GASTRIC BYPASS

Pre-Op Tips for Bariatric Surgery

Learn more about weight loss surgery at Rocky Mountain Associated Physicians || www.RMAP.com || (801) 268-3800

As your surgery date approaches, it is important to us here at Rocky Mountain Associated Physicians (RMAP) that you, as one of our patients, are prepared and knowledgeable to the bariatric procedure you and your surgeon have chosen. Now is the perfect time to create a checklist of things you need to do pre-surgery, as well as being prepared for what you will need post-operation.

How to Prepare for Surgery

By now, you should have already attended our Risks and Benefits seminar, attended our consent class and had a consultation with the surgeon you have chosen, and finally, attended (or soon will) our surgery orientation class where you will pay all your fees for surgery and receive our blue binder (RMAP Bible).

Pre-Surgery Diet
You will start your pre-surgery diet two weeks prior to your surgery date. Studies show that if you lose a minimal amount of weight prior to surgery, it can shrink your liver, giving your surgeon more room inside of your body to perform the surgery. This also helps reduce the risk of complications.

You will be given a handout with examples of what to eat. Your diet will consist of a high protein, low carbohydrate diet, consuming no more than 1,000 calories per day. This is not a full liquid diet. You should be consuming adequate amounts of dense proteins, as well as drinking 64+ ounces of water per day.

Prepare for Your Return from the Hospital
You will be recovering from a major abdominal surgery, so you will want to have everything you will need prepared and ready to go. This will help ease the stress while you are healing.

Fill your fridge with fluids such as water, non-carbonated/non-sugary beverages, and sugar-free popsicles.
Buy groceries 3-7 days prior to surgery. Include items that are for the clear liquid stage, the full liquid stage, and when you are 14-15 days post-op, you can move to a soft food diet. (Please refer to your RMAP Bible for the food stages of your procedure, and the food examples given.)
Have your bariatric vitamins purchased and stored in a safe place. Be sure to have also purchased the magnesium citrate liquid bottle you will need to drink the day before surgery for your bowel prep.

What to Bring to the Hospital

Pack light
- Leave your jewelry and valuables at home
- Wear loose fitted clothing: cotton shirt and underwear, slip on shoes, robe
- Family members can bring you your phone, tablet, lap top, reading material, etc., to you post-op
- Don’t forget the chapstick!
- You will want to bring your RMAP Bible to the hospital with you
Bring your own CPAP/BiPAP and any other medical devices
Bring your hearing aids, glasses, ID and insurance cards

If you get ready for your weight loss surgery ahead of time, chances are that you’ll be glad that you did! We wish you all the best, and always remember we are here to answer any questions, and willing to help. Weight loss surgery is only a tool, the long-term success is up to you. Remember, you got this!

www.RMAP.com
Rocky Mountain Associated Physicians
801-268-3800
1521 East 3900 South, Suite 100
SLC, UT 84124

Justin A.’s Gastric Bypass Story

Oct 9 By rmap nurse

I just wanted to share my weight loss surgery journey over the past two years with Rocky Mountain Associated Physicians (RMAP). For decades I battled with my weight. In 2021, it finally reached a breaking point when, as a single full time father of two very young children, I was in the shower and realized that I had been standing for less than five minutes before I was in so much pain that I was actually considering buying a medical chair in order to just keep myself hygienic and I was the heaviest weight I had ever been.

At that moment, I knew I had to do something different because the diets I had tried and failed for years weren’t cutting it. I had a family member who had gotten the Gastric Bypass RNY with RMAP and decided that I needed to take a drastic step to take back control of my life for myself and my kids. I was ready for change and all of the mental/physical requirements that came with it. I refused to end up a 36-year-old man who was bedridden by the prison he had created for himself. I was pre-diabetic. I couldn’t climb stairs, walk long distances or play with my children, and I was eating every single one of my emotions.

When I started the process with RMAP in October of 2021, I was 506 pounds. By my RNY surgery date on February 15^th, 2022, I was down to 465 pounds. The surgery was a success. Afterward, as with most patients there were struggles with eating and balancing the much-needed vitamins, water, and protein intake to lose and maintain. There were absolutely moments of “What the heck did I do? I shouldn’t have taken such a drastic step. I’m not going to make it through this.” I want current and future patients to know that this is absolutely normal. You will have brief moments of regret. Push through them. Stick to the plan set forth by your physicians. The payoff is worth all of it. When you see the numbers on the scale, and you feel the difference…I promise, it’s worth it.

Here I am, two and half years post-surgery, and I have never felt more incredible. My numbers are all healthy, no longer pre-diabetic, cholesterol is all good, my lungs don’t struggle, my sleep apnea is gone, and there is no longer the strain on my heart.

I started at 506 pounds. Now I weight 245 pounds. With an astounding 261-pound weight loss, I am literally half the man I was, and I owe my success to the team and resources at RMAP. Without them, I may not have even still been around.

Thank you for all the support and care that you offer to your patients. The way you save lives is absolutely life changing. I’m a whole new me!!!

–Justin A.
Surgeon: Dr. Steven C. Simper
Surgery: Gastric Bypass
Surgery Date: 2/2022
SW: 506
CW: 245
TWL: 261

Read more patient stories here.

Interested in learning more about weight loss surgery? Learn more information here.

If you would like to share your weight loss surgery story with others and on Rocky Mountain Associated Physicians (RMAP) other social media outlets, contact Jessica at Jessica@rmapinc.com.

www.RMAP.com
Rocky Mountain Associated Physicians
801-268-3800
1521 East 3900 South, Suite 100
SLC, UT 84124

Susan O.’s Gastric Bypass Story

Sep 25 By rmap nurse

My name is Susan, and I have spent many years of my life gaining and losing weight. I was doing great losing in 2017 when I was diagnosed with breast cancer. I quit dieting to focus on that.

I gained a lot of weight after. I am without a doubt a food addict. I’m currently a six-year cancer survivor. Over the years, my dad suggested bariatric surgery. I said no, because I knew I wasn’t ready to make that kind of lifetime change and commitment. But then in 2023, something changed in me.

I was 345 pounds and in terrible health. I was about to turn 50, and I was a spectator in my life, no longer a participant. I knew in my heart I was ready to change, ready to get my life back. I started the process in May of 2023 to get bariatric surgery. I did all of my insurance requirements and had Gastric Bypass on December 19^th, 2023. I was 345 pounds.

At 7½ months post-op, I’m down 129 pounds so far! I now weigh 216 pounds. My personal goal is 180 pounds. I would be happy with that. My surgeon was Dr. Douglas Greer, and he is awesome. I had a rough first night after surgery, and Dr. Greer explained that I would no doubt at some point have “buyers’ remorse,” because most people do. My first 3 months were rough learning my new stomach, and dumping syndrome sucks, but I finally got the hang of it. I now have no regrets. I feel better than I have in years, and I am once again participating in my life. I do still struggle with body dysmorphia, and I have a lot of loose skin, but I’m so glad I had the surgery.

Surgeon: Dr. Douglas C. Greer
Surgery: Gastric Bypass
Surgery Date: 12/19/2024
SW: 345
CW: 216
TWL: 129

Read more patient stories here.

Interested in learning more about weight loss surgery? Learn more information here.

If you would like to share your weight loss surgery story with others and on Rocky Mountain Associated Physicians (RMAP) other social media outlets, contact Jessica at Jessica@rmapinc.com.

www.RMAP.com
Rocky Mountain Associated Physicians
801-268-3800
1521 East 3900 South, Suite 100
SLC, UT 84124

Heather M.’s Gastric Bypass Story

Sep 18 By rmap nurse

A year ago, I had a small idea of where my life was headed, but I’m not sure I could ever have truly pictured just where my life would be and where I see it heading.

I just celebrated my one-year anniversary of my Gastric Bypass. The surgery that I chose to have. The surgery that has truly changed my life…saved my life! I have a second chance at living the life I have always wanted.

First, let me share what I feel bariatric surgery is NOT:

It is not a quick fix to weight loss problems. It is an invasive and life altering surgery that takes months and, for some even years, to get approved by insurance and the surgeons themselves. Mine took about 5-6 months of jumping through hoops to make sure I was both medically and psychologically ready for what would come after the surgery took place.

It is not the easy way out. A year out and I still have to be careful of what I eat and how much. Sometimes I make the right choices and sometimes I do not. Does that mean I have failed? No. It just means I have to choose differently at my next meal. It also can mean that I may never be able to eat that particular food again, or maybe in time, my body will say “okay, we can have this in small doses.” The fact that my stomach is much smaller does help tremendously in losing weight, but it is not a cure-all in keeping weight off forever.

Bariatric surgery is not a permanent solution. Over time, it is possible to stretch my stomach back out. This is something I am quite scared of having happen, and yes, I have had my moments of eating too much to where I am uncomfortable or even “dumping,” and that worries me. So, I try very hard to be mindful of the amount I eat at each meal, because I have worked far too hard to allow myself to go back to where I was a few years ago.

Bariatric surgery has been the most difficult lifestyle change I have ever made.

Now let me tell you what bariatric surgery IS to me:

It is a chance to take back your life—if you are willing to work HARD! And I mean hard, because this is probably the most challenging thing I have ever been through. Deciding to change one’s entire life—completely—is not some easy feat. You have to put in the work. You also have to surround yourself with people who will support you. Luckily, every person in my life (family, friends, coworkers) all jumped on board and supported me during my crazy new life journey. For that, they have my sincerest and deepest THANK YOU and LOVE!

That being said, this journey is also a real eye opener of who you are surrounded by. I am so very blessed to have a positive support system during this crazy time in my life. Going through something like this isn’t easy, even with a fantastic support system. I cannot even begin to wrap my head around what it would have been like to have not been encircled by people who were not supportive of the path I have chosen.

This process messes with your head. A full year post Gastric Bypass surgery, and 171 pounds off my body, 125 pounds of that is since surgery, and I still have “fat girl” mentality. I still find myself reaching for clothing that is a few sizes too big. Maybe it’s because I’ve always been that big girl hiding under her clothes. Maybe it’s because I’m afraid to be disappointed when I try a smaller size and it doesn’t fit. Maybe I’m just “trained” to grab the larger size. I don’t know, but it messes with your head. I have tried to help myself a bit with this by routinely purging my closet of clothes that are too big. That is as much as my pocketbook will allow, because I cannot afford a whole new wardrobe since I’m still in the process of losing to maintenance.

I also have a very hard time seeing myself getting to what is considered my ideal weight for my height (108-145 pounds), but my sister has that one covered for me. She won’t let me give up on myself. Not saying I won’t try, it’s just hard to wrap your head around that number when you haven’t been that particular weight since you were a kid.

Last, but certainly not least, this has been one of the best things I have ever done. Making the choice to have Gastric Bypass has given me my life back in so many ways. I have more energy to spend doing things with my family. I am able to do things that for MANY years I was unable to do. I have plans for the future that I hope to make happen, if finances allow, that I could have never even contemplated making a reality before this surgery, but now it won’t be my weight holding me back.

At almost 50 years old, my life is just beginning and I am going to enjoy, appreciate, and savor every single moment!

Surgeon: Dr. Steven C. Simper
Surgery: Gastric Bypass
Surgery Date: 8/2023

Read more patient stories here.

Interested in learning more about weight loss surgery? Learn more information here.

If you would like to share your weight loss surgery story with others and on Rocky Mountain Associated Physicians (RMAP) other social media outlets, contact Jessica at Jessica@rmapinc.com.

www.RMAP.com
Rocky Mountain Associated Physicians
801-268-3800
1521 East 3900 South, Suite 100
SLC, UT 84124

Should I Have a Weight Loss Goal Following Bariatric Surgery?

May 29 By rmap nurse

Learn more about weight loss surgery at Rocky Mountain Associated Physicians || www.RMAP.com || (801) 268-3800

One of the most commonly asked questions we receive from patients following weight loss surgery is this: Should I set some sort of weight loss goal before or even right after my procedure? Amidst your journey of researching about surgery types, getting insurance approval, and going through with the procedure of your choice, you might find that you haven’t taken much time to plan for life after surgery. It is common to experience confusion surrounding how much weight is expected to be lost and what can be considered a “healthy weight.”

Generally, we would like to see each of our patients be able to reach and maintain a Body Mass Index (BMI) of less than 35 in the years following their surgery. This can be a great goal to reach for many of our patients since pre-surgery criteria recommends anyone above this BMI to lose weight. Our patients differ in starting BMI and therefore, the amount of weight loss to be achieved will as well. In order to reach this BMI, a certain amount of excess body weight must be lost by each of our patients.

When creating a weight loss goal, it is first important to understand that weight loss will look different for each individual. The amount of weight that can be lost depends on several factors including starting weight, gender, age, genetic factors, dietary choices following surgery, surgical complications, exercise habits, and more. One other important factor to consider is surgery type. The current research data suggests that these are the expected average weight loss trajectories for various procedures:

Duodenal Switch/Traditional (BPD-DS): 80-90% of excess weight loss
Duodenal Switch/Sadi (SADI-S): 80-90% of excess weight loss
Gastric Bypass Rou-en-Y (GBP): 70-75% of excess weight loss
Gastric Sleeve (SLEEVE): 60-70% of excess weight loss

Another important aspect of both setting and reaching any weight loss goal is to strive for healthy dietary patterns and lifestyle choices following your surgery. This can make a different in your ability to lose additional weight and keep it off in the long term. If you can stick to the common recommendations of 70% protein and 30% vegetables, and strive to move 30 minutes each day, then you can expect to see more promising results than those who do not. Overall, it is important to realize that your weight loss goal and results based on that goal will be different than others. If you choose to set a weight loss goal, we will continue to support you in any effort we can!

Links to related articles:
Hunger Between Meals
Tips to Help with Hunger
Weight Regain: Living with Fear and Dread

www.RMAP.com
Rocky Mountain Associated Physicians
801-268-3800
1521 East 3900 South, Suite 100
SLC, UT 84124

Recognizing Your Hunger Signals: Is It Actual Hunger?

Mar 25 By rmap nurse

Learn more about weight loss surgery at Rocky Mountain Associated Physicians || www.RMAP.com || (801) 268-3800

Regrettably, weight regain can happen after bariatric surgery. It’s actually quite common! Just know that if you have experienced weight gain, you are not alone. Many people fall back into old habits or find themselves still tempted by foods you know won’t help you reach or maintain your goal weight.

Fortunately, with a little help and willpower—as well as determination and commitment—there are ways you can develop a more deliberate mentality and stay on track with your dietary choices. People who tend to “fall off the wagon” or mindlessly consume unhealthy meals routinely, should stop and take a moment to ask themselves these questions first:

Are you physically hungry? If you are physically hungry, there will be true hunger cues to look for. Such as stomach growling, low energy, shakiness, headaches, and problems focusing.
Are you angry or stressed with someone or a situation? There really is such a thing called stress eating. When upset or stressed, people tend to turn to food to relieve those emotions. The nervous system sends signals to the adrenal glands on top of the kidneys to pump out adrenaline (also known as epinephrine). This hormone helps trigger the body’s fight or flight response—a supercharged physiological response that puts delays eating. But if these upset or stressed feelings persist, another hormone called cortisol is released as well, which motivates to eat. Cortisol levels should decrease once the stressful or angry episode is over, but if those feelings don’t go away, cortisol stays elevated.¹
Are you actually bored? When people are bored, studies have shown that we attempt to distract ourselves from boredom with food.² Boredom snacking in between meals leads to consuming more food than your body needs, which sequentially, turns to weight gain.
Are you emotionally eating? Emotional eating is “eating as a way to suppress or soothe negative emotions, such as stress, anger, fear, boredom, sadness and loneliness.” Fore most, turning to food to cope with emotional eating creates guilt and shame—more hard feelings to navigate.

Misinterpreting Hunger Cues

Listening to your body’s natural cues helps you become more well informed and mindful of what your body really needs. Pay attention to the types of foods you are eating and the amount. Sugary, high saturated-fats, and processed foods aren’t filling, and you will find yourself hungry faster than should you eat unprocessed foods that are high in protein and fiber.

Hunger Vs. Thirst

It may be possible that you are misinterpreting your body’s thirst signals as hunger. Our bodies send the same signal when we are hungry or thirsty, so before you go snacking, try drinking some water and staying well hydrated throughout the day. You should be drinking a minimum of 64 ounces of water daily.

Eating Regularly

Life can get hectic, and it’s true! It’s easy to either forget a meal, or skip a meal simply because of not being prepared. Skipping meals—intentionally or not—often results in being starving later, which can make you more likely to make poor food choices and/or to overeat. Ensuring that you are eating three meals a day is important to keep your energy up so your body performs the tasks of daily living.

Keep Snacking Healthy

Sometimes you do need a little snack in between meals, and that’s okay! Snacks can help manage hunger, stabilize blood sugar, and energize you. Keep your snacks focused on protein and veggies. Eating salty or sweet snacks can make you bloated and hungry faster, and ultimately lead to weight gain.

Overtime you will notice patterns and discover your personal body cues once you get into the habit of listening to your body. It can be a slow process, ending an old habit, but it’s not impossible. Perfection is never the goal, especially at the beginning.

Links to related articles:
Hunger Between Meals
Tips to Help with Hunger
Weight Regain: Living with Fear and Dread

www.RMAP.com
Rocky Mountain Associated Physicians
801-268-3800
1521 East 3900 South, Suite 100
SLC, UT 84124

Resources:

Harvard Health Publishing, “Why stress causes people to overeat”; Harvard Medical School; https://www.health.harvard.edu/staying-healthy/why-stress-causes-people-to-overeat
Andrew B. Moynihan, Wijnand A.P. van Tilburg, Eric R. Igou, Arnaud Wisman, Alan E. Donnelly, and Jessie B. Mulcaire; “Eaten up by boredom: consuming food to escape awareness of the bored self.”; 2015 Apr. 1. Doi: 10.3389/fpsyg.2015.00369; https://www.ncbi.nlm.nih.gov/pmc/articles/PMC4381486/

Rediscovering Success: Navigating Weight Loss after Bariatric Surgery Setbacks

Feb 27 By rmap nurse

Learn more about weight loss surgery at Rocky Mountain Associated Physicians || www.RMAP.com || (801) 268-3800

Bariatric surgery is a life-changing procedure, a powerful tool to achieve significant weight loss and improve overall health. However, it’s important to acknowledge that the journey doesn’t end with the surgery itself. Life changes, circumstances shift, and sometimes, weight regain becomes a reality several years post-surgery. Through 20 years of bariatric surgery practice, I have observed that significant challenging life events can often be linked to weight regain. These challenges may include a job change, a death in the family (or significant loss of any kind), a car accident, or any event that limits physical abilities. This article aims to guide individuals through the process of reclaiming control over their weight and fostering a healthier lifestyle after facing setbacks.

Understanding Weight Regain

Weight regain after bariatric surgery is not uncommon, and there are various factors that contribute to this challenge. These factors include metabolic changes, lifestyle choices, psychological factors, and hormonal fluctuations. In fact, it’s good to remember that some amount of weight gain reaching one’s lowest weight after surgery is actually normal. If you recall from our pre-operative classes, we review the normal weight loss trajectory following bariatric surgery.

Most people reach their lowest weight 1-2 years after surgery and then re-gain about 15-20% of the weight they lost over the next 2-4 years. Beyond 6 years from surgery, our research indicates that the average weight loss across thousands of patients remains relatively stable, but individual variation definitely occurs. Life throws us curveballs–like the stressful events just mentioned—and they can happen at any time postoperatively. It’s crucial to approach weight regain with compassion and a willingness to explore the root causes before embarking on a new weight loss journey.

Reassessing Dietary Habits

One of the fundamental aspects of post-bariatric weight loss is reassessing and adapting dietary habits. After surgery, the stomach size is reduced, and certain foods may become difficult to tolerate. The inability to tolerate certain foods may be due to dumping syndrome, texture of the food, or simply a loss of appetite or “craving” that food. For foods that are high in sugar or carbs, this is a good thing as it promotes weight loss and aversion to these less nutrient dense foods.

However, over time, your body’s hormones may adapt, your gastric pouch or sleeve may often soften to allow a greater amount and variety of food to pass through, and old habits can creep back in. A good way to begin is by consulting with a registered dietitian or nutritionist to create a personalized meal plan that aligns with your surgery and addresses your specific nutritional needs. Those types of visits can be arranged through our office with Juliana (dietitian) or one of our nurse practitioners: Lissa Hutchings, Stacy Parry, or Elizabeth Hanna, who can help get you back on track. If you still have your blue binder, aka the “RMAP bible”, refer to it again to revisit early dietary instructions to help get started.

Focus on Protein Intake

Protein is a vital component for post-bariatric patients, as it supports muscle preservation and helps with satiety. Reevaluate your protein intake and ensure that it meets the recommended levels. We typically advise that during the first year after surgery, about 70% of your meal should be protein based. After the first year or achieving your weight loss goal, at least 50% of your meal should be protein based, but there is no harm in continuing the 70% protein level. Obtaining at least 1 gm of protein per kilogram (or 2.2 pounds) of body weight is a good goal. Include lean sources of protein such as poultry, fish, tofu, and legumes in your meals. Protein supplements may also be considered, but it’s essential to consult with healthcare professionals before incorporating them into your routine. We prefer wholesome naturally occurring protein foods, but protein shakes or supplements may be used if protein intake is otherwise very challenging.

Mindful Eating Practices

Practicing mindfulness during meals can significantly impact your relationship with food. Slow down, savor each bite, and pay attention to your body’s hunger and fullness cues. Avoid distractions like watching TV or using electronic devices while eating. This approach fosters a greater awareness of portion sizes and helps prevent overeating. Before eating, especially snacking, ask yourself, “Am I truly hungry?” Sometimes the answer will be “no”. If that’s the case, put off eating until a normal meal time or you are actually hungry. Try drinking water instead of eating. If you truly are hungry and you’re between meals, have a healthy protein-based snack available like a piece of string cheese, handful of nuts, or beef jerky.

Recommitting to Physical Activity

Regular physical activity is a key component of maintaining weight loss and overall well-being. Engage in activities that you enjoy and that align with your fitness level. Begin gradually and aim for a mix of cardiovascular exercises and strength training. We typically recommend aiming for 3 hours a week of physical activity. This may include a brisk walk, a jog or run, swimming, or cycling for cardiovascular activity, and strengthening activities like pushups, sit-ups, yoga, or lifting weights. Key features of your exercise routine are sustainability and consistency, so choose activities that you LIKE to do.

Seeking Emotional Support

Weight loss journeys are not solely physical; they also involve emotional and psychological components. It’s essential to address any emotional triggers or challenges that may contribute to weight regain. Consider seeking support from a mental health professional, joining a support group, or connecting with individuals who have undergone similar experiences. Our support groups at Rocky Mountain Associated Physicians offer a good starting point, and participation is free to those who have had surgery with us. Our patients also may seek individual counseling/therapy for a deeper dive into psychological triggers and solutions. Emotional well-being is integral to sustained weight loss success.

Role of Weight Loss Medications

As many people are aware, the FDA has recently approved more powerful weight loss medications such as semaglutide (Ozempic, Wegovy), and tirzepatide (Mounjaro, Zepbound). These drugs target a digestive hormone called glucagon-like polypeptide (GLP-1) that plays a key role in metabolism and weight control. Ozempic and Mounjaro are approved by the FDA for type 2 diabetes, but they have been used off-label for weight loss by some health care providers. The FDA recently approved these drugs under different brand names (Wegovy and Zepbound) specifically for weight loss. These medications may be costly depending on insurance coverage and/or in short supply, and they may have side effects such as nausea and vomiting. Nevertheless, they may be very helpful tools in helping patients re-lose weight after regain following bariatric surgery, especially in cases where earnest dietary and exercise changes have been consistent. We have two providers in the office, Stacy Parry and Elizabeth Hanna, who are available to see patients for medical weight loss after bariatric surgery.

When to Consider Revision Bariatric Surgery

This article primarily aims to address accessible and low-risk ways to reduce weight after regain following bariatric surgeries. Indeed, most patients are not anxious to have a second or third procedure for weight loss. With that said, revision bariatric surgery may be a reasonable option for some patients, including those whose BMI is above 40, or for those who may have (re)developed a major weight related problem, such as type 2 diabetes, high blood pressure, obstructive sleep apnea, or high cholesterol, despite maximizing efforts at diet, exercise, psychological health and medications.

At our practice, about 80% of our surgeries are primary bariatric surgeries, and 20% are revision surgeries. It is important to bear in mind that revision bariatric surgery typically involves more risk and less predictable benefits than primary weight loss surgery, which is why we encourage our patients to address diet, exercise, psychological health, and medications before seeking revision bariatric surgery for weight gain. Nevertheless, in some cases, it may be favorable to add metabolic power to a previous bariatric procedure through revision bariatric surgery.

For example, a gastric band can be removed and converted to a Sleeve, Gastric Bypass, or Duodenal Switch. A Sleeve can be converted to a Gastric Bypass—especially if severe reflux is a problem—or more commonly to a Duodenal Switch, which is a more powerful option to address significant weight gain after Sleeve. Finally, a Gastric Bypass can be converted to a Duodenal Switch, which is a more complex revision surgery. For complex revisions, we typically spend extra time going over risks and benefits to make a sound decision about whether benefits of revision surgery outweigh risks. Some insurance plans do not cover revision bariatric surgery for weight gain, so you may need to check with your plan or with our office to determine your insurance benefit.

Conclusion

Embarking on a weight loss journey after experiencing setbacks post-bariatric surgery requires a holistic approach that encompasses nutrition, physical activity, and emotion well-being. Remeber that each individual’s journey is unique, and there is no one-size-fits-all solution. Approach the process with patience and resilience. As a practice, we are here to provide support as you tackle this challenge. With commitment and the right strategies in place, it is possible to regain control of your weight and rediscover success on your post-bariatric journey.

About the Author:
Dr. Rodrick D. McKinlay, MD, FACS, joined Rocky Mountain Associated Physicians (RMAP) in 2004 as a board-certified surgeon with expertise in minimally invasive or laparoscopic surgery. In addition to the surgical treatment of obesity, his practice involved a wide range of minimally invasive gastrointestinal surgery, including hernia repair, gallbladder removal, anti-reflux surgery, and the surgical treatment of the spleen and adrenal disorders.

www.RMAP.com
Rocky Mountain Associated Physicians
801-268-3800
1160 East 3900 South, Suite 4100
SLC, UT 84124

The Connection Between Sleep and Weight

Mar 1 By rmap nurse

Learn more about weight loss surgery at Rocky Mountain Associated Physicians www.RMAP.com (801) 268-3800

It is well known that losing weight—or regain after bariatric surgery—is hard. Keeping weight off and maintaining can be just as challenging. There are few studies out there in the medical community still trying to straighten out the connections between sleep and weight, but there are some which emphasize the potential weight loss benefits of a good night’s sleep and negative health impacts of sleep deprivation.

New research suggests that adults who are better rested consume significantly fewer calories than those who are chronically sleep-deprived. A study published by JAMA Internal Medicine finds that people who sleep less consume more calories and foods that are high in calories. This is compared with people who sleep for longer periods.¹

The study concludes with the participants who slept an hour longer each night consumed an average of 270 fewer calories each day and lost about a pound compared to control group participants, who gained just under a pound on average.

The Link Between the Stomach and Your Appetite

True or false: Your appetite is linked to your stomach. Answer: False. Your appetite is actually controlled by the neurotransmitter’s ghrelin and leptin, not your stomach. The hormone ghrelin promotes hunger and increases appetite. The hormone leptin contributes to the sensation of feeling full. The body will naturally increase and decrease the levels of these neurotransmitters throughout the day, signaling the need to consume calories.²

Obesity and Sleep Deprivation

Depending on the cause, chronic sleep disruptions increase the risk of high blood pressure, heart attack, stroke, and irregular heartbeats.³

Past studies show that people who get less than 6 hours of sleep at night are more likely to be diagnosed as obese, though it’s difficult for these studies to determine cause and effect.⁴ Obesity in itself can cause an increase risk of developing conditions that interfere with sleep, such as sleep apnea. Though it’s unclear if not getting enough sleep is the cause of obesity, and/or if obesity is causing people to sleep less. Commonly, sleep-deprived individuals tend to choose foods that are high in calories and carbohydrates.⁵

Sleep and Losing Weight

Research shows that not getting enough sleep while trying to lose weight can sabotage the amount of weight lost and encourage the tendency to overeat.⁶ When treating obesity in adults, medical experts encourage improving sleep quality.

Sleep and Physical Activity

When you aren’t getting enough sleep, it can result in having less energy for exercise and physical activity. Exercise is essential and necessary to maintain weight loss and overall health. For example: walking, running, weightlifting, dancing, swimming, sports, etc. Listen to your body to see what time of day works best for you when working out in response to how well you sleep. For some individuals, exercising too late in the day can interfere with how well they rest at night.

Ways to Help Improve Sleep

It’s important to try and get adequate sleep, as well as quality sleep, as part of a healthy weight plan. Here we have put together some tips and suggestions that could help improve your sleep:

Keep to a regular sleep schedule
Sleep in a dark room; purchasing blackout curtains can help with blocking out light and noise
Don’t eat right before bed
Reduce stress
Become an early bird
Keep a sleep log
Monitor sleep times with wrist actigraphy devises such as smartwatches
Limit use of electronic devises at least 1 hour before bed
Turn temperature to a comfortable number
Exercise regularly

Healthy Looks Different for Everyone

Remember that good health and healthy looks and feels different for everyone. Health is a lifelong journey that includes not only healthy habits and eating nutritious foods, but by also having a healthy relationship with your body. Work closely with your doctor’s guidance, as well as keeping your own personal decisions in mind.

www.RMAP.com
Rocky Mountain Associated Physicians
801-268-3800
1160 East 3900 South, Suite 4100
SLC, UT 84124

Resources

Esra Tasali, MD, Kristen Wroblewski, MS, Eva Kahn, MS, et al Jennifer Kilkus, MS, RDN, Dale A. Schoeller, PhD, “Effect of Sleep Extension on Objectively Assessed Energy Intake Among Adults with Overweight in Real-life Settings”, JAMA Intern Med., 2022; 182(4):365-374. Doi:10.1001/jamainternmed.2021.8098, https://jamanetwork.com/journals/jamainternalmedicine/fullarticle/2788694
Karine Spiegel, Esra Tasali, Plamen Penev, Eve Van Cauter, “Brief Communication: Sleep Curtailment in Healthy Young Men is Associated with Decreased Leptin Levels, Elevated Ghrelin Levels, and Increased Hunger and Appetite”, Ann Intern Med., 2004 Dec 7; 141(11):846-50, doi: 10.7326/0003-4819-141-11-200412070-00008, https://pubmed.ncbi.nlm.nih.gov/15583226/
“Losing Weight, Especially in the Belly, Improves Sleep Quality, According to a John Hopkins Study”, https://www.hopkinsmedicine.org/news/media/releases/losing_weight_especially_in_the_belly_improves_sleep_quality_according_to_a_johns_hopkins_study
Yili Wu, Long Zhai, Dongfeng Zhang, “Sleep Duration and Obesity Among Adults: A Meta-analysis of Prospective Studies”, Sleep Med, 2014 Dec; 15 (12):1256-62, doi: 10.1016/j.sleep.2014.07.018, https://pubmed.ncbi.nlm.nih.gov/25450058/
Stephanie M Greer, Andrea N Goldstein, Matthew P Walker, “The Impact of Sleep Deprivation on Food Desire in the Human Brain”, Nat Commun, 2013;4:2259, doi: 10.1038/ncomms3259, https://pubmed.ncbi.nlm.nih.gov/23922121/
Marie-Pierre St-Onge, Andrew McReynolds, Zalak B Trivedi, Amy L Roberts, Melissa Sy, Joy Hirsch, “Sleep Restriction Leads to Increased Activation of Brain Regions Sensitive to Food Stimuli”, Am J Clin Nutr, 2012 Apr;95(4):818-24, doi: 10.3945/ajcn.111.027383, https://pubmed.ncbi.nlm.nih.gov/22357722/

Daniel R.’s Gastric Bypass Story

Feb 8 By rmap nurse

My journey started earlier in the year when I ended up at the ER for high blood pressure. I wasn’t feeling good and went to urgent care, and my blood pressure was at 299, so they sent me to the ER where I spent the night. After that, I set up an appointment to establish a regular doctor.

On the first visit, the doctor said with my weight, sleep apnea, prediabetes, and high blood pressure, that he recommended weight loss surgery. I told him I had already considered that and was looking into going to Mexico to do it. He told me that a lot of insurances cover [weight loss surgery] if it was medically necessary, and so I put in my paperwork with his recommendation. Part of that was to lose weight on my own first, which I lost 40-ish pounds in about a month. I saw a dietician and psychologist at St. Mark’s and then I got approved. I was super excited and nervous. I wanted to better my health so I can be around longer for my son, Daniel Cruz.

I finally got my surgery date, and a week before, my wife and I found out we were expecting a second child! That just backed up my decision even more that I was doing the right thing.

The week right after surgery, I ended up at the ER twice because my blood pressure dropped down to 43 and got severely dehydrated. I tried my hardest to stay hydrated, but it is very difficult to consume water for the first few weeks. It gradually got easier. At that point, I got taken off all my medicine and no longer needed my sleep apnea machine to sleep. I no longer snore while sleeping either! I only take my multivitamins and calcium chews!

I quickly started losing lots of weight and dropping sizes in clothes. Before I knew it, I went from using 5XL shirts and size 50 jeans to my current L-XL shirts and size 34 jeans. I can sit and put one leg on top of the other, which I had not done for over 20 years!

I also started being able to go on long walks and not be suffocating trying to catch my breath. I have been implementing better behaviors for my son as well.

I really enjoy playing with my children and being able to do more activities with them that I was not able to before. It’s always crazy and fun seeing people I had not seen for a long time, and seeing their reaction to my drastic changes.

For me, the only complications I had was the first week post-surgery, like I mentioned before. Besides that, I have been very blessed and lucky with my results. My goal the first year was to lose 150 pounds, and I hit that goal. This year, I am trying to lose another 30-50 pounds so that I can do skin removal surgery, then I want to get back into bodybuilding like I did when I was fresh out of high school!

There are times when I feel like I don’t recognize the person I see in the mirror, but inside, I am the same person, but better and healthier than before my surgery.

–Daniel R.
Surgeon: Dr. Rodrick D. McKinlay
Surgery: Gastric Bypass Roux-en-Y
Surgery Date: 12/13/21
HW: 433
SW: 397
CW: 253
TWL: 144

Read more patient stories here.

Interested in learning more about weight loss surgery? Learn more information here.

If you would like to share your weight loss surgery story with others and on Rocky Mountain Associated Physicians (RMAP) other social media outlets, contact Jessica at Jessica@rmapinc.com.

www.RMAP.com
Rocky Mountain Associated Physicians
801-268-3800
1160 East 3900 South, Suite 4100
SLC, UT 84124

Bariatric Surgery Aftercare

Jan 11 By rmap nurse

Learn more about weight loss surgery at Rocky Mountain Associated Physicians www.RMAP.com (801) 268-3800

The surgeons and staff here at Rocky Mountain Associated Physicians (RMAP) want to see our patients achieve their goals, as well as have a lifetime of success with their new tool and healthy behaviors we have educated them on. We seek to be a partner in your journey for health, not just for the first year of weight loss, but for life. This could be means of annual bloodwork, support groups, continuing education of the bariatric world, and annual follow-ups. We want to help keep you on track and provide a place for you, our patients, for when you feel overwhelmed. Bariatric surgery is life changing, and it will change your way of living for the rest of your life!

Your follow-up care with us is important! It is to help us monitor your health and weight status, but also assist you in establishing patient-selected incremental goals as well as long-term goals.

There are numerous reasons as to why you should continue to follow-up with your surgeon and bariatric clinic after weight loss surgery. Here we have listed three of the top reasons why:

Annual Bloodwork: Bloodwork is important after bariatric surgery so that we can monitor your vitamin levels and overall health. We can see if anything looks amiss, causing unusual symptoms you might be experiencing, any deficiencies developing, or the reason why some unexplained or unwanted weight loss or gain could be happening.

We have our patients do annual bloodwork every year after surgery. Your family physician or our office can order them once to two weeks before your annual visit. The tests you need are:

Comprehensive Metabolic Panel
Lipid Profile
CBC with diff
Vitamin B-12 level
Thiamine (Vitamin B1) level
Folate
Hemoglobin A1c

***You must be fasting 6 hours prior to blood draw.

Duodenal Switch patients
Get all of the labs listed above PLUS

Vitamin A level
Vitamin D level
Protime

Mail or fax a copy of these tests to our office. The tests will be reviewed by your surgeon and placed in your chart. Fax number: (801) 268-3997.

Keeping You on Track: After the weight loss stage, it can be easy to lose focus of the guidelines and education materials we have provided for you. Understanding that the necessary adjustments to your present behaviors are yours to make, we are here to help in any way we can! Having someone else following your achievements and setbacks could help you stay on track with your weight loss results and maintenance goals. We could provide education and our professional advice if you find yourself straying, getting off track, or becoming overwhelmed with the anatomy changes of weight loss surgery.

Your Overall Health: In addition to getting bloodwork done annually, our surgeons and medical staff members like to follow our patients to continue monitoring their health in general; the positives—no more CPAP, remission of diabetes, doing activities you were unable to do before—but also the complications that can occur after surgery—vitamin deficiencies, gas, diarrhea, bowel blockage, hernias, excess skin. Additional testing could be necessary after surgery, so keeping your follow-up appointments with us is essential.

Post-Op Visits

You should schedule an appointment to see your surgeon/assistant for follow-up visits at:

3-4 weeks (scheduled at the time of your surgery orientation class)
2 months
4 months
6-8 months
1 year or additionally as requested by your surgeon
Annually thereafter

Bariatric surgery is undoubtedly a major lifestyle change, and it takes strong determination and commitment to have long-term success. Your surgeon, nurses, and health staff are your unified team with your best interests in mind. We want you to reach improved health and experience an enriched quality of life. We want to be a partner in your health and along for your weight loss journey.

Keep in contact with us, and attend the weekly support groups we provide for our patients regularly.

www.RMAP.com
Rocky Mountain Associated Physicians
801-268-3800
1160 East 3900 South, Suite 4100
SLC, UT 84124

Pre-Op Tips for Bariatric Surgery

Justin A.’s Gastric Bypass Story

Susan O.’s Gastric Bypass Story

Heather M.’s Gastric Bypass Story

Should I Have a Weight Loss Goal Following Bariatric Surgery?

Recognizing Your Hunger Signals: Is It Actual Hunger?

Rediscovering Success: Navigating Weight Loss after Bariatric Surgery Setbacks

The Connection Between Sleep and Weight

Daniel R.’s Gastric Bypass Story

Bariatric Surgery Aftercare

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