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Bariatric Surgery
An Option for Long-Term Weight Loss

by Jacqueline Craig, M.S., R.D., C.D.E.

For the rest of a person’s life, it is of utmost importance to sip liquids slowly at and between meals, chew foods well, and consume very small portions. Following a gastric bypass Roux-en-Y procedure, in which the part of the small intestine is bypassed, taking a multivitamin supplement that includes iron, folate, and vitamins A, B12, D, E, and K will help prevent deficiencies. To meet calcium needs, an extra supplement is usually required. Injections of vitamin B12 may also be needed. Regular and life-long follow-up is required for evaluation of possible deficiencies.

Protein malnutrition is another possible side effect. Our bodies use protein to make new cells, enzymes, and hormones. Bypassing part of the small intestine and reduced stomach size results in less protein being consumed and reduced absorption of the protein eaten. Many people find liquid protein supplements are necessary for the first few months after surgery or longer, depending on their tolerance of protein-rich foods. Foods high in protein include beef, pork, fish, chicken, cheese, peanut butter, and eggs. Seeing a registered dietitian for dietary advice before and after the operation will help prevent nutrition problems.

What follows is an example of what may be consumed in the course of a day once your diet has advanced to solid foods (usually 2–3 months after surgery).

8 AM: Breakfast
1/4 cup Cream of Wheat (about 6 bites of food)
1 poached egg
1/2 cup low-lactose milk or soy milk

9–10 AM
1 cup water, sipped slowly

10 AM: Snack
1/2 cup artificially sweetened or plain yogurt
1/2 cup water, sipped slowly

12 Noon: Lunch
1 slice bread
2 ounces turkey breast (about 2 slices)
1 tablespoon mayonnaise or salad dressing
1/3 cup unsweetened applesauce

1–2 PM
1 cup water, sipped slowly

2–3 PM: Snack
1/2 ripe banana
1/3 cup vegetable juice

3–5 PM
1 1/2 cups water, sipped slowly

6 PM: Dinner
2 ounces lean ham (about 2 slices)
1/3 cup mashed sweet potatoes
2 teaspoons margarine
1/3 cup green beans

7–8 PM
1 cup water, sipped slowly

8–9 PM: Snack
1 tablespoon peanut butter
4 crackers
1/2 cup fresh strawberries

Other sugar-free beverages (such as Sugar Free Kool-Aid or Crystal Lite) may be substituted for water. After the first six weeks of surgery, you can try to drink small amounts of a soft drink, but many people find they cannot tolerate the carbonation. Alcohol is also not recommended.

As you can see, portions eaten after surgery are 1/4 to 1/2 the amount a typical person would eat.

Insurance coverage

If you think weight-loss surgery is an option you’d like to explore, discuss it with your primary-care physician. Ask whether you are a good candidate for surgery and, if so, ask for a referral to a surgeon or bariatric center in your area. Bariatric surgery is very expensive (it costs $20,000 to $25,000), so you would want to get insurance approval before surgery.

Going through all of the proper channels and insurance prerequisites can be a challenging task. You may be able to find advice on navigating the insurance process by talking to others who are or have been in your situation by going to a support group.

If you decide to move forward with surgery, your primary-care physician will need to write a “letter of necessity” to submit to your insurance company. This letter explains why this surgery is needed and its benefits. Contact your insurance company to determine what other documentation is needed. It is not uncommon for companies to require preoperative consultations with a dietitian, psychologist, cardiologist, and lung specialist and documentation of failed attempts at weight loss in the past. Having detailed records will help the approval process. People who have untreated depression or alcohol or drug abuse problems will want to get their condition under control before undergoing surgery to satisfy the insurance company’s psychological evaluation.

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