How to measure BMI

BMI (Body Mass Index) is a measurement of body fat based on height and weight that applies to both men and women between the ages of 18 and 65 years.
BMI can be used to indicate if you are overweight, obese, underweight or normal. A healthy BMI score is between 20 and 25. A score below 20 indicates that you may be underweight; a value above 25 indicates that you may be overweight.
You can calculate your BMI by using BMI Calculator

What is Waist Circumference?

How to measure BMI

BMI (Body Mass Index) is a measurement of body fat based on height and weight that applies to both men and women between the ages of 18 and 65 years.
BMI can be used to indicate if you are overweight, obese, underweight or normal. A healthy BMI score is between 20 and 25. A score below 20 indicates that you may be underweight; a value above 25 indicates that you may be overweight.
You can calculate your BMI by using BMI Calculator

What is Waist Circumference?

According to the National Institutes of Health, a high Waist Circumference (WC) is associated with an increased risk for type 2 diabetes, dyslipidemia, hypertension and cardiovascular disease when the BMI is between 25 and 34.9. (A BMI greater than 25 is considered overweight and a BMI greater than 30 is considered obese.) Waist Circumference can be useful for those people categorized as normal or overweight in terms of BMI. (For example, an athlete with increased muscle mass may have a BMI greater than 25 – making him or her overweight on the BMI scale – but a Waist Circumference measurement would most likely indicate that he or she is, in fact, not overweight). Changes in Waist Circumference over time can indicated an increase or decrease in abdominal fat. Increased abdominal fat is associated with an increased risk of heart disease.

To determine your Waist Circumference, locate the upper hip bone and place a measuring tape around the abdomen (ensuring that the tape measure is horizontal). The tape measure should be snug but should not cause compressions on the skin.

What are comorbidities?

Comorbidities are the conditions and ailments you may have besides obesity and which are often caused or aggravated by obesity. This can include sleep apnea, diabetes, arthritis, high blood pressure, etc. Obesity is the primary condition with these other conditions being referred to as comorbidities.

I am in my late sixties…can I still undergo bariatric surgery?

Studies have shown that age (more than 65) did not seem to be a significant factor for mortality or major adverse events among bariatric patients. It was, however, tied to a longer hospital stay following surgery. All bariatric patients are carefully evaluated, yet older patients may warrant extra consideration.

I have Diabetes, but my BMI is less than 35…can I still undergo bariatric surgery?

Current guidelines suggest operation can be safely performed in patients with a BMI over 27.5

How do you decide which procedure is the most suitable for me?

When deciding on which type of procedure is best suited for a patient, we consider his or her weight, general condition and possible comorbidities, as well as the personal expected weight loss goals of the patient.

How long after surgery can I resume normal/professional activity?

Your will be mobile the day, or the day after surgery. Some people recover faster than others, but most patients feel well less than a week after surgery. Your time off of work will depend on the type of weight loss surgery you have. After gastric banding surgery, you can return to work in about one-week. Full recuperation after a gastric bypass, or a sleeve gastrectomy procedure takes two to four weeks.

Can I still drink coffee/soda/alcohol after bariatric surgery?

You should avoid soda and other carbonated drinks. They contain gases that can expand your stomach causing an uncomfortable feeling or even a stretching of the stomach. Sodas also contain a lot of calories which had better come from more nutritious sources. Coffee and alcohol are allowed, but should be consumed in small amounts and without excess

Will I have to take supplements for the rest of my life?

Yes. However, the number depends on your weight loss procedure. The gastric bypass and Gastrectomy procedures require a lifetime of vitamin and calcium supplementation. Gastric banding requires a multivitamin every day.

What is Dumping Syndrome?

Dumping syndrome is a common side effect that can occur after having bariatric surgery if you don’t follow some basic eating habits (see below). While dumping syndrome can cause discomfort and inconvenience it is not life threatening.

Dumping syndrome happens when the contents of your stomach rapidly dump into your intestines. This can cause you to experience the following symptoms that can range from mild to severe but will often subside rapidly:

  • Feeling full, even after eating a small amount
  • Abdominal cramping
  • Nausea or vomiting
  • Severe diarrhea
  • Light-headedness
  • Increased heart rate

Dumping syndrome can be managed by strictly monitoring your diet. You should limit foods containing large amounts of sugar, as well as dairy and alcohol. These foods are known to increase the severity of dumping syndrome.

You should also follow some basic eating tips like

  • Eat five or six small meals per day
  • Keep portions small
  • Chew all of your food thoroughly
  • Stop eating as soon as you begin to feel full
  • Drink liquids 30 to 45 minutes after meals

How long will I be in the hospital after bariatric surgery?

It will depend on the type of weight loss surgery you have. Generally, hospital stays are between three and five days.

How much weight will I lose after bariatric surgery?

The amount of weight you lose, and how fast you lose it, depends on the type of weight loss surgery you have. Patients usually loose between 20 and 50% of their original body weight.

What will happen to the excess skin after I lose weight?

The amount of excess skin you experience depends on the amount of weight you lost, your age, and smoking habits. Exercising and the application of firming creams have positive results; however patients sometimes choose to have plastic surgery to have this skin removed.

Will I keep losing weight or will I bottom out?

Depending on the procedure you have it should take between one and two years to lose your maximum excess weight. Then, if you have changed your eating habits and adopted a healthier life style, you will regain 10 to 20 percent of that weight and stabilize there.

How soon after surgery will I lose weight?

The amount of weight you lose, and how fast you lose it, depends on which weight loss surgery you have. On average patients lose about 10kg within the first month after surgery, 30 kg in the first six months, and 40 kg within the first year.

Can my stomach stretch back to its original size after bariatric surgery?

Though your stomach can and will stretch after your surgery, it is almost impossible that it will stretch back to its full original size. After your weight loss surgery your stomach size will be greatly reduced and initially will only be able to take in about 2 tablespoons of food. With time, your stomach will and should stretch to hold about 1 cup of food at a time. This is both normal and expected. Stretching of the stomach beyond what is intended can lead to you not feeling full as easily and inhibit weight loss in the long term.

You should stop eating solid foods as soon as you feel full as this will prevent any potential issues with stretching or regaining too much weight

What is the success rate of bariatric surgery for weight loss?

Weight loss surgery is considered successful when excess weight is reduced by 50% of the original weight and that weight loss is sustained for a minimum of 5 years. So a patient who is 40 kg overweight needs to lose a minimum of 20 kg and keep that weight off for the first 5 years after surgery.

While ultimately each person is unique, each weight loss surgery does experience different success rates. However, success from any of these weight loss surgery options will decide on how hard you work at changing your diet and exercise habits post surgery. These are the factors that will ultimately decide if your surgery can be considered a success.

What is the success rate of bariatric surgery in treating Diabetis Mellitus Type II?

One of the main factors influencing the success rate of bariatric surgery in curing DM Type 2 is the time elapsed since the onset of the disease; the sooner after the onset you have metabolic surgery treatment, the higher the chance of remission. Studies show that nearly 80% of patients with DM Type 2 who undergo metabolic surgery don’t need to take diabetes medicine soon (days or weeks) after the procedure.

What is the success rate of bariatric surgery in Hypertension?

Studies show that 50% of patients see an improvement in their hypertension after bariatric surgery, and the problem is totally solved in nearly 30% of the cases.

What is the success rate of bariatric surgery in treating Sleep Apnea?

Unless sleep apnea is cause by craniofacial obstruction, it is solved in almost 100% of the cases.

What are the reasons why some patients don’t achieve the expected results?

Bariatric surgery is a way to help the patient kick start a “new”, healthier life. However, lasting success depends on the active and sustained involvement of the patient in the process. Some basic post-op rules need to be followed to reach and sustain the expected results. Most people who fail to reach or sustain these results did so because they didn’t adhere to the new habits that enabled them to get there in the first place. In some rare cases, metabolic factors make it impossible for the patient to achieve the desired objectives.

Are the procedures reversible?

Since part of the stomach is removed during a sleeve gastrectomy, this type of procedure is obviously not reversible. All the other procedures are, in principle, reversible.

Will I still feel hungry after bariatric surgery?

Of course, you will still feel hungry at times, but to a lesser degree. It will also take less food for you to feel satisfied.

Will my tastes change after bariatric surgery?

Some patients report taste and/or smell changes of foods and beverages, or even food repulsion following bariatric surgery. These disorders, referred to as dysguesia and dysosmia, need to be taken seriously for they can lead to anxiety, frustration, and nutritional deficiencies. Although the exact cause of these changes is not yet known, studies point to the reduction in the level of ghrelin, an appetite-stimulating hormone primarily secreted in the stomach and parts of the small intestine, as the factor most likely to influence the changes in taste. Not only does ghrelin stimulate appetite, it also plays a role in the olfactory sensitivity required to locate, select, and identify food; since its level is significantly reduced following a gastric bypass or a sleeve gastrectomy, patients feel satiated and the “attractiveness” of foods and food odors can be notably and specifically reduced.

While this taste dysfunction might actually help prevent postoperative overeating in the bariatric surgery patient, it can also potentially cause nutritional deficiencies among patients who suddenly don’t know what to eat. It is important for such patients that they experiment with different kinds of foods, supplements, and seasonings to discover what flavors their body is comfortable with.

Can I become pregnant after bariatric surgery?

Women should avoid pregnancy for at least 18 months after surgery.

Care plan after bariatric surgery

You will wake up from surgery in the recovery room from which you will be released when all your vital signs have been checked and you have been cleared to go back to your room.

In the next few hours (or a couple of days for some) you might feel some back/shoulders soreness; during surgery your abdominal cavity was inflated in order to allow the surgeon to use his laparoscopic tools. As a result your muscles were somewhat stretched and you now feel the way you’d feel after a workout. You will also be sweating a little through your scalp; that is a result of the gases used during anesthesia evaporating from your body.

We encourage our patients to get moving as soon as possible. This helps stimulate bowel movement and the passing of gas. You won’t be allowed to drink anything until you’ve passed gas, so the sooner the better. This can take anywhere from a few hours to a couple of days.

The first time you have a bowel movement you may notice some dark, or bloody streaks in your stools, they are leftovers of some of the blood lost during surgery (only small amounts of blood are lost during surgery).

Bariatric surgery is done laparoscopically, so incisions are small and recovery time fast. You will be released from the hospital a few days after surgery and allowed to proceed with your recovery at home (if you live in Taiwan) or in a nearby hotel. There is no need to remove the stitches which are of the soluble type, however, we will schedule a follow up appointment with the surgeon one week after surgery to make sure that all is well with you.

If you are a foreigner, once you have returned to your home country and you normal life, the follow-up will consist of a monitoring of your weight loss variations and metabolic profile. You should send us a copy of blood tests done every three months (the first year), six months (the second year), or yearly (after the second year) to enable us to follow your case. You can also ask questions about your current health condition by email. Your primary care doctor can assist you in the monitoring and most are quite aware of the changes in the medical condition of bariatric patients.

After surgery you are advised to:

  • Start gently with liquid or pureed foods and gradually build up to three daily meals of low in fat and sugar solids.
  • Stop eating when full.
  • Give priority to the protein component of your meal.
  • Drink one to two litres per day of calorie-free and fizz-free fluids between meals.
  • Take vitamin and mineral supplements.

Expect phases of weight change with initial loss peaking at 18 months, followed by a period of stabilisation. To avoid further weight gains, stick to a healthy diet and exercise.

Remember that bariatric surgery is a way to kick start a new life, and that in order to make it a lasting success active involvement of the patient is necessary.