Understand the four rules of weight-loss surgery before you go under the knife

Weight loss surgery (WLS) is often perceived as an easy means of losing weight that requires little or no effort on the part of the patient. However, patients undergoing bariatric surgery are prescribed Four Rules of Diet and Lifestyle Management that they will follow for the rest of their lives if they want to lose weight and maintain a healthy weight. All surgical weight loss procedures, including gastric bypass, adjustable gastric banding (gap band), and gastric sleeve, promote weight loss by decreasing energy (calorie) intake with a reduced or restricted stomach size. The little stomach bag is only effective when a patient rigorously follows the Four Rules: eat a high-protein diet; drink a lot of water; avoid eating empty calorie snacks; engage in daily exercise.

As part of their introduction to a bariatric program, most patients are taught the Four Rules, which tend to be consistent from bariatric program to bariatric program. Many patients agree to follow the Four Rules that will work in conjunction with their surgically altered stomach and digestive system to achieve rapid and massive weight loss. Some patients mistakenly believe that they can return to their pre-surgery eating and lifestyle habits once they have lost the desired amount of weight. However, patients who return to their pre-surgery lifestyle and diet often fail to lose all of their body fat and often regain much of the weight they initially lost.

In order for patients to lose all of their excess weight and maintain that weight loss, they must follow the Four Rules for the rest of their lives. Before undergoing any surgical procedure for weight control, one must be fully aware of the Four Rules and be willing to commit to them for life. Below is a quick look at each rule as it applies to WLS patients:

  • Protein first: At each meal, the WLS patient will eat lean animal, dairy, or vegetable protein before any other food. Protein shakes or supplements may be included as part of the weight loss surgery diet. Patients are advised to consume between 60 and 100 grams of protein per day. Eating lean protein will create a feeling of tightness in the surgical stomach bag: this feeling is the signal to stop eating. Many patients report discomfort when eating lean protein, however, this discomfort is why the stomach pouch is effective in reducing energy intake. Patients should not consume liquids while eating solid foods because liquids will cause the stomach pouch to empty too quickly, preventing nutrient absorption and satiety.
  • Much water: Like most weight loss programs, bariatric surgery patients are instructed to drink plenty of water throughout the day. Water hydrates the organs and cells and facilitates the metabolic processes of human life. Water removes toxins and waste from the body. Patients are prohibited from carbonated beverages and are advised to drink caffeinated or alcoholic beverages in moderation.
  • Without snacks: Patients are discouraged from snacking as they may prevent weight loss and lead to weight gain. Specifically, patients are prohibited from eating traditional processed carbohydrate snacks such as chips, crackers, baked goods, and candy. Patients who go back to snacking or grazing overcome the restrictive nature of the surgery and the results are weight gain.
  • Daily exercise: Patients recovering from morbid obesity should increase their daily activity and progress to formal physical development activities that include aerobic conditioning and muscular strength and endurance. Walking, swimming, and bicycling are recommended after gastric surgery. Patients who follow an exercise routine will maintain their weight loss and live a healthier life. Patients who do not include exercise as part of their bariatric weight loss program will likely regain weight and suffer from comorbidities that they hoped to alleviate with surgical weight loss.

Nearly half a million Americans this year will undergo some type of bariatric surgery to treat their morbid obesity. Surgical intervention has been shown to be the best treatment for many people to affect long-term weight loss and weight control. However, surgery does not work alone. Patients who adhere to the Four Rules of diet and lifestyle changes are more likely to enjoy better health and mobility after bariatric surgery.

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