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Understand weight loss after bariatric surgery

Understand weight loss after bariatric surgery

There are different goals for bariatric / metabolic procedure . The reason for this is that there are some postoperative effects that are independent of weight loss, such as the almost immediate improvement of type 2 diabetes in the postoperative period, which has already been discussed in previous columns.

This time we will address the loss of weight in the postoperative period of the various technical options regulated by the Federal Council of Medicine, which already have long-term studies and are established as effective and safe procedures.

There are several physiological alterations that follow bariatric interventions. The main ones translate as a decrease in hunger and greater satiety after meals mainly in Roux-en-Y gastric bypass (DGJYR-gastric bypass), which is the most performed operation in our country. Vertical gastrectomy (GV) has a somewhat greater restriction component than gastric bypass, but it also has some hormonal responses that contribute to decreased hunger and increased satiety. The operations that favor caloric malabsorption such as the duodenal switch and Scopinaro surgery have different mechanisms of action and have the greatest weight loss in the long term, but the nutritional complications that follow in these surgeries are not very well performed in Brazil and in the world and will not be discussed in this article. To better understand the various types and indications of bariatric and metabolic surgeries, I suggest you read the December column from last year here. Gastric bypass and GV make up about 90 to 95% of the operations performed in Brazil, and it will be on these two that I will discuss the postoperative weight loss.

Our group of the Center for Obesity and Diabetes of Oswaldo Cruz Hospital in São Paulo prescribes the liquid diet only in the first week of postoperative, evolving to pasty diet the following week and from the 3rd week is oriented "general" diet, in smaller portions and higher feeding frequency. The weight loss in the first week is 800g to 1 kg / day, associating the metabolic changes of the surgeries to the hypocaloric diet. At the end of the first month, patients regularly lose about 8 to 12% of their total weight. Note that there are groups that maintain the diet liquid for 1 month, which is uncomfortable for the patient and without greater weight loss in the same period when compared to our group that has a faster progression of the consistency of the diet. gold "weight loss in both DGJYR (bypass) and GV are the first 12 to 14 months postoperatively, where the vast majority of post-bypass patients lose about 30 to 35% of their total weight and those in post- of GV lose between 25 and 30% of their weight. Usually up to 18 to 24 months weight loss is lower and from this period stabilizes. After the third postoperative year, the differences in weight loss between gastric bypass and GV will be more evident. In addition to a lower weight loss than the bypass, patients with a GV have a greater chance of long-term weight regain for various physiological reasons pertaining to each procedure.

It is never too much to reinforce that obesity alone is a chronic and progressive condition and that surgeries are excellent forms of treatment and that the long-term maintenance of balanced nutrition and physical activities are important tools for the long-term success of any clinical or surgical intervention. I apply the same reasoning of the balanced life in the postoperative period of bariatric surgery with the smoke after surgeries of lung resection by cancer. Smoking cessation is mandatory after lung surgeries and balanced lifestyle after bariatric surgeries are excellent complement!


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