The Big E—How Essential is Exercise Post Surgery?
July 25, 2013Where’s the Time and Energy For It?
It is almost a cliché — or perhaps white noise to your ears–that exercise is a key component to losing weight. Many of my patients dread the “Big E.” I have mixed feelings myself. Yet, investigating the role it plays pre-and post-bariatric surgery, specifically a year out, provides insight into why or why not you may be losing or gaining weight. By understanding this, I’ve found it has helped motivate and empower my patients.
Obesity is an inflammatory disease that affects every organ in the body, manifesting itself through conditions such as diabetes, high-blood pressure, cardiovascular disease, cirrhosis, hypothyroidism, headaches, depression and more. Weight is just one manifestation of this disease. What starts it all is probably too much sugar. Consistently in excess it produces metabolic changes that are extremely difficult to reverse.
On a cellular level weight gain instigates a civil war within your body. Excess sugar, often paired with fat is saved as fat. The cells most able to store fat are lipocytes and as they take on more and more fat they swell to a size that outgrows their oxygen supply. When this happens, the cells begin to break down, alerting your immune system that there are unhealthy cells to be dealt with. Dying fat cells release chemicals toxic to other cells in your body and an immune system, already on high-alert, begins attacking what would usually be normal cells.
Simply put, exercise increases your muscle capacity to use fat and sugar that would otherwise be stored in your cells. While many metabolic abnormalities associated with weight gain are reversed with bariatric surgery, the metabolic changes induced by weight gain do not change in muscle without exercise.
Two kinds of exercise allow your muscles to burn fat and sugar: cardiovascular exercises–activities that raise your heart rate to a level where you’re working at it but you can still talk–burn fats and sugars mostly during the exercise. While resistance exercises– also known as strength training and builds muscle mass and bone strength–continue burning off fats and sugar well after the activity.
In the beginning, just walking may allow for both cardio and resistance exercise; simply carrying your body weight may provide enough resistance. As your stamina and mobility improve, in order to continue losing weight you may need to progress from walking to more intensive exercise (i.e., hiking, jogging, exercise classes, etc.).
Adding variety–different types of cardio and resistance exercises–keeps you from getting bored or burned out. Choosing activities you enjoy or doing them in an environment you enjoy will also help you stay committed to an exercise routine.
“I want to do things with my kids and with my spouse; I’m tired of being left out and behind; I used to be an athlete and I want to get some of that feeling back,” are some of the more personal reasons why my patients want to get surgery in the first place.
And the reason I most often hear for the absence of exercise in my patients’ lives post-surgery? “There is no time.” They have jobs and other responsibilities that leave them exhausted. I believe them. In a more perfect world, our bosses and jobs would entail mandatory time out to take care of ourselves physically, especially considering how much it benefits or mental health and work productivity.
The Scientific 7-Minute Workout written up recently in the New York Times is an example of how even seven minutes can make a difference. The workouts’ instant popularity (including a cell-phone app) reflects the need and interest in fitting exercise into busy lives. This workout may not be compatible with your body at this point, but understanding the science behind it, can empower you to develop your own effective routine. In short, it is about combining high intensity while addressing all the major muscle groups. It can be as quick as seven minutes, but it does still require effort.
Surgery is not a ticket to banishing exercise for good. To keep weight off, especially when some of the metabolic advantages of surgery wear off (usually a year out), you need to increase the intensity of the exercise to match your body’s ability; a slow-paced walk needs to be graduated to burn fat and build muscle.
I know the effort exercise requires. I also know how it raises the quality of my life each day that I do it. On days that I work out in the early morning, it influences my whole day; I feel more positive, have a stronger self-image, and my interaction with people is more upbeat and enjoyable. Despite the energy the Big E requires initially, the energy it generates lifts me throughout the day. There is a sense of self mastery that comes with exercise that few other activities provide, at least on a regular basis.
Editor’s Note: Come Meet Dr. Owens At The OH National Conference! Click here for more information.
Milton Owens, MD, FACS, FASMBS began his medical career in vascular and transplantation surgery and moved to weight loss surgery in 1987. He is presently one of the most highly skilled and experienced bariatric surgeons in the world. He has performed well over 8 thousand weight loss surgeries including laparoscopic gastric bypass, gastric sleeve and adjustable band surgeries. His “Inverted Corner Gastric Sleeve” technique, developed to minimize heartburn and prevent leaks has been published in the premier journal for weight loss: SOARD. His experience in bariatric surgery led him to expertise in complex revision surgeries, care for seniors and other high risk patients. His management of bariatric patients both pre and post op make him a trusted choice for all patients seeking safe surgery and great outcomes.
After earning his medical degree from the prestigious McGill University in Montreal, Canada, Dr. Owens went on to head the Kidney Transplant Services unit with the Veterans Hospital in West Los Angeles. Presently, Dr. Owens serves as the director and as a surgeon with the Coastal Center for Obesity.