowledge and the confidence to continue care with their GP. 

Your support network

Another very crucial group of team members are family members and friends. It is well worthwhile keeping them involved with your weight management journey by asking them to come to your pre-and-post operative appointments with you.  Your support network can assist you to stay on the right track or encourage you to seek further help by making a follow-up appointment with us.  

Ready to start your health journey?

If you decide to go ahead with bariatric surgery, it is important not to become one of the 1/3 who falls short of their long-term goals. Our team at Upper GI Surgery are with you not just for the short term but for the long term.  

If you would like more information about bariatric surgery or the other services we offer at Upper GI Surgery, please visit our website or call 9553 1120.