23 Feb What can exercise give you – that bariatric surgery alone cannot?
The decision to undertake bariatric surgery is not one that people take lightly. The Australian Institute of Health and Welfare has reported that the rising number of weight-loss procedures being completed is not actually proportional to the rise in obesity rates – instead, the increase has been linked to more publicity, accessibility, safety and reported successes as a result of surgery.
There is a growing body of research that bariatric surgery has the highest effectiveness and long-term impact on clinically severe obesity. Following surgery, dietary intake is closely monitored and guided by dietitians. But what about exercise? With weight coming off rapidly after surgery, is it that important to get moving? The main thing to remember is this:
Weight loss through bariatric surgery doesn’t equal fitness.
When people try conservative weight loss methods, it’s highly likely that they incorporate regular exercise. Exercise alone is not always a significant contributor to weight loss, but it works wonderfully alongside a healthy diet. When even just a few kilograms are lost this way, there is a noticable improvement in physical fitness and function, if the exercise is consistent and purposeful.
What might fitness mean to you? Everyone has a different level of capacity which would be required to go about their day to day lives. If your body mass is interfering with your daily activities, it is important to note that underneath the excess weight are muscles, which require movement to gain strength and also require strength to provide you with movement.
Biologically speaking, our bodies were made to move. Specific, and even gentle exercise can reverse the spiral of immobility and disuse, and if that wasn’t motivation enough, patients who undertake exercise following bariatric surgery lose 4% more from their BMI than those who don’t. That could mean the difference between clothing sizes, fitting comfortably into seatbelts and chairs, or simply going about your day with ease.
A real life example: Tracy’s* story
I had the pleasure of working with Tracy (*name has been changed) in the lead up to her Roux-en-Y Gastric Bypass surgery. Her main goal was to tone up the muscles under the skin, and assist with her required weight loss prior to surgery. We started with one exercise session per week, and this quickly led to two, as she began to enjoy the feeling of meaningful movement once more.
Our exercise was especially tailored to consider her medical and physical background, taking extra care not to cause overuse injuries. Even prior to surgery, Tracy had exceeded her expected weight loss, increased all weights and walking distances in the gym, and reduced some of her Type 2 Diabetes medication. As soon as Tracy had the all clear to return to exercise, she continued her excellent efforts with exercise. It had become a positive habit, and a big part of her life.
What stood out to me the most was Tracy’s experience after surgery. The nurses were shocked that she was able to help herself out of bed and walk around with her IV drip! She was the only one on the ward able to move herself in this way and practically ‘bounced back’ from the procedure. 4 months on, Tracy has lost 32.5kg and 40cm has been reduced from her waist.
Functonally, Tracy reports how easy it is now to get in and out of the car, she can walk faster (particularly up hills), and she can go down stairs with a new level of mobility. I am still seeing Tracy – but she now requires no assistance to complete her exercise program!
The measurable, and immeasurable benefits of exercise
One study of interest has proven that large-scale weight loss through bariatric surgery alone leads to a in a decrease in muscle strength and no improvement in aerobic capacity. In contrast, those patients whom undertook surgery and an exercise program increased the strength of most major muscle groups, improved aerobic (heart-related) fitness and boosted their functional capacity.
Other well known benefits of exercise include:
- Increased management of bloog sugar and type 2 diabetes
- Reduced blood pressure
- Correction of high cholesterol
- Prevention and management of heart disease
- Addressing musculoskeletal aches and pains, including arthritis
- Increased energy
- Peaceful sleep
- Increased mood, less depression and anxiety
- Overally feeling a sense of control over health and wellbeing
Do any of those appeal to you? Perhaps they all do! If so, read on…
So, where do you begin?
When a particular level of weight has been reached, and surgery becomes an option, it is highly likely that an individual has tried exercise before. And perhaps it didn’t ‘work’, in relation to the scales, for a number of reasons. The truth that I would like everyone to know is: that is okay.
In the lead up to, or following surgery, working with an Accredited Exercise Physiologist no longer becomes purely about weight loss but about other factors: function, sleep, energy, self-esteem, habit forming. If we can make exercise a habit prior to surgery, we know that it will be easier to continue losing weight after the initial benefits of the surgery.
In my exercise physiology appointments, I take a full history, undertake an assessment, and then we discuss goals, barriers, facilitators and devise a plan that fits exactly into your life. I liase with your other practitioners and report back to your GP regarding your progress. I see it as my responsibility to empower you, and ensure that you are guided to make the right decisions – especially when nobody is around.
If you are ready to make a life-changing decision to lose weight through surgical means, why not value-add to your experience with exercise? If you commit to surgery, you might as well commit to making a healthy habit of exercise to add strength and mobility to your new figure. You never know the positive power of movement on the body and mind until you try it.
AIHW 2010, ‘Weight Loss Surgery in Australia’, http://www.aihw.gov.au/WorkArea/DownloadAsset.aspx?id=6442472773
ASCM 2011, ‘Exercise and Bariatric Surgery’, http://certification.acsm.org/files/file/CNews22_3pp4_webready.pdf#page=11
Endocrine Society 2013, ‘Long-Term Impact of Bariatric Surgery on Body Weight, Comorbidities, and Nutritional Status’,