Question

The patient came to your exercise sessions 80% of the time during the 8 week period. Since she only needed to comply by 70%, she was granted the lap band surgery. After 12 weeks, she has lost 50 pounds and has eliminated her insulin and cholesterol medications but is still on the hypertension meds. Her knees also are starting to feel better. You meet with this person post-surgery for an exercise assessment and the post surgery program. This time, she is very resistant to your exercise advice. In fact, she has no interest in participating in your exercise program anymore.

What might this patient need to progress to the action stage? To answer this, describe how you would approach the patient through each stage leading to ACTION.

Answer 1

It is very important to understand that it is very necessary to take a physically active lifesyle along with healthy diet for long term success of lap band surgery.

If there are any postoperative complications, that is physical problems following the weight-loss surgery, schedule an appointment with your bariatric surgeon and follow the surgeon’s recommendations for an exercise program. For the first four weeks after surgery, focus on flexibility exercises, deep breathing and getting back into performing normal daily activities.

Gradually incorporate low-intensity aerobic exercise (i.e. walking, biking or swimming). If the surgery was laparoscopic, it is generally safe to start exercising up to your pain threshold two weeks after surgery, but it is best to consult with your surgeon before starting any exercise program. If the surgery was “open,” it may take a few more weeks to recover. Here are some tips for those that underwent “open” procedures:

• During the first six weeks after surgery, do not lift any more than 15 pounds; Dont cross your pain threshold.
• Avoid abdominal exercises for the first eight to 12 weeks. This helps alleviate abdominal hernias near or around the incision.
• Significantly reduce caloric intake. During the first few weeks to months after surgery, patients should consume less than 500 calories a day. This significant decrease in calories may initially cause some fatigue. Therefore, do not perform high-intensity exercise. As weight is lost and the level of fitness is improved, you will be able to take in a few more calories as well as exercise at higher levels of intensity. Follow the surgeon’s dietary recommendations.

Caloric Intake

The bariatric surgeon may increase the caloric intake to 1,200-1,400 calories six to 12 months after surgery, particularly if their patient has lost a large percentage of their excess weight. Follow the surgeon’s and/or dietitian’s recommendations on food intake. Regularly monitor and assess your exercise program to ensure continued compliance and continued weight-loss which ultimately leads to weight maintenance.

Conclusion

A lifelong exercise program is critical to a weight-loss surgery patient’s long-term success. Bariatric surgery is a valuable tool for rapid weight loss; however, in two to three years, if a physically active lifestyle has not been adopted, the weight returns.

Exercise is insurance for long-term weight-loss. If you can stick to this advice, you’ll be at a healthy weight and in good physical condition for years after your weight-loss surgery.