Management of Pregnancy after Bariatric Surgery

Navigating Pregnancy After Bariatric Surgery: What You Need to Know

Obese women in reproductive age, looking forward to bariatric surgery as a weight loss option, are usually dubious about chances of conception and pregnancy after bariatric surgery.

Hormonal Imbalances and Infertility

Women with a high BMI, have a lower likelihood to become pregnant as compared to lean women, mainly due to irregularity in menstrual cycles or anovulation associated with obesity.

About 50% of obese women with infertility or PCOD are dissatisfied with their sexual life. This might be caused by increased circulatory androgens (testosterone and DHEA-S), raised due to decreased hepatic production of sex hormones-binding globulin (SHBG). Hyperinsulinaemia also triggers lieutinizing hormone-mediated androgen production in ovarian theca cells, these hormonal imbalance cause infertility.

Benefits of Bariatric Surgery for Fertility

Bariatric surgery also called as weight loss surgery improves chances of conception, pregnancy and delivery. Weight loss surgery cures PCOD (Poly Cystic Ovarian Disease), improves hormonal balance and fertility. After bariatric surgery there is a steep rise in SHBG and a drop in testosterone, androstenedione and DHEA-S levels in women which thereby improves menstrual irregularities and infertility.

Contraceptive Considerations Post-Surgery

As the fertility improves after bariatric surgery, all women in reproductive age should take additional contraceptive measures. Oral pills may not provide sufficient protection after bariatric surgery especially after gastric bypass due to malabsorption.

Planning Pregnancy After Bariatric Surgery

Pregnancy should be planned after 12 to 18 months post-bariatric surgery and requires regular and more frequent follow-up visits to the doctor. Delivery should be planned in a tertiary care center with experienced interdisciplinary teams and the availability of a neonatal intensive care unit.

Micronutrient Supplementation During Pregnancy

After bariatric surgery, micronutrient supplementation is advised to all the pregnant women. Supplementation of Iron, calcium, zinc, vitamin D, folic acid, vitamin B12 and vitamin A are important to prevent maternal and fetal complications.

Postpartum Care and Lactation

During lactation, regular follow-up at every 3 months is recommended for new moms after bariatric surgery. Regular examination of the new born is highly recommended.

Monitoring Nutritional Intake for Breastfeeding Mothers

Mothers who have got bariatric surgery done should also exclusively breast fed the baby for 6 months after birth and should be monitored for nutritional intake and deficiencies. Mothers should take advised micronutrient supplementation regularly, as maternal intake of nutrients has strong influence on the quality of the breast milk delivered to the offspring. Malnutrition of the mother can potentially cause undernourishment of the breastfed baby, especially vitamin B deficiency can cause megaloblastic anaemia and development delay in the offspring. Calcium deficiency may lead to reduced calcium secretion in the breast milk and might cause insufficient mineralization of the bones of baby.

Safety and Benefits of Pregnancy After Bariatric Surgery

Pregnancy after bariatric surgery is safe, if properly planned and monitored. Several research studies have reported decreased risk of maternal complications in post bariatric surgery pregnancies, and improved neonatal outcomes, compared with obese women. Also in pregnancy after bariatric surgery, lower risk of gestational diabetes, high blood pressure, miscarriages and preterm birth are detected as compared to obese women.

Have more doubts regarding post-surgery pregnancy? Schedule an appointment with Smart Cliniqs and consult with the top bariatric surgeon in Delhi.

Pulses & Legumes: An important component of vegetarian diet after bariatric surgery

The Role of Pulses and Legumes in Post-Bariatric Surgery Diet: A Guide for Vegetarians

Post-Bariatric surgery diet demands good quality protein intake. India is predominantly a vegetarian country, so pulses and legumes have become an essential part of the Indian diet, to fulfill daily protein needs. Apart from providing proteins, pulses also exhibit many nutritional values. Pulses are edible fruits or seeds of pod-bearing plants. Various varieties of pulses are available and are being used in various ways. Legumes (rajma, chholey, chana, lobia), husked-whole pulses (moong sabut, masoor sabut, and urad sabut dal), and dehusked pulses (moong dhuli, masoor dhuli and arhar dal) are an important part of every Indian kitchen.

Pulses: The Primary Source of Protein

Especially in a vegetarian Indian diet, pulses are the primary source of protein. The calorie content of pulses per 100g is almost similar to that of cereals but they give about 20 to 25% protein which is double the amount of protein compared to cereals. The per 100 g calorie value ranges between 315 to 372 Kcal and protein content ranges from 17 to 25 g/ 100g, legumes are generally rich in proteins and high fibre. Pulses contain calcium, iron, magnesium, zinc, potassium, and phosphorus. Legumes are an excellent source of B-complex vitamins. Antioxidant levels are highest amongst Rajmah and Soyabean.

Nutritional Benefits of Pulses

Pulses generally generate a low rise of blood sugar, due to their low glycemic index and provide more satiety than cereals due to the high protein content. During sprouting nutritive value is improved. Raw pulses do not contain vitamin C, however, it is synthesized during sprouting, as much as sprouts can be substituted for fruits. Germination enhances the concentration of n-3 and n-6 fatty acids, specially linoleic and linolenic acid, and also PUFAs (polyunsaturated fatty acids) like EHA and DHA. Cowpeas (lobia), black gram (urad sabut dal), and Bengal gram (kala chana) help in lowering high cholesterol levels.

Fermentation and Its Benefits

Fermentation of pulse-based batters, like for idli and dhokla, improves nutritional value by increasing vitamin C and B-vitamins. It also improves the availability of essential amino acids. Phytates present in legumes may play a protective role in reducing colon and breast cancer risk. Isoflavones present in Bengal gram may help reduce serum cholesterol levels if consumed over several weeks. Cluster beans (guar ki phalli) have been shown to reduce plasma cholesterol and improve blood sugar levels, with the help of guargum, a gel-forming galactomannan polysaccharide present in it.

Daily Inclusion of Pulses

One medium katori-cooked pulses and legumes provide 4 to 6 g protein and 2 serves should be included daily in the diet. The inclusion of different variations like cooked pulses, sprouts, pancakes, cheelas, dhokla, kadhi, and sambhar can make your daily diet after bariatric surgery interesting and variety full. Keep control over using oils and fats while cooking pulse-based preparations to keep a check on total calorie intake. After bariatric surgery, vegetarian patients should use pulses and legumes more frequently to meet protein requirements.

Having more doubts regarding which diet to follow after bariatric surgery? Consult today with the best bariatric surgeon in Delhi at Smart Cliniqs.

Hair Fall After Bariatric Surgery

Understanding Hair Fall After Bariatric Surgery: Causes and Solutions

People who undergo bariatric surgery are mostly anxious about their hair health. After undergoing bariatric surgery, some hair loss is common between 3 and 6 months and can last up to 6 to 12 months or more, however, it is almost always temporary.

The reasons for hair loss are not absolutely clear. The probable causes may be age, gender, comorbidities, medications, harmful cosmetics, and genetic factors.

The Hair Growth Cycle

Human hair has a two-phase growth cycle. The Anagen (hair growth) phase and the Telogen (inactive) phase. Our 90% of hair follicles are in the anagen phase at any given time. The inactive phase (telogen), lasts about 1 to 6 months, and about 5-15% of our hair is in this phase at any given time. All hair originates in the anagen phase, grows for a certain duration of time, and then moves into the telogen phase, which continues for approximately 100 to 120 days and then the hair falls out. If this process is accelerated, the condition is called telogen effluvium, which is the cause of hair fall after bariatric surgery in some patients.

Factors Contributing to Telogen Effluvium

Reasons to develop “telogen effluvium” after bariatric surgery are surgical stress, rapid weight loss, low appetite, and low nutrient intake specially protein, iron, zinc, biotin, and essential fatty acids. Also, patients who have poor compliance to the nutritional supplements or those who experience rapid weight loss, difficulty eating, food intolerances, especially with good quality protein sources, or do not practice healthy eating habits, may experience hair fall.

Importance of Protein Intake

Protein intake significantly decreases after bariatric surgery, especially in the first 6 months, which may lead to hair fall. Less availability of hydrochloric acid and gastric juice enzymes (pepsin and renin), limits protein digestion, so even the ingested protein is not completely utilised. A minimum of 60g per day protein is recommended to all patients after undergoing any bariatric surgery procedure, ideally, it should be 1g per Kg body weight. The protein requirements should be fulfilled through high biological value proteins, having a PDCAA score of 1.0. Patients should include eggs, chicken, fish, and other sea foods, soy products such as nuggets, granules, soy milk, and tofu; and milk and milk products to get good quality protein through diet. Protein supplements containing whey protein isolate should also be taken to complete protein needs, as small meal sizes cannot meet these requirements.

Effects of Reduced Protein Intake

Reduced protein intake causes thinning of hair, diminished hair growth, and depigmentation. Among all essential amino acids (the building blocks of proteins), deficiency of L-lysine, may contribute to hair fall. It is mainly present in fish, meat, and eggs.

Iron Deficiency and Hair Loss

Less intake and absorption of iron after surgery may contribute to hair loss, due to less availability of hydrochloric acid as stomach size has been reduced especially after gastric bypass, as the iron absorption sites get bypassed.

In females, iron deficiency is more prevalent amongst those who are of reproductive age. Highly bio-available forms of iron supplements are recommended after all bariatric procedures for better absorption and utilisation of iron, to prevent anaemia and hair fall.

Role of Biotin

Deficiency of biotin may cause depigmentation of hair and may weaken hair follicles. A multivitamin containing biotin helps prevent hair loss if taken regularly.

Importance of Zinc

Zinc also plays a crucial role in the growth and development of hair. Zinc bisglycinate is the most bio-available form of zinc and should be regularly supplemented.

Essential Fatty Acids

Essential fatty acids e.g. linoleic and linolenic acids also prevent hair fall in patients after bariatric surgery. Bypass procedures alter the digestion and absorption of dietary fats, hence essential fatty acids.

Dietary Sources of Essential Fatty Acids

Flaxseed, linseed, and olive oil are good sources of essential fatty acids and should be included in the post-bariatric surgery diet in recommended quantities to prevent deficiency.

Conclusion: Hair Fall After Bariatric Surgery

From the foregoing it can be concluded that hair fall after bariatric surgery is not a permanent feature, they do come back. The patients as advised to adhere to the dietary and nutritional supplements advice and to attend follow-up visits regularly for timely care and guidance.

Have more doubts? Schedule an appointment at Smart Cliniqs, and speak with the best bariatric surgeon in Delhi.

Nutritional Problems after Bariatric surgery

Essential Follow-Up Care: Addressing Nutritional Problems After Bariatric Surgery

Maintaining weight loss after Bariatric surgery requires lifelong commitment and care. Bariatric surgery is the most effective tool to lose weight substantially and for the long term. But there is no guarantee that you will stay fit all your life unless you eat healthy and exercise regularly, and stay off alcohol or drink in moderation. You must follow your Bariatric team every 3 months in the first year and then annually at least to manage any nutritional problems after bariatric surgery.

Why regular follow-up is necessary after Bariatric surgery?

Regular follow-up is necessary after Bariatric surgery. The most important reason is to prevent nutritional deficiencies which are bound to creep up unless monitored. As many of the obese already have low vitamin D and iron levels, the situation gets worse after the surgery due to inadequate diet.

Vitamin B1 or thiamine is a special case in point. This vitamin is essential to keep your nerves and haemoglobin healthy. Thiamine is found in abundance in fresh vegetables and fruits. As it is, Its stores are small and can be depleted quickly in just a few days if there is persistent vomiting. This problem is more common in people who have been drinking heavily. An acute deficiency can damage nerves and the brain and impair vision permanently. The more acute form is known as Wernick’s encephalopathy which requires prolonged hospitalization and its symptoms may not reverse completely.

The blood tests to check its levels are not commonly available; therefore the treatment is started immediately without waiting for the results. In its mild form, thiamine deficiency is difficult to detect, so one should take it routinely.

We will discuss other nutritional deficiencies in our next blog.

Have more questions related to nutritional problems after bariatric surgery? Consult today with the top bariatric surgeon in Delhi at Smart Cliniqs.

Precautions After Bariatric Surgery During Covid Times

Continued from the previous blog...

Key Precautions After Bariatric Surgery: Staying Safe During the Pandemic

The Covid epidemic is relentlessly spreading; there is still no respite in sight. We are now the epicentre of this dreadful pandemic, but life has to go on. All the vital surgeries are now increasingly being performed, with similar outcomes as during the pre-Covid times. However, once we have undergone bariatric surgery we need to be more vigilant and adhere to all the precautions after bariatric surgery.

Follow these precautions after Bariatric Surgery

Maintain a strict diet schedule

Take plenty of fluids, and keep yourself well hydrated, at least 1.5 liters per day is the minimum necessary.

Ensure Adequate Protein Intake

Take a good amount of proteins, so that you don’t feel weak and don’t lose your muscles instead of your fat. A good protein diet boosts your immunity against infections including Covid. You should take a minimum of 60 grams of proteins every day i.e. at least 1 gram of proteins for every Kg of your ideal body weight.

Vitamins are Essential

Similarly fill up yourself well with plenty of vitamins, as most obese patients are low in vitamin D and B complex and Vitamin C. These vitamins are particularly essential to boost immunity.

Maintain a Regular Exercise Routine

Since you may not be able to exercise outdoors, you must maintain a regular indoor daily exercise routine, it may not be advisable to join a gym, especially during the first 4 weeks after the operation.

Monitor Your Temperature

Keep a watch on your temperature, a mild rise that is 99° F or 100° F can be due to the normal response of the body to surgery. But anything above this range should be immediately brought to the notice of the surgical team.

Follow Up Regularly

Finally do follow up with regular Phone, or video consult unless a physical check-up is indicated. Do keep your surgical team regularly updated with your blood sugar, Spo2, Blood pressure, urine output, temperature, fluid intake, or other parameters if indicated.

Need more tips for precautions after bariatric surgery? Speak with the best bariatric surgeon in Delhi at Smart Cliniqs.

Is It Safe to Undergo Bariatric Surgery During the Covid Times?

Ensuring Safety: Bariatric Surgery During COVID-19

We are grappling with this monstrous epidemic which has taken a heavy toll all over the world. India had to undergo a strict lockdown in March and April this year. Life had come to a standstill; things are now slowly limping back to normal. The people were scared of coming out of their houses and were rightly so. Only patients with dire emergencies visited the hospitals, many hospitals in Delhi have been converted to exclusive COVID hospitals. Elective surgeries were deferred till the month of May.

Safety of Bariatric Surgery During Covid-19

Now all surgeries including bariatric surgery are routinely being performed as safely as they were before. Hospitals are safe places to visit, maybe even more so, as they are taking stringent precautions. Although this menace is not yet completely over, the situation is easing out a bit in Delhi. Life has to go on. So the question is, is it safe to get your keenly awaited bariatric surgery for which you had made up your mind and had even fixed up the date with your surgeon, and then the lockdown happened? The answer is a clear Yes! Provided you take all the normal precautions which you should be taking otherwise.

Precautions to follow during COVID-19:

You must wear a surgical or better still N95 mask at all times when you visit the hospital or your doctor.
Get a covid test, before your surgery as close to the date as possible, certainly not before 5 days.
Maintain a gap of 3 feet between the next person and you.
Check your mask before you enter the lift it should cover both your mouth as well as your nose completely. It is a common tendency to let the mask slip from the nose.
Better still use stairs if you can.
It is a good idea to carry soap sachets, or a hand sanitizer with you. And clean your hands once you touch the railing, door knobs, or other objects.
Once admitted, ask your friends and family not to visit you unnecessarily, after all normally the whole process involves a one to three days stay.

Lastly, choose your surgeon and hospital carefully, high volume centres take follow international and nationally approved protocols to see you through safely. There are some designated “surgeons, and centres of excellence” in Delhi accredited only after they undergone rigorous credentialing and periodic monitoring.

Confused about choosing which hospital is best for bariatric surgery? Worry not! Because Smart Cliniqs is here. We have the best bariatric surgeon in Delhi for all bariatric procedures.

Wishing you all the best.

Our next blog will be; Precautions after bariatric surgery during covid times.

Severe Protein Energy Malnutrition (PEM) after Bariatric Surgery

Understanding Protein Energy Malnutrition: The Crucial Role of Protein After Bariatric Surgery

Understanding Protein and Its Importance

Protein is a macronutrient and building block of body tissues. It also serves as a fuel source, 1gm gives 4 Kcal. Protein is needed for growth and maintenance and can be found in all body cells (Total body protein = 50% in muscles + 20% in bones + 10% in skin + rest in other parts).

The term “Protein” comes from the Greek word ‘protos’ – to take first place!! The same applies to its intake after bariatric surgery. Bariatric patients are advised to feed themselves with protein first to fulfil their protein needs as well as for healthy weight loss.

Risks of Protein-Energy Malnutrition After Bariatric Surgery

After weight loss surgery patients can be at risk of PEM due to Inadequate protein and/or energy intake, food intolerances to good quality protein, restrictive/malabsorptive surgeries (reduced Length of gut hence less area available for absorption, Pancreatic), small stomach pouch, increased protein need for wound healing, food aversions or food faddism, poor compliance or ignorance of post-surgical nutrition guidelines and/or Inability to recognize or afford high-quality protein.

Sources and Requirements of Protein

Various sources of protein are available which can be included in the diet such as Pulses and legumes, Nuts, Eggs and poultry, Fish, Milk & Milk Products and supplements in different forms like Whey protein isolates, Whey protein concentrates, Soy protein and Pea protein to fulfil protein needs. WHEY PROTEIN ISOLATE is best suitable for bariatric surgery patients as this provides PDCAAS of 1.0, supplies 90% pure protein and is easily digested and absorbed.

Protein requirements after bariatric surgery are 1–1.5 g/kg IBW to maintain Fat-Free Mass during weight loss, whereas the normal RDA for Indian males and females is 1 g/kg body weight. In the case of Malabsorptive procedures, it should be 1.5–2 g/kg IBW. The protein provided should be of High Biological Value and is easily digested and absorbed.

Assessing and Managing Protein Energy Malnutrition (PEM)

PEM after bariatric surgery can be assessed by the ABCD approach, where ‘A’ stands for ANTHROPOMETRIC (Muscle mass and fat-free mass), ‘B’- BIOCHEMICAL (Total proteins, Albumin and Globulin), ‘C’- CLINICAL signs & symptoms and ‘D’- DIETARY RECALL. Clinical signs of PEM are generalized weakness, excessive hair loss, poor wound healing, loss of lean body mass and anaemia.

Based on blood protein levels PEM can be classified as:

Stages of PEM	Serum Albumin levels (g/dl)
Mild	3.0 to 3.5
Moderate	2.5 to 3.0
Severe	<2.5

PEM is generally observed at 3 to 6 months after surgery. Vomiting, diarrhoea, depression, and alcohol consumption, may also lead to/ or exacerbate this condition.

Recommendations for Managing Protein Energy Malnutrition (PEM)

For Mild to Moderate PEM Oral feeding with a high protein diet (1.5 to 2gm/kg IBW) and protein-rich supplements, esp. short-chain whey protein isolates is recommended.

For Severe PEM admission to the hospital is required and patients are managed with enteral feeding/Albumin infusion/Total Parental Nutrition/ Restoring the anatomy/ Feeding gastrostomy/ileostomy in select few cases is required.

Preventing and Monitoring Protein Energy Malnutrition (PEM)

To prevent PEM, pre-operative routine screening (laboratory measures of visceral proteins) is important to assess the risk of protein malnutrition. Post-operatively monitoring of serum albumin concentration (remains in the normal range until late) and/or Lean body mass. Close monitoring for any clinical signs and symptoms. Helping patients fulfil protein needs & identify high-quality protein foods and supplements (rich in leucine). Regular assessment of protein intake is critical. Patients are advised to include and choose protein first in all meals especially at breakfast to relieve the catabolic state of overnight fasting. Continued multidisciplinary efforts are important to establish best practices for protein intake.

Have more doubts or queries related to signs and symptoms of protein energy malnutrition or undernutrition after bariatric surgery? Schedule a consultation with us at Smart Cliniqs and get in touch with the top bariatric surgeon in Delhi.

Which Protein is Best After Bariatric Surgery?

Why Protein is Vital After Bariatric Surgery: Essential Nutrients for Recovery and Health

Why Protein is Vital After Bariatric Surgery

When I counsel my patients that after surgery protein is the most important nutrient for them and they must include it and try to eat it first in every meal, they ask me why protein is so vital after bariatric surgery and are some proteins better than others? So here are my answers to these!!

Increased Protein Demand Post-Surgery

Surgery reduces meal portion size, though at the same time increases the demand for protein:

For healing,
To support rapid weight loss,
For good glycaemic control, and
to prevent lean body mass.

The Role of Protein in the Body

Protein is a macro-nutrient required by the human body for growth and maintenance. Besides water, proteins are the most abundant molecules in the body. Protein is found in all cells of the body and is the major structural component of all tissues, especially muscles. When fragmented into amino acids, are used as precursors to nucleic acid, co-enzymes, hormones, immune response, cellular repair, and other molecules vital for life. Additionally, protein is needed to form blood cells. Protein is a building block required for your muscles, immune system, and internal organs to function properly. Protein also helps you stay full for longer and is available in various forms such as whey protein concentrates and isolates, soy protein, pea protein, peanut protein, etc. The choices are endless, but which one is best is important to know and understand before buying your protein supplements.

Understanding Protein Quality

The most significant characteristic of protein from a nutritional viewpoint is its amino acid composition. There are numerous methods that rate proteins by their usefulness to an organism based on their relative percentage of amino acids and, in some systems, the digestibility of the protein source. These include Biological Value (BV), Net Protein Utilization, and PDCAAS (Protein Digestibility Corrected Amino Acids Score). The FDA as an improvement developed the PDCAAS over the Protein efficiency ratio (PER) method. The PDCAAS was adopted by the US Food and Drug Administration (FDA) and the Food and Agricultural Organization of the United Nations/World Health Organization (FAO/WHO) in 1993 as “the preferred best” method to determine protein quality. A PDCAA score of 1.0 indicates the best quality protein, so whenever you buy your protein supplement, just check on the nutritional label for the PDCAA score.

Whey Protein Isolate: The Best Choice Post-Surgery

The Whey protein isolate (WPI) is manufactured by separating components from milk. Whey is a by-product of the cheese-making procedure. Whey proteins can be processed to yield whey protein in three forms: whey isolate, whey concentrate, or whey hydrolysate. The difference between the whey protein forms is particularly related to the protein, carbohydrate, and fat content. Whey isolates contain the highest percentage of pure protein and are pure enough to be virtually lactose-free, carbohydrate-free, fat-free, and cholesterol-free. The PDCAA score of whey protein isolates is 1.0. Whey proteins are highly bioavailable, are very rapidly absorbed, and have a high concentration of branched-chain amino acids (BCAAs) which are needed for working muscles and stimulate protein synthesis.

Conclusion

Post weight loss surgery whey protein isolate is the best choice as a protein supplement, because patients have limited capacity to eat, and at the same time protein requirements are high. Bariatric surgery also alters digestion, which is why patients need a kind of protein that is readily digested and absorbed and a complete protein in terms of amino acids made up, especially essential amino acids. Animal sources such as eggs, chicken, and seafood are also good choices for eggetarians and non-vegetarians, plant-based proteins are not as high quality and would require long-term supplementation to attain comparable benefits.

Hence, Protein choices should be tactical and emphasis should be on the highest quality protein based on amino acid composition and digestibility.

For more queries regarding protein intake post-surgery, talk with the best bariatric surgeon in Delhi at Smart Cliniqs.

Why Gradual Diet Progression is Advised After Bariatric Surgery

Understanding Gradual Diet Progression After Weight Loss Surgery: Key to Healing and Success

Gradual Diet Progression After Weight Loss Surgery

Candidates for bariatric surgery often wonder why there is a gradual progression of diet after weight loss surgery?? They ask me why they have to be on a liquid diet for the first 15 days, and they question me if they have to be on liquids for weight loss then why surgery is required?? It is important to make prospective patients understand that they have a key role in their healing process. They have undergone a major change physically and emotionally. The purpose of dietary phases is to provide appropriate time for proper healing. Also, gradual progression helps decrease acid reflux, provide early satiety, prevent dumping syndrome while maximising weight loss and at the same time prevent lean body mass during the period of extreme weight loss.

That is why the gradual dietary progression must be adhered to strictly in order to support tissue healing, aid in weight loss and prevent possible complications.

Phases of Post-Surgery Diet

The diet progresses in 4 phases, such as:

• Clear liquids
• Full liquids
• Pureed diet
• Soft to normal diet

Clear liquids include sugar-free, non-aerated liquids that supply fluid and electrolytes and also help encourage the restoration of gut activity after surgery. Patients usually follow this diet post-operatively during hospital stay only, i.e. 1 to 2 days. From the day of discharge, they may start introducing full liquids including skimmed milk, lassi, buttermilk, strained veg/dal, and chicken soups etc. and continue the same for 2 weeks. Then from week 3, they are advised to take a pureed diet consisting of foods that have been blended or liquified to a puree consistency like milkshakes, well-cooked and mashed pulses and vegetables, scrambled eggs and grilled fish. They need to be on a pureed diet for the next 2 weeks. After 4 to 5 weeks of surgery, they may gradually progress from a soft to a normal diet including well-cooked foods, avoiding sugary and fatty meals.

The post-surgery diet is designed to restrict calorie intake, as well as to help develop appropriate eating habits and diet behaviour to promote weight loss while maintaining good nutritional status.

Nutritional Goals and Diet Behaviour

The primary nutritional goals and diet behaviour involve:

• Taking adequate liquids say around 1 to 1.5 lts to stay hydrated.

• Consume protein first in each meal to minimize loss of lean body mass and facilitate healing. It is usually difficult to get enough protein through food which is why protein supplements are recommended to meet the needs.

• Avoid 5 “S”, i.e. Sugar, Spirits, Smoking, Soda and Straw.

Sugar and spirits are avoided to prevent dumping and also to aid weight loss, straw and soda may cause bloating and patients may suffer from stomach discomfort, pain or feeling of fullness. Smoking is prohibited to prevent reflux and marginal ulcers.

Bariatric surgery procedures alter the gastro-intestinal tract, hence modifying many food-related behaviours such as portion size, perception of taste and smell, likes and dislikes or food choices. Patients are advised and educated to learn new diet behaviours to easily adapt modifications. They should eat at regular intervals, including 6 to 7 meals a day. They are advised to chew the food very well and eat at a slow pace. Avoid drinking liquids along and for 30 minutes before and after meals as drinking beverages along with meals can cause early satiety and may hinder adequate protein intake. The meal portion should be small to avoid overeating and vomiting.

At our Institute we assess each patient in detail pre-operatively to recognize their nutritional and dietary patterns as well as to evaluate their ability to incorporate nutritional changes after weight loss surgery.

Each patient may have a different capacity and appetite to eat; one should listen to his/her body as to when to stop eating. Be definite to abide by the instructions of your surgeon and/or dietitian to reduce your risk of developing malnutrition and surgical complications and all of this will be well worth it!

For more diet and nutrition-related queries, talk with the top nutrition counsellor in Delhi at Smart Cliniqs.

Can Lack of Sleep Cause Obesity?

How Lack of Sleep Contributes to Obesity and Weight Gain

There are many possible ways that lack of sleep could increase the chances of becoming obese. Obesity develops when energy intake is more than depletion. Diet and physical activity play an important role in this, but in addition, inadequate sleep may also be an equally important factor. Unfortunately, many people are not getting enough sleep.

Sleep-deprived people may be too tired to exercise or may take in more calories than those who do, clearly because they are awake longer and have more chance to eat. It’s not that if you sleep, you will lose weight, but if you are not getting enough or good quality sleep, your metabolism will not function properly.

Not getting enough sleep is common, even talked about with pride by some people, but we do pay a price for staying up late and getting up early.

Less sleep makes you more likely to eat more calories at night, your appetite increases and you are less likely to resist eatables and control portions which may lead to weight gain.

Poor food choices combined with lack of physical activity set the stage for obesity and further sleep loss.

Poor sleep completely alters the way the body responds to food.

On the other hand, starting healthy sleep habits can help your body maintain a healthy weight.

Tips for Better Sleep

Here are a few tips to keep in mind to get a good night sleep:

1. Avoid any caffeine late in the evening

2. Exercise also helps improve sleep quality.

3. Turn off all electronics – no screen time before bed

4. Make sure your bedroom is dim and quite

5. Have a bedtime routine – try to go to bed the same time daily, your body gets used to a schedule

6. Avoid big meals before bedtime – can increase the risk of heartburn, which will certainly keep you up all night.

Suffering from obesity? Looking for obesity surgery in Delhi? Schedule your appointment with us at Smart Cliniqs.

Also Read: Understanding the Causes of Obesity in Children and Adolescents