Posts Tagged ‘Bariatric 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

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

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

New Year, New You – Why it’s Critical to Your Health to Lose Weight in 2013

Now that the holidays are finally behind us, it’s time to get serious about your New Year’s resolutions. With more than a third of the adult population in the United States obese, it’s no surprise that one of the top resolutions every year is to lose weight.

If you’re one of the millions of Americans resolving to lose weight in 2013, it’s important to understand that losing weight isn’t just about looking good. It’s more about getting and staying healthy – and even improving health issues that are associated with being overweight, such as high blood pressure, Type 2 diabetes and joint pain.

Because losing weight truly is a journey, Arvinpal Singh, MD, Medical Director of the Emory Bariatric Center and an American Board of Obesity Medicine (ABOM) Certified medical bariatrician, is hosting an online chat on Tuesday, January 8 at noon EST to share tips on healthful living and weight loss pearls of wisdom, as well as give his insight on different approaches to weight loss, including surgical and non-surgical options.

Get 2013 off to a healthy start and join Dr. Singh and other chat participants to share tips, ideas and get questions answered related to how you can make positive changes to last the new year and beyond.

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:

Weight Loss Surgeries Help Families Get Healthier, Too

Weight Loss Surgery Online ChatA recent study found that family members living with patients who underwent weight loss surgery dropped significant amounts of weight and made more positive lifestyle changes.  In this study, 35 morbidly obese patients underwent Roux-en-Y gastric bypass surgery. Overweight spouses and family members living with the patient attended three lifestyle counseling sessions before surgery and five sessions after surgery. At these sessions, patients and their family members learned about healthy eating habits (portion control and a healthy diet) and how to increase physical activity.

At one year after surgery, patients lost an average of 100 pounds and decreased their body mass index (BMI) from 48.7 to 33.3. In addition, their overweight spouses and family members lost an average of 10 pounds and decreased their BMIs from 38 to 36.3.Family members also watched less television, exercised more, and reported fewer instances of uncontrollable eating.

The result of this study reinforces the importance of social support as a motivator to maintain healthy changes. If we mimic the positive lifestyle changes of those around us, we might find ourselves making healthier decisions more often. You may not realize, but people may use you as an inspiration to change their lifestyles! It is important to remember that over time, small steps turn into large strides.

If you’re interested in learning more about weight loss surgery and the options that exist for you or someone you know, now is the perfect time to sign up for a free online chat with Dr. Edward Lin of the Emory Bariatric Center. You don’t be ready for surgery or live in Atlanta to attend, just sign up using this form, and you can ask Dr. Lin all of your questions on weight loss surgery during the chat on January 26th.

Related Resources:



Controlling Stress While Maintaining Your Weight

Tanya McGill, two years after bariatric surgery.

Tanya McGill, two years after bariatric surgery.

Coping with stress and huge life changes can be extremely challenging as our lives can quickly spin out of control in this zany world we live in. We are  pulled in so many directions, expecting more and more  of ourselves (as we feel others expect an ever-increasing amount out of us). Businesses are running lean and mean and focusing on newer, more efficient ways to do handle transactions which can leave you feeling as if you handle the workload of multiple people at the end of the day!

This is precisely why taking a moment out for yourself is more important than ever, particularly for those of us who used to use food as a way of coping with stress before bariatric surgery. And the great news is that we have more resources than we’ve ever had  to unwind and get in touch with ourselves when things get hairy. My experience has been that I actually live a higher quality life when I make some “me” time on a regular basis, not just when I’m feeling overextended. Of course, one might say that this is easier said than done. With a very long commute into the work place each day, I’ve tried to get creative with my time to maximize my “me” time opportunities.

One of the best things I ever did for myself was get a membership to an online audiobook distributor. Having this has allowed me the opportunity to listen to a myriad of audiobooks on my MP3 player during my two- to three-hour commute each day. A great distributor will give you a free, trial membership so you can see if you like their product, and they usually have tens of thousands of audiobooks, lectures and all sorts of things to listen to. I also have used that time commuting to brush up on other languages I wanted to learn, and to catch up on some of the fabulous podcasts that are out there, most of which are free! May I recommend the Nutrition Diva from the Quick and Dirty network of podcasters? She’s got a wealth of information tucked under her health belt!

Another way I’ve captured a little time for myself is to actually take my lunch to work, find an office or conference room that isn’t being used when it’s time for me to take a break, and I jump in, shut the door, turn off the lights, set the timer on my phone and drift off into about a twenty-five minute meditation. Some people prefer to meditate without guidance, some with guidance, some with music alone and some people (like me) enjoy listening to binaural beats during meditation. If you’re interested, but there are loads of great meditation resources out there. Just grab your headphones and MP3 player on the way out the door before you start your day and you’re set! I often find that this midday reset feels terrific and there’s usually still time to nosh on something yummy I’ve brought from home for lunch (and it’s a terrific money saver, too)!

Lastly, on Friday nights, my finance and I always enjoy “Italian Date Night” which consists of delicious Italian food together at home. It’s become a tradition for us (yes, you can still eat delicious, Italian food after bariatric surgery!). Afterwards we try to make it a habit of dancing in the living room to fun music. If you can picture this in your head, then I’ll go ahead and apologize now.  Seriously, today there are so many fun “games” on the market for anyone interested in shedding some serious calories and simultaneously reliving stress, it’s amazing! One of our favorites is something we recently purchased for the Xbox 360 called “Dance Central.” Any kind of working out indoors is beneficial during what can be the most biting of winter months.

Maintaining a low level of stress in my life and not falling into the old habits I used to have in using food to cope with the stress has been an ongoing challenge for me. But having tools to deal with it which was jump-started with the surgery, has been key for me. It’s my hope that you find the same for your life!

The Costs of Being Overweight

We know that being overweight or obese can have a significant impact on our physical and emotional health. But, did you know that being overweight can also carry a financial price tag?

The Department of Health Policy at The George Washington University School of Public Health and Health Policy recently released a research report entitled “A Heavy Burden: The Individual Costs of Being Overweight and Obese in the United States.” The report, which tallied the annual, incremental costs of overweight and obesity from the individual perspective,  found that the annual overall costs of being obese are  $4,879 for an obese woman and $2,646 for an obese man. This includes medical costs, lost wages, higher work-related costs, and higher costs associated with the purchase of personal goods. For overweight women and men, the incremental annual costs are $524 and $432 respectively.

The report found that the main cost driver for those who are overweight are direct medical costs –  health care costs for an overweight person are $346 higher per year than the health care costs for a normal-weight person. However, lost wages is the main cost driver for obese women.

Today, two out of three Americans are obese or overweight.  If the current trajectory continues, one in two adults will be obese by 2030.

Viewed in this light, participating in a weight loss program can have significant health and financial benefits. When considering the costs of a weight loss program – such as bariatric surgery or a medically-supervised diet – factor in the impact of these programs in reducing your weight as well as the direct costs of being overweight.

My Journey Through Weight Loss – Part 6

Tanya McGill, two years after bariatric surgery.

Tanya McGill, two years after bariatric surgery.

It seems that no matter how many testimonials I heard from other patients prior to surgery and no matter how many books I read about other people’s experiences, the many miracles I experienced after bariatric surgery blew my mind over and over again! I would get on the scale and some days I would lose two to three pounds from one day to the next. That was insane (and that was mainly in the first month, mind you). My size twenty-eight pants were suddenly falling right off my hips and I just couldn’t wear them anymore. I certainly wasn’t complaining, and a monthly trip to the discount big box store to purchase a couple of new pairs of pants with elastic waist bands became my new reward for another month of weight forever gone.

One of the most mind-blowing things I remember is going to one of these discount stores to look at a few pairs of pants. I thought to myself, “Well, I’ve lost a few more pounds. I’ll grab a size twenty-four from the rack and see how they fit.” I was completely dumbfounded when I zipped them up only to find that they swallowed me. They were super baggy all over! Could it be that a twenty-two would be my size? Nope, those were too big, too! You can imagine my amazement when I found that a size twenty is what I settled on, and I still remember thinking those were a little loose. I don’t think I could wrap my head around the fact that I might have almost made my way out of the size twenties all together.

About ten months after surgery (I was down 129 pounds and 32 pounds away from my goal weight) I went on a Labor Day trip to the beach with some friends. We were all playing cards, having a great time, and one of my friend’s brothers picked me up and started carrying me around the room, acting like a caveman! They were all laughing and cheering him on, but I was in a complete panic. In my head I was thinking: “Marc’s not strong enough to be doing this! He’s going to realize he’s picking up my enormous, fat behind and he’ll drop me any minute!” But he didn’t. See, I couldn’t even realize that I was just a few pounds heavier than all the other gals that were there, and 167 pounds was an easy load for him to lift. But my mind was still thinking it was in an almost 300 pound body.

One of the strangest miracles I encountered which I never, ever expected (and ladies, I thought we’d all be safe here but we aren’t, believe me!) was when I lost a shoe size through weight loss! Yes-you heard it here. It didn’t happen right away but when it did happen, it seemed as if it happened overnight. I used to wear a size 9, sometimes a 9½. And I love shoes-love them! We’ve all heard the adage, “We can gain all the weight in the world, but our shoes will always fit!” I always believed that, and I assumed the opposite was true as well. Well, I’m here to tell you that it might not always be so. I remember the days of feeling deep sadness after an afternoon of plus-size clothes shopping when I felt nothing fit properly. I knew I could always stop by any number of fabulous shoe warehouses where a plethora of gorgeous shoe options were just waiting for me. The only thing I didn’t love about my feet was that they were kind of large; even at only 5’4½” I had these rather large size feet. Well, I’m here to tell you that even your feet can carry the bulge as I was so shocked to learn  when I realized that I was going to have to get all new shoes because my previous size 9’s & 9½’s were slipping from my feet!

This journey of weight loss has brought more miracles into my life than I could ever count and I am so grateful for bariatric surgery each and every day.

My Journey Through Weight Loss – Part 5

Tanya McGill enjoying dinner with friends in Barcelona, Spain.

Tanya McGill enjoying dinner with friends in Barcelona, Spain.

Getting back into the swing of things following bariatric surgery was fairly easy given that I was well prepared. The nutritional classes I’d attended at Emory Healthcare prior to surgery, as well as the vast amount of information I’d collected from all the support group meetings I’d gone to really helped take out as many unknowns as possible. I’d even seen a psychologist regularly who specialized in helping weight loss surgery patients prepare for what to expect after surgery.

I thought I had done the entire course of the weight loss surgery’s version of “What to Expect When You’re Expecting” but I still wasn’t fully prepared for what life would be like emotionally after surgery. This wasn’t anyone’s fault; this was because life is weird and people are strange and there was absolutely no way to predict how each and every person was going to respond to me after I began losing weight, and I couldn’t know how I was going to handle the huge variance in responses. Finding my center and staying grounded was one of the most challenging things I faced as a post-op gastric bypass patient.

Because hormones are stored in fat cells, as the fat cells begin to rapidly shrink those hormones are released in very quick bursts. This can lead to mood swings or depression in some people. Others may not notice any change in mood whatsoever. Some people in our support group spoke of mourning the loss of their best friend: food! Before my surgery, food was a great companion, a loyal consoler to whom I could always turn during times of stress and pain as well as during times of great happiness and celebration. I could always count on food to be there for me.  After my procedure, that was no longer the case. I had to cultivate new tools in order to move smoothly into my new life as a person whose tiny new pouch could only accommodate enough to maintain nutrition – certainly not emotional eating.

As I alluded to earlier, dealing with others around you can be a little tricky, as well. Those who know you have had surgery may feel the need to scrutinize every individual thing you put on your plate or in your mouth (even if they never went through a weight loss surgery nutritional class in their life). They could be concerned, they may wish to help or support you, or they may just be downright nosey. This might be a good time to whisper a personal mantra to yourself, something like, “I am surrounded by many good people who want only the best for me.” Well, at least something close to that worked for me so I wouldn’t go crazy every time I had to explain to people that yes, I actually could have cheese grits for breakfast if I wanted to and still lose weight!

One of the most poignant moments I remember concerning the topic of my impending  bypass surgery took place in my favorite fondue restaurant. I and dear friend of mine (whom I had known since I was thirteen) were there along with our another close friend and her husband. The four of us were chatting when the theme of the conversation moved to my surgery which was just a few weeks away. The friend I’d known since I was thirteen suddenly became very concerned, not about the surgery itself and how I might fare during the procedure or anything of that nature. She was quite concerned about my losing weight and therefore losing the real “me” in the process. I remember so vividly her saying that she loved me just the way I was and that she didn’t want me to change who I was in this process. I had to assure her that I was, indeed, going to change, but only in the best of ways. I knew in my heart that this surgery was the right thing for me to do. And I still feel that way more than six years later.

Next up: A handful of the countless miracles I have experienced on this journey.