Weight Loss Surgery – Not the quick fix people may think

By: David Cover

When most people think of weight loss surgery, they assume that it is taking the easy way out. What they don’t realize is that many of the patients who decide on getting weight loss surgery are the opposite of lazy. They have tried multiple different weight loss programs throughout their lifetime. I know this first hand from my previous work with Medifast where most clients have been on more diets than you can imagine. Currently, the prevalence of obesity in Americans is estimated  to be roughly 39.8% and rising. Obesity is a multifactorial disease, which is influenced by lifestyle, cultural, and genetic factors. All those factors make it exceedingly difficult for people to both lose and maintain their weight loss. It became apparent during my rotation with Inova Bariatric Surgery that surgery wasn’t an easy way out; it provided patients with a tool to help them lose weight and keep it off.

There are various surgical options to treat obesity, however the sleeve gastrectomy and Roux-en-Y gastric bypass procedure are the two most commonly performed. During this rotation, I learned that the surgery selection depends on the severity of obesity, patient medical history, and other factors. Additionally, research has shown that multifaceted preoperative preparation greatly improves long term success rates after weight loss surgery. The staff at Inova understand this and utilize a multidisciplinary approach to weight loss. In addition to the bariatric surgeons, Inova employs dietitians, exercise specialists, behavioral specialists, and certified bariatric nurses to counsel the patient on all stages of their weight loss journey. For example, during a diet education patients would frequently bring up topics such as exercise type and duration. Fortunately, we had a certified exercise specialist in the next office to answer all of their questions. Additionally, bariatric patients may have a propensity for certain addictions, and having a behavioral health specialist available was very helpful for our patients. It was a great experience to see firsthand how all the specialists in their respective field work together to improve their patients’ health.

During this rotation I worked alongside a dietitian who provided weight loss counseling and diet prescriptions to patients through all phases of their weight loss journey. When a patient is planning to have bariatric surgery, there are multiple diet phases they must undergo in order to prepare their body for surgery. In addition to this, a patient must prove they are able to maintain, if not lose weight, prior to surgery in order for insurance to cover the procedure cost. This is where the dietitian is crucial in ensuring patient success. Before this rotation, I was not fully aware of the diet progression patients must undergo. For example, for two weeks prior to surgery, patients can consume only clear liquids in addition to two protein shakes per day. The reason for this isn’t only weight loss, the low carbohydrate and fat nature of this diet are used to exhaust liver glycogen and lipid stores, thereby shrinking the liver. This helps make the surgery easier for the surgeon to perform and decreases the risk of complications. After surgery, the patient remains on a clear liquid diet for two weeks and progresses towards thicker foods overtime, which allows the stomach to heal properly.

After observing a few of the dietitian’s consults, I was allowed to speak with the patients regarding their diet progression and vitamin and mineral supplementation instructions. Many patients who undergo bariatric surgery are unable to properly absorb the micronutrients from food. Therefore, it is very important for them to get routine lab work for the dietitian to review and provide supplementation as needed. I was also able to conduct a pre-bariatric diet education session to a group of roughly 15 patients using a large auditorium in our building. I gave a powerpoint presentation on how they can properly prepare themselves for bariatric surgery and how to structure their diet both pre and post operatively. Following the presentation, I held a brief Q&A session for patients to ask me specific diet related questions. This was also a great experience as I have never held group classes before. The physicians are also allowing me to observe one of their surgeries and I am very grateful for that opportunity. Working oneonone counseling patients was similar to my previous work experience. However, this area of dietetics involved a patient population with more specific needs. This made my rotation at Inova a great learning experience, while also strengthening my existing skill set.

I enjoyed interning at Inova Bariatric Surgery. The staff are extremely professional and it was very apparent how much they care about the lifelong health of their patients. I hope to have the opportunity to work in this area again because I found this clinical rotation the most rewarding. Interning at Inova reinforced that bariatric surgery isn’t a quick fix it only provides a tool for weight loss. It takes a lot of courage to tackle obesity through weight loss surgery. Surgery itself would not work if the patients were not both motivated and dedicated to a total lifestyle change, and I can tell you from experience that many of them are.

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