Packing on a couple of extra pounds after indulging in too much fruitcake and eggnog may not sound like a big deal, but those Christmas calories can add up over time. Consider a 30-year old who gains an additional five pounds each holiday season. Without taking action to curtail the trend, those extra calories will result in a 50-pound weight gain by the time he or she is 40 years old. Research also shows that it is harder to lose weight the older you get, particularly for women after menopause.

Weight loss surgery is a proven treatment for the management of obesity for people who are at least 80 to 100 pounds overweight. Weight loss surgery restricts the amount of food you can comfortably consume at one sitting, which in turn restricts your caloric intake. Most patients lose weight rapidly within the first 12 to 18 months – often a pound a day or more – and are much less likely to gain additional weight during the holidays.

Gastric bypass, gastric sleeve, and adjustable gastric banding (Lap-Band) surgery are the most common forms of bariatric surgery. Each procedure has a track record of success and is effective for achieving significant weight loss for patients who have a body mass index (BMI) of 35 or higher. Gastric bypass surgery can have the added effect of dumping syndrome, which can result in painful cramping, diarrhea or vomiting that is often triggered by eating foods high in sugar. Many patients actually consider this side effect a benefit, as it prevents them from consuming too many sweets during the holidays and throughout the year, helping them keep the weight off for the long term.

To have a lasting effect, weight loss surgery patients must stay mindful of their new eating habits even years after their procedure. Bariatric surgery can result in rapid and dramatic weight loss, but it is not a miracle cure. You still need to eat a healthy diet, keep portion sizes small, and follow the guidelines for pouch management to ensure you do not regain weight over time. Getting regular exercise – even walking for 30 minutes a day – can also help you maintain a normal BMI and increase your longevity after weight loss surgery.

If you gained a couple of extra pounds this holiday season, you need not be overly concerned. Cutting back on fatty foods and sweets for a few weeks and increasing your physical activity can help you shed the excess weight within a month or two. But, if you have struggled with obesity for several years and have not been able to lose the weight with diet and exercise alone, weight loss surgery may be your best option. We invite you to attend one of our upcoming informational sessions or call our office to schedule a free consultation with Dr. Provost to learn whether bariatric surgery is right for you.

Dr. Provost addresses the pros and cons of gastric bypass surgery in comparison to the Lap-Band procedure to help prospective weight loss surgery patients make an informed decision.

Click here to learn more about gastric bypass surgery.

Click here to learn more about the Lap-Band procedure.

Prior to your appointment, your medical insurance will be verified, and we will contact you and go over all medical benefits. Please keep in mind, if your medical insurance did not cover your initial bariatric procedure, it is likely they will not cover follow-up care. In that case, you will be a self pay patient. Initial appointments are $250.00 and all non-fluoro requiring band fill appointments will be $75.00. General care office visits are $50.00. Please note that the cost of these appointments does NOT include the costs of lab or imaging studies that may need to be performed.

Once we have your medical records, we will schedule you for a screening Upper GI performed at Texas Health Presbyterian Hospital of Denton on the same day of your initial consult with us. Typically, your appointment will be scheduled with Dr. Provost’s Physician Assistant, Chrystyna Senkel.

To ensure that you have a clear understanding of how to make your weight loss procedure most effective, all patients transferring care from other surgeons will be required to attend our post-op nutrition class. In addition, transfer-care patients are welcome to utilize our program services, such as our weight loss surgery support group meetings, patient connections list, and Lap-Band Back-on-Track classes.

Please call the office at 940-323-3450 to schedule an appointment and obtain a medical records release.

Dr. Provost is one of the nation’s leading specialists in weight loss surgery revisions, including the StomaphyX procedure. He says that revisions represent about 45 percent of all the operations he performs. Click here for more information about StomaphyX and other revision procedures, or contact our office for assistance.

Below is a general listing of dietary guidelines and phases for pre- and post-operative weight loss surgery patients. These may change, depending on your personal circumstances. It is important that you follow the slow progression from liquids to solids and that you do not advance the foods until Dr. Provost or his team members tell you to move to the next phase. The purpose of the post-op diet progression is to help in the healing process, minimize stress on surgical sites, and allow time for your body to adapt to the new eating patterns. You may cause yourself unnecessary complications if you do not follow these guidelines.

Pre-op Diet

For two weeks prior to surgery: you will be on a special low-calorie/ low-carbohydrate liquid diet. It is very important that you follow this diet, as its purpose is to shrink the size of your liver before surgery. This decreases your chances of having complications or needing an open operation.

Night before and morning of surgery: you should have nothing to eat or drink after midnight.

• 1-2 days after surgery: you will be on clear liquids, such as water, Crystal Light, broth, and sugar free juices. You will be sent home on full liquids.
• 1 – 2 weeks after surgery (PHASE I “Full Liquids”): you will be on full liquids, such as protein drinks, broths, and decaffeinated / sugar free / non-carbonated beverages.
• 2 – 5 weeks after surgery (PHASE II “Softs”): You will still be on liquids, such as protein drinks, but will add soft / pureed items, like tuna, eggs, chicken, vegetables, and fruit. Soft and pureed foods are foods with a consistency of a smooth paste or a thick liquid or are ground or finely diced. Continue lots of sugar free / calorie free / non-carbonated beverages.
• 3 – 5.5 weeks after surgery (PHASE III “Solids”): you will have an appointment with our dietician via phone or in person to advance you to solid foods, such as all meats, vegetables, fruits, and whole grains and lots of sugar free / calorie free / non-carbonated beverages. This will be your lifelong food plan and we do not want you to go back to phase I or II unless we direct you to do so.

During the diet progression, you eat several small meals a day and sip liquids slowly throughout the day (never with meals). You might first start with four to five small meals a day, then when following a regular diet, decrease to three meals a day. Each meal should include protein-rich foods, such as lean meat, fish, poultry, or eggs, that are eaten first.

Life-long Changes: New Eating Habits and Behaviors

Once you are at Phase III “solids”, to avoid problems that may require re-operation and to ensure you’re getting nutrients you need, you should closely follow the guidelines below. We encourage you to adopt these habits BEFORE surgery.

• Eat solid protein at each meal. We want you to feel satisfied after a small amount of food and to stay satisfied for several hours. This will only be achieved if you eat protein at each meal. Acceptable solid protein choices include: beef, chicken, turkey, eggs, pork, fish or other seafood. We DO NOT encourage you eating mushy or crunchy low-protein foods, such as cheese, beans, yogurt, peanut butter, and nuts as your main protein with a meal.

• Eat small amounts. Just after surgery, your stomach holds only about 1 ounce of food. Though your stomach stretches over time to hold more food, by the end of three months, you may be able to eat 1 to 1 1/2 cups of food with each meal. Eating too much food not only adds more calories than you need, but also may cause pain, nausea and vomiting. Make sure you eat only the recommended amounts and stop eating before you feel full. Remember, the goal is not to be stuffed, but to be satisfied on a small amount of food.

• No more then 15-20 minutes at each meal. Once patients are used to their new eating pattern, we ask that they take no longer than 15-20 minutes at each meal. If you sit for a long period of time at meals, you will be able to eat more and you will stretch your new pouch. In essence, you will defeat the purpose of your surgery.

• Avoid all carbonated beverages. This includes diet and non-diet sodas and beer.

• Take pea-sized bites and chew food thoroughly. The new opening that leads from your stomach into your intestine is very small, and larger pieces of food can block the opening. Blockages could cause vomiting, nausea and abdominal pain. Take pea-sized bites of food and chew them 15-20 times before swallowing.

• Drink NON-CALORIC liquids between meals. This means we DO NOT want you drinking juice, milk (even skim), sweet tea, Starbucks drinks, protein / vitamin water, or soups. Please avoid caloric beverages, as these will all lead to weight gain or little weight loss. You may have water, Crystal Light, coffee or tea (sweetened with no-calorie sweetener).

• No drinking 30 minutes before, during, and up to 1 hour after meals. Drinking liquids with your meals can cause pain, nausea and vomiting, pouch dilation or dumping syndrome (in gastric bypass patients). Expect to drink at least 6 to 8 cups (48 to 64 ounces) of fluids a day to prevent dehydration.

Exercise

Dr. Provost expects you to be up and in a chair the night of your surgery and walking the halls the day after your surgery. Once you go home, you should begin exercising immediately. Walking is the easiest exercise.  We expect that you will engage in DAILY sustained aerobic exercise, beginning at 5 minutes per day and working your way up to 30 minutes per day. This aerobic activity may include:

• Swimming
• Jogging
• Walking
• Biking
• Seated chair exercises
• Dancing
• Aerobics or other fitness classes

You will know you are getting a good workout because you are sweating a little and feeling a little short of breath. Although housework, walking or climbing stairs at work, parking far away in parking lot, and playing with children are all great starts, but we would like you to advance to more vigorous, sustained exercise as your health improves.

HOW TO CHOOSE A BARIATRIC SURGEON:

• To reduce avoidable surgical complications and mortality, it is imperative you go to a surgeon who has performed at least 100 operations at a high-volume (>100 cases/ year) surgical center that has specific bariatric surgery credentialing guidelines. Ideally, you should have your surgery at a Bariatric Surgery Center of Excellence (BSCOE.)
• Follow-up care is essential for the long-term success of the operation, and your surgeon should have a formal life-long after care program administered at his or her office, which includes support groups and a multidisciplinary team.
• Consider seeing a surgeon who is in bariatric practice >75% of the time to ensure he or she will continue to provide your life-long aftercare. (Finding a surgeon to assume your care in the event your doctor retires or no longer wishes to practice bariatric surgery can be difficult.)
• Be sure you not only are satisfied with your surgeon, but also with his or her support staff. Having surgery places you in a life-long relationship with your surgeon; be sure their office meets your needs and you feel comfortable.

Dr. David Provost has nearly 20 years’ experience in bariatric surgery and has performed hundreds of successful weight loss surgery procedures, including gastric bypass surgery, adjustable gastric banding (Lap-Band®) surgery, and revision surgeries, including the StomaphyX procedure. He is regarded as one of the most skilled and highly qualified bariatric surgeons in the nation, and has taught bariatric surgery techniques to doctors from across the country.

Dr. Provost performs all of his weight loss surgery operations at the Texas Health Presbyterian Hospital, which has been named an American Society for Metabolic and Bariatric Surgery (ASMBS) Bariatric Surgery Center of Excellence®.

We invite you to attend one of our informational meetings, or call our office at 888.715.4330 and schedule a consultation to learn more about how to gain control of your weight and your health through bariatric surgery.

At these meetings, you’ll have the opportunity to talk about and deal with the emotional pain of obesity and its aftermath in a comfortable setting, surrounded by people who have been through the same thing. The discussions are guided by an approach called Attitudinal Healing, which is a program of spiritual and emotional care founded on nonsectarian principles and designed to improve a patient’s health in conjunction with traditional health care practices. Its goal is to help you address the tumultuous feelings, many of which stem from childhood, related to your behaviors and self-worth and enjoy a more fulfilling and peaceful life.

Attitudinal Healing began in 1975 under the guidance of Dr. Gerald Jampolsky, who in 1977 founded the Center for Attitudinal Healing in Tiburon, California. Today, the establishment (now known as Corstone Center and located in Sausalito, California) works toward the goal of developing and support emotional resilience – the ability of people and institutions “to function competently, powerfully and peacefully under stress.” It seeks to reinforce people’s confidence that they can help themselves and others, enabling “individuals, families and communities to face challenges, develop and maintain a positive attitude, make healthful choices, and solve problems on every scale.”

The Provost Bariatrics Support Group meets from 7:00p.m. to 8:00 p.m. on the second and fourth Tuesdays of each month at Dr. Provost’s office (2501 Scripture Road, Medical Building #6, Suite 303 in Denton).  You can also come early (at 5:45 p.m.) and join other patients and the group’s leaders for an hour-long walk around the hospital grounds and neighboring park. After all, why not get in some exercise as part of your new, healthy lifestyle? The group is open to anyone who has had bariatric surgery, regardless of the surgeon, and friends and family are also welcome to attend.

For more information on the Weight Loss Surgery Support Group offered by Dr. David Provost, please call his office at 940-323-3450.

Dr. David Provost has helped thousands of patients during his 20-year career as a surgeon and is committed to the life-long treatment of his weight loss surgery patients. He is a recognized expert in bariatric surgery and performs weight loss surgery in Denton, Texas, at the Presbyterian Hospital of Denton.

Weight loss surgery has changed the lives and health of thousands of patients. Until recently, the fact that many of those patients no longer suffered from diabetes was only whispered in waiting rooms.

But a 2008 study led by Dr. John Dixon at the Monash University Medical School in Melbourne, Australia, showed patients who had Lap-Band surgery to reduce the size of their stomachs were five times more likely to see their diabetes disappear over the next two years than were patients who had standard diabetes care. Other studies have shown that gastric bypass surgery can also resolve diabetes in most patients.

The 2008 study was published in the Journal of American Medical Association and compared diabetes in patients who underwent Lap-Band surgery against those who received standard medical care for weight loss. This was the first randomized study on weight loss surgery and diabetes, and scientists consider randomized studies to yield the highest-quality evidence.

The Risks of Type 2 Diabetes

Type 2 Diabetes is sometimes called “death by inches,” because it erodes the quality of health and life slowly, often resulting in loss of eyesight, nerve damage in fingers and toes, and even amputation as circulation deteriorates from the disease.

The biggest common factor among Type 2 Diabetes patients is excess body weight: 55 percent of Type 2 Diabetes sufferers in the U.S. are obese. Hypertension, elevated cholesterol, metabolic syndrome, aging, a high-fat diet, and a less-active lifestyle also increase a person’s risk of getting diabetes. Of course, many of these symptoms are associated with obesity, also.

New Research on Weight Loss Surgery

The results of this study and previous research on the effect of weight loss surgery to treat diabetes are bringing recognition in the medical community to what many bariatric patients have realized for years: weight loss surgery is a possible cure for diabetes. In fact, more and more scientists are realizing that the weight loss that results from gastric bypass and gastric band surgery is really more of a side effect; the real benefit of weight loss surgery is that it appears to eliminate Type 2 Diabetes in the vast majority of cases.

In fact, more recent data is even more encouraging. Researchers from Virginia Commonwealth University examined 177 morbidly obese patients with Type 2 Diabetes who underwent gastric bypass surgery. Nearly 90 percent of the patients experienced a return to normal blood sugar levels within the first year and almost 60 percent were still diabetes-free 5–16 years later. Those who were insulin dependent at the time of surgery were most likely to have their diabetes return.

And, researchers from New York University School of Medicine examined 95 patients who had laparoscopic gastric banding (more commonly known as Lap-Band surgery), with 88 percent taking oral diabetes medication and 15 percent on insulin. After five years, 83 percent had an improvement or remission of Type 2 Diabetes.

These dramatic results offer hope to the millions of people who suffer from Type 2 Diabetes. And although many medical experts caution that more research is necessary to determine the long-term health effects of bariatric surgery on patients with Type 2 Diabetes, current evidence leaves little doubt that weight loss surgery can have a positive impact on those who suffer from the disease.

Patients seeking weight loss surgery in Denton, TX, with Dr. Provost often suffer from diabetes and other co-morbidities. If you are concerned about how obesity is affecting your health, call to schedule a free consultation with Dr. Provost at 888.715.4330.

The biggest change will be in your portion size. If you’ve been to a restaurant recently, you know that what is considered a normal serving size in the U.S. is often enough food for three people. If you’re used to sitting down to a heaping dish of pasta or a large steak and stuffed bake potato, you may be surprised at just how little food you add to your plate following weight loss surgery.

After either gastric bypass or gastric banding (Lap-Band) surgery, you will only be able to eat a few bites at each meal. You must take small bites, chew your food well, and eat slowly, taking two to three minutes between each bite. By slowing down, you will be more aware of what you are eating, and are more likely to feel satisfied sooner. Most importantly, you should stop eating when you become comfortably full or are no longer physically hungry. Overeating or eating too quickly will result in discomfort or vomiting. Similarly, you will no longer be able to gulp large volumes of liquid when thirsty, and you will have to learn to drink water continually throughout the day to prevent dehydration.

FOOD CHOICES
After a gastric bypass, the types of food you eat will also change. You may have difficulty eating tough meats, particularly beef, following surgery. And, you should avoid greasy or fried foods, because your body cannot process them the way it is used to and they can make you feel ill. You generally won’t have a problem with most vegetables, although you may want to avoid raw vegetables, such as broccoli, celery or carrots. Carbonated beverages, even diet sodas, are a big no-no. They can stretch your pouch, limiting weight loss, and defeating the purpose of the surgery. And, if you know anything about the gastric bypass procedure, you know that foods high in sugar cause the dumping syndrome, which causes light-headedness, sweats, a jittery feeling, nausea, and vomiting. Cake, candy, ice cream, pies, cookies, and other sweets and desserts all can cause dumping and are off limits. (Artificial sweeteners, however, are permitted.)

With the Lap-Band procedure, adherence to the prescribed eating habits is equally important, and follow-up visits with your surgeon for adjustments are essential to long-term success. If you do not go back for routine fills to maintain the appropriate amount of restriction for the Lap-Band, you can easily regain the weight that you lost after your initial procedure. When the Lap-Band is adjusted correctly, you should feel full or satisfied fairly quickly. If small meals no longer satisfy you, if you still have weight to lose but have plateaued, or if you find yourself snacking more often and eating foods you previously couldn’t eat, like white breads and fibrous vegetables, then you are probably overdue for an adjustment. Overall, if you follow the nutrition guidelines provided by your surgeon, when you choose your food and then chew it well, you should not feel hungry or deprived.

PROPER EXERCISE
Exercise is an essential component of any weight loss program, and both the gastric bypass and Lap-Band procedures are no exception. You will be expected to begin a daily walking program upon discharge from the hospital. Patients who are unable to walk due to joint or back problems are encouraged to participate in alternative methods of exercise including water aerobics and stationary biking.

Like your new eating habits, maintaining an exercise regimen will be a long-term commitment. You don’t have to become a fitness junkie, but you do need to work regular exercise into your daily routine. Even walking on a treadmill for 30 minutes a day will help you shed pounds fast, and keep them off for good. Plus, you will lower your risk of heart disease by improving your cardiovascular fitness.

If you are considering weight loss surgery, you need to have a complete understanding and acceptance of the changes you will face. This is not the easy way out. Achieving weight loss goals requires dedication, and if you do not believe you can comply with your surgeon’s instructions, then weight-loss surgery may not be your best option.