Babies born to mothers who have had bariatric surgery are strikingly healthier at birth and throughout childhood than siblings who were born before their mother’s surgery, according to results from a large new study from Quebec.

Even as they grow, children mirror their mother’s metabolic health at the time of childbirth, the study suggests. If the mother’s lipid profile is good and she has a healthy weight when she delivers the baby, that child will have better metabolic

health and less likelihood of gaining weight as he or she grows compared with siblings who were born when their mother was obese.

“Some would say it’s a question of lifestyle but these findings don’t support that. These [metabolic differences between siblings] were noted at birth,” said senior author Picard Marceau, MD, PhD, a surgeon at Laval University in Quebec, Canada.

The results indicate that bariatric surgery—or the weight loss produced by bariatric surgery—dramatically alters the intrauterine environment, resulting in infants who are born at healthier weights than their siblings born before the surgery.

As they grow, these children develop fewer problems with high cholesterol, less fat deposits and less insulin resistance or signs of metabolic disorder than their siblings born before their mother’s surgery, even when the younger children are breastfed the same way and eat similar food quantity and quality as their older brothers and sisters.

Results showed that babies born after surgery carried health advantages from gestation onward compared with their older siblings. During pregnancy, the mothers experienced far fewer complications with no cases of gestational diabetes, eclampsia or hypertension; for babies born before surgery, 12 women developed gestational diabetes, nine had eclampsia and 15 were diagnosed with hypertension. At birth, the infants born after their mothers underwent bariatric surgery weighed 17% less (P<0.001) and had 86% less macrosomia (0.06) than their siblings.

As the children grew, so did the health disparity with their siblings. They were significantly less likely to become obese or severely obese, with a 75% drop in severe obesity when measured by body mass index (BMI) percentile and a 65% decline when measured by BMI z-score. Overall, the children born after their mothers had bariatric surgery had an 11% decrease in BMI percentile, an 11% drop in waist circumference over height, a 38% reduction in BMI z-score and a 20% decrease in fat content compared with their older siblings. They accumulated belly fat five times slower than their older siblings (P=0.01).

What is most striking, said researchers, is the stark contrast in metabolic conditions in children born before and after surgery. Laboratory tests showed a 30% decrease in insulin resistance, 20% decrease in triglycerides, a 12% increase in high-density lipoprotein (HDL) cholesterol and a 13% decline in the ratio of total cholesterol over HDL in the offspring born after their mother’s operation.

“Bariatric surgery before pregnancy significantly improves an obese woman’s chances of giving birth to children who don’t have obesity-related metabolic disorders,” he said.

Surgery can halt the cumulative transmission of obesity from one generation to the next, what Dr. Marceau called a “vicious cycle of obesity.”

“If we are to curb the obesity epidemic, the focus must be on pregnancies,” he said.

The study also showed that boys’ and girls’ bodies responded differently. In boys, the predominant effect was prevention of severe obesity and correction of the lipid metabolism, whereas in girls the greatest effects were improved insulin sensitivity and decreased tissue fat percentage, independent of weight loss.

 Even minimal weight loss in an obese woman can significantly improve the health of her children, said Dr. Marceau. “Pregnancy is a time for great investment in life, even if it is minimal weight loss or restrictive diets.”

One point to note is that the study pertains to patients who had undergone Bilio-pancreatic Diversion (BPD in short)– a rare operation. In India, BPD is an unusual procedure indeed, especially in vegetarians who need high amount of proteins in their diet after this operation.

Pic credit: GSN

To make matters better (and more interesting) you do not feel too hungry anyways, and there are usually no cravings for food that go unfulfilled. It is not as if the operation will leave you salivating for a huge meal, and you are cursed with a tiny portion of it all your life. You will be happy with what (and how much) you can eat.

For three to four weeks after surgery, you will consume liquids only. 

Week One: Thin liquids only

Sample Full Liquid Meal Plan (1 week post-op)  

  7:00  am — 4 ounces of milk

8:00   am —  2 Tablespoons plain yogurt  

10:00  am — 1 ounce whey protein isolate drink (e.g. Isopure Zero Carb) with 4 ounces  

  of skim or 1% milk 

11:00 am — cup of dal

1:00 pm — 2 Tablespoons low fat cottage cheese (plain) 

3:00 pm — 4 ounces whey protein isolate drink  

6:00 pm —  tea

8:00 pm — 4 ounces whey protein isolate drink made with skim or 1% milk 

9:00  pm — 4 ounces of  vegetable/chicken soup  

 

Week Two to Week Four: Pureed/blenderized diet

Use natural, whole foods (like vegetables, meats, fish, dal and milk) and blenderize them till you obtain the consistency of a thick sauce. Strain out the larger particles/seeds/skin and use the rest. 

How to measure your portions: use a measuring spoon or shot glass or an ice tray (each cube in the tray measures 1 ounce.

 

Rules for the liquid/pureed diet after operation:

1. No colas, sodas, or alcohol.

2. No sugar, commercial ‘low-fat’ drink, honey, agave nectar, corn syrup or HFCS, chocolate syrup, ice cream, etc. Your protein shake (as in the pic) may be chocolate-flavored.

3. Very limited ghee, butter, or olive oil.

4. Avoid coffee, especially if you have heart problems or diabetes.

5. Avoid restaurant food (they generally tend to be unhealthy).

6. Avoid hard meats and nuts till well into your second month after surgery.

7. If you feel like having something sweet (like milk or tea or a smoothie), add a sugar substitute, avoiding overuse.

8. No processed foods like chips, cakes, cookies, breads, pizzas, burgers, whatever!

9. Total fluid consumption in a day should be at least 1.5 to 2 litres (including water)

10. Take time in having your meals- your stomach is not what it used to be!

11. Have only less than 4 ounces of feeds at a time. 

12. Eat 60 to 100 grams of proteins daily. 

13. Use an online food journal like Fitday to calculate your protein intake or contact us.

14. Drink water at a different time from your meal.

15. Avoid fruit juices– they have a high glycemic index and could raise your blood glucose. 

(pic source: here)

In regard to the above, weight training is as important, but that is another article!

(pic credit goes to this site)

If you have decided to go for a bariatric operation, you need to do some preliminary preparation for it.

1. We tell our patients to go on a liquid diet for 15 days before the day of surgery. This does not mean you can drink ghee, condensed milk, juices and colas. You can drink soups, milk, dal, meat stocks, etc. You could also take ultra-low calorie liquid supplements like Optifast. The caloric deficit created by this would lead to around 15-20 lbs of fat loss or even more. 

2. Significant fat loss immediately preceding bariatric surgery is good in terms of improving post-operative results and also in making the surgeon’s job easier. Much of the effects of the pre-operative low calorie diet is to shrink the size of the liver. This causes better visualisation during surgery. 

3. A last binge before surgery is NOT a good idea! This is understandable from the patient’s point of view, but really does not do much good to him/her. Often, the last binge gives rise to one more, and then one final one, and so on. Rather than losing weight, the patient puts on some more!

4. Stop smoking and drinking alcohol! This is simply non-negotiable. Bariatric surgery is not a painless, cosmetic solution to some excess blubber your body may have. It is a serious undertaking on your (and our) part, in order to restore health to your body. There can be no healthy life if you drink and smoke. One is not referring to the occasional social drink or cigar, but you know what we are talking about! Smoking increases post-operative respiratory complications like pneumonia, as well as heart attacks and deep vein thrombosis. All these complications are terrible and potentially fatal, so be careful! Nothing is worth losing your life and health to, so quit NOW!

5. Continue to take your diabetes and hypertension medicines, unless told otherwise. 

6. If you have respiratory problems like asthma, please see a respiratory physician or therapist who would treat your lungs with nebulisers, antibiotics (when indicated), and chest physiotherapy. In some patients, vaccines against respiratory pathogens (like Pneumococcus and Hemophilus influenzae) are also prescribed. Patients suffering from sleep apnea may need a CPAP machine that helps to oxygenate the lungs during sleep.

7. Walking every day or doing some mobility exercises is good for you– this is also important for you. We encourage patients to be ambulant immediately after surgery, and this helps.

8. Prepare a food journal– this should become a habit after your operation, so start anyways.

9. Ask other patients about how they have adapted to life after bariatric surgery. Remember that they may have a different procedure and their adaptations and restrictions may not apply to you!

10. Do you need further counselling? Are you nervous or unsure about anything? Don’t hesitate. Ask your bariatric surgeon!

(pic source: here.)

The answer to that question, therefore, has to be contextual. In the more common non-surgical weight loss candidate, the question is not easily answered. How much of weight someone could lose is dependent on so many variables that it is foolhardy and unwise to venture a straight answer. This is in direct contrast to the typical slimming center approach of treating the entire complex subject of weight loss as a potatoes-by- the-kilo thing. You want to lose ten kilos? No problems, pay x amount.

The answer I give in the above context is, “How much do you want to lose, and what are you willing to do for that?” The focus, therefore, comes squarely back to the patient. It is not I who will melt your fat. It is you who will do so. I will merely set you on the right path for it. You would need to walk the path. If you are looking for a painless option, find yourself a slimming center, have a nice day!

The bottom-line being that in fat loss, you have to work hard– there is no escaping that. You will have to find a way to avoid the cravings. You will have to get up from bed for your workout. You will have to take your fish oil capsules. You will have to push yourself for that last rep when your body is screaming for you to rest at the end of your workout. I can only help you if you stand up to be counted.

If you have the requisite motivation, as I say in this article, we will surely guide you to success. But you can take all the credit for that. We only facilitate weight loss, demystify it, and bring a scientific perspective to it.

When a bariatric candidate asks, “How much fat can I lose?”, the answer is, “It depends“. Again, a contextual answer. In procedures like the gastric bypass, around 70-75% of excess body weight loss is typical. After this, the results depend on how well the patient controls his lifestyle. In the lap band procedure, weight loss is around 50%, much less. But then the mortality risks of this procedure are also less. On the other hand, more complex procedures like the duodenal switch have a greater (85%) weight loss, but also a higher risk of mortality.

In perspective, the more successful procedures (in terms of fat loss) come with a higher risk, and the lowest risk procedures give you the lowest fat loss rates.

Nature demands that we get something only if we take risks!

If you are the guy or girl intent on losing around 10 to 20 kgs of fat, the answer to your quest is that of course you can be successful but are you willing to be successful? Do you have what it takes to work your way to success?

Article source here.

A summary in Medpage Today says that “Among diabetics who followed a Mediterranean-style diet, only 44% required antihyperglycemic drug therapy, compared with 70% of patients who followed a standard low-fat diet (95% CI -31.1% to -20.1%, P<0.001)”.

“Compared with a low-fat diet, a low-carbohydrate, a Mediterranean-style diet led to more favorable changes in glycemic control and coronary risk factors and delayed the need for antihyperglycemic drug therapy in overweight patients with newly diagnosed type 2 diabetes,” Dario Giugliano, MD, PhD, of the Second University of Naples, and colleagues wrote.

Full Medpage Today article may be read here.

In this scenario, they often resort to taking drugs to help with weight loss. One such drug, now popular all over the world, is Orlistat, sold over the counter in the US as Alli.

The drug works by inhibiting the digestion and absorption of ingested fat in the alimentary tract. Net result- the ingested fat is passed off in the stool. So, the patient can eat fats and not put it on– after all, it is not getting absorbed into the body. Cool, ain’t it?

Not really. The drug, as we have seen with rimonabant before, is not without its inherent problems. The stools become oily and loose, not to say foul-smelling. As a result of this, much time is spent in the toilet. If that is not bad enough, the oil trickles in through the anus and soils your clothes!

Orlistat (sold in India in the names of Reeshape or Obelit, among others) also causes malabsorption of fat-soluble vitamins and could be harmful if consumed for longer periods of time. Remember that fat is an important macronutrient for the body, even in fat people!

According to this report (and some others), Orlistat has been found to cause severe liver toxicity, including liver failure in several patients, leading the FDA to launch a product review on the drug.

FDA said it “is not advising healthcare professionals to change their prescribing practices with orlistat. Consumers currently taking Xenical should continue to take it as prescribed, and those using over-the-counter Alli should continue to use the product as directed.”

But the FDA advised orlistat users to “consult their healthcare professional if they are experiencing symptoms possibly associated with the use of orlistat and development of liver injury, particularly weakness or fatigue, fever, jaundice, or brown urine. Other symptoms may include abdominal pain, nausea, vomiting, light-colored stools, itching, or loss of appetite.”

However, if history is any indicator, it is our prediction that this will go the way of rimonabant and Ephedra and die a natural death in some time in the future.