dumb question thread

Why do some surgeon's require a pre-op diet and some don't?   Do those surgeon's that don't require a pre-op diet have a higher rate of open RNY vs lap?  
Please don't take this as me not being willing to follow my surgeon's pre-op diet.  In the scheme of things it isn't that bad, but I've always been curious why some surgeon's don't require one.  You would think the requirements would be uniform throughout the surgical community.

To my understanding that varies even within a surgeon's practice. Some PATIENTS with the same surgeon have to do it and some don't. I think it has something to do with the size of your liver and/or excess fat around your airways. My surgeon didn't require me to do a pre-op liquid diet (or any kind of diet) but he seemed to indicate that it was because I wasn't carrying a lot of fat around my neck.

I dunno. I want to know now too!

What I think is that it's based on how they were taught, their personal experience and personal preference.  I don't think it's really based in science.  Like I've seen no studies showing what kind of pre op diet is most effective.

All surgeons have their own quirks and requirements and beliefs. So it's hard to know what's inside their heads and why they choose to do one thing or another. 

However, we can look at some science to figure out the outcome of certain recommendations. For instance, we know that if you lose weight before surgery you have a greater chance of keeping off a higher percentage of weight in the long term. 

Here's a post on my blog about the Pre-Op Liquid Diet and what one study shows 
http://pamtremble.blogspot.com/2010/11/pre-op-liquid-diet.html

• For every 1% of your weight you lose on your pre-op diet and see an increased weight loss of 1.8% over non-losers at 12 months post-op. So if you weigh 300 pounds and lose 1.5 pounds (1% ewl), that means at 1 year post-op, you'd lose an extra 3 pounds over friend friend who didn't lose anything pre-op. 
• Gain 1 BMI point pre-op and see a reduced weight loss of 1.34% at 12 months post-op over the losers.
• Lose more than 5% of your excess weight pre-op and you're on the operating table for 36 minutes less than other folks. 

I'm with Nik on this one... at my surgeon's practice they did things differently for different patients. I am an "hourglass" shape (not pear or apple) and never carried as much fat in my abdominal cavity and while my liver was fatty, I didn't have the internal issues that some people have. Others I met in the waiting room of the surgeon WERE complaining about the preop diet and I noted that they were apples in body type (traditional apple body types carry a LOT of internal fat around their organs) I didn't mention that I wasn't doing the pre-op diet to this person, because I didn't want to make them feel bad.

Heck, my surgeon had different postop plans as well. I was sipping a Propel in the waiting room to see him after surgery and one of the other people in the waiting room saw what I was drinking and asked if I was pre- or post-op and just about pounced on me for ALREADY breaking the no-artificial-sweetener rule...... and frankly, if I'd been given that rule, I woudl have found a different surgeon!

I think that like any professional, surgeons have experience with a lot of things, and they make rules based on their experience. As a teacher, if I didn't teach 40 kids at one time, if it was only a handful, I'd do things a lot differently based on individualization. Since I can't, everyone has to do the same thing, even though the same amount of homework won't benefit each child in the same way.

Ok, here goes.

Has anyone read anything or know anything that suggests that, in the long term, it's actually harder for us to lose weight than someone who has not had surgery?

I've heard of people losing re-gained weight but I've heard of precious few who've managed to lose a significant amount more after years out from surgery (I'm referring to people who didn't get close to goal).

For my part, 160 was the number I had in my head where I wanted to be and maintain. I don't think that's what's in the cards for my body and I can accept that. But some part of me always wonders if it is because I don't try hard enough.

I've never seen any studies or anything that shows that and I don't know why it would be the case, but I can't say it's not the case, either.  Your surgeon might be a good person to ask.

There is actually some evidence in SOME patients that the regrowth of villi in the small intestine actually gets a little out of control sometimes. So instead of growing stronger and longer villi to the same level that it was pre-op, for some patients we actually grow MORE than we had before surgery. So this suggests that we have hyper-absorption of calories at some point down the line. Of course we can't absorb more than 100% of the calories we eat... but we can get all the way up to that 100% mark pretty easily.

So what you are saying is...no more deep fried peanut butter Snicker balls?

Dang!

 What?! They make those? Can I have one???