Colleen Campbell BSc (Hons) MSc  Assoc Nutr.
Nutritionist and Patient Services Manager
enquiries@wlsgroup.co.uk

Our surgical programme, which incorporates your pre-operative and post-operative care, was developed by likeminded passionate people.

We really care about our patients, and we understand that having surgery is a big investment in many ways. Because of this, we make it our vision, and our mission to help and support all of our patients in getting the best outcome from their surgery.

We combine the skills and personal and professional experience of our multidisciplinary team, together with patient feedback and evidence based scientific research, to ensure we deliver a successful programme of care to our patients. We are also advised in our work by independent experts.

This section of our website aims to keep you up to date with research that is relevant to the medical field of bariatric surgery (weight loss surgery).  Just click on the topic that is of interest to you.

Nutritional deficiencies associated with Bariatric Surgery (weight loss surgery)
Vitamin & Mineral Supplementation after Weight Loss Surgery

Vitamin B12 Injections after gastric bypass

Effectiveness of oral contraception after bariatric surgery

Pregnancy After Gastric Banding
Gastric band adjustments during pregnancy
Behavioural Changes that are crucial to success after Gastric Bypass surgery

Effectiveness of Telephone and Email Support for weight loss
Statistics on Obesity
The National Institute of Clinical Excellence (NICE guidance for achieving weight loss)
Meal Replacements for Weight Loss
Physical Activity in the Prevention of Obesity
PROTEIN AND FIBRE - The Appetite Suppressors

Nutritional deficiencies associated with Bariatric Surgery
(weight loss surgery)

Bariatric surgery is currently considered to be the most effective treatment for patients with clinically severe obesity (BMI of 40kg/m2 or more). Bariatric operations are classed into 3 groups:

• Restrictive procedures – these include Adjustable Gastric Banding and Sleeve Gastrectom

• Malabsorptive procedures –  Jejuno-Ileal bypass

• Combined procedures – these include the Roux-en-Y Gastric Bypass ;  Bilio-Pancreatic Diversion and Sleeve Gastrectomy with Duodenal Switch

 

It is widely agreed that patients undergoing restrictive procedures without malabsorption are at a lower risk of developing long-term diet related complications (i.e. nutritional deficiencies), compared to patients who have had malabsorptive procedures (1).

A number of studies (1,2, 3, 4) looking at the nutritional implications of bariatric surgery have highlighted that the most common nutritional deficiencies, particularly amongst patients who have had malabsorptive procedures, include protein, iron, calcium, folate, vitamin B12 deficiency, and deficiencies of fat soluble vitamins such as vitamins A, D and E.

The various studies conclude that adherence of patients to eating behaviour guidelines, supplement prescriptions, and frequent monitoring of nutritional status for all patients is imperative and can aid in preventing severe deficiencies and associated complications (1-5).

References

1. Couaye M, Puchaux K, Bogard C et al. Nutritional consequences of adjustable gastric banding and gastric bypass: A 1 year prospective study. Obes Surg. 2008; Jun10 (Epub ahead of print)

2. Parkes E.  Nutritional management of patients after bariatric surgery.Am J Med Sci. 2006; 331 (4): 207-13

3. Bloomberg RD, Fleishman A et al. Nutritional deficiencies following bariatric surgery: what have we learned? Obes Surg. 2005; 15 (2): 145-54

4. Folope V, Coeffier M and Dechelotte P. Nutritional deficiencies associated with bariatric surgery. Gastroenterol Clin Biol. 2007; 31 (4): 369-77

5. Brolin RE. Metabolic Deficienices and supplements following bariatric operations. McGaw-Hill,  2004. p.275-300

 

COMMENTS FROM THE WLS GROUP EXPERTS

 Colleen Campbell, Nutritionist and Patient Services Manager for the WLS Group

Most diet related surgical complications can be prevented by following some key dietary and nutritional guidelines. The WLS Group Aftercare programme ensures that patients are followed up regularly and given sound nutritional and dietary advice from the pre-operative stage, including advice about supplementation. In addition, all patients are provided with a Bariatric Surgery Guide, which outlines the nutritional and dietary guidelines that need to be adhered to.

The evidence highlights that gastric bypass patients are more at risk of nutritional deficiencies. As part of our Nutritional Management Protocol, we arrange with the GP for gastric bypass/sleeve patients to regularly have vitamin B12 injections, and to have routine blood tests to keep a check on their nutritional status.

 

Vitamin & Mineral Supplementation after Weight Loss Surgery

There are different mechanisms by which nutritional deficiencies can occur after weight loss surgery:

• The restriction of overall food intake caused by the creation of the small gastric pouch
• Insufficient intake due to dietary restrictions and potential intolerance to certain types of food (e.g. red meat, fibre, bread)
• The malabsorption of nutrients (in bypass patients only) due to the creation of a smaller stomach pouch and the restructuring of the small bowel

 

In order to protect patients from developing nutritional deficiencies after weight loss surgery, vitamin and mineral supplementation in the post-operative period is generally advised and recommended in the literature (1-5).

For gastric band patients an adult multi-vitamin and mineral supplement is considered sufficient (6). Gastric bypass patients, because of the malabsortpive element of the procedure, may be required to take higher dosages of certain nutrients, and sometimes, dependent on the nutrient and any deficiency that may exist, patients may be required to take the supplement in a different form (4,6).

References

1. Bloomberg RD, Fleishman A et al. Nutritional deficiencies following bariatric surgery: what have we learned? Obes Surg. 2005; 15 (2): 145-54

2. Folope V, Coeffier M and Dechelotte P. Nutritional deficiencies associated with bariatric surgery. Gastroenterol Clin Biol. 2007; 31 (4): 369-77

3. Malinowski SS. Nutritonal and metabolic complications of bariatric surgery. Am J Med Sci. 2006; 331 (4) 219-25

4. Shah M, Simha V, Garg A. Long term impact of bariatric surgery on body weight, comorbities and nutritional status. J Clin Endo & Metab. 2006; 91 (11) 4223 – 4231

5. Fernanda et al. Need for multivitamin use in the post-operative period of gastric bypass. Obes Surg. 2008; 18: 187-191

6. Elliot K. Nutritional consideration after bariatric surgery. Critical Care Nursing 2003;26: 133-138

 

COMMENTS FROM THE WLS GROUP EXPERTS

Colleen Campbell, Nutritionist and Patient Services Manager for the WLS Group

Following a review of the literature and evidence, it appears that there are currently no strict guidelines for supplementation after weight loss surgery. Given the rapid increase in surgical treatments for morbid obesity in recent years, as well as the diet related surgical complications that can potentially develop, further studies are needed to determine, in effect, a ‘supplement prescription’ to prevent nutritional deficiencies.

There are a number of vitamin & mineral supplements being marketed in chemists and supermarkets, but not all of them are suitable for bariatric surgery patients in terms of covering the nutritional requirements. Using the existing evidence, we advise our patients of the best vitamin and mineral supplements to choose from and the dosage, and in some cases patients will need to take more than one supplement depending on the patient’s medical history, their diet, nutritional status and the type of procedure they have had. Gastric bypass patients in particular require more specialised follow up with regards to diet and nutrition.

Patient compliance with the recommended supplement regimen can sometimes be a problem. For patients who struggle with tablets, vitamin and mineral supplements can be taken in the liquid, chewable or effervescent forms. Regular evaluation of serum nutrient levels via blood tests is recommended to all patients, particularly gastric bypass patients.
 

Vitamin B12 Injections after gastric bypass

Deficiency of vitamin B12, which can cause neurological problems and in the longer term pernicious anaemia has been frequently observed after gastric bypass surgery, amongst other nutritional deficiencies (1, 2).  Many authors have highlighted particular concern about the possible long term complications of vitamin B12 malabsorpion in patients who have had the Roux-en-Y gastric bypass, and the need for Vitamin B12 supplementation. Interestingly, recent studies have shown that standard multivitamin preparations/supplementation may not be sufficient to prevent vitamin B12 and other nutritional deficiencies (2,3).

There are a few possible mechanisms though which vitamin B12 deficiency can arise. Firstly, some of the major food sources of vitamin B12, which includes animal foods such as meat and milk products, are often not well tolerated well by gastric bypass patients. Secondly, the creation of the small gastric (stomach) pouch after Roux-en-Y surgery has been shown to significantly reduce acid secretion into the stomach (4). The absence of sufficient stomach acid secretion results in food-bound vitamin B12 being maldigested and subsequently malabsorbed. In addition, to enable vitamin B12 to be absorbed efficiently, it needs to attach a protein called ‘intrinsic factor’ (IF), which is also secreted into the stomach. This process of the secretion of the intrinsic factor protein and absorption of the protein bound vitamin B12 has also been reported to be markedly impaired in gastric bypass patients (5).

The results of these studies and others (6) have led some authors and surgeons to now recommend giving vitamin B12 (in addition to one multivitamin supplement) either in the injectable form, or in a crystalline oral form, which are both better absorbed after Roux-en-Y gastric bypass.

References

1. Shah M, Simha V, Garg A. Long term impact of bariatric surgery on body weight, co-morbities and nutritional status. J Clin Endo & Metab. 2006; 91 (11) 4223 – 4231

2. Gasteyger C, Suter M, Gaillard RC, Giusti V. Nutritional deficiencies after Roux-en-Y gastric bypass for morbid obesity often cannot be prevented by standard multivitamin supplementation. Am J Clin Nutr. 2008; 87 (5) 1128-33

3. Vargas-Ruiz AG, Herandez-Rivera G, Herrera MF. Prevalence of iron, folate and vitamin B12 deficiency anaemia after laparoscopic Roux-en-Y gastric bypass. Obes Surg 2008; 18 (3) 288-93

4. Smith CD, Herkes SB et al. Gastric acid secretion and vitamin B12 absorption after vertical roux-en Y gastric bypass for morbid obesity. Annals of Surgery 1993; 218 (1) 91-96

5. Rhode BM, Arseneau P et al. Vitamin B-12 deficiency after gastric surgery for obesity. Am J Clin Nutr 1996; (63) 103-

6. Behrns KE, Smith CD, Sarr MG. Prospective evaluation of gastric acid secretion and cobalamin absorption following gastric bypass for clinically severe obesity. Dig Dis Sci 1994; 39 (2) 315-20
   
   

COMMENTS FROM THE WLS GROUP EXPERTS

Colleen Campbell, Nutritionist and Patient Services Manager for the WLS Group

Given the tendency for many patients to forget or ignore the dietary guidance and nutritional instructions regarding vitamin and mineral supplementation, and also given that there are many studies that suggest that a standard multivitamin supplement is not sufficient to maintain a normal plasmatic (blood) concentration of vitamin B12, we recommend as a preventative measure that our patients arrange to have a vitamin B12 injections and routine blood tests to check their nutritional status. The support of the patients’ GP is required and much appreciated here.

In order to manage patients’ expectations, I think it is only good practice to advise patients in advance of the nutritional implications of weight loss surgery and support and encourage them to be partly accountable for maintaining their nutritional health.

 

Effectiveness of oral contraception after bariatric surgery

Abstract reproduced by: Merhi ZO. Gynecol Obstet Invest. 2007, 64 (2): 100-2

‘As surgical weight loss becomes more commonly performed in fertile women, adequate contraception is more frequently becoming an issue. The purpose of this article is to appraise the literature to ascertain whether the use of oral contraception is effective and adequate after bariatric surgery.

The literature search revealed that the combination of lower oral contraception dosages and surgical gastrointestinal disturbances might place patients at higher risk of unintended pregnancy. Until clinical trials show its efficacy, physicians should use oral contraception with prudence after bariatric surgery.’

COMMENTS FROM THE WLS GROUP EXPERTS

Dr Bruno Dillemans, Consultant Bariatric Surgeon, Belgium

Pregnancy and contraception after bariatric surgery remains a contentious issue as most of the evidence so far is mainly observational as confirmed by the above review. In our practice we do not recommend pregnancy for at least a year after the operation due to concerns of fetal malnutrition. We also warn the patients about possible malabsorption and consequent ineffectiveness of oral contraception. However choice of contraception is largely left to the patient.

 

Pregnancy After Gastric Banding

Evidence has shown that increasing BMI (Body Mass Index) is associated with increased incidence of pre-eclampsia, gestational hypertension and diabetes, macrosomia, induction of labour and caesarean delivery (1). Gastric band surgery has repeatedly been proven to be a safe and effective method of weight loss for morbidly obese women of child bearing age, with certain gestational complication rates actually lower than those associated with pregnancy in the obese (2-6).

Researchers have found that there is a decrease in maternal complications in gastric band patients because of better maternal weight gain control (3,5). In particular, a decrease in maternal hypertension and diabetic complications have been reported, as has a decreased rate of fetal macrosomia (a high birth weight) after gastric banding (2-6).

These results suggest that gastric banding is well tolerated during pregnancy and can be safely recommended to obese women of childbearing age.

The general consensus and current recommendations suggest that patients should delay pregnancy until after the first postoperative year in order to maximise maternal weight loss and minimise the risk of poor fetal growth and nutritional deficiency (6). Recent evidence, albeit with regards to gastric bypass patients, however has shown that pregnancy outcomes are similar in women conceiving during or after the period of maximal weight loss (7)

 

1. Bhattacharya S, Campbell DM, Listonm WA. Effect of Body Mass Index on pregnancy outcomes in nulliprous women delivering singleton babies. BMC Public Health. 2007; 24 (7) 168

2. Grundy MA, Woodcock S Attwood SE. The surgical management of obesity in young women: consideration of the mother and baby’s health before, during and after pregnancy. Surg Endosc. 2008; 22 (10); 2107-16

3. Vejux N, Campan P, Agostini A. Pregnancy after gastric banding: maternal tolerance, obstetrical and neonatal outcomes. Gynecol Obstet Fertil. 2007; 35 (11): 1143-7

4. Weintraub AY, Levy A et al. Effect of bariatric surgery on pregnancy outcome. Int J Gynaecol Obstet. 2008; Sep 1 (Epub ahead of print)

5. Jasaitis Y, Sergent F et al. Management of pregnancies after adjustable gastric banding.

            J Gynecol Obstet Biol Reprod 2007; 36 (8): 764-9

6. Bienstman-Pailleux J, Gaucherand P. Laproscopic adjustable gastric banding and pregnancy.  

J Gynecol Obstet Biol Reprod 2007; 36 (8) 770-6

7. Wax JR, Cartin A, et al. Pregnancy following gastric bypass for morbid obesity: effect of surgery-to-conception interval on maternal and neonatal outcomes. Obes Surg. 2008; Jul (Epub ahead of print)

 

COMMENTS FROM THE WLS GROUP EXPERTS:

Wendy Stubbs, Bariatric Nurse and Clinical Director for the WLS Group

I see many patients in my clinic who worry about the consequences of getting pregnant after gastric band surgery. There is a wealth of evidence out there to prove that it is safe to become pregnant after gastric banding and many of my patients have had gastric banding and gone on to have beautiful healthy babies. In our practice we do recommend that patients aim to wait around 18 months before planning to conceive.

We are currently working on developing an Antenatal Bariatric Surgery Programme specifically aimed at patients who become pregnant following weight loss surgery. It has been designed to offer patients all the support and guidance they need about how to keep themselves and their baby safe and healthy during the gestational period after weight loss surgery.

 

Gastric band adjustments during pregnancy

It has more or less been common practice to fully deflate the gastric band once a patient finds out that they are pregnant. Presumably this is to ensure that the mother can eat a sufficient amount of food to be able to provide the fetus with all the nutrients it needs.

However, research has shown that this may not be necessary. In one study it was found that there was a significantly greater maternal weight gain, a significant increase in the incidence of fetal macrosmia and a case of gestational diabetes in patients who had their band fully deflated (1). The researchers confirmed other results in the literature that gastric banding limits the usual complications associations with morbid obesity during pregnancy, however they also concluded that the band should not be deflated by principle, but only on symptoms. This was also confirmed in another study which concluded that adjustment of the gastric band during pregnancy must be undertaken individually according to symptoms (vomiting, gain of weight, total dysphagia/difficulty swallowing) (2).

In another study it was concluded that the ability to adjust gastric restriction allows optimal control of maternal weight change in pregnancy, and should help avoid the risks of excessive weight change (3).

References

1. Jasaitis Y, Sergent F et al. Management of pregnancies after adjustable gastric banding. J Gynecol Obstet Biol Reprod 2007; 36 (8): 764-9

2. Bienstman-Pailleux J, Gaucherand P. Laparoscopic adjustable gastric banding and pregnancy. J Gynecol Ostet Biol Reprod 2007; 36 (8) 770-6

3. Dixon JB, Dixon ME, O’Brien PE. Pregnancy after lap band surgery: management of the band to achieve healthy weight outcomes. Obes Surg 2001; 11 (1) 59-65

 

COMMENTS FROM THE WLS GROUP EXPERTS
Wendy Stubbs, Bariatric Nurse and Clinical Director for the WLS Group

Once a patient realises that they are pregnant, we arrange for them to come in for a review so that we can assess their diet and medical history and make approriate recommendations. Although pregnancy after bariatric surgery appears to be safe, we should take extra care to properly monitor post-op pregnant patients for appropriate weight gain and nourishment.

We are currently working on developing an Antenatal Bariatric Surgery Programme specifically aimed at patients who become pregnant following weight loss surgery. It has been designed to offer patients all the support and guidance they need about how to keep themselves and their baby safe and healthy during the gestational period after weight loss surgery.

 

Behavioural Changes that are crucial to success after Gastric Bypass surgery

Judy Dowd (MA, RD, LDN) highlighted nine areas of behaviour change that are crucial to success after weight loss surgery:

1. Meal Frequency
2. Food Volume and meal Pacing
3. Adequate fluid Intake
4. Consumption of fruits, vegetables and whole grains
5. Adequate protein intake
6. Avoidance of sweets
7. Vitamin/Mineral Supplements
8. Regular attendance at support group meetings
9. Compliance with exercise programme

 

Reference

Dowd J. Nutritional management after gastric bypass surgery. Diabetes Spectrum 2005, 18 (2): 82-84

 

COMMENTS FROM THE WLS GROUP EXPERTS

Colleen Campbell, Nutritionist and Patient Services Manager for the WLS Group
                                                                           
Diet, physical activity and behavioural change are essential if you want to get the best outcome from weight loss surgery. Relying on the weight loss surgery alone is a common mistake that many patients make. The procedure should be seen as a “tool”  to help patients manage their weight. It is not designed to do all the work and should not be seen as miracle cure. At WLS Group we understand that adapting to the dietary and lifestyle changes (highlighted above) that have to take place after weight loss surgery can be daunting and difficult. That is why our aftercare programme ensures that you are given all the right guidance, encouragement and support from out multidisciplinary bariatric team. We also encourage our patients to attend our monthly support groups meeting where we cover educational modules from our 12-module Behavioural Change Programme.

Although the paper cited above focuses on gastric bypass surgery, the 9 areas of behavioural change highlighted are applicable to all patients who have had weight loss surgery, including gastric band, and therefore are highly encouraged amongst all weight loss surgery patients along with other eating behaviours.

 

Effectiveness of Telephone and Email Support for weight loss

Traditionally a one to one consultation approach has been used in obesity management in the NHS. Problems such as appointment availability and a lack of resources resulting in limited review appointments and long term follow up has often resulted in low attendance at clinics and poor clinical outcomes. One of the key elements to successful behavioural change is frequent contact and support (1). Telephone and email based interventions may contribute to improving clinical outcomes.

Many successful weight loss programmes described in the literature include some form of telephone or email support in addition to other methods of treatment for weight loss (2,3,4 ). Although it is difficult to identify to what extent the telephone or email support alone is responsible for a patient’s weight loss success, the common pattern observed in the studies is that interventions that included telephone or email support resulted in better weight loss outcomes.

Tucker (4) and his fellow researchers found that weight loss was significantly greater in study participants that received telephone coaching sessions compared to those who received no telephone support, and concluded that adults can be educated and motivated via telephone to change behaviours leading to weight loss. Other researchers have identified that, email behavioural weight loss counselling can also be effective (5) in achieving good weight loss outcomes.

I must point out that some studies looking at telephone based interventions have shown only modest weight loss success (6) and therefore additional work is needed to identify clear guidelines on how to get the best outcome from telephone conversations and email dialogue with patients who are trying to lose weight.

Reference

1. Avenell A, Sattar N, Lean M Management: Part 1- Behaviour change, diet and activity. BMJ. 2006; 333 740-743

 

2. Saelens BE, Sallis JF et al. Behavioural Weight Control for overweight adolescents initiated in primary care. Obes Res. 2002; 10 (1): 22-32

3. Tsiros MD, Sinn N et al. Cognitve Behavioural therapy improvs diet and body composition in overweight and obes adolescents. Am J Clin Nutr. 2008; 87 (5) 1134-40

 

4. Tucker LA, Cook AJ, Nokes NR, Adams TB. Telephone based-det and exercise coaching and a weight loss supplement result in weight and fat loss in 120 men and women. Am J Health Promot. 2008; 23 (2) 121-9

5. Tate D, Jackway E, Wing R. A randomised trial comparing human email counselling, computer automated tailored counselling and no counselling in an internet weight loss programme. Arch Intern Med.  2006; 166: 1620-1625

 

6. Hellestedt WL, Jeffrey RW. The effects of a telephone-based intervention on weight loss. Am J Health Promot. 1997; 11 (3) 177-82

 

COMMENTS FROM THE WLS GROUP EXPERTS
Colleen Campbell, Nutritionist and Patient Services Manager for the WLS Group

Although there is no literature confirming the effectiveness of telephone and email support specifically after weight loss surgery, there are studies which show that it can be used successfully as an additional intervention in weight loss programmes

As part of our aftercare commitment we provide weekly follow up calls to all of our patients for the first 8 weeks post-operatively, monthly thereafter. We have an open door policy and encourage all of our patients to call us or email us for additional advice and support. I find that behavioural change, motivation and weight loss is greater in patients that maintain regular contact by phone, email or face to face. The telephone and email contact gives me the opportunity to assess a patient’s progress frequently and suggest changes accordingly without the added expense and time pressure of attending a clinic.

 

Statistics on Obesity

The main source of data on the prevalence of obesity and overweight is the Health Survey for England (HSE). This is an annual survey designed to monitor the health of the population of England. Some of the main findings from their most recent survey (1) are:

• In 2006, 24% of adults (aged 16 or over) in England were classified as obese. This represents an overall increase from 15% in 1993

 

• Overall, 67% of men and 56% of women were either overweight or obese in 2006.

• Men and women were equally likely to be obese, however women were more likely than men to be morbidly obese (3% compared to 1%)

 

• Thirty seven per cent of adults had a raised waist circumference in 2006 compared to 23% in 1993. Women were more likely than men to have a raised waist circumference

• Using both BMI and waist circumference to asses risk of health problems, of men 20% were estimated to be at increased risk, 13% at high risk and 21% are very high risk. Equivalent figures for women were 14% at increased risk, 16% at high risk and 23% at very high risk

 

Forecasts of the future prevalence of overweight and obesity in England have been undertaken by various government departments. In 2006 the Department of Health published a report forecasting obesity to 2010 (2). The Foresight Report (3) predicts that if current trends persist, by 2050, 60% of men and 50% of women and 25% of children could be clinically obese.

References

1. Health Survey for England 2006. The Information Centre 2008. Available at www.ic.nhs.uk/pubs

 

2. Forecasting Obesity to 2010. Department of Health, 2006. Available at: www.dh.gov.uk/en/publicationsandstatistics

3. Foresight Tackling Obesities: Future Choices 2nd edition – modelling future trends in obesity and their impact on health. Forseight, Government Office for Science, 2007

 

COMMENTS FROM THE WLS GROUP EXPERTS
Colleen Campbell, Nutritionist and Patient Services Manager for the WLS Group

Looking at the findings above it certainly looks like a bleak picture. Tackling obesity has become the most significant public and personal health challenge facing our society. Everyone from health care professionals to politicians to the lay person on the street are starting to understand the seriousness of this epidemic and are looking at a variety of approaches to try to reverse the trends. Perhaps we should take comfort in knowing that we as a country are not just sitting back and doing nothing. I think the concern now is more about the time and resources required to try to tackle the problem.

In terms of the evidence on treatment of obesity, a variety of clinical guidelines and research documents have been identified. There is evidence to support the use of a variety of dietary interventions and increasing physical activity, however surgical treatment of obesity is considered to be the most effective intervention, both in terms of weight loss and weight maintenance, compared with any other treatment.

 

The National Institute of Clinical Excellence (NICE guidance for achieving weight loss)

The NICE guidance (1) states that “dietary changes should be individualised, tailored to food preferences and allow for flexible approaches to reducing calorie intake”. The Weight Loss Surgery Group uses the NICE guidance as a basis for helping patients to achieve healthy realistic weight losses by:

1. Helping people assess their weight and deciding on a realistic healthy target weight (people should usually aim to lose 5-10% of their original weight, although weight losses tend to far exceed this after weight loss surgery. The 5-10% is a worthwhile goal to aim for initially)

2. Aiming for a weekly weight loss of 0.5-1kg (this may be greater in bypass patients)

3. Focussing on long-term lifestyle changes rather than short term, quick-fix approaches

4. Using a balanced, healthy eating approach to weight loss

5. Recommending regular physical activity (particularly activities that can be part o daily life such as brisk walking) and offering practical, safe advice about being more active

6. Including some behaviour change techniques, such as keeping a food diary and advice on how to cope with lapses and high-risk situations

7. Recommending and/or providing ongoing support

 

Reference

1. National institute for Health and Clinical Excellence (2006) Obesity: guidance on the prevention, identification, assessment and mamangement of overweight and obesity in adults and children. London

Meal Replacements for Weight Loss

As we know, in order to lose weight, we need to take in less calories than our body needs. Traditional dieting, surgery and physical activity are proven to result in weight loss because of the calorie deficit they create.

Incorporating meal replacements (eg. shakes and soups, the Slim Fast range being probably the most popular) into weight loss interventions is a popular route for many people who are trying to lose or maintain their weight , but there is some question about the efficacy of such an approach and consequently ‘dieters’ and practitioners have been somewhat reluctant to use or recommend them in the past.

There is research to suggest that meal replacements can be effective in treating overweight or obese patients (1, 2). Ashley et al’s (3) work has supported previous findings which showed that people consuming meal replacements successfully lost weight. Moreover they found that those people who incorporated fortified meal replacements tended to have a more adequate essential nutrient intake compared to those following a more traditional food group diet.

Noakes at al (2) also concluded from their study that meal replacements were equally effective for losing weight compared with conventional but structured weight loss diets. In their study they also found that compliance and convenience were viewed more favourably by people who consumed meal replacements than those in a conventional weight loss programme. These two factors, along with others, are likely to explain the successful outcome of the participants in this study.

References

1. Heymsfield SB et al. Weight Management using a meal replacement strategy: meta and pooling analysis from six studies. Int J Obes Relat Metab Disord 2003, 27 (5): 537-549
2. Noakes et al. Meal replacements are as effective as structured weight los diets for treating obesity in adults with features of metabolic syndrome. The Journal of Nutrition 2004 134: 1894-1899
3. Ashley et al. Nutrient adequacy during weight loss interventions: a randomized study in women comparing the dietary intake in a meal replacement group with a traditional food group. Nutritional Journal 2007, 6: 12

COMMENTS FROM THE WLS GROUP EXPERTS

Colleen Campbell, Nutritionist & Patient Services Manager for the WLS Group

These findings along with others suggest that meal replacements can be an effective approach for losing weight. Meal replacements are beneficial in that they remove the decision anxiety on the patients part, they allow the patient and practitioner to closely control the calorie intake in a structured way and by law, meal replacement products must provide the recommended amount of nutrients needed for good health - therefore they are nutritionally appropriate for most dieters.

The WLS Group recommends meal replacements pre-operatively for the pre-operative diet, where patients need to lose weight quickly in order to shrink the liver before surgery. In addition they are recommended in the initial post-operative phase when patients have to stick to a liquid diet after their surgery. This ensures that patients take in a good level of nutrition and it also offers convenience, structure and calorie control during the recovery period.

Once patients resume normal eating, I would encourage them to learn about and consume a healthy balanced diet so that their weight loss is sustainable in the longer term and their nutritional intake is optimal. Most people would prefer not to remain on meal replacements for the rest of their life and the chances are that when you come off them, you may put the weight back on. Therefore a sustainable approach of eating a balanced and varied diet and portion control is key for long term weight loss success and health.

Physical Activity in the Prevention of Obesity

Current Recommendations from the Chief Medical Officer:

• For general health benefits 30 minutes of at least moderate intensity physical activity is recommended on 5 or more days of the week
• This can be achieved by doing all the activity in one session or through several shorter bouts of activity of 10 minutes or more. The activity can be structured sport or lifestyle activity (part of everyday life e.g. climbing stairs, brisk walking) or a combination of both
• To prevent obesity 45 -60 minutes of moderate intensity physical activity each day may be needed
• To maintain weight loss 60-90 minutes of moderate intensity physical activity each day may be required in people who have been obese and have lost weight

References

1. Department of Health (2004) A report of the Chief Medical Officer: At least five a week. Evidence on the impact of physical activity and its relationship to health. London: HMSO

COMMENTS FROM THE WLS GROUP EXPERTS
Colleen Campbell, Nutritionist & Patient Services Manager for the WLS Group
Michelle Harrison, Fitness Advisor for the WLS Group

This side of energy equation is often forgotten. Most people tend to focus on restricting calorie intake and do not pay enough attention to expending/burning calories. Most often this is due to time pressure and therefore we tend to recommend that patients incorporate physical activity into their everyday lives instead of having to find 1-2 hours to go to the gym – and then not enjoy it! An activity that we can incorporate in to our everyday lives is walking. This is a great way to help preserve muscle mass and burn calories as you are using some of the major muscle groups. A pedometer is a nice little tool for monitoring how much walking you do from day to day and it also works by motivating you to do more. Some studies have shown that people who wear a pedometer walk more! Investing in a good pedometer that is accurate is worthwhile though. I am familiar with the Yamax pedometers as they have been shown to be one of the most accurate brands on the market! Aim for 10,000 steps, but build up to this gradually.

PROTEIN AND FIBRE - The Appetite Suppressors

Achieving and maintaining a healthy body weight is always easier if we can manage our appetite. The feeling of emptiness or hunger encourages us to eat, however in most cases the feeling of fullness would bring our eating to a stop and minimise how much we eat throughout the day. There are two definitions I would like to introduce here that have been described in the literature:

1. Satiation – this process occurs during a meal. It is the feeling of fullness that results in you stopping eating. i.e. the feeling of "I've had enough"
2. Satiety – this process happens after a meal. It is the feeling of fullness that persists after eating, potentially reducing the amount of food you consume between meals and at the next meal

Essentially weight loss surgery works in these two ways, firstly by removing the feeling off hunger and replacing it with satiety and secondly, by giving you a feeling of fullness after a small amount of food.

Several studies have suggested that protein and fibre can promote satiation and enhance satiety and therefore can have beneficial effects on the control of calorie intake (1,2). In fact weight loss has been found to be up to 3 times greater in people consuming high fibre low fat diets compared to a low fat diet alone (3), and Iin a very recent study it was found that a protein based breakfast promoted satiety and sustained feelings of fullness when placed on a calorie restricted diet (4).

References

1. Slavin J and Green H. Dietary Fibre and Satiety. Nutrition Bulletin, 2007. 32 (supp 1) 32-42
2. Halton TL and Hu FB. The effects of high protein diets on thermogenesis, satiety and weight loss: a critical reviw. Journal of the American college of Nutrition. 2004, 23 (5): 373-85
3. Yao et al. Dietary Enerygy density and weight regulation. Nutrition Reviews, 2001, 59: 247-258
4. Leidy H J et al. Increased dietary protein consumed at breakfast leads to an initial and sustained feeling of fullness during energy restriction compared to other meal times. British Journal of Nutrition, 2009, 101: 798-803

COMMENTS FROM THE WLS GROUP EXPERTS
Colleen Campbell, Nutritionist & Patient Services Manager for the WLS Group

We encourage our patients to consume a high protein diet, not only because of its effect on satiety and satiation but also because it helps to preserve muscle mass during periods of weight loss. Protein containing foods also provide patients with a good range of nutrients that bariatric surgery patients can easily become deficient in, particularly if they have had the gastric bypass.

Fibre containing foods tend to be a little bit more tricky for bariatric surgery patients to consume because of their fibrous nature, nonetheless we encourage patients to consume fibre containing foods as part of a healthy diet, but of course only foods that they can tolerate. For instance some high fibre breakfast cereals may be easier to tolerate than others, and toast using high fibre bread tends to be easier to digest than consuming the bread as a sandwich.

The combination of a high protein and high fibre diet coupled with their weight loss tool should result in great success for the patient.