How to Choose a Bariatric Surgeon?

Here are tips on how to choose a bariatric surgeon for yourself – http://bit.ly/1M4WhN7

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To do or not to do, that is the question that everybody asks themselves when thinking about going under the knife. Once you have decided to opt for Bariatric Surgery, choosing a Bariatric surgeon can be a crucial factor for  successful weight loss in your journey towards good health.

Weight loss surgery is not a new technique since it is practiced worldwide for over 60 years. The winds of time have favorably changed directions for the surgery. Many of us already know someone who has had Bariatric surgery.

It is definitely not a cosmetic procedure. To start, bariatric surgery isn’t performed by plastic/cosmetic surgeons. Today there is a slew of bariatric surgeons, options for procedures to choose from and other additional services assisting the weightloss surgery.

There are a plenty of factors to keep in mind before you finalize a surgeon, Here is a list of things you should ask your surgeon before making final decision.

Doctor’s Credentials

Is your surgeon qualified? Ask for your doctor’s credentials. One should know if your bariatric surgeon is well trained and accredited by international / national rating agencies. The most well known rating agency worldwide is ‘Surgical Review Corporation, USA.’

It is also important to know if the surgeon will be operating himself or a team member or associate surgeon will be operating you.

Numbers Matter

A doctor’s credibility lies in his/her experience. When it comes to a bariatric surgeon’s expertise, it’s important to see whether surgeon is doing atleast 100 bariatric surgeries/year.

Is he a complete bariatric surgeon?

Within Bariatric surgery, there are a number of procedures that one can undergo. It is also important to know how many types of procedures the surgeon can perform. A surgeon performing various types of bariatric surgery can objectively suggest the best possible procedure & individual bias can be avoided.

Support Team

After the surgery, different patients have different needs. The actual weight loss surgery is just the first part of your journey. Post op care is an important part of the overall journey. It is important that the facility that you have chosen is equipped with ample amenities for patients. Knowing the support staff team in advance helps smoothen post op recovery.

Trust

Ultimately, it all boils down to the fact whether or not you can trust your doctor. Bariatric surgery may be a simple procedure but it still requires experienced surgeons to perform it. After having met all the criteria, you need to listen to your instincts and go by your gut feeling before choosing your doctor.

Choosing the right bariatric surgeon may seem unnerving, but it doesn’t have to be. It is crucial to select a surgeon who understands your concerns, is able to answer your queries and can put you at complete ease. Asking the right questions and knowing what to look for in a bariatric program can help you cruise ahead in weight loss journey.

 

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Insurance in Bariatrics

Dr Ramen Goel, Director, Center of Bariatric & Metabolic Surgery, Wockhardt Hospitals bats for the inclusion of bariatric surgery under insurance coverage. He explains that contrary to popular belief it is more than just a cosmetic procedure and often is a life-saving surgery

Dr Ramen Goel

Insurance for bariatric surgeries has been a controversial subject in our country for almost 20 years. Routinely almost all insurance companies (private or public) had been declining claims and pleas for payments (cashless or reimbursement) citing various reasons.

These refusals arise from a perception that obesity is a self inflicted problem and these self indulging individuals have no right to insurance largesse. Mostly reasons cited for rejection includes exclusion of obesity and related treatment in policy document and/ or bariatric surgery is a cosmetic procedure. None of these arbitrary pronouncements can withstand evidence-based scientific and legal scrutiny.

Source:http://obesity-care.com/2016/11/14/insurance-in-bariatrics/

The Complete Guide to Diet after Bariatric Surgery

Bariatric surgery is a life-saving procedure. One is able to lose the stubborn weight along with associated diseases and most importantly feel and look healthy. However, for the surgery to be effective, one has to be vigilant about his/her diet intake. This is required for 2 reasons –

  1. For adequate healing of recently operated stomach/intestine
  2. For adequate weight loss and long term weight maintenance

For adequate healing post surgery, there are three stages to a Bariatric diet. Here is a quick guide to the do’s and don’ts when it comes to following a healthy diet post-Bariatric surgery

Liquid Diet (2 weeks after weightloss surgery)

The first three days after the surgery mainly involves clear liquid diet. This is to be followed in order to maintain adequate hydration levels in the body. During this period, a patient is guided to limit consumption to plain water, coconut water (if sugars are normal), clear soups, green tea, lime water etc. From the fourth day onwards, a patient can consume protein shakes, thin dal, buttermilk, tea/coffee, and soups.

Soft Diet (2-4 weeks after surgery)

The duration of this stage may vary depending on the type of surgery. A patient who has undergone a Gastric Bypass surgery needs to follow it for two weeks, while sleeve Gastrectomy patient needs it for 4 weeks. The diet mainly involves the consumption of egg whites, fish, porridge, dal, khichdi, low-fat paneer, curd, idli, dhokla, beans etc. It is important to ensure that foods should be soft and slightly overcooked. Things like bread, salads etc are not allowed.

Full Diet

4-6 weeks after surgery, person can start consuming even bread, dry fruits etc as staple lines have adequately healed.

Adequate Weight loss & Maintenance

Everyone loves to eat, who doesn’t? Nothing gives more satisfaction than a plate of food that you love. An obese person has to remember that bariatric surgery does not change the tendency to gain weight. So, in order to live a healthy life, optimal care of diet is necessary. Being healthy is a lifelong commitment for everyone irrespective of bariatric surgery. In our experience, most patients opting for bariatric surgery have immense will power as they have given up smoking /alcohol for years and have been exercising regularly for years.

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After weight loss surgery, person is allowed to eat the food of his choice till he is full. Emphasis has to be on adequate protein intake (50-60 Gms per day) & liquids (1.5-2 litres per day). This can include fish, chicken, eggs, dal, roti, rice etc & there is no need to eat salads etc. Healthy food choices and a dose of exercises can help achieve lifelong healthy weight in all bariatric patients.

CMS Team

Obesity and overweight: what is the difference?

Obesity and being overweight are often misunderstood as synonyms for each other. A better understanding of these will help us to understand the optimum resolutions for each Obesity is defined as having a body mass index (BMI) of greater than 25. BMI is a measure of your weight relative to your height.  India has more than 30 million obese people, and the number is increasing alarmingly. The problem is more acute among women than men.

Obesity is looming threat of the 21st century and is a major causative factor for many other metabolic disorders and comorbidities. 

If one is to look at the causes, there is no single cause of obesity or excess weight. Though both are primarily a result of energy imbalance, excess calorie intake, and insufficient physical activity or a combination of both, there are various genetic, behavioural, and environmental factors that also contribute to the causes of overweight and obesity. The modern lifestyle is often blamed for increasing obesity. Our typically urban lives allow us access  to comforts and luxuries alike use of mechanized transport, increasing the availability of processed and fast foods, increased television viewing, adoption of less physically active lifestyles and consumption of more “energy dense, nutrient-poor” diets. It is this very modern lifestyle that brings with it an unwanted epidemic of obesity and various health conditions that eventually become a threat to healthy living.

The risk of many diseases including cardiovascular diseases (CVDs), hypertension, hyperlipidemia, diabetes mellitus, and certain cancers increases many folds in association with obesity. There are no quick-fire solutions to the looming threat of the obesity epidemic. When an individual fails to lose enough weight to improve his health using other methods such as diet and exercise regimes and yet faces serious obesity-related health problems, then weight loss surgery or bariatric surgery are suggested for such individuals.

Various procedures of bariatric surgery leverage innovative technologies and enable severely obese individuals to live longer and more fulfilling lives. When used for a right candidate, irrespective of the procedure used, it has been clinically proven that weight loss surgery results in greater improvement in weight loss outcomes and obesity-related health conditions. Bariatric surgery holds the potential to improve many obesity-related health problems, such as type 2 diabetes, high blood pressure, unhealthy cholesterol levels. Bariatric surgery also positively impacts a person’s quality of life by improving physical function and mood.

Having said that, it is important to understand that bariatric surgery is no replacement for healthy habits It can only help if the candidate undergoing the surgery is willing to abide by a healthy lifestyle post-surgery.

 

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My Experiences With Truth

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The feedback from our facebook page ‘Centre for Metabolic Surgery, Mumbai’ & emails received have shown that expectations & concerns vary between patients. Apparent annonymity provides an outlet for expression which may not happen during consultations esp in presence of family or friends.

Just last week a gentleman, operated almost 3 years back, messaged me that he has gained few kgs in last 1 year. He is one of those who is regular in follow up & extremely bullish about bariatric outcomes. However, alcohol had been his achilles heel, as is with so many others.

A common adage is that if one cannot eat, drink & make merry than what use is life? Personally, I am also a supporter of the view that quality of life is eqully important. Majority of those opting for weight loss surgeries have phenomenal will power – eating small portions, exercising regularly & have given up smoking/alcohol years back.

On the other hand, most of our obese or diabetic patients have never experienced a situation where they can consider themselves free of these diseases. Post bariatrics, patients start believing that, alcohol or sweet consumption is an expression of new found freedom or normalcy which had eluded them for decades, failing to realise that, unlike their slim friends, they continue to have tendency to gain weight if they go overboard.

Is alcohol consumption a complete no-no after bariatric surgery? Consumption of alcohol per se is not a major concern after adequate weight loss but regular & significant intake with consumption of high calorie snacks can indeed cause weight regain & maybe other health problems.

How much is too much? Well, for the first year after surgery or till weight stabilises alcohol should be completely stopped for excellent results. After that, if absolutely necessary, 1-2 drinks a week should not be a problem, but anything more & ……. It is important to remember that these lifetime problems have lifestyle origins.

For most, losing weight or getting rid of diabetes had been a major problem for years. The effort to lose weight is usually stupendous before surgery & now that you are living a dream after losing 30, 50 or over 100 kgs and with normal blood sugars, without daily insulin jabs, the party has just begun.

Why let a drink spoil the party!

Dr Ramen Goel

http://obesity-care.com/

 

 

 

 

 

 

 

 

 

 

My Experience With Truth

ArticlesMy-Experiences-with-Truth-960x3721.jpgInter human variation always intrigues me. How come the same surgery works well for most while not for few? They believe  ncreased hunger & ability to eat frequent meals is the culprit.

This explanation is based on poor understanding of post bariatric dietary education. Hunger is a physiological process & there is nothing wrong if the person is hungry before a meal. Hunger indeed reduces after surgery for few months due to decrease in hunger hormones. But body compensates by producing hormones from other organs & hunger is back.

The key message is that surgery is done to enhance satiety or feeling of fullness after a meal & not to curb hunger.  Surgery is also expected to increase interval between meals. This is possible to achieve & maintain lifelong if the principles of surgical follow ups are adhered to, which include –

Consumption of liquids with meal – Post surgery stomach capacity is usually 30-50 ccs, which can increase to ~200 ccs after 1-2 years. Even this capacity is 1/3rd of normal stomach size so meal portion remains small permanently. Few patients realise that by gulping liquids with a meal, they are able to flush the food down from their stomach & consume larger meal. This also results in feeling of emptiness within 1-2 hours of surgery. This is completely avoidable by learning to eat without liquids for at least 1/2 -1 hour after a meal. 

Protein intake – Many patients believe that they they eat more sweets & fried items, when stressed. The fact is that once high GI(glycemic index) food like sweets, refined flour etc are consumed, the blood sugar precipitously rise & fall. This makes person hungry again & craving of food manifests within 1-2 hours.On the contrary, high protein meal results in slow & sustained provision of nutrients to body. Thus a protein meal is known to result in satiety which keeps hunger away for hours. Thus food choices play an important role in altering hunger mechanism.

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Food choices & technique of eating plays an important role in feeling full & keeping hunger at bay. Hunger is normal & should not be considered as personal failing.

Surgery has worked well for millions across the world & do not let few episodes of indiscretion envelope you in feeling of guilt, personal failing or hopelessness. Important thing is to always remember years of lost hope & control over your body. The secret of success lies within you through education, compliance and positive approach. Yes…..you can.