What You Need to Know About Long-Term Follow-Up Care After WLS
July 23, 2018Obesity is a deadly disease and, as a physician, I am part of a group that is doing a poor job of curing it. In fact, obesity is a growing health problem. In 1960, the obesity rate was around 10% in the United States. In 2009 it was close to 36%. It is projected that by 2030 half of Americans will be obese.
Obesity is robbing Americans of their health and well being. If you’re a 40-year-old non-smoker you will lose nearly a decade of life if you remain obese; something needs to be done.
Patient access to bariatric surgery, which has been shown unequivocally to be the best long-term treatment for obesity, is less than 1% of the eligible population.
Follow-up Care After WLS is Multidisciplinary
Obesity is a chronic systemic disease that impacts all races, ages, and socioeconomic classes. It is systemic which means that it affects the whole body and chronic which means it is a medical condition that could potentially last a lifetime. It is a disease that is a contributor, if not the cause, of a host of medical conditions including diabetes, high blood pressure, sleep apnea, high cholesterol, arthritis, depression, heart disease, lung disease, and various cancers.
Like any chronic systemic disease the treatment centers upon a treatment plan and adherence to the plan. The success of any chronic disease relies heavily on patient follow-up and obesity is no different.
Follow-up for the bariatric surgery patient is multidisciplinary and includes physicians, nurses, dietitians, psychologists, and support groups to name a few.
There are a few types of physicians that should follow your progression as a bariatric surgery patient. You should follow-up with your surgeon several times throughout the first year and then yearly thereafter. It is important to see your surgeon because there are several things that can happen after bariatric surgery that your surgeon will be looking for. Amongst these are internal hernias, hernias at the incisions, gastric ulcers, narrowing of the new connection between the stomach and small intestine, and gallbladder disease to name a few. These problems, fortunately, are not common and a surgeon is the best physician to diagnose and cure them in an expeditious manner.
Providers with Special Training in Metabolic and Bariatric Medicine
Your bariatric center should also have a dedicated physician with special training in metabolic and bariatric medicine.
This physician is typically a board-certified medical doctor that has additional training in diet, exercise, and obesity. These highly trained physicians appreciate the different physiology of bariatric patients and are able to diagnose and prescribe diet and exercise regimens that are personally tailored to each patient.
They work in close concert with the team when a patient undergoes surgical treatment for obesity but they also play a pivotal role when a patient elects non-surgical treatment. They are the quarterback for preparing patients for surgical treatment and direct the care to the appropriate providers. Follow-up with this physician is essential for monitoring progression of weight loss as well as changes in blood sugar, cholesterol levels, blood pressure, and sleep apnea just to name a few.
Follow-up with a dietician that specializes in obesity is also critical.
Not only will they monitor your diet but they also play a key role in keeping track of your protein levels and water intake. Frequently, especially initially after bariatric surgery, patients can become nauseated. Two of the most common causes of early nausea after surgery are dehydration and inadequate protein intake.
Additionally, bariatric patients need lifelong vitamin supplementation post-operatively. These vitamins and minerals can change from time to time and frequent monitoring is key to preventing a host of medical conditions.
Without supplementation, iron and folate levels can become dangerously low leading to anemia which is a decrease in red blood cells in the circulatory system. This can cause fatigue, shortness of breath, chest pain, fainting, and in severe cases, can lead to strokes and heart attacks. Folate plays a role in making proteins and without proteins, the cells in your body cannot properly function.
Vitamin B12 also plays a role in the production of red blood cells which can lead to problems with your stomach, anemia, and neuropathy (which is a nerve condition that can be very uncomfortable).
Magnesium and zinc are elements that function in many different cellular processes. Monitoring these levels is important for many things including prevention of hair loss, muscle weakness, high blood pressure, high blood sugar levels, and depression and anxiety to name a few.
In addition to the above vitamins and minerals being too low, they can also be too high which can cause health problems as well. A blood panel will also be drawn to check for kidney function, liver function, red blood cells, and platelets. It is critical that all of these things be monitored not only for the good health but also to keep you feeling well. If the levels are too high or low, your dietitian can recommend changes in your diet and vitamin intake to correct the problems.
A Clinical Psychologist is an Important Part of the Bariatric Team
There are many wonderful changes that occur when a patient loses a significant amount of weight but also some of the changes that occur can be challenging to both the patient and their families. The clinical psychologist has special training and experience and can help guide you through the process.
They play an important role in both the preoperative and the post-operative follow up of the patient.
In addition to psychological factors, eating disorders such as night eating disorder and binge eating disorder are commonplace amongst bariatric patients and diagnosing them preoperatively and monitoring their progression postoperatively is helpful in maintaining weight loss.
In addition to the above team members, follow up with nurse practitioners, case managers, and exercise specialists is key to successful and sustained weight loss. Support groups are often an underutilized resource. These groups have been shown to have a positive impact on the durability of weight loss. They provide a safe environment where people can share similar stories and experiences and feel comfortable asking sometimes difficult questions that people without obesity cannot fully appreciate.
Follow-Up is Key to Maintaining Motivation
Finally, follow-up is key to maintaining motivation. Many of my patients express that they feel “stuck.” They feel like they have hit a weight loss wall.
This is not a unique problem and is something that we hear frequently. This occurs commonly around 18 to 24 months post-operatively, and many patients feel like it is something they have done wrong. Physiologically, the weight loss plateaus at this point and in some patients, a weight gain can occur.
Typically, bypass patients have lost around 60% of excess body weight at this point. As a surgeon, I remind them that gaining 10 to 20 pounds will oftentimes leave them at a total loss of 50% or more excess body weight which is a tremendous success!
Most importantly 96% of patients in a recent study were completely satisfied with their surgery and would recommend it to other bariatric patients. Surgery is a tool to combat a chronic systemic medical condition known as obesity. Like any tool, knowing how to use it and when to use it makes the job a success. Continued follow-up at a center of excellence will give you all the information necessary to combat the vicious cycle of obesity and finally put an end to it.
 | ABOUT THE AUTHOR Tyler Bedford MD, is a board certified general surgeon and fellowship trained in advanced laparoscopic and bariatric surgery at Summa Akron City Hospital. He specializes in abdominal laparoscopic surgery, minimally invasive weight loss surgery (Laparoscopic Roux-en-Y Gastric Bypass, Laparoscopic Banding, and Laparoscopic Sleeve Gastrectomy), laparoscopic treatment of abdominal/inguinal hernias, and laparoscopic colon resection for both benign and malignant disease. |
