Lifestyle Modification after Bariatric Surgery

Lifestyle modification after bariatric surgery is one of the cornerstones for successful and sustained weight loss, and healthy living.  However, the majority of emphasis is placed on dietary changes – as a result of the surgical alterations to stomach capacity.  While dietary modification for healthy eating (energy intake) is extremely important – we are also going to talk about the other part of the equation for both weight loss and healthy living: Exercise (energy expenditure).

Exercise and physical fitness are critical for multiple reasons – beyond initial weight loss, but many people often question the ability of the morbidly obese to exercise vigorously (and safely).  A new study by Shah et. al (June 2011) in Obesity magazine examines this concept.  Shah and his team of researchers divided gastric bypass patients and gastric banding patients into two groups ;  a control group receiving standard therapy and a high intensity exercise group.  The findings confirmed that physical fitness is both possible and beneficial for these patients.

Since both the original article and several articles discussing these finds are paid/ subscription sites, I have re-posted from Medscape (which is more freely accessible for most people.)

For more articles on Bariatric Surgery, see the sidebar for our archives.

Rigorous Exercise May be Feasible after Bariatric Surgery

Laurie Barclay (Medscape)

July 15, 2011 — Rigorous exercise may be feasible and beneficial to maintain weight after bariatric surgery, according to the results of a randomized controlled trial reported online July 7 in Obesity.

“[W]e didn’t know until now whether morbidly obese bariatric surgery patients could physically meet this goal,” said senior author Abhimanyu Garg, chief of nutrition and metabolic diseases at University of Texas Southwestern Medical Center at Dallas, in a news release. “Our study shows that most bariatric surgery patients can perform large amounts of exercise and improve their physical fitness levels. By the end of the 12 weeks, more than half the study participants were able to burn an additional 2,000 calories a week through exercise and 82 percent surpassed the 1,500-calorie mark.”

The investigators studied the tolerability and efficacy of high-volume exercise program (HVEP) in 33 obese, postbariatric-surgery patients who had undergone Roux-en-Y gastric bypass and gastric banding. Mean body mass index (BMI) was 41 ± 6 kg/m2. Participants were assigned for 12 weeks to an HVEP (n = 21) or to a control group (n = 12). All participants were advised to limit energy intake, and the HVEP group was also counseled to take part in moderate-intensity exercise resulting in energy expenditure of at least 2000 kcal/week. Repeated measures analysis allowed determination of treatment effect.

In the HVEP group, more than half (53%) of participants expended at least 2000 kcal/week during the last 4 weeks of the study, and 82% expended at least 1500 kcal/week. Compared with the control group, the HVEP group had significant improvement at 12 weeks in step count, reported time spent and energy expended during moderate physical activity, maximal oxygen consumption relative to weight, and incremental area under the postprandial blood glucose curve (group-by-week effect: P = .009 – .03).

“We found that participants in the exercise group increased their daily step count from about 4,500 to nearly 10,000 so we know that they weren’t reducing their physical activity levels at other times of the day,” Dr. Garg said. “We also found that while all participants lost an average of 10 pounds, those in the exercise group became more aerobically fit.”

Some quality-of-life scales improved significantly in both groups. The groups did not differ significantly in changes in weight, energy and macronutrient intake, resting energy expenditure, fasting lipids and glucose, and fasting and postprandial insulin concentrations.

“HVEP is feasible in about 50% of the patients and enhances physical fitness and reduces postprandial blood glucose in bariatric surgery patients,” the study authors write.

Limitations of this study include short duration, small sample size, dropout rate higher in the control group vs the HVEP group, dietary and exercise counseling provided at an individual level and not at the group level, and use of an unsealed pedometer to measure physical activity.

“Whether a HVEP helps to maintain weight loss and improvement in comorbidities in these patients remains to be evaluated in long-term studies,” the study authors conclude. “The studies also need to assess how exercise over the long-term effects factors that influence energy balance including energy intake, nonexercise activity levels, body composition, metabolic rate, and gastrointestinal hormones related to satiety and hunger.” [end of article].

Interestingly, the exercise group did not lose more weight than the control group – but as many people know – exercise and physical fitness are important for more than just weight maintainance.

Aerobic exercise, in particular is important for cardiovascular health.  Physical activity is also important for bone and muscle strength and general performance status and maintenance of activities of daily living (ADLs).  All of these contribute to the overall quality of life for individuals.

Diabetes and Soft drinks

If I can get readers to make one significant change to improve their health today  – Stop drinking soft drinks (and juices.)  These high sugar containing drinks are more than just empty calories, and this one small change can significantly reduce your risk of developing diabetes!

(P.S.)  Substituting for diet drinks is no improvement since diet sodas etc. have been linked to an increased incidence of strokes and high blood pressure (HTN) – switch to coffee, tea or water!!)  Coffee has even been shown in several studies as reducing the risk of diabetes, pancreatic disease.

High Fructose Corn Syrup

High fructose corn syrup was a uniquely American product that was initially created as a result of a government subsidy for farmers which has since spread to the UK, Japan and several other nations.  With these government subsidies, corn syrup became a cheaper sweetening agent in comparison to cane sugar.  This led to the pervasive use of corn syrup in many American food products.   Today it is used extensively, and avoiding this additive requires considerable effort and extensive examination of product labeling.  One of the main products that uses large amounts of high fructose corn syrup are soft drinks such as Pepsi and Coca-Cola.

As the American obesity (and corresponding Diabetes) epidemics continue unchecked, multiple researchers have attempted to pinpoint causes for these phenomena.  High fructose corn syrup has emerged as a likely culprit.  (However, even this scientific research is politically charged, as mega-corporations attempt to discredit findings that hurt their bottom line, similar to tobacco manufacturers in the past[1].)

Stanhope & Havel (2010), researchers at UC Davis recently compared the effects of fructose ( high fructose corn syrup is a mixture of fructose and sucrose) to sucrose (regular table sugar.)  They found that fructose use increased visceral adiposity (fat around internal organs), dylipidemia and decreased insulin sensitivity.  Decreased insulin sensitivity is a hallmark of the development of diabetes and is one of the ways that Diabetes in Americans differs from diabetes in other countries.  This means that people need more insulin to do the same job (transport nutrients into the cells).  This is also why we see people requiring more insulin that ever before.  In the past, patients could often be managed with 5 units of insulin (per meal).  Now, more commonly, due to this insulin resistance, similar patients are requiring 50 units of insulin (per meal).

But the problem isn’t just high fructose corn syrup – it’s our overall sugar consumption in general – Americans are just consuming WAY, WAY too much sugar – in “energy’ drinks, colas,  designer coffee drinks, ‘sweet teas’ and the so-called ‘healthy fruit juice.’  [I cringe every time I see a parent give their child juice as a ‘healthy alternative.’]

This sugar is KILLING us, by causing a myriad of health problems which in turn have a domino effect causing even greater health problems..  Sugar —->  Obesity/ High cholesterol ——>diabetes , hypertension,  atherosclerosis ——-> coronary artery disease (heart attacks), renal failure, vascular disease (ischemia/ limb loss/ strokes)..  The obesity epidemic, and sugary drink consumption has also been linked to fatty liver disease.

Now Malik, et. al. (2010) over at Harvard/ Brighams performed a meta-analysis on this subject.  Now if it’s been a while since you’ve read a lot of scientific literature, then let me remind you that meta-analyses are fairly high-powered studies because they take  ALL of the existing data, compiled it, and report the findings.. This is much stronger evidence that some six person study looking at cinnamon and diabetes.  (Yet – the media blazed that study everywhere – so  now plenty of people are putting cinnamon in everything.)


Starting today – I want you to care about your health, more than drinking that coke, pepsi or kool-aid.  Don’t try to cheat – with ‘diet’ options – because you are only cheating/ fooling yourself..

Make this one change:  switch to water, coffee (not loaded down with sugar/ cream) or UNSWEET tea.

Try it for at least thirty days..  and let’s start from there..   Just this one small change, not because I asked – but because you love yourself.  (And if you don’t love yourself – we need to work on that too!)

Additional references:

This study says diet sodas don’t cause diabetes but does link it to strokes..   It’s from MSN health which is an ‘okay’ site for consumer health information (articles are not always well written.)

Four reasons to avoid sodas – Health content from Yahoo! – it’s actually a reader’s digest article, which I typically avoid because they are usually poorly written, and not factually based.

[1] A good rule of thumb:  Whenever an industry starts advertising for their product (versus individual brands) than strong scientific evidence has probably emerged implicating the product in serious health conditions.  Think of the recent corn syrup ads, and “Beef – it’s for dinner,” and other campaigns in the past.