Weight Loss Surgery

Required Supplementation Following Bariatric Surgery

protein-shakes (1)Bariatric surgery is a major event in a patient’s weight-loss journey, but the event is best seen as a new beginning. Surgery with good aftercare and moderate lifestyle changes can give wonderful long-term results for health and weight. One of the requirements after surgery includes the need for lifelong daily supplements. Lifelong supplements are required to prevent nutrient deficiencies.

The need for supplementation arises from the following:

  1. The bariatric procedure is restricting how much you are able to consume. This restriction results in an inability to consume all the necessary nutrients via your food.
  2. The bariatric procedure may be malabsorptive. This means that even though you are consuming nutritious food, your body’s ability to absorb all the nutrients is inhibited.
  3. A combination of the two above.

There are several supplements required and many others that may be recommended. Typically, the required nutrients are:

  • B-12: must be in one of these forms – sublingual (under the tongue), intramuscular (a shot) or intranasal (spray into the nostrils).
  • Calcium: must be in the citrate form.
  • Complete multivitamin/mineral supplement with iron: usually two per day. If your supplement does not contain iron, you must take separate iron.
  • Protein shakes: whey protein isolate is best absorbed/utilized by the body. This is generally temporary for 2-6 weeks after surgery, depending on physician.

This list includes the typical required nutrients, however, your physician or dietitian may direct you to take additional supplements and/or decrease the amount of a supplement.

The important thing to remember about supplementation is that it is required for life. You run the risk of deficiency and its related side-effects if you quit supplementing. Your surgeon will monitor your lab work, which is why your annual follow-up visits are vital.

Life after bariatric surgery is not all easy, but strong planning, appropriate education, and determination can help as you make this journey.

For more information about bariatric surgery offered at Emory Bariatrics, call 404-778-7777 or visit emoryhealthcare.org/emorybariatrics.

Takeaways from Emory Bariatrics’ Successful & Lasting Weight Loss Live Chat

successful-weight-loss-cilThank you to everyone who joined us on Tuesday, August 11th, for our live online chat on “Successful & Lasting Weight Loss: Strategies for Reaching Your Goals”, hosted by Emory Bariatrics registered dieticians, Megan Moyer, RD, and Kasey LaPointe, RD.

For the millions of Americans who diet, stop dieting and then promise to diet again, the constant struggle to lose weight and keep it off can be exhausting, not to mention discouraging. During this live chat, Megan and Kasey discussed strategies for long term weight loss success. They offered healthful living tips to get you on the path to lasting weight loss and provided successful strategies to help make this time the one that leads to a healthier, happier lifestyle. Here are just a few highlights from the chat:

Question: What’s the best way to keep on track: daily weigh-ins? listening to tapes?

Meagan Moyer, RD: The best way to stay on track really depends on the person. Some people choose to weigh themselves everyday, but that can take a mental toll if they beat themselves up every time they step on the scale. That’s why I recommend not weighing yourself more than once a week. It’s also helpful to have a person you can call when you need support and in moments of “weakness.” Some people also choose to track what they eat using a website or app.

Question: Does eating before bedtime make you gain weight? What time should I stop?

Meagan Moyer, RD and Kasey LaPointe, RD: It’s a misconception that the metabolism stops at a certain time during the night. Usually the problem lies more with eating later in the night after your calories have been consumed for the day. Late night eating can be out of boredom or habit. One thing I suggest is asking yourself the reason you are eating, whether it’s out of boredom or actual hunger. Try to occupy your time with something else to keep you from snacking late at night. I keep a crossword puzzle next to my bed if I feel my mind wandering towards hunger.

Question: After months of steady weight loss, I feel like I might be at a plateau. My weight loss has been incredibly slow for the past few months. Any suggestions on how to adjust my diet to see better results?

Meagan Moyer, RD and Kasey LaPointe, RD: Reaching a plateau is completely normal when it comes to weight loss. The body gets used to your behaviors and habits, so it’s good to adjust your routine and diet. Try incorporating new activities into your work outs in order to continue to see results.

Also, while you may reach a plateau when it comes to the scale, the body often continues to change in other ways. Try to focus on other non-scale victories to measure your weight loss success. You can focus on how your clothes fit, seeing a decrease in inches using a tape measure, having more energy, sleeping better and other noticeable changes is a good way to measure your success.

Question: How do I know if I’m a candidate for Bariatric surgery?

Kasey LaPointe, RD: If your body mass index is greater than 40 or if your body mass index is greater than 35 and you have weight related health issues, you are a candidate for bariatric surgery. You also have to be ready to commit to a lifelong healthy lifestyle and be mentally prepared for these changes.

If you missed out on this live chat, be sure to check out the full list of questions and answers on the chat transcript. You can also visit emoryhealthcare.org/emorybariatrics for more information.

Also, if you have additional questions for our registered dieticians, Megan Moyer, RD, and Kasey LaPointe, RD, please feel free to leave a comment in our comments area below.

Bariatric Surgery: What are the Differences in Surgical Options?

bariatric-appleLosing weight with diet and exercise can work for many individuals. However, for some, diet and exercise may not be enough causing individuals to be at high risk for disease-related complications due to obesity. In these cases, weight loss surgery may be an option.

The decision to have weight loss surgery should never be taken lightly. Contrary to popular belief, it is not “the easy way out” and won’t instantly cure the emotional and physical issues which lead one down the path to obesity.

Emory Bariatrics performs three types of weight loss surgery. Below is a brief description of each type offered.

  •  Roux-en-Y, also know as “gastric bypass”, is a combination procedure. It is a restrictive procedure and a malabsorptive procedure. The surgery reduces the size of your stomach, therefore limiting the amount of food you can eat at one time. A malabsorptive procedure means your intestines are rerouted so that your body does not absorb as much nutrients from food. Lifelong vitamin and mineral supplements must be taken to avoid deficiencies.
  • Sleeve gastrectomy, also known as “sleeve”, is a restrictive procedure. About 80% of your stomach is removed, leaving a tube-like pouch that resembles a banana. The stomach and intestines are not rearranged, but since you are eating less, there may be vitamin & mineral deficiencies if the recommended supplements are not taken throughout life.
  • Adjustable gastric banding or “band” is a restrictive procedure. An inflatable band is placed around the upper portion of the stomach, therefore making you feel full on less food. Tubing connects the band to a port under the skin, and the band is inflated or deflated using a needle, as needed. You may have to visit your physician’s office several times for as long as you have the band. Vitamins & minerals must also be taken when you have the band to prevent malabsorptive issues.

All three procedures have pros and cons. Your doctor will recommend a procedure based on many things such as your medical history, your weight, and past surgeries. The most important thing to remember is that weight loss surgery will help you lose weight, but maintaining this loss for years to come is up to you. Weight loss surgery is a tool. Making healthy food choices and exercising regularly are essential to maintaining weight loss. If behavior changes are not embraced, weight loss is not guaranteed. Attending support groups and seeing a psychologist or mental health counselor will help you with these behavioral changes. Remember, it is a “journey”, not a sprint.

For more information about bariatric surgery options offered at Emory Bariatrics, call 404-778-7777 or visit emoryhealthcare.org/emorybariatrics.

Recommended readings:

  • “Weight Loss Surgery for Dummies” by Mariana S. Kurian, Barbara Thompson and Brian K. Davidson
  • “The Emotional First Aid Kit – A Practical Guide to Life After Bariatric Surgery” by Cynthia L. Alexander, PsyD
  • “Eat It Up! by Connie Stapleton
  • “Emotional Eating Toolbox” by Melissa McCreery, Ph.D
  • “Dying to Change” by Katie Jay
  • “Eating Well After Weight Loss Surgery Cookbook” by Patt Levine, Michele Bontmpo-Saray, William B. Inabnet and Meredith Urban-Skuros

Emory Bariatric Center Patient Prepares for his First Peachtree Road Race

Just a couple of years after undergoing gastric bypass surgery, Jim Blackburn prepares for his first Peachtree Road Race. Since the operation, Blackburn has dropped over 200 pounds and no longer needs a C-PAP to help with snoring.  Jim stated, before receiving care at Emory University Hospital, his knees and ankles hurt terribly from carrying his weight. Along with high blood pressure and sleep apnea he began to experience the early on-set of diabetes.

Since surgery, “My life has changed 180 degrees. It’s totally turned around,” said Blackburn.

Check out Blackburn’s interview with Fox 5 Atlanta.

Are you running the Peachtree Road Race along with Jim? Then check out 10 tips that will ensure you get to the finish safely.

Related Resources

Can Weight Loss Surgery Cure Type 2 Diabetes?

Diabetes Treatment Weight Loss SurgeryThe typical treatment methodology for Type 2 diabetes includes medications, diet changes, and exercise, but two recent studies have found that weight loss surgery, also known as bariatric surgery, may in fact be much more effective in curing Type 2 diabetes. Not only that, but those with Type 2 diabetes who underwent weight loss surgery also saw decreases in blood pressure and cholesterol.

Findings from the two new studies were published this week in The New England Journal of Medicine and have helped shed light on a trend doctors have been noticing for years, that bariatric surgery often rids its patients of Type 2 diabetes as well.

“Type 2 diabetes is one of the fastest growing epidemics in human history,” and in the U.S. alone, the number of diabetes cases has tripled over the last 30 years. There are currently over 20 million Americans living with diabetes.

The first study compared two different types of bariatric surgery with the typical medical treatment regimen for Type 2 diabetes. After two years of following the participants, those in the surgical weight loss group had complete Type 2 diabetes remission rates of 75%-95%, whereas those in the standard medical treatment group saw no remissions from diabetes. The second study compared two surgical procedures with a more intense medical treatment regimen.Findings showed ~40% remission rates in the surgical group, whereas the rates were much lower, 12%, for the medical treatment group.

In addition to the findings from these studies, research at Emory has shown that bariatric surgery can also aid in the improvement of Gastroesophageal reflux disease (GERD), sleep apnea, depression, and joint pain among other conditions. The sleeve gastrectomy and gastric bypass procedures were two of the surgeries evaluated in the studies up above, both of which are offered at the Emory. For more information on the study and these procedures, see the links the below.

Related Resources:

Why does Weight Loss Surgery Demand Continue to Grow?

More and more people in Georgia are considering weight loss surgery as an option for returning to a healthy body weight. Because those who are overweight are at a higher risk for the development of conditions such as diabetes and heart disease, for many people, weight loss surgery means both regaining activity and mobility via a healthier body weight and the possibility of a longer, healthier life in general.

Dr. Edward Lin

Dr. Edward Lin

Because the demand for information on surgical weight loss options is growing, Dr. Edward Lin of the Emory Bariatric Center has been taking big action to help educate the community. Today, he held an online chat on the topic of surgical weight loss options (check out the transcript) to help answer questions on the pros and cons of weight loss surgery and dig deeper into the differences between each type of weight loss surgery.

Dr. Lin’s efforts were also recognized by Fox5 News of Atlanta recently, in a story documenting Emory patient, Jim Blackburn’s experience in undergoing a gastric bypass with Dr. Lin as his surgeon.

At 47, and 420 pounds, Jim Blackburn was ready to lose weight in a serious way. “I think I added up 24 different diets that I had been on. I had severe sleep apnea. I had a fatty liver condition, and I was on a lot of medications,” Jim told Fox5. He was worried he wouldn’t make it long enough to watch his children grow up. “My knee joints, ankle joints, hips, I hurt. At 47 years old, that was, that was frightening.”

After Jim decided to undergo surgery, he found Dr. Lin, who looked at Jim’s family history of obesity, his failed weight loss attempts, and identified Jim as a good candidate for gastric bypass.

But according to Dr. Lin, gastric bypass, a permanent procedure, is not for everyone. Pros of the gastric bypass procedure include: dramatic, rapid weight loss and reversal of health problems (including 85% reversal of Type 2 Diabetes cases). However, gastric bypass is a major surgery and is only reversible in a medical emergency. It also comes with a few short term risks, including bleeding and infection. But, because gastric bypass is permanent, it forces patients to adopt new lifestyle and eating habits, typically resulting in better long-term weight loss results.

In contrast, a lap band procedure comes with fewer risks and is a less invasive surgery. The band that is placed around the entrance of the stomach during the procedure can also later be loosened, tightened, or removed, making it less permanent than a gastric bypass. Because of its flexibility, patients who undergo this procedure require “a lot more willpower and mind control,” said Dr. Lin.

Two years after his gastric bypass procedure, Jim Blackburn is now 200 pounds lighter and feeling great. And as findings from a recent study support, family members of weight loss surgery patients, such as Jim’s wife who has since his surgery lost 80 pounds, also benefit from being around relatives who have undergone surgery.

For more information on each of the procedures discussed above and others, check out the Emory Bariatric Center website.

Related Resources:

Life Since My Weight Loss Surgery – Part Three

By Dustin Hartman

Through diet alone I lost half of my excess weight…and then I stopped. My insurance required I see a psychiatrist before the surgery (which now I am very thankful for) and the one thing Dr. Santavicca told me that I will never forget is that I wouldn’t be able to achieve my goals through diet alone. I would need to exercise.

Dustin Hartman & His Wife, Elizabeth (she also has had Gastric Bypass Surgery by Dr. Lin)

I remember thinking at the time “Yeah right, I don’t exercise, if I did I wouldn’t need the surgery,” so I didn’t exercise. Pre-surgery, I would join gyms but I would usually stop going after a month because it was hard work. When I hit a plateau, I remembered what Dr. Santavicca said and reluctantly started exercising. I was surprised by how much easier it was to exercise now that I had lost so much weight. Although exercising was still hard, I wasn’t as miserable as I was before surgery. In the beginning, I started slowly – just walking down the driveway and back a few times a week. I walked further and further each day and turned the walking into jogging. When I discovered cycling, I fell in love. Now I cycle at least six hours a week and recently completed a 100-mile ride.

Through Emory Bariatric’s monthly support group meeting as well through my personal interactions with other post-op patients, I have realized that the success of the surgery is 100% based on the commitment of the patient. The surgery itself is just a good kick-start to get you going in the right direction. Everyone who has weight loss surgery will lose weight during the first months because of the smaller stomach. After that, you get to the point where the weight loss becomes less dependent on the surgery and much more dependent on your behaviors.

I know that without the surgery, I would have never been able to lose the weight that I have, but keeping the weight off is going to be a daily choice for the rest of my life. I am able to keep on track through the support of my wife (who just had the surgery herself a few months ago) and with the knowledge that the Emory Bariatric’s program has provided and continues to do so in the monthly support group meetings. Having the surgery has meant a new level of discipline in my life regarding nutrition and exercise, but it has improved my life in so many ways that I wished I would have had the surgery years ago.


My Weight Loss Surgery Experience – Part Two

Dustin Hartman (post surgery)

By Dustin Hartman

I started the weight loss surgery process by attending the Emory Bariatric Seminar to learn more about my options. At the seminar, the leader told us to look around at the other people attending the seminar. He said that the majority of my peers would not follow through with weight loss surgery. At the time I thought that was ridiculous, but he was right – the majority of the people who attended the seminar didn’t complete the process. Between my insurance requirements, Emory’s requirements and my own personal life, the process of getting insurance approval and becoming mentally and physically prepared for surgery took a year.

The surgery itself was incredibly easy; I was in and out of the hospital in three days and back to work in three weeks.

Life after surgery is completely different, yet still the same as my life before surgery. I had thought that once I had the surgery, food wouldn’t be such a big part of my life anymore. I was wrong! Now it’s a bigger part of my life. I plan every meal ahead of time.

Before I go out to dinner, I look at the nutritional information and decide what I am going to eat.  I have to chew my food for what at first seemed like an eternity and I carry a measuring cup with me so that I can always measure out my one cup so that I know I won’t overeat. I set my iPhone timer for 30 minutes before and after meals so that I remember not to drink and I religiously log every calorie I eat. I can no longer go to a drive-through and order something or just get whatever I want at the grocery store. Now I have to know exactly what I’m eating and how it will affect me. Because I pay such close attention to nutritional information, I know how bad my eating habits were before I had surgery. I make better decisions based not solely on taste but also nutrition.  One of the dietitians at Emory suggests asking yourself “Will this help me reach my goals?” before eating something. That has really helped me determine which foods I choose to fuel my body.

Previous post: Life Before My Weight Loss Surgery

Next post: Life Since My Weight Loss Surgery

Life Before My Weight Loss Surgery – Part 1

Dustin Hartman (before surgery)

By Dustin Hartman

My name is Dustin Hartman and I’m 28 years old. Dr. Edward Lin performed my gastric bypass surgery on December 1, 2009. Since my surgery, I have become (literally) half the man I used to be – I’m down 150 pounds from my top weight of 300.  Before gastric bypass surgery, I had several co-morbidities. Food was a comfort mechanism and brought real joy to my life, but at the expense of being physically unable to live the life I wanted. Now after the surgery and weight loss, I have no weight-related medical conditions and am so full of energy and life. My physical and emotional well-being has increased dramatically as I find happiness in activities other than eating.

My family history is fairly common; my entire family on both sides for several generations is morbidly obese. Growing up, I was proud that I was always the biggest kid in my class. I have several physical disabilities due to birth defects and as a result, I walk with a severe limp. Being the biggest kid during school was actually an advantage for me because the kids were afraid to pick on my disabilities since I was bigger than all of them. I weighed 225 pounds in the 9th grade. For me, my weight was never an issue – it was how I identified myself, and in some ways I was proud of being “the big kid.”

The way I felt about my weight slowly changed as I grew older. I became more aware of my physical limitations due to obesity: roller coasters were tight, people asked me why I was out of breath all the time, and I didn’t have any energy. When I was in my early twenties, I began having medical complications. I developed sleep apnea, which meant I had to wear a dreaded CPAP mask every night. Because weight loss surgery is such a serious decision, I tried more conventional weight loss methods, first. I did Weight Watchers, Atkins, low calorie diets, weight loss medication and even starvation diets. All of these diets worked while I was on them, but inevitably I would quit the diet and gain the weight back…usually more than what I started with.  After several years of yo-yo dieting, I decided I needed surgical intervention in order to manage my weight.


Next post: My weight loss surgery experience.


Emory University Hospital Midtown Receives Level 1 Reaccreditation for Bariatric Surgery

Congratulations to Emory University Hospital Midtown for being granted “Full Approval” Level 1 Reaccreditation by The American College of Surgeons Bariatric Surgery Center Network (ACS BSCN)

Accreditation from The ACS BSCN is given to facilities in the United States that have undergone an independent, voluntary, and rigorous peer evaluation in accordance with nationally recognized bariatric surgical standards. Bariatric surgery accreditation symbolizes institutional commitment and accountability for safe, high-quality surgical care, proven by performance and the measurement of outcomes.

ACS BSCN would like to “again, commend the staff at (Emory University Hospital Midtown) for providing high-quality care to your patients undergoing bariatric surgery.”