Bariatric surgery is becoming more and more prevalent as the number of obese and morbidly obese people increases. Currently, 35.5% of adult men and 35.8% of adult women are considered obese (BMI ? 30.0 kg). The physical, emotional, and financial burden of obesity is now being recognized. Well-documented consequences of obesity include cardiac and pulmonary problems, metabolic disease, endocrine disorders, digestive problems, orthopedic issues, and an increased rate of developing some cancers. However, the most alarming consequence is the direct increase in mortality.
Surgical treatment for obesity has become medically necessary for the morbidly obese as being the only proven method of long-term weight control. According to the American Society for Metabolic & Bariatric Surgery about 200,000 people in the United States had one form of bariatric, or weight loss surgery. Unfortunately, the vast majority of these patients discover that bariatric surgery is not a magic weight loss pill. Candidates for bariatric surgery include patients who have a BMI over 40 kg or being 100 pounds over ideal weight and have decreased quality of life due to obesity. Less obese patients who have a BMI between 35 and 40 kg may be considered for surgery if they have high risk co-morbid conditions related to their obesity. All patients must clearly understand the procedure and life-changes that are necessary and must undergo psychological evaluation of readiness for surgery. They must prove they have tried and failed at other weight loss attempts.
An exercise program is a key component in a successful weight loss journey. A patient should begin an exercise program before bariatric surgery and resume it as soon as allowed by their doctor. Exercise intervention can not only help with weight loss and weight maintenance, but also help improve the quality of life for these patients.
Incorporating some form of exercise into your daily life prior to surgery will drastically improve and can even speed up the weight loss process following bariatric surgery. For instance, walking, cycling, aerobics or swimming can help you feel great even before the surgery. Try to get at least 30 minutes of physical activity each day.
Begin with very short walks several times a day and gradually increase the distance and/or intensity. Walking improves muscle tone and cardiovascular fitness in addition to helping you lose weight. Do not, at first, engage in strenuous exercise. It is encouraged to set goals for yourself, but keep them SMART.
Exercise for bariatric surgery patients is often the first part of a patient’s long-term plan to be skipped following surgery. In reality, it is almost as important as your diet. If you don’t follow your diet plan, you will most likely get sick… ranging from trouble with digestion to vitamin and mineral deficiency. The diet progression post-surgery is as follows: clear, full liquids, soft/puree diet, then very small portions of protein-focused meals.
Incorporating exercise after any bariatric surgery is critical for effective weight loss. When we lose weight rapidly, we lose muscle. This can be detrimental for long term success of weight maintenance by patients. Muscle gauges and controls our metabolism. Exercise, especially resistance training, is a safe and effective way of maintaining lean body mass as well in reducing the risk of osteoporosis due to mineral deficiency.
Resistance training should not be started until cleared from the surgeon. After clearance, higher repetition exercise is usually better tolerated. Flexibility training increases or maintains joint range of motion, which can alleviate aches and pains associated with obesity.
A recent analysis found that consistent exercise, both cardiovascular and resistance training for bariatric surgery patients, leads to a 4.2% lower body mass index.Another study compared the weight loss of bariatric surgery patients who completed moderately intense physical activity for a minimum of 2 ½ hours per week against those who did not. The “2 ½ hours+ per week” patients showed significantly greater weight loss.
Still not convinced? A third study evaluating 200 bariatric surgery patients found that physical activity adherence was the sole significant behavioral predictor of weight loss outside of dietary habits. In other words, other than sticking to your diet plan it’s the main thing you can do to achieve and sustain your weight loss goals.
So how does exercise contribute to weight loss? It burns calories. But this is not the main reason it works. After all, if you weigh 275 pounds, you will burn 200 calories per mile walked at a pace of 5 mph. One cup of dried apples has over 200 calories, let alone your entire daily intake. Exercise will only directly burn a small portion of your daily calories. The main reason is it boosts your metabolism, which is especially important considering your body’s natural tendency to slow down your metabolism as you lose weight. A higher basal metabolic rate (BMR) means that your body will automatically burn calories at a faster rate even while you are resting, thus leading to additional weight loss.
Immediately post-surgery, don’t sit or stand in one place for a long period of time. Light housekeeping may be undertaken when you feel you are able. Driving a car is usually permitted one week after surgery. Most patients are able to return to light work after two weeks and to heavy labor after six weeks. The time of your return to work will depend upon the physical demands of your job and the rate of your recovery. Talk with your physician before starting anything new.
Remember, the surgery is only a tool; the lifestyle changes made are the best predictors of success. Need help? Ask your Certified Fitness Professional what you can do.
Resources: ACSM’S Certified, Pacific Bariatric, Bariatric Surgery Source