What if we spent our money like the way we eat? How much money would you allow yourself to spend each day?
The answer is simple. We never learned the currency: the calorie. The average person should not be eating any more than 2000 – 2500 calories per day, depending on how many calories that person burns daily. And diabetics should be eating no more than 1800 calories a day. How many calories a day do you eat? I bet you do not know. The problem is until you do know this number, it will be very hard for you to lose weight, and even harder to maintain that weight loss.
The first step for anyone who wants to lose weight is to record the number of calories you eat each day. Record this number for 3 days in a row, and then divide by 3. This will give you an average
What happens when you cannot control your intake?
Calorie counting should be
How do you know if you are overweight? What is your ideal body weight? The first step is to know your height and weight. Then look up the Metropolitan Life table average weights based on height (http://www.bcbst.com/MPManual/HW.htm). Use the numbers listed for the middle bone-frame, take the average of the high and low weight and then that is your “ideal body weight (IBW)”, and then take the difference from that IBW and your actual weight and this is your initial excess weight (iEW). (Example: if the average ideal weight of a female who is 5 foot, 2 inches tall is 124 pounds, then if she weighed 234 pounds, her initial excess weight is 110 pounds. This initial excess weight is really the most important number used to determine your expected weight loss with a diet or weight loss surgery.
Why choose surgery?
At a certain BMI (>35), dieting alone becomes very challenging and is often met with weight regain. Weight
Weight Loss Surgery Works
Generally, within a certain average, a band helps people lose approximately 40% of the iEW, a sleeve about 50-60% of iEW, and a gastric bypass up to 75%iEW. A BPDDS can help people lost almost 80-90% of their iEW. The durability of this weight loss depends on many variables, and some people lose less and some people lose more. These averages already assume a patient will be doing some exercise.
So what are your choices for weight loss surgery?
There are 4 main choices today for weight loss surgery that include 1) the laparoscopic adjustable gastric band (LAGB), 2) the laparoscopic vertical (sleeve) gastrectomy (LSG), 3) the Laparoscopic Roux-en-Y gastric bypass (RYGB), and 4) the biliopancreatic diversion with duodenal switch (BPDDS).
All of these procedures can be performed laparoscopically (often confused with the term ‘laser’) which means minimally invasively, through small key-hole sized incisions.
Recovery from each is rapid, but they all require general anesthesia and you should consult your surgeon to better understand your risks for undergoing general anesthesia.
The surgery with the least immediate risks and the quickest recovery is the LAGB. This operation involves the insertion of an implantable device around the highest part of the stomach. The device is connected to a port that is placed under the skin in your abdominal wall. The port can be accessed by a needle and the band filled with fluid. By filling the band with fluid, it tightens around the stomach, creating the sensation of being full. In addition, the narrow opening does not allow more than a little food in at a time. Thus, by limiting the portion of food consumed, the calories ingested are limited.
If the band works, it usually helps the average person lose about 40% of their initial excess weight, but this takes time. Weight loss after a lap band is generally slow paced. At an average speed of ½ to 1 pound a week, to lose 40-50 pounds can take almost one year. So be patient, don’t rush it, and use the band as a tool to limit the number of calories you eat.
A word of caution. Overeating with the band can lead to vomiting. The band is NOT designed to make you vomit. If you are vomiting to lose weight, then you are abusing the band and should tell your surgeon. Bands can either erode (get inside the stomach) or slip (move out of position). Both situations require immediate attention. An eroded band may present as an infection at the port site. A slip may present as pain, or weight
While there are many patients very satisfied with the band, it requires dedication and routine follow up with your doctor. Bands don’t work alone, they need you to help!
The Laparoscopic Vertical (Sleeve) Gastrectomy (LSG)
Instead of inserting a device to limit caloric intake, the sleeve gastrectomy is an operation where the surgeon actually cuts off and removes about 60% of your stomach. The remaining stomach looks like the shape of a shirt sleeve, thus the nickname. This resection is done over a calibration tube so that the remaining stomach inside of you is about 1.5cm wide, like a narrow tube connecting your esophagus to the end of your stomach. Unlike the gastric bypass, even though stomach is resected, the surgeon still leaves the order of food passage intact from
In most centers, a sleeve gastrectomy requires a 1-2 night hospital stay, although some surgeons will try to send you home the same day. This is not advisable. The risks of a sleeve include a bleed (3-5%) or a leak (2-3%) from the staple line breaking down. Both of these risks can happen within the first 2 days, and so you should be carefully monitored during this period of time. Leaks can happen later as
The Roux-en-Y gastric bypass is a more involved
The RYGB takes anywhere from 1-3 hours to perform, and usually requires 2-3 nights in the hospital. There are a number of risks involved including but not limited to a leak and a bleed, as well as the stomach to
The weight loss is rapid as well, with patients losing up to 3-4
This operation is usually reserved for severe obesity (BMI >60) or for those patients who fail to lose enough weight after a sleeve gastrectomy, or for those who need revisions. It is basically like combining a sleeve gastrectomy with a surgery that diverts the food from the duodenum directly to the end of the intestines such that very little of the ingested calories will get absorbed. Because this is the only truly malabsorptive operation, the weight loss is the most significant, and patients can expect to lose over 75% of their excess weight.
It is the
If you choose to undergo a BPDDS, make sure you choose a surgeon who performs this procedure regularly.
Make sure to review these operations with your surgeon, and then determine the best type of obesity surgery for you. They all can work; it just depends on your motivation and working with it. It is important to remember that weight loss operations are just
Learn to eat correctly from these operations, after all, these operations do teach tradition. They teach portion control, and thus calorie control. They quite effectively provide you with the ability to decrease your daily caloric intake if you do not abuse it.
Like any tradition, once you get the hang of it, it becomes second nature. So will losing weight, and so will maintaining that weight loss. Weight loss surgery will re-teach you the eating habits you once knew long ago, and perhaps you will make these new eating habits tradition. Practice makes perfect, and each of these operations has the ability to help you practice a new eating habit, and provide you with a new beginning and a new chance at life.
Dr. Brian Jacob is an Associate Clinical Professor of Surgery and operates at Mount Sinai Medical Center in New York City. To contact Dr. Brian Jacob, call (646) 859-1400 or visit him at http://www.nychernia.com