Bariatric Surgery - Weight Loss Surgery

Bariatric Surgery - Weight Loss Surgery

Weight loss surgery, also called bariatric surgery, is used as the last resort to treat people who are morbidly (dangerously) obese (carrying an abnormally excessive amount of body fat). This type of surgery is usually available to treat people with potentially life-threatening obesity when other treatments, (e.g. lifestyle changes), have not worked.

Potentially life-threatening obesity is defined as: 

• having a body mass index (BMI) of 40 or above
• having a BMI of 35 or above, and having another serious health condition which could be improved if the patient loses weight (e.g. type 2 diabetes mellitus (DM), or hypertension (high blood pressure)).

For people who meet the above criteria, weight loss surgery has proved to be effective in significantly and quickly reducing excess body fat. However, it is always recommended that the patient tries to lose weight through a healthy, calorie-controlled diet and increased exercise, before they consider weight loss surgery, as surgery carries a risk of complications, and requires a significant change in lifestyle afterwards.

Due to these associated risks, most surgeons, whether they are working privately or in a public hospital, would only consider a person for bariatric surgery if there was a clinical need, and not just for cosmetic reasons.

Availability of weight loss surgery

Even if a patient is eligible for weight loss surgery, the demand for this surgery on the public sector in developed countries, is currently usually much higher than the supply. Therefore, there may be a considerable waiting list.

Weight loss surgery is also available privately. Prices are around: 

• £5,000-8,000 ($8,000 - 15,000) for gastric banding
• £9,500-15,000 ($13,000 - $22,000) for gastric bypass surgery

An increasing number of people are seeking treatment abroad, as costs for private treatment are often cheaper in other countries, but this option must be considered carefully. 

Types of bariatric surgery

The two most widely used types of bariatric (weight loss surgery) are: 

• gastric band (where a band is used to reduce the size of the stomach, so that a smaller amount of food is required to make the patient  feel full) 
• gastric bypass (where the patient's digestive system is re-routed past most of their stomach, so that they digest less food, and it takes much less food to make them feel full).

Several other surgical techniques may be recommended in certain circumstances.

Life after weight loss surgery

Weight loss surgery can achieve often quite impressive results in the amount of weight lost, but it should not be seen as a magic cure for obesity. People who have had weight loss surgery will need to stick to a rigorous and lifelong plan afterwards, in order to avoid putting weight back on or any long-term complications.

This plan will include:

• a carefully controlled diet
• regular exercise

The rapid weight loss may cause relationship problems, (e.g. with a partner who is also obese), and it may lead to unwanted loose folds of skin, which may need further surgery to correct. Also, many people with mental health problems, (e.g. depression or anxiety), find that these problems do not automatically improve because they have lost weight. It is important for patients to have realistic expectations about what life after weight loss surgery will be like.

Risks

As with all types of surgery, weight loss surgery carries the risk of complications, some of which are serious and potentially fatal, such as: 

• internal bleeding 
• a blood clot inside the leg (deep vein thrombosis - DVT) 
• a blood clot or other blockage inside the lungs (pulmonary embolism - PE).

It is estimated that the risk of dying shortly after gastric band surgery is around 1 in 2,000. A gastric bypass carries a higher risk of around 1 in 100. However, this risk can be as high as 1 in 40, if a patient has other risk factors (e.g. high blood pressure or a BMI of greater than 50).

Results

As long as a person is willing and able to stick to their agreed plan afterwards, surgery can effectively reduce their weight and treat conditions associated with obesity, such as diabetes.

Recent research carried out in America found that on average: 

• People with a gastric band will lose around half their excess body weight.
• People with a gastric bypass will lose around two-thirds of their excess body weight.

Both techniques also lead to a considerable improvement (and sometimes a complete cure) of obesity-related conditions, such as diabetes or high blood pressure.

Weight loss surgery is only recommended for people with a BMI of 40 or more, or a BMI of 35-40 and a serious health condition that could be improved if you lose weight, such as type 2 diabetes or high blood pressure.

The National Institute for Health and Care Excellence (NICE) also recommends that weight loss surgery should only be offered on the NHS if all the following conditions apply:

• A patient has tried all the appropriate non-surgical methods, (e.g. diet and exercise), but they have failed to achieve or maintain a beneficial level of weight loss for at least six months.
• The patient agrees to commit to long-term follow-up treatment after surgery at a specialised obesity service.
• The patient is fit and healthy enough to withstand the anaesthetic (painkilling medication) and surgery.

There may be slightly different criteria depending on local clinical commissioning groups (CCG) which could affect patients' access to surgery. If a patient pays for private surgery, it is still likely that a surgeon will only agree to perform the operation if similar criteria are met, due to the risks associated with surgery.

When weight loss surgery is not suitable 

Weight loss surgery may not be recommended if a patient has a serious illness which would not be improved after the operation, such as: 

• liver disease
• advanced cancer 

Weight loss surgery is also unlikely to be recommended if a mental health condition or other underlying factor means that the patient would be unable to commit to long-term follow-up and  lifestyle changes.

Examples include:

• schizophrenia for which a patient is refusing to seek treatment 
• actively abusing alcohol and/ or drugs
• a previous history of not complying with medical recommendations about their care

Children

Weight loss surgery would only be considered to treat obese children in exceptional circumstances, and only if the child is physically mature (this would be around the age of 13 for girls and 15 for boys).

Most experts in obesity would only recommend surgery as a treatment of last resort for children who are severely morbidly obese (a BMI of 50 of above), or who are morbidly obese (a BMI of 40 or above) and also have a serious health condition that would improve if they lost weight.

Preparation

Getting ready for weight loss surgery 

Weight loss surgery and adapting to life after surgery is a challenging process, requiring the input of not just the surgeon but many different medical professionals working together as a team. This is known as a multidisciplinary team (MDT) and it may consist of:

1. a surgeon 
2. an anaesthetist
3. a psychologist
4. a dietitian
5. a gastroenterologist (doctor who specialises in treating digestive conditions)
6. a specialist weight loss surgical nurse, who will usually be the patient's first point of contact.

Most MDTs operate out of specialist bariatric surgery units, which are typically based in larger hospitals. Before a patient's weight loss surgery can take place, the patient will probably be referred to their nearest specialist unit for an assessment, to see if they are a suitable candidate for surgery.

Assessment

The pre-operative assessment may consist of three main phases:

• physical assessment 
• psychological assessment 
• nutritional assessment

Physical assessment

The purpose of the physical assessment is to check whether they have any health problems or there are other factors that could complicate the surgery. The patient may receive the following tests:

• blood tests
• an electrocardiograph (ECG), where electrodes are used to measure the electrical activity of their heart
• chest X-rays (CXRs)
• spirometer – a machine that measures how well they can breathe in and out
• an ultrasound scan (USS) – this uses sound waves to build up a picture of the inside of the body, and is useful for spotting conditions such as gallstones and non-alcoholic fatty liver disease.

Psychological assessment

The psychological assessment determines whether:

• A patient has any mental health conditions or emotional problems that could prevent them sticking to your lifestyle plan after surgery 
• they have developed unhealthy patterns of eating (e.g. binge eating), which could cause problems after surgery
• they have realistic expectations of what life will be like after surgery.

The process of assessment can differ from unit to unit, but it is likely the patient will be asked questions about:

• how obesity is affecting their emotions
• how obesity is affecting their relationships with others
• how obesity is affecting their daily activities
• whether they are currently taking medication or seeking treatment for a mental health condition
• their current pattern of eating and their willingness to change the pattern after surgery
• what benefits they expect surgery to bring to them, and how they feel their life will be after surgery.

Having a mental health condition such as depression, or an eating disorder does not automatically mean patients are not suitable for surgery. However, surgery may be delayed until these are under control.

Nutritional assessment

The nutritional assessment has two main purposes. The first is for the dietitian to obtain a detailed history of the patient's current diet and associated patterns of eating, and how these have contributed to their obesity. The second is to ensure that they fully understand the dietary commitments they will need to make after surgery, which may include:

• improving the nutritional content of their meal
• eating small amounts of food slowly rather than rushing through a meal as quickly as possible.

The dietitian may also recommend that they go on a calorie-controlled diet for several weeks or months before surgery. This is because losing even a modest amount of weight before surgery is known to reduce the risks of complications, especially if a patient is going to have keyhole surgery.

Risks of weight loss surgery 

The rapid weight loss associated with weight loss surgery can cause a number of side effects and has a number of risks.

Complications immediately after surgery

Complications that can occur during or immediately after surgery include:

• infection – this affects around 1 in 20 people (5%)
• blood clots in the legs (deep vein thrombosis - DVT) or lungs (pulmonary embolism - PE) – this affects around 1 in 100 people (1%)
• internal bleeding – this affects around 1 in 100 people (1%).

Excess skin

While weight loss surgery can successfully remove the fat in the body, it cannot cause skin to revert to its pre-obesity tightness and firmness. Therefore, if a patient has been obese (especially for many years), they may be left with excess folds and rolls of skin, particularly around the breasts, tummy, hips and limbs.

These folds and rolls normally become most apparent 12-18 months after surgery. They can look ugly and are difficult to keep clean, so patients may be vulnerable to developing rashes and infections.

Cosmetic surgery can be used to remove the excess skin. However, as this treatment is for cosmetic and not clinical reasons, it is not available on the public sectror, such as the NHS. The price for a course of skin-removal treatment can range from £1,500 to £6,000 ($2,000 to $10,000), depending on the amount of skin that needs to be removed.

Gallstones

Around 1 in 12 people (8%) will develop gallstones after weight loss surgery, typically 10 months after surgery. Gallstones are small stones, usually made of cholesterol, which form in the gallbladder. In most cases, gallstones do not cause any symptoms. However, if they become trapped in a duct (an opening or channel), they can irritate and inflame the gallbladder and cause symptoms, such as:

• a sudden intense pain in your abdomen (tummy) n
• nausea and vomiting (feeling and being sick)
• jaundice (yellowing of the skin and the whites of the eyes)

Psychosocial effects of surgery

While most people who undergo weight loss surgery report an improvement in their quality of life, several psychosocial effects may be related to rapid weight loss. Some people have reported relationship problems with their partner, as their partner begins to feel nervous, anxious or possibly jealous about their weight loss.

Additionally, social occasions which revolve around food (e.g. family meals), can become awkward, as it is common to feel self-conscious about their reduced capacity to eat. It is also common for a person to experience a worsening of mood when their weight stabilises, typically two years after surgery. This is often because many people realise that problems which existed before surgery, (e.g. money worries or difficulties at work), are still there after surgery.

Patients may find it useful to discuss these issues with people who have also had weight loss surgery. The British Obesity Surgery Patient Association’s website contains a service directory of support groups in the UK along with more information.

Stomal stenosis

A common complication in people with a gastric bypass is that the hole (stoma) which connects their stomach pouch to their small intestine becomes blocked by a piece of food. This is known as stomal stenosis, and it is thought to occur in one-fifth (20%) of people with a gastric bypass.

The most common symptom of stomal stenosis is persistent vomiting. Stomal stenosis may be treated by directing a small flexible tube (known as an endoscope), to the site of the stoma. A balloon attached to the endoscope is inflated to unblock the stoma. The best way to prevent stomal stenosis is to always cut food into small chunks, chew the chunks thoroughly and avoid drinking during meals.

Gastric band slippage

Gastric band slippage is a complication that affects around 1 in 50 people (2%) with a gastric band. As the name suggests, the band slips out of position. This means that the stomach pouch becomes bigger than it should be. This can cause symptoms such as:

• heartburn
• nausea
• vomiting

Further surgery may be required to repair the band.

Food intolerance

Around 1 in 35 people (3%) with a gastric band develop a food intolerance, often many years after their surgery. A food intolerance is when the body is unable to tolerate certain foods (e.g. red meat or green salad), resulting in a number of unpleasant symptoms like:

• nausea
• vomiting
• gastro-oesophageal reflux disease (GORD) 

The reason why a food intolerance can develop after surgery is still unclear. In most cases, avoiding foods which trigger a reaction should help improve symptoms, but if a patient has persistent symptoms associated with a number of different foods, then it may be necessary to remove the band and replace it with a gastric bypass.

Death

No surgery is entirely safe, and all surgical procedures carry a risk of death, however small. Death may occur for a number of reasons during or shortly after weight loss surgery, including:

• a pulmonary embolism (PE), which causes serious breathing difficulties and then death
• infection
• internal bleeding
• stroke
• heart attack

The risk of dying is:

• 1 in 2,000 (0.05%) shortly after a gastric band
• 1 in 100 (1%) shortly after a gastric bypass.

A number of risk factors have been identified which increase the risk of death during or shortly after weight loss surgery. These are:

• being over 45 years old
• high blood pressure
• having a BMI of 50 or above
• being male, as obese men tend to weigh more than obese women
• having a known risk factor for a pulmonary embolism

Known risk factors for a pulmonary embolism include:

• having a previous history of blood clots
• pulmonary hypertension, when the blood pressure inside the lungs is particularly high
• obesity hypoventilation syndrome, when a patient has persistent breathing difficulties related to their obesity.

The risk factors above can have a significant impact on a patient's individual risk of death. For example, if a patient has no risk factors, then their risk of death would be 1 in 500 (0.2%). If they have four or more risk factors, their risk of death could be as high as 1 in 40 (2.5%).

However, untreated obesity, especially morbid obesity, carries a significant risk of premature death itself. In most cases, the benefits of surgery outweigh the risks in people who meet the National Institute for Health and Care Excellence's criteria for weight loss surgery.

The Operation

How weight loss surgery is performed 

The two most widely used types of weight loss surgery are gastric banding (based on restriction), and gastric bypass (which uses a combination of restriction and malabsorption).

Gastric banding

Gastric banding is usually performed as a type of laparoscopic (keyhole) surgery, where a series of small incisions are made in the abdomen (tummy), rather than one large incision. The advantage of this type of surgery is that it causes less pain afterwards, and has a faster recovery time.

However, laparoscopic surgery may not always be possible in severely morbidly obese people.

Gastric banding is carried out under general anaesthetic, which means patients will be asleep during surgery and will not feel any pain.

The surgeon makes the incisions in their abdomen, and then inserts an instrument known as a laparoscope through one of the cuts. A laparoscope is a thin, rigid tube containing a light source and a camera. The camera relays images of the inside of the abdomen to a television monitor.

Other small instruments are placed through the cuts to place the band around the stomach, effectively dividing the stomach into two, leaving a small pouch at the top of the stomach. It will take less food to fill the pouch, so it will take less food to make the patient feel full after surgery. The band contains an access port through which saline (sterile salt water) can be passed to inflate the band. This allows the band to be adjusted as required after surgery. The surgery usually takes about an hour to complete.

Gastric bypass

Gastric bypass is usually performed as a type of laparoscopic surgery where possible, as this causes less pain afterwards and has a faster recovery time. However, it may not be suitable for severely morbidly obese people. As with gastric banding, a small pouch is created at the top of the stomach. This pouch is then connected directly to a section of the patient's small intestine, bypassing the rest of the stomach and bowel. This means that it will take less food to make patients feel full after surgery, and they will also absorb fewer calories from the food they eat.

Bypass or banding?

Both types of surgery have advantages and disadvantages. There is usually more weight loss after a gastric bypass than after a gastric band. Most people with a gastric band will lose around half their excess body weight, whereas most people with a gastric bypass will lose around two-thirds of the excess body weight.

However, because it is more technically demanding, a gastric bypass carries a higher risk of complications, including death. The risk of any sort of complication after a gastric band is around 1 in 10 (10%), compared to 1 in 5 (20%) for a gastric bypass.

The risk of death after a gastric band is around 1 in 200 (0.5%) compared to 1 in 100 (1%) for a gastric bypass. A gastric band is reversible, so if a patient finds it difficult to cope with the restrictions associated with their life after surgery, they can have the band removed. A gastric bypass, on the other hand, cannot be reversed. Patients will also be required to take nutritional supplements for the rest of their life, if they have a gastric bypass.

It is recommended that patients discuss the advantages and disadvantages of both types of surgery with their surgical team.

Sleeve gastrectomy

A sleeve gastrectomy is a type of surgery used to treat extremely morbidly obese people (with a BMI of 60 or above). Such a high level of obesity means that performing a gastric band or bypass would not be safe as both procedures carry a very high risk of causing complications in people of that weight.

During surgery, a section of the stomach is surgically removed, reducing the size of the stomach by three-quarters. The short to medium term weight loss should be around 60-70%. Once this weight loss has been achieved, it should be possible to perform either a gastric band or bypass safely.

Bilo-pancreatic diversion

A bilo-pancreatic diversion is similar to a gastric bypass, except a much larger section of the small intestine is bypassed, meaning patients will absorb even fewer calories from the food they eat. A bilo-pancreatic diversion can achieve a good level of weight loss (up to 80% of excess body weight), but it carries a high risk of complications, and it can cause unpleasant side effects, such as unpleasant-smelling diarrhoea.

Because of this, a bilo-pancreatic diversion is usually only recommended when it is felt that rapid weight loss is required to prevent a serious health condition (e.g. heart disease), from getting worse.

Intra-gastric balloon

An intra-gastric balloon is a soft silicone balloon which is surgically implanted into the stomach. The balloon is filled with air or saline solution (sterile salt water), and therefore takes up some of the space in the patient's stomach. This means they do not need to eat as much before they feel full.

This procedure is only temporary, and the balloon is usually removed after six months. The procedure is useful if a patient does not meet the criteria for the other types of surgery (e.g. they are too obese). 

An intra-gastric balloon procedure can usually be done without making an incision in the abdomen. Instead, the balloon can be passed through the mouth, and down into the stomach using an endoscope (a thin, flexible tube that has a light and a camera on one end).

Recovery 

Recovering from weight loss surgery  

After weight loss surgery, patients will need a few days to recover. It may also be several weeks or months before a patient can resume normal activities, depending on the type of surgery they have.

Recovering from a gastric band operation

When they wake after surgery, they will probably have some pain at the site of the surgery. This is normal and should pass within a few days. Blood clots are an uncommon, but serious, complication which can occur after banding and can include:

• deep vein thrombosis (DVT) – a blood clot which develops inside one of the leg veins
• pulmonary embolism (PE) – a blood clot which develops inside the lungs.

To reduce the risk of blood clots, patients may be given a blood-thinning medication (e.g. heparin), and compression stockings to wear. Once they feel well enough, it is recommended that they move around as much as they can, as this will further reduce their risk of blood clots.

For the first 24 hours, the patient will only be allowed to drink a small amount of liquids. This is because their stomach will be very swollen and sore from the effects of the surgery. Gradually, small amounts of solid food will be introduced into their diet.

Gastric band surgery may be carried out as a day case and most people are well enough to leave hospital within 24 hours of surgery. Patients can resume normal activities within four to six weeks. Four to six weeks after surgery, the stomach should have healed enough that the band can be adjusted by inflating it with saline (sterile salt water).

This is done by inserting a needle via the access point through which the saline is pumped. The band will then inflate, which will constrict the upper pouch of your stomach. The whole process takes around 15 minutes. This is sometimes done after numbing the abdomen with a local anaesthetic, using an X-ray to locate the band.

Often, this process of adjustment is a fine balancing act. For example, if the band is too loose patients may not lose weight, but if the band is too tight, patients may vomit after eating. Therefore, it can take a number of sessions before the ideal adjustment for a patient's band is reached.

Recovering from a gastric bypass

Once the patient wakes after surgery, they will probably have a drip in their arm, to provide the body with liquids, and a tube in their urinary bladder (known as a urinary catheter), to drain urine out of their bladder.

These tubes will be removed once they are well enough to get out of bed. Again, they may be given blood-thinning medication and compression stockings to wear to help prevent blood clots. They will only be allowed a liquid diet immediately after surgery, and solids will be slowly introduced into their diet. Most people are well enough to leave hospital one to four days after surgery and resume normal activities within three to five weeks.

Recovering from other types of weight loss surgery

The recovery time for other less commonly used types of weight loss surgery are:

• sleeve gastrectomy – one to four days to leave hospital and four to six weeks to resume normal activities
• bilo-pancreatic diversion – one to four days to leave hospital and three to six months to resume normal activities
• gastric balloon – fitting a gastric balloon is a non-invasive procedure (does not involve making incisions in the body), so patients should be able to leave hospital on the same day, and resume normal activities almost immediately.

The advice about adopting a liquid diet immediately after surgery and then gradually introducing small amount of solids also applies here.

Life Afterwards

Life after weight loss surgery 

It is very important that patients stick to their recommended diet plan after their surgery. Diet plans can differ between specialist centres and depending on a patient's individual circumstances, but most people will be given a plan similar to the ones described below.

Diet after a gastric band operation

The diet after a gastric band operation will progress over three main stages:

1. In the first four weeks after surgery, patients will only be able to drink liquids and eat small amounts of pureed food (e.g. mashed potato).
2. In weeks four to six, patients can you have soft food (e.g. chicken).
3. After six weeks, patients can gradually resume a healthy diet based on eating small amounts of nutritional food.

First four weeks

It is important that any food patients eat during this period is pureed. Attempting to eat solid foods at this stage could put pressure on the band and damage it. Pureed food has the same texture and consistency as baby food. Patients can puree food using a food processor, hand-held blender or potato masher.

Additional fluids (e.g. sauces or water), may be required to soften some types of food. Patients must aim to eat small portions four to five times a day. A portion is around 100g or five to six tablespoons of food. They must eat all their meals slowly, taking small mouthfuls. They must also stop eating as soon as they feel full. Due to the position of the band, they will probably experience a feeling of fullness or tightness in their chest rather than in their stomach.

They should also drink about 1.5 litres (2.5 pints) of water every day. They must drink small glasses, around 100-200ml, between meals but never with their meals. If they experience repeated episodes of vomiting after eating, it may be a sign that they are eating too much, or that their band needs to be adjusted. They need to contact their surgical unit for advice.

Weeks four to six

Patients need to continue to eat a similar diet as they did for the first four weeks, but their food no longer has to be pureed, although it must be soft. For example, they could eat:

• porridge
• wholewheat breakfast cereals mixed with milk
• soup
• mashed potatoes and melted cheese
• yoghurt
• rice pudding

After six weeks

After six weeks, patients will be ready to adopt a long-term diet which they will need to stick to for the rest of their life. Their band should now be adjusted correctly, so that they should need to eat much less to satisfy their appetite. While weight loss is an important goal of their diet, they need to not neglect the nutritional content of their food.

The British Obesity Surgery Patient Association (BOSPA), a charity for people who could benefit from surgery, has six golden rules that patients will need to follow to get the maximum benefit from their gastric band:

1. Only eat three meals a day.
2. Avoid snacking between meals. If you are following your recommended guidelines, there is no reason why you should feel hungry between meals.
3. Eat solid food. While soft foods may be easier to digest, they usually contain more carbohydrates and fat and make you feel less full than solid foods.
4. Eat slowly and stop eating as soon as you feel full. Cut your food into very small chunks, around the size of a pencil-top rubber, then chew each chunk 10-25 times before swallowing. Stop eating once you feel a sensation of fullness or tightness in your chest. Overeating or eating too fast could cause unpleasant symptoms such as pain and vomiting.
5. Do not drink during meals. This can flush food out of your stomach pouch and make you feel less full. Avoid drinking fluids 30 minutes before a meal and for an hour afterwards.
6. Avoid drinking high-calorie drinks, such as cola, alcohol, sweetened fruit juices and milkshakes. These types of drink will quickly pass out of your stomach and into your small intestine, increasing your calorie intake. Ideally, drink water or zero-calorie drinks, such as diet cola or diet lemonade.

Diet after a gastric bypass

The progression of diet stages after a gastric bypass is broadly similar to those after a gastric band:

1. In the first week after surgery, patients can drink liquids only (this does not include pureed food).
2. In weeks two to four, patients can eat pureed food in the same quantities (100g) and frequencies (four to five times a day) as described above.
3. In weeks four to six, patients can eat soft food.
4. After six weeks, they can gradually resume eating a healthy diet.

The golden rules above also apply to the diet after a gastric bypass. However, patients need to be aware of several additional issues. Firstly, they will need to avoid eating food which is high in sugar (e.g. cakes, chocolate, sweets and biscuits). This is because their bypass will affect how they digest sugar, and any sugar they eat will trigger their body to produce high levels of insulin.

The excessive amount of insulin can cause a number of unpleasant symptoms which are collectively known as Dumping syndrome. Symptoms of Dumping syndrome include:

• nausea
• abdominal (tummy) pain
• diarrhoea
• light-headiness

Secondly, patients will need to take daily vitamin and mineral supplements, as their small intestine will no longer be able to digest all the vitamins and minerals their body needs from their diet. The dosage and type of supplements can vary from case to case, but most people are required to take:

• a multivitamin supplement, that contains a combination of different vitamins
• a calcium supplement (the body requires calcium to maintain healthy bones)
• an iron supplement

Diet after other types of weight loss surgery

The recommended diet after other types of weight loss surgery is likely to be similar to the advice above. The specialist centre will be able to provide more detailed advice.

Exercise after weight loss surgery

Losing weight and then maintaining a healthy weight does not simply involve reducing the amount of calories a patient eats. Burning calories while exercising is also important. Regular exercise also has additional health benefits other than weight loss. These include reducing the risk of developing heart disease and some types of cancer, and boosting their self-esteem and wellbeing.

Patients will probably be given an exercise plan which starts gradually with low to moderate amounts of physical exercise (e.g. 10 minutes a day), before the amount is gradually increased.

The exercise must be intense enough to leave them feeling out of breath and getting their heart beating faster.

Recommended types of physical exercise include:

• activities which can be incorporated into everyday life (e.g. brisk walking, gardening or cycling)
• supervised exercise programmes
• activities such as swimming, walking (where patients aim to walk a certain number of steps a day) and stair climbing.

Patients must choose physical activities which they enjoy, as they will be more likely to continue doing them.

Source: NHS Choices.

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