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Patient Information

Considering surgery?

Losing weight can be achieved through eating a healthy balanced diet, changing habits and becoming more active. Sometimes long term weight loss though is difficult to achieve and maintain.  Weight loss surgery may be suitable for individuals who have tried unsuccessfully to lose weight many times in the past using diets or medication. Surgery is not an easy route to weight loss. You must be an active participant in this process, both in order to maintain a good nutritional status and maximise weight loss. You will still need to work hard to lose weight even with surgery. There are often significant changes that you will need to make to your lifestyle and your diet before we can be sure surgery is going to be a successful route to weight loss. It is not necessarily the right choice for everyone.

Surgery is a serious step and should only be undertaken after you have given it a lot of thought and understand what it will entail. You need to undertake research into the various options in order to prepare yourself for the changes that surgery will make to your life. While there are many gains to weight loss surgery there may also be some losses, such as missing the feeling of fullness. It is important that you make sure you can commit to the recommended lifestyle changes and can attend the necessary follow up appointments – otherwise you may not succeed at losing weight.

Questions to consider if you are thinking of surgery

  • Are you ready to make changes to your lifestyle? Surgery will only help you lose weight if you can alter your lifestyle and diet. Otherwise, you may regain your weight in the long term, particularly if you go back to your old eating habits and lifestyle.
  • If you comfort eat in response to emotions or situations or eat through boredom, have you thought about what else you might do to help you through these times. These situations will still be there after surgery.
  • How will you find time to eat slowly and not rush meals? You will need to allow 20 - 30 minutes for each meal.
  • Are you prepared to commit to attending follow up appointments at the Royal Derby Hospital as this is important for the success of the operation
  • How will you cope with the changes to your body shape and the excess skin that may result after weight loss surgery?  It is unlikely that cosmetic surgery to remove this would be available on the NHS.
  • Are you ready to have a life long commitment to eating in a restricted/slower way? Unlike with ‘diets’ you will not be able to have a ‘day off’ to allow for cravings, celebrations or when you are just fed up with it!  Planning ahead and setting aside time to eat is essential. Surgery will not prevent food cravings.  How will you cope with this?
  • Have you got the support of everyone you currently cook and eat with? Your portions and speed of eating will need to change. There may be some foods you aren’t able to manage and you may have to cook different meals on occasions. If someone else cooks, you will need to have their full support and understanding.
  • Where do most of your excess calories come from? Is it from foods that ‘melt’ when inside you such as ice-cream, chocolate, biscuits or crisps? It is likely you will still be able to eat relatively large portions of these foods so you will still need to be motivated and use willpower to control them after surgery for you to lose weight. 

 

Is weight loss surgery right for me?

Some things to consider before having surgery:

  • Surgery will not make decisions for you about what foods to eat or take away the ‘non-hunger’ reasons that cause you to over eat. Why do you think you will be disciplined enough to stick to the dietary guidelines necessary for you to lose weight? Have you had any success at this in the past when you have tried ‘diets’? If not, why will having surgery be any different for you?
  • If you comfort eat in response to certain feelings or situations, or eat through boredom, have you thought about what else you might do to help you through those times? These situations will still be there after you have had surgery – how will you avoid or minimise these?
  • How will you find time to eat slowly and not rush meals? You will need to allow about 30 minutes to eat each meal. You are also likely to need to plan ahead more to ensure there is something suitable for you to eat, especially when you are out of the home.
  • How will you cope eating only very small amounts and eating slowly when eating out, or in other social situations?
  • Are you ready to have a life long commitment to eating in a restricted/slower way? Unlike with ‘diets’ you will not be able to have a ‘day off’ to allow for cravings, celebrations or when you are just fed up with it! How will you cope with this? 
  • Have you got the support of everyone you currently cook and eat with? Your portions and speed of eating will need to change. There may be some foods you aren’t able to manage and you may have to cook different meals on occasions. If someone else cooks, you will need to have their full support and understanding.
  • Where do most of your excess calories come from? If it is from foods that ‘melt’ when inside you such as ice-cream, chocolate, biscuits or crisps, surgery may not be the best weight loss option for you. It is likely you will still be able to eat relatively large portions of these foods so you will still need to have willpower to control them after surgery for you to lose weight.

 

Who can be considered for surgery?

To be eligible for surgery you must meet the guidelines set by the East Midlands Strategic Commissioning Group or your local commissioning group. These state that to be considered for weight loss surgery, you must meet the following criteria:

  • You have tried to lose weight both by dieting and by weight loss medication
  • You have a body mass index (BMI) equal to 40 or BMI =35 with obesity-related comorbidities (type II diabetes mellitus, sleep apnoea or obesity hypoventillation syndrome, ischaemic heart disease, hypertension, polycystic ovary syndrome (PCOS), hypercholesterolaemia, fatty liver disease, arthritis).
  • You do not smoke
  • You are ready to change your diet and become more active
  • You are prepared to return to The Royal Derby Hospital for follow up at least 5 times in the first year (however you may require more visits than this) and at less frequent intervals after that

 

Dietary and lifestyle changes

Once committed to surgery, there are different types of surgery to consider. It is important to understand the differences and choose the surgery best suited to your situation.  Once you are listed for surgery you will be encouraged to lose 5kg weight, if you gain weight in this time your operation will be postponed.

Dietary and lifestyle changes after your operation

How you eat after your operation will determine how successful you will be at losing weight. Following the dietary guidelines will also reduce your risk of complications.

Some important changes you will have to make are:

  • Eating small, regular, healthy meals. Plan ahead and avoid missing meals.
  • Eating food slowly and taking care not to rush either food or drink.
  • Eating until you feel satisfied rather than until you are ‘full’ as overeating will stretch the pouch formed by surgery.
  • In the initial period after surgery taking food in altered textures and taking time to find out what foods you can tolerate or find difficult. These are likely to change over time so you need to prepare yourself for this.
  • Control intake of high calorie snack food and fluids as these will continue to be easy to eat.
  • Avoid drinking with meals – wait at least 30 minutes before and after a meal to have a drink.
  • Try to identify any barriers that prevent you losing weight. Emotional problems can be a serious block to weight loss.
  • Increasing your physical activity will protect your muscles and ensure your success.

 

If you are unable or need help to answer these questions, you should carefully consider whether surgery really would help you lose weight. It isn’t the right choice for everyone.