The previous post discussed the run-up to bariatric surgery. because both before and after surgery, lifestyle interventions will be the patient’s new reality. The whole point is to make lifestyle interventions become the lifestyle, and to accomplish that is a lot more difficult than it sounds.
This brings up a quotation from a recent paper with the imposing title, “Effects of Lifestyle and Educational Bridging Programs before Bariatric Surgery on Postoperative Weight Loss: A Systematic Review and Meta-Analysis.” A rather chilling assessment undermines basic assumptions concerning the safety and efficacy of such procedures:
[A]lthough preoperative lifestyle interventions reduce body weight before bariatric surgery more effectively than usual care, this difference disappears 1 year post-surgery… [I]t is currently unclear whether, and if so under what circumstances, participation in a preoperative lifestyle intervention is beneficial.
Of course, the implication here is that if pre-op lifestyle intervention is useless, then maybe post-op lifestyle intervention is futile too, and so is any other kind of attempt to improve the situation. It is very dreary to contemplate. Which leads to another assertion made in this document:
Secondary outcomes and psychological well-being are rarely investigated.
It seems that the way to make a real mark in this field would be to vigorously investigate secondary outcomes and psychological well-being.
After bariatric surgery
The Ochsner Clinic, which offers both the adjustable gastric band (LAGB) and the Roux-en-Y gastric bypass (LRGBY) laparoscopic procedures, describes its method:
During the period of weight loss, we closely observe our patients; we then follow up with them once a year. During these visits, patients commonly have appointments with multiple persons on the bariatric team, including the surgeon, a physician extender, a registered dietician, and/or a mental health care provider, depending on the needs of each patient.
To this institution’s credit, it acknowledges that in the early post-operative stage, due to the “extreme and instant” lifestyle changes, patients tend to be in emotional turmoil. In light of that, once a year doesn’t somehow seem like enough in-touch-keeping. Of course, another section says a patient should report back “at the earliest signs of weight regain” because the sooner, the better.
A thought experiment
This description applies to post-op bariatric patients, but how many of these reactions, or very similar ones, might be let loose by the GLP-1 drugs?
Depression and anxiety medications should be continued for at least the first 6 months. Symptoms of depression should be monitored closely at the first few appointments… If patients were previous stress eaters and become stressed after surgery, they no longer have the ability to eat for stress relief.
Medications for all weight loss patients need to be in crushed, liquid, or chewable forms during the first 6 months for LRGBY and for the patient’s lifetime after LAGB. The use of whole medications may lead to ulceration as they sit in the stomach pouch or pouch enlargement.
Many patients also experience changes in their social scenes, as many American holidays are centered on a big meal. The way patients interact with the significant people in their lives changes dramatically, and their social structure can be irreparably broken.
Your responses and feedback are welcome!
Source: “Effects of Lifestyle and Educational Bridging Programs before Bariatric Surgery on Postoperative Weight Loss: A Systematic Review and Meta-Analysis,” Karger.com, 10/07/22
Source: “Long-term Management of Patients After Weight Loss Surgery,” NIH.gov, Fall 2009
Image by Joel Kramer/CC BY 2.0