You need to be referred by your GP. We encourage you to discuss this process with them when you have the chance. Unfortunately, the public system has a limited resource and there are clear criteria regarding who is eligible for publicly funded surgery. Surgery is targeted to those who have obesity and significant weight-related illnesses.
-
-
-
Currently there are two bariatric surgeries performed in Northland, sleeve gastrectomy and gastric bypass. Some people have health factors that determine which operation best suits them and the team will talk you through this. Some people have a strong preference for which operation they have, and this can usually be accommodated. You can be sure that your best interests are in mind and we will discuss the options in an open manner.
-
In the lead up to surgery we help patients learn about healthy diet and lifestyle choices. After surgery your stomach will be smaller meaning you eat a smaller volume of food. The nutrients from the food are often less well absorbed too. It is therefore essential that the food you choose is nourishing for your body.
After surgery you will slowly progress from a liquid to a puree diet, to a soft diet then your regular texture foods. You will meet with your dietitian every step of the way to support you with this.
The focus is on protein intake with other foods being low fat and low sugar options. This is to ensure the weight that is lost is from fat stores whilst maintaining muscle store. Food needs to be eaten slowly and when at soft and solid texture chewed well.
Foods will be protein sources such as fish, chicken (skin removed), mince (fat drained after cooking), lean meats, chickpeas, beans, lentils. Other options may be low fat dairy options, cottage cheese, trim milk, tofu and low fat yoghurts. A variety of vegetables are encouraged. In early stages these will be cooked and pureed then slowly progressing to raw and regular texture. Carbohydrates and starchy vegetable should be eaten after the protein option and only in small amounts. These could be porridge, weet-bix, low fat crackers, potatoes, kumara.
-
In healthcare, we often refer to BMI (body mass index). This is not a perfect system but is the best way we have to relate your weight to height.
BMI = weight (kg)/height (m)2
For example:
If you were 1.6m tall and weighed 140kg, your BMI would be 55 kg/m2
By definition, BMI is classified as follows:
<20 kg/m2 Underweight
20-25 kg/m2 Healthy range
>25 kg/m2 Overweight
>30 kg/m2 Obesity
The weight loss after surgery is significant. As health professionals we usually talk about your ‘ideal body weight’ and the ‘excess weight’ you carry. Ideal body weight is calculated as the weight you would be if your BMI was 25 kg/m2. Your excess body weight is the difference between your current weight and your ideal body weight.
For example:
if you were 1.6m tall and weighed 140kg, your BMI would be 55 kg/m2
Your ideal body weight (if your BMI was 25 kg/m2) would be 64kg
So, your excess body weight is (140-65) 75kg.
Bariatric surgery outcomes are variable, but usually result in 55-70% excess body weight loss. For the above example, this would equate to 41-52kg weight loss.
Another way to look at this is how much of your total weight can you expect to lose. This is usually in the realm of 25-35%.
As you can see, bariatric surgery doesn’t make you a ‘normal’ weight, but it does make you a much healthier weight. A key concept is that of your ‘best weight.’ This is an achievable weight where your health is improved and that is sustainable. Throughout your bariatric surgery journey, the team will continue to refer to your best weight.
-
Bariatric surgery is a tool to be used in your weight loss journey, and not a magic fix. After bariatric surgery, the operation usually works on auto for the first period and people often reach their lowest weight at 12-18 months. For success, it’s important to re-invent your lifestyle during this time to maintain your best weight. Eat healthy and get active.
Its normal to put on a small amount of weight at 18-24 months after surgery as your body finds its new ‘normal.’ A healthy lifestyle during this time should help to limit this weight gain but is no guarantee. For several reasons, some people regain a substantial amount of weight. The team can talk to you more about this if required.
-
A gastroscopy is a camera test of your oesophagus and stomach. It’s performed by our surgeon in the endoscopy unit in Whangarei and Kaitaia. You arrive in the morning, have the procedure, and then go home. It is usually performed under sedation.
A gastroscopy provides useful information about your stomach’s arrangement that can have an influence of surgical planning.
-
Bariatric surgery results in a degree of malabsorption (abnormal absorption of food nutrients from your intestines). This occurs to a greater degree with a gastric bypass, but still occurs with a sleeve gastrectomy. For this reason, it’s important to be on bariatric multivitamins for life after surgery. While these are usually sufficient, we check your lab work before surgery and on a regular basis after surgery and correct any specific abnormalities. After surgery, you will have blood tests at 3 months, 6 months, 12 months and annually thereafter.
-
After bariatric surgery, you need to take bariatric multivitamins for life. If you stop taking these, you could encounter some major nutritional issues. Some examples are:
- Iron deficiency can show as fatigue
- Zinc deficiency can cause hair loss and changes in taste
- Calcium deficiency can lead to bone weakness and osteoporosis
The best multivitamins are those that are specific for bariatric surgery. There are many options available for purchase online. Some of the most common providers are as follows:
- www.tric.co.nz
- www.bnmulti.co.nz
- www.barilife.co.nz
After a sleeve gastrectomy, you require:
• A daily bariatric multivitamin with iron
After a gastric bypass, you require:
• A daily bariatric multivitamin with iron
• Daily calcium citrate with vitamin D
• A monthly Vitamin B12 provided by your GP. This usually doesn’t need to begin until 6 months after surgery
Occasionally blood tests will show a specific abnormality that needs addressing with specific vitamins
-
Prior to surgery, you will be instructed to be on an Optifast liquid diet. The length of this will vary from patient to patient but is usually between two to six weeks. This period is very important for the success and safety of the operation.
The Optifast diet is very low in calories and induces what is called ketosis. During ketosis your body makes a metabolic shift to use energy stored in fat cells, and in particular the fat cells in the liver and around the intestines. In addition, ketosis often reduces appetite. The liver needs to be lifted up during the surgery to get to the stomach and the intestines need to be moved around. A fatty liver and fatty intestines are hard to move and, on occasion, prevent surgery from being possible. The Optifast diet and ketosis help to address this problem.
Prior to surgery, the team will advise you of the length of your Optifast diet and the date to begin this. The hospital will provide you with four weeks of Optifast free of charge (one week is for the first week after surgery). If you require more, this will need to be purchased from your local chemist. Although this will cost some money, it is a meal replacement and is cheaper than any average meal. The team can give you more information on this if required.
-
Surgery is performed in Whangarei and you are usually admitted to the hospital early in the morning on the day of your surgery. The operation takes 2-3hrs, although you aren’t always aware of your surroundings for the first couple of hours after surgery.
On average, people stay in hospital for two nights after surgery. In order for you to be ready for discharge, your pain needs to be controlled, you need to be mobile, and you need to be able to consume sufficient fluids to avoid dehydration. If you come from far afield, you may stay for longer.
When you leave hospital, you are on a liquid diet. It takes 6-8 weeks to progress to a diet of normal food consistency. After about a week, your abdomen will feel well healed. However, people often feel fairly run down for a few weeks after surgery.
Currently there are two bariatric surgeries performed in Northland, sleeve gastrectomy and gastric bypass. Some people have health factors that determine which operation best suits them and the team will talk you through this. Some people have a strong preference for which operation they have, and this can usually be accommodated. You can be sure that your best interests are in mind and we will discuss the options in an open manner.
In the lead up to surgery we help patients learn about healthy diet and lifestyle choices. After surgery your stomach will be smaller meaning you eat a smaller volume of food. The nutrients from the food are often less well absorbed too. It is therefore essential that the food you choose is nourishing for your body.
After surgery you will slowly progress from a liquid to a puree diet, to a soft diet then your regular texture foods. You will meet with your dietitian every step of the way to support you with this.
The focus is on protein intake with other foods being low fat and low sugar options. This is to ensure the weight that is lost is from fat stores whilst maintaining muscle store. Food needs to be eaten slowly and when at soft and solid texture chewed well.
Foods will be protein sources such as fish, chicken (skin removed), mince (fat drained after cooking), lean meats, chickpeas, beans, lentils. Other options may be low fat dairy options, cottage cheese, trim milk, tofu and low fat yoghurts. A variety of vegetables are encouraged. In early stages these will be cooked and pureed then slowly progressing to raw and regular texture. Carbohydrates and starchy vegetable should be eaten after the protein option and only in small amounts. These could be porridge, weet-bix, low fat crackers, potatoes, kumara.
In healthcare, we often refer to BMI (body mass index). This is not a perfect system but is the best way we have to relate your weight to height.
BMI = weight (kg)/height (m)2
For example:
If you were 1.6m tall and weighed 140kg, your BMI would be 55 kg/m2
By definition, BMI is classified as follows:
<20 kg/m2 Underweight
20-25 kg/m2 Healthy range
>25 kg/m2 Overweight
>30 kg/m2 ObesityThe weight loss after surgery is significant. As health professionals we usually talk about your ‘ideal body weight’ and the ‘excess weight’ you carry. Ideal body weight is calculated as the weight you would be if your BMI was 25 kg/m2. Your excess body weight is the difference between your current weight and your ideal body weight.
For example:
if you were 1.6m tall and weighed 140kg, your BMI would be 55 kg/m2
Your ideal body weight (if your BMI was 25 kg/m2) would be 64kg
So, your excess body weight is (140-65) 75kg.Bariatric surgery outcomes are variable, but usually result in 55-70% excess body weight loss. For the above example, this would equate to 41-52kg weight loss.
Another way to look at this is how much of your total weight can you expect to lose. This is usually in the realm of 25-35%.
As you can see, bariatric surgery doesn’t make you a ‘normal’ weight, but it does make you a much healthier weight. A key concept is that of your ‘best weight.’ This is an achievable weight where your health is improved and that is sustainable. Throughout your bariatric surgery journey, the team will continue to refer to your best weight.
Bariatric surgery is a tool to be used in your weight loss journey, and not a magic fix. After bariatric surgery, the operation usually works on auto for the first period and people often reach their lowest weight at 12-18 months. For success, it’s important to re-invent your lifestyle during this time to maintain your best weight. Eat healthy and get active.
Its normal to put on a small amount of weight at 18-24 months after surgery as your body finds its new ‘normal.’ A healthy lifestyle during this time should help to limit this weight gain but is no guarantee. For several reasons, some people regain a substantial amount of weight. The team can talk to you more about this if required.
A gastroscopy is a camera test of your oesophagus and stomach. It’s performed by our surgeon in the endoscopy unit in Whangarei and Kaitaia. You arrive in the morning, have the procedure, and then go home. It is usually performed under sedation.
A gastroscopy provides useful information about your stomach’s arrangement that can have an influence of surgical planning.
Bariatric surgery results in a degree of malabsorption (abnormal absorption of food nutrients from your intestines). This occurs to a greater degree with a gastric bypass, but still occurs with a sleeve gastrectomy. For this reason, it’s important to be on bariatric multivitamins for life after surgery. While these are usually sufficient, we check your lab work before surgery and on a regular basis after surgery and correct any specific abnormalities. After surgery, you will have blood tests at 3 months, 6 months, 12 months and annually thereafter.
After bariatric surgery, you need to take bariatric multivitamins for life. If you stop taking these, you could encounter some major nutritional issues. Some examples are:
- Iron deficiency can show as fatigue
- Zinc deficiency can cause hair loss and changes in taste
- Calcium deficiency can lead to bone weakness and osteoporosisThe best multivitamins are those that are specific for bariatric surgery. There are many options available for purchase online. Some of the most common providers are as follows:
- www.tric.co.nz
- www.bnmulti.co.nz
- www.barilife.co.nzAfter a sleeve gastrectomy, you require:
• A daily bariatric multivitamin with ironAfter a gastric bypass, you require:
• A daily bariatric multivitamin with iron
• Daily calcium citrate with vitamin D
• A monthly Vitamin B12 provided by your GP. This usually doesn’t need to begin until 6 months after surgeryOccasionally blood tests will show a specific abnormality that needs addressing with specific vitamins
Prior to surgery, you will be instructed to be on an Optifast liquid diet. The length of this will vary from patient to patient but is usually between two to six weeks. This period is very important for the success and safety of the operation.
The Optifast diet is very low in calories and induces what is called ketosis. During ketosis your body makes a metabolic shift to use energy stored in fat cells, and in particular the fat cells in the liver and around the intestines. In addition, ketosis often reduces appetite. The liver needs to be lifted up during the surgery to get to the stomach and the intestines need to be moved around. A fatty liver and fatty intestines are hard to move and, on occasion, prevent surgery from being possible. The Optifast diet and ketosis help to address this problem.
Prior to surgery, the team will advise you of the length of your Optifast diet and the date to begin this. The hospital will provide you with four weeks of Optifast free of charge (one week is for the first week after surgery). If you require more, this will need to be purchased from your local chemist. Although this will cost some money, it is a meal replacement and is cheaper than any average meal. The team can give you more information on this if required.
Surgery is performed in Whangarei and you are usually admitted to the hospital early in the morning on the day of your surgery. The operation takes 2-3hrs, although you aren’t always aware of your surroundings for the first couple of hours after surgery.
On average, people stay in hospital for two nights after surgery. In order for you to be ready for discharge, your pain needs to be controlled, you need to be mobile, and you need to be able to consume sufficient fluids to avoid dehydration. If you come from far afield, you may stay for longer.
When you leave hospital, you are on a liquid diet. It takes 6-8 weeks to progress to a diet of normal food consistency. After about a week, your abdomen will feel well healed. However, people often feel fairly run down for a few weeks after surgery.