#bariatricsurgery – Welcome to MillaPhatLife's Blog

Low-Calorie Diet (LCD) Before Bariatric Surgery

Although reducing body weight before any surgery is generally a good way to decrease risks associated with surgery, particularly with general anaesthesia, rapid weight loss has another crucial effect beneficial to bariatric surgery (or other abdominal surgery). It will reduce fat and glycogen stores around the liver, making it smaller and softer to work around; therefore, Low Calorie Diet (LCD) is often synonymously known as a Liver Shrinking Diet.

There are a few different ways to go about the pre-op LCD, and the tricky part is to ensure you maximise the nutritional quality of whatever method you use. The chemist, health shop and well-stocked supermarkets usually offer a variety of meal replacement drinks and products that are nutritionally complete. And, of course, many are also available online. Thus, in practical terms, LCD drinks can be easier to ensure you receive the nutrients you need and track your calorie intake to ensure it doesn’t exceed 1000 kcal a day.

The length of time you need to be on an LCD before surgery varies depending on your Body Mass Index (BMI); your consultant will discuss this with you. Generally, if the BMI is at the higher end of the obesity range, your LCD period will be longer than when the BMI is in the lower range. For example, my BMI was 50+++, so my consultant asked me to do an LCD for 4-5 weeks.

I am not going to lie – I was dreading it. Before starting the LCD, I purchased several different products, including Slim Fast drinks and HUEL shakes, and I could not stand any of them or any flavour. And the thought of not chewing for five weeks didn’t appeal to me. So, therefore, I opted for a food based diet, counting calories.

The first few days were awful; the expression ‘hangry’ really applied, but it appeased after 4-5 days and felt much more manageable. The experience was completely different from any other time I’d gone on a diet, this was hard, but psychologically it was easier as it helped to know there was a definite end to it. Also, I’m not planning to ever go on a calorie-restricted diet again as long as I live. I actually relished the challenge of the LCD, and it was encouraging to know I would have better tools to manage overeating after the surgery. My body would work with me rather than against me. Of course, post-surgery, you must adapt to making better and healthier food choices. But the great thing is that there are no ‘forbidden’ foods in principle. Nevertheless, some foods can be more challenging to consume, particularly in the first few months, and you should avoid highly sugary and fatty foods.

A comforting thought, for me at least, is that it is not like you can’t ever have another piece of chocolate again (I’m a recovering chocoholic 😉). However, you won’t be able to eat much of it, as consuming too much sugar or fatty food can cause dumping*. The beauty of bariatric surgery is that your body will draw your appetite towards healthier, more nutritional food. Basically, the signals between the gut and the brain will be rebooted, upgraded even. It will be easier to understand what your body needs rather than trying to decode corrupted messaging about false appetites and cravings. However, it is probably a good idea to mention that getting used to this ‘new system’ can take some time. You may need up to 12 months to adjust to this new system and adapt to new habits. Because your food preferences will likely change, and you will need to eat smaller portions and more regularly throughout the day, you will need time to implement these changes.

I lost 12kg during the LCD, which was the target the consultant had set for me. Since I was having my surgery abroad and would be staying in Sweden for the duration of my recovery, I was very busy at work leading up to travelling. In addition, I worked from home, so I had only rotated a few different pieces of clothing and not worn many different clothes during the LCD before travelling. When I arrived in Malmö, in the south of Sweden, before my surgery, I changed into clothes I’d not used since the previous winter and found that most of the items I’d brought were extremely loose already. This was a big contrast to my previous experience, where I’d put on clothes I’d not worn for a while, only to find that they were too tight.

That was where my weight loss journey started to kick off. I am currently 13 weeks post-op, and the weight is effortlessly coming off at a steady pace. The enjoyment is that I am not ‘on a diet’.

Before signing off, I would like to emphasise again that using an LCD as a quick way to lose weight is not recommended unless supervised by a health professional. The risks of malnutrition and corrupting your metabolism will likely lead to regaining the weight again and even promote additional weight gain. To understand why dieting is problematic, particularly in people who have been chronically overweight or those living with obesity, please (re)visit my featured blog (Mis)Understanding Obesity.

*” Dumping syndrome occurs when food, especially sugar, moves too quickly from the stomach to the duodenum—the first part of the small intestine—in the upper gastrointestinal (GI) tract. This condition is also called rapid gastric emptying.”

“Dumping Syndrome.” Wikipedia, Wikimedia Foundation, 24 February 2023, en.wikipedia.org/wiki/Dumping_syndrome.

Navigating the Road To Bariatric Surgery – Part 2 (2)

After fifteen months, which felt like forever, from talking to the GP (General Practitioner), completing a 12-month Healthy Weight (HW) programme and finally meeting the NHS (National Health Service) specialist bariatric consultant, I decided to seek private treatment.

The fifteen months leading up to my decision to do that was challenging. When I first decided to go for weight-loss surgery, I felt elated; however, simultaneously, my sister was seriously ill with lung cancer. Then, five months later, my sister died. After that, life did not feel the same. I was, and still am, grief-stricken. When you lose a loved one, it is natural to question and re-evaluate your beliefs and priorities in life. But, although I had already started taking action to pursue bariatric surgery, my sister’s passing strengthened my conviction. I knew I’d made the right decision to get help to optimise my future health.

A parent is not supposed to bury their child, regardless of age. It is not in the correct order of life. My dad passed away years ago, so I wanted to be there for my mum. I live in London in the UK, but I was born and grew up in Stockholm, Sweden, where my mum still lives. One good thing as a result of the pandemic was that many organisations figured out how people can effectively work from home. It meant I could work remotely and be with my mum for a couple of months.

A few days after losing my sister, I encountered another obstacle while preparing to travel to Stockholm. I went to a regular weigh-in as part of the HW programme, where I told them I was going abroad. Apart from the weigh-ins’, I’d had all my therapy-, dietician- and activity coach sessions over the phone. As we were in the middle of the pandemic, the guidance also stated that if you were uncomfortable attending in person, you could weigh yourself at home and report it back to the HW practitioner. So, I hadn’t expected any issues to arise with me going abroad for a period. Instead, they told me I would have to start again when I returned to the UK – I was three months into the programme at that point. They said they wouldn’t treat me while abroad. I was FUMING! It didn’t make any sense. How I managed to keep my composure, I don’t know, but I did. Instead, I asked if they could make an exception since I’d suffered a family loss. They were going to check with a supervisor and come back to me. I left and sat in my car in the clinic’s car park, bawling my eyes out.

After 15 minutes of tears running down my face and an emotional phone call to my mum, I made my way home. As I pulled up outside my house, my mobile phone rang; as promised, the HW practitioner had checked with the supervisor, and everything was fine. I would not need to start again when I returned to London, and the treatment would continue while I was away as it had – over the phone. I could have done without the upset and the stress of it, though.

To receive weight-loss surgery treatment through the NHS in the UK can be difficult and seemingly unnecessarily so. The process patients must go through is agony when they already fit the criteria set by the NHS. Having weight loss surgery is not a quick fix, nor should it be looked upon as some kind of cosmetic vanity surgery. It is a medical procedure that will save lives and ultimately costs by reducing the development of comorbidities. Weight loss surgery will have a significant impact on a person’s life, both physical and emotional. Thus, I would argue that the format of the HW programme would be much more beneficial as a post-surgery resource. Any necessary pre-surgery preparation can be covered solely by the services at the bariatric clinic. It seems redundant that a GP cannot refer a patient directly to a bariatric specialist; since, at that point, the GP should have established that the patient’s previous attempts to lose weight have been unsuccessful.

The list below outlines the criteria for when weight loss surgery is available on the NHS:

you have a body mass index (BMI) of 40 or more, or a BMI between 35 and 40 and an obesity-related condition that might improve if you lost weight (such as type 2 diabetes or high blood pressure)
you’ve tried all other weight loss methods, such as dieting and exercise, but have struggled to lose weight or keep it off
you agree to long-term follow-up after surgery – such as making healthy lifestyle changes and attending regular check-ups

People who might benefit from bariatric surgery don’t know it is a viable treatment option. Many don’t even seek help from their healthcare provider because of the stigma attached to fatness. Instead, they join a weight loss club or start a diet plan based on calorie reduction and exercise to burn more calories. When the diet and exercise plan collapses, people put the ‘failure’ down to poor character. Because this is what society tells us, fat people are lazy, lack discipline and eat nothing but unhealthy foods. Fat phobia is living large in the UK (and across the world).

Another problem, and it is a huge one, is that knowledge about effective obesity treatment is still lacking among health practitioners. They are still harping on with the ‘eat less, move more’ approach, which has proved ineffective for most obese patients. Also, keep in mind that health professionals are not immune to the deep-rooted misconception about fatness and the impossible societal beauty ideals. More importantly, they are not necessarily well-educated in the complex factors causing obesity, such as abnormal regulation of energy balance (which is influenced by genetics, hormones, etc.). Energy balance is not as simple as the balance between calories consumed and energy expenditure (basal metabolic rate^(*) + physical activity), which is the driving concept of ‘eat less, move more’.

When excessive weight is sustained over an extended period, the chances of shaking it off and maintaining weight loss with diet and exercise become slimmer (excuse the pun). The ‘set point’ theory explains how your body fights to maintain the elevated weight, making it nearly impossible to sustain a significant weight loss achieved by a calorie-controlled diet. Yet, surprisingly, the set point theory is not public knowledge or widely known within the health profession (or industry) outside of metabolic/bariatric specialists.

Your body is very clever, but it has not adapted to the relatively recent increase in food availability over the last 40-50 years; its instinct is survival. Throughout human history, the body has negotiated survival in a state of starvation (for thousands of years) more than in an environment of abundant food availability. Hence, it’s not surprising the body is protecting the excess – it’s conditioned to build a reservoir in case of future scarcity. Also, the body doesn’t care what it looks like.

Despite the 30 minutes of upset where I thought I would have to restart the 12-month HW programme, I persevered. Just a couple of days before I travelled to Sweden, I met with the regional specialist consultant assigned to the HW programme to provide guidance and assess your suitability for surgery. Taking my knowledge and experience into account, I found that talking to a bariatric consultant was probably the most helpful element of the 12-month programme. Fast forward ten months, when I had completed the HW programme, I sat in the same consultant’s clinic in a South London Hospital on a beautiful August morning. That’s when I received the gut-wrenching news that the current waiting time for surgery was 3 to 5 years.

That afternoon, I called a well-renowned clinic in Stockholm, which referred me to GB Obesitas in the south of Sweden. This was when I experienced a fundamental shift, and things started moving at my preferred pace (‘make it happen now’). The most amazing nurse called me in response to a brief email explaining my circumstances. I had comprehensive information sent to me backing up what the nurse had outlined to me over the phone. It can be overwhelming to receive a lot of information in one go, so the guidance notes were beneficial as I could revisit the guidance when needed. Finally, we booked a date for surgery in November 2022.

The ball really got started rolling from there on. I attended an online information group meeting, a 1:1 consultation with the bariatric consultant, did blood tests through my GP surgery in London, emailed the results to the clinic nurse, and then started the pre-op diet. I will tell you more about the pre-op diet in a separate post.

I was excited that I finally had a date for surgery. From the beginning, I had been pretty set on having gastric sleeve surgery, which I had discussed with the consultant in London. However, after talking to the consultant in Sweden, I changed my mind. By their recommendation, I decided to have a gastric bypass instead. Both surgeries are very effective, but the bypass generally generates more significant weight loss, approximately 80% of the excess weight compared to 70% with a sleeve. Thus, the bypass is generally a better option for someone like me with a very high BMI and you have more weight to lose. Ultimately, that was the deciding factor for me to choose gastric bypass surgery over a gastric sleeve.

If you are considering bariatric surgery, do your due diligence and research which surgery might suit your circumstances best. For example, if you already have acid reflux problems, it can get worse after gastric sleeve surgery, and it is also something that might start to occur even if you haven’t suffered from it before. Also, smoking can cause ulcers after bariatric surgery – especially with a gastric sleeve. Finally, among the side effects of gastric bypass is bowel obstruction which would require another surgery.

All this is due to the difference in post-surgery anatomy and not the surgeon’s skill level. Discuss your preference with your consultant but be receptive to their professional recommendation. After all, you want to achieve the best possible long-term health outcomes.

You might find the YouTube video below helpful in your research, where the American doctor John Pilcher explains how the two different surgeries work and the difference between the two (gastric sleeve and gastric bypass).

I wish you great success and all the best if you are about to set off on a journey exploring bariatric surgery.

All is well.

Milla ♥

^(*)basal metabolic rate – the amount of energy expended while at complete rest

My Decision To Go For Bariatric Surgery

By no means am I suggesting that surgery is for everyone. However, if you, like myself, have struggled with your weight for a long time and are tired of weight yo-yo-ing, I recommend looking into it. My post-surgery journey has just started (2 months post-op); the journey to get there was long, but I can already say it has been life-changing.

I also want to accentuate that having a bigger body is absolutely nothing wrong. If you are happy, healthy and comfortable in your skin (and body), I want you to know that you are valuable, beautiful and deserving of all that life has to offer just the way you are. Don’t let that mean, self-doubting inner critic or society tell you anything different. Love yourself, and do you.

My decision to go for bariatric surgery came after years of lugging around a vast amount of extra weight, and I’d reached a point where I felt ‘enough is enough’. The Covid-19 pandemic was the nail in the coffin. I’d already gained more weight leading up to the pandemic due to a knee injury that had seen my activity levels plummet. So I decided to bury the coffin filled with past feelings of failures, shame and inadequacy, doubts and fears and let it go. In my head, I heard Marianne Williamson’s voice “Our deepest fear is not that we are inadequate. Our deepest fear is that we are powerful beyond measure”.

For years I had been resistant to even considering bariatric surgery because I found it difficult to accept that I needed help beyond the changes that I knew I had the power to implement for myself. I can do meal plans and exercise programmes; I have a Bachelor of Science degree in Nutrition and Exercise Science and a Master of Science degree in Public Health Nutrition. On top of that, I am an experienced behaviour change specialist. My inner voice was constantly telling me, ‘You should do better. You know better.’ Which was often backed up by a meaner version saying, ‘you don’t deserve better’.

In 2004, or possibly 2005, I attended an obesity action conference in London where a consultant did a presentation on weight loss surgery. Although I always had that internal battle that I should be able to do it myself, I also knew that weight loss surgery was not the solution for me then. Bariatric surgery is not a quick fix. Like many people who have been overweight or obese for a long time, I had a dysfunctional relationship with food. Which, at the core of things, had nothing to do with food. I knew I had to heal that relationship to successfully shed the weight for good. It took years of working on myself to understand the emotional wound I had, do the work, and start healing it. Eventually, I reached a crossroads where I had to either keep carrying on my life feeling rubbish about my body and allowing the weight to get in the way of living the life I wanted for myself OR ask for help.

The trigger to make that first doctor’s appointment to discuss bariatric surgery was following a telephone conversation I had at the end of May 2021 with a family member that was two weeks post-op gastric sleeve surgery. They were open to personal questions, and the conversation unveiled common (misguided) feelings of shame and failure to ‘resort to’ bariatric surgery. However, we had witnessed the tremendous transformation in both the physical and mental well-being of another family member who’d had a gastric sleeve surgery a couple of years earlier. We both agreed it had inspired us and wavered our resistance to considering surgery as a solution. So as soon as I put the phone down, I called my GP (General Practitioner) surgery to make an appointment.

I felt incredibly empowered by my decision to move forward; I embraced the fact that I could not do it alone. There was no reason for me to deny an opportunity to change my life. There is no badge of honour for not asking for help when you need it. ♥ M