Pre & Post-Operative Care

Obesity is a complex, chronic condition requiring long–term engagement with us after surgery. At SIOS we like to take the opportunity to personalise your treatment, and introduce you to our team who will look after you before, and in the months to years after surgery.

Before your weight loss surgery you will see our:

  • Practice manager and bariatric nurse
  • Medical doctor
  • Dietitian
  • Psychologist

Getting ready for surgery

Initial consultation and medical screening

Your initial consultation will be with our bariatric nurse. This is a complimentary appointment where we can assess any medical conditions you have, discuss your dieting history, and decide on an appropriate course of treatment.

After your initial consultation you will have some blood tests, so we can check your blood sugar, thyroid function, blood count and vitamin levels. Some medical conditions may require further assessment and/or treatment so that you are as fit as possible before your operation.

Approval to proceed with surgery should be obtained from your GP as we encourage their involvement in your peri–operative care. If you are unsure about whether your GP supports your decision to have weight loss surgery you should discuss it with them.

A good support network will improve your chances of success, and support from your GP, as well as from your spouse/partner, friends and family is invaluable.

Seeing a dietitian

You will see one of our dietitians before and after surgery. Nutrition for weight loss surgery is very different to normal healthy eating and weight loss. Our dietitians specialise in nutrition management of weight loss surgery and have extensive experience in this field, particularly gastric banding, sleeve gastrectomy and gastric bypass.

Before your surgery you will meet with a dietitian to discuss your goals and expectations of weight loss surgery. You will also have the opportunity to ask questions and discuss any of your concerns related to long-term eating and nutrition so that you are fully informed before you proceed. During this consultation you will also be advised how to follow a very low calorie diet (VLCD) pre-operatively to make your operation safer.

After your surgery you will see a dietitian to learn how to safely transition through a textured modified diet (fluids, puree foods, soft foods, and solid foods) to minimise the risk of complications while your operation heals.

To assist you in making the most of your weight loss surgery whilst optimising your nutritional intake in the longer-term, our dietitians provide ongoing post-operative support and education on safe eating practices, portion size, healthy food choices and essential supplements.

Seeing a psychologist

Undergoing weight loss surgery is a major life changing decision.

All patients will attend a consultation with one of our psychologists before surgery. This appointment is designed to help you to understand the implications of weight loss surgery and to ensure that you are ready to take this important step. The psychologists at SIOS are experts in supporting you to make the lifestyle changes that will enhance your outcome after surgery.

Additional psychological support or health coaching is available before and after surgery at your request to help you identify solutions to your struggles with behaviour change. Our psychologists can also work with you on other difficulties that might be affecting your weight and wellbeing such as stress, anxiety, body image issues and depression.

Very low calorie diet

You will need to follow a weight-loss very low calorie diet (VLCD) pre-operatively to make your operation safer. The length of time you will need to follow the VLCD will depend on your weight and other health conditions. Your dietitian will individualise your VLCD program to you.

During the VLCD you will consume formulated meal replacements in place of your normal meals and snacks. These meal replacements may be milkshakes, soups, or bars. The VLCD restricts the amount of calories (energy) you consume, whilst providing all of the nutrition of a balanced diet: macronutrients (carbohydrates, protein, and essential fat) and micronutrients (vitamins and minerals). Our dietitians will advise you which VLCD brands are suitable and how to use these meal replacement products safely and effectively.

Pre-surgical weight loss using a VLCD is particularly useful for decreasing surgical complications by:

  • Minimising the amount of fat that is stored in your liver and around your internal organs (which also makes your operation safer, faster and significantly less painful)
  • Reducing the severity of weight related health conditions (for example diabetes, high blood pressure and sleep apnoea)
  • Improving your respiratory and cardiovascular function

Smoking

Smoking increases your risk of blood clots and other surgical complications and so you should quit smoking before you undergo any surgery, particularly weight loss surgery. We suggest you speak to your GP for assistance and support in quitting smoking.

After the operation

To help you get the full benefit from your weight loss surgery the team at SIOS will guide you through the early post-operative healing phase, and continue to provide ongoing support you as you make long-term lifestyle changes.

Exercise and physical activity

From day one after your operation we will ask you to get out of your bed and walk around the hospital ward. During the early healing phase once discharged from hospital we encourage all patients to gradually increase their walking and incidental physical activity as they feel comfortable. It should be noted that during this recovery phase heavy lifting must be avoided.

In the longer-term consistent, regular exercise is crucial for weight loss maintenance. Aim to make exercise a part of your routine so that eventually it becomes a part of your life and something that you do automatically.

It is important to engage in both aerobic exercise (e.g. walking, swimming, dancing etc.) and resistance exercise (e.g. weight training, using resistance bands, or performing body weight exercises such as push-ups). There are many different types of exercise that fall into these two categories, but the most important thing to help you stay on track is to find activities that fit your lifestyle, that are sustainable, and that you ENJOY!

Healthy eating and supplements

There are three phases of dietary change after surgery:

  • Early post-operative phase (first 6–8 weeks)
  • Weight loss phase (2–18 months)
  • Weight loss maintenance phase (18 months and beyond)

Each phase requires different advice in order to get the best results.

Early post-operative phase (first 6-8 weeks)

In the early post-operative healing phase, the nutritional priority for patients is recovery from surgery, not weight loss. The key elements are:

Hydration: All patients are at risk of dehydration following weight loss surgery. As a safety measure you will not be discharged from hospital until the medical team are satisfied you are able to drink enough water. Dehydration after surgery can increase your risk of nausea, constipation, and in severe cases, re-admission to hospital.

Texture modified diet: You will not be able to eat normal solid foods until you have healed internally. Consumption of a texture modified diet for the first 6-8 weeks after surgery is required to avoid surgical complications and abdominal discomfort. Food texture recommendations vary depending on the type of surgery. Your dietitian will advise you of the appropriate post-operative diet for your surgery. This may consist of a liquid diet, followed by purée foods, and then soft foods. During the early post-operative recovery phase it is very important to consume adequate protein to promote wound healing and recovery. Your dietitian will provide individualised information on how to reach your daily protein requirements when following a texture modified diet.

Supplements: All patients will need to take a multivitamin each day after surgery regardless of the procedure you have had. You may also need to commence additional supplements such as calcium, Vitamin D, or iron. Your dietitian can advise which supplements you will need to take based on the type of surgery you have had, and the results of your blood tests. Additionally, a daily fibre supplement is recommended to help you open your bowels regularly and without discomfort.

Weight loss phase (2-18 months)

Once you are recovered from your operation it is appropriate to start your weight loss journey. During the weight loss phase it is very important to strike a balance between significantly reduced food intake and good nutrition.

Most people will reach their maximum weight loss during this phase, and it can be easy to fall into the trap of the ‘honeymoon period’. In addition to significant weight loss, it is crucial to make the most of this time to establish good eating habits and set yourself up for the weight maintenance phase.

Follow-up with our expert dietitians is a key component of the SIOS aftercare program. During your weight loss phase our dietitians will provide you with support and education regarding your food choices, eating/lifestyle habits, and appropriate supplements.

Weight maintenance phase (18 months and beyond)

Having weight loss surgery is not a magic cure and the weight maintenance phase requires just as much effort as non-surgical weight loss. By now the ‘honeymoon period’ is well and truly over and it’s during this time that patients are at high risk for relapse. If the habits and behaviours that led you to become overweight return, your weight problem will return.

The skills and strategies required for weight loss maintenance are very different to those used for weight loss. By the time patients have chosen to have weight loss surgery, they have lost and regained weight on numerous occasions because they lack the necessary skills to maintain their weight loss.

Our dietitians are experts in weight loss maintenance and by providing you with individualised care in the long term can help you to avoid slipping into old habits and undoing all of your hard work.

  • International Federation for the Surgery of Obesity and Metabolic Disorders
  • The American Society for Gastrointestinal Endoscopy
  • American Society for Metabolic and Bariatric Surgery
  • Obesity surgery society of australia and newzealand
  • Society for surgery of the alimentary