Having Bariatric Surgery

This booklet aims to describe: l What is bariatric surgery page 2 l How the surgery works page 2 l What will happen before you surgery page 3 l What will happen to you while you are in hospital page 4 l What will happen on the day of your discharge page 5 l Follow-up care page 6 l Diet after surgery page 7 l Liver reducing diet page 21 l Becoming pregnant after surgery page 28 l Further information and useful websites page 29 What is bariatric surgery? Bariatric surgery (weight loss surgery) includes a variety of procedures performed on people who are obese. Weight loss is achieved by reducing the size of the stomach with a Gastric Band or through removal of a portion of the stomach (Sleeve Gastrectomy) or by resecting and re-routing the small intestines to a small stomach pouch (Gastric Bypass). Information on each surgery is available and should be provided along with this booklet. Each booklet will include detailed information about each operation including the risks and benefits and how each operation works. The booklets available are: l Having a Gastric Bypass l Having a Sleeve Gastrectomy l Having a Gastric Band How the surgery works All of the operations work by restricting the amount of food that the stomach can hold at any one time. This has the effect of making you feel fuller after smaller meals. A sleeve gastrectomy removes part of the stomach that produces an appetite inducing hormone called Grehlin, and this reduces your hunger. There is an element of reduction in hunger after gastric bypass too, but not after gastric banding. With the band the doctor or nurse is able to increase or decrease the restriction that the band places on you, thereby making it easier or more restrictive when eating meals. 1 2

What will happen before surgery? l You will see a specialist nurse who will go through the operation with you and talk through your hospital stay. l You will be seen by a dietician who will discuss your required pre and postoperative diet plan. You will be asked to adhere to a liver reducing diet (see eating plan page 21) for two weeks before your operation. This helps reduce the size of your liver making your operation easier and safer. If you have not followed the diet prior to your operation you may be denied your surgery on the day l You may have to have some breathing tests (sleep studies) performed to check if you have sleep apnoea. If you do, you may then require a special machine to help you breathe when sleeping (CPAP) l You will be seen and assessed by a clinical psychologist l You will see a surgeon who will be carrying out the operation, so you can discuss the risks and benefits associated with the surgery l You will be seen by a nurse and an anaesthetist in the pre-operative clinic, where you will have your bloods taken and a heart tracing (ECG) What will happen to you while you are in hospital On the day of your surgery You will be admitted to the hospital in the morning and you will need to be nil by mouth for at least 6 hours before your operation. You will be admitted by the nursing staff a surgeon and an anaesthetist. You will be asked to wear a hospital gown and elasticated stockings to help prevent blood clots in your legs. You will also be given a small injection of heparin in order to thin the blood and help to further prevent blood clots. You will then be taken to theatre for your operation after which you will go to a recovery area until you are stable and your pain is well controlled. You will then be transferred to the ward. When you return to the ward Your pulse blood pressure, temperature and breathing will be regularly monitored. You will have a further injection of heparin and will have to wear special boots (Flowtrons) which will massage your legs overnight to help prevent bloods clots in your legs. You will be given regular antisickness medication to prevent nausea and vomiting. You will also be given pain relief which may include Patient Controlled Analgesia (PCA) which contains morphine. This will be discussed and explained by the anaesthetist. When you are fully awake you will be able to have sips of water, which may be increased later. You will then spend the night on the ward where you will be regularly monitored by the nursing staff. 3 4

What will happen on the day of your discharge On the day after your operation You will be encouraged to mobilise as soon as possible. Your PCA will be stopped and you will start on oral pain killers. You will also be given regular anti-sickness medication. You will continue on your liquid diet and before you can go home will need to be able to manage some soup. You will be seen by the specialist bariatric nurse who will discuss your operation and answer any questions you may have and also discuss all the information you will need to know before you go home. You will be seen by the specialist bariatric dietician to discuss your eating plans for the coming weeks. You will also be seen by the pharmacist in order to ensure that all your medications are changed so that you can take them with a liquid diet. If you are diabetic you will also be seen by the diabetic nurse specialist. You will be seen by the surgeon who will discuss your operation it s outcome and plan. Usually the surgeon will then be happy for you to go home later that day. Before you are discharged You will be given all the medication you require including heparin injections (usually for 5 days), which the nurses will show you how to use. Information and contact numbers are provided in this leaflet for any advice and support you may need. You will also be informed of the follow up service that will be provided over the coming weeks Follow-up care l You will be contacted over the phone one week after your operation by the specialist bariatric nurse to make sure you are recovering well and that you have no anxieties or concerns. A further call is made two weeks after your operation. l At three weeks you will be contacted by the specialist dietician to ensure you are managing well and that you are well prepared to progress with your specialist diet (see eating plan page 21) l At 6 weeks and 4 months you will be seen in the nurse led outpatient clinic by the specialist nurse and the dietician l Regular follow up by the dietician will be provided for 2 years l You will also be seen on a yearly basis by the Medical Weight Management Team (MWMT) For gastric band patients: You will also be seen in radiology outpatients approximately 4-6 weeks after your operation for your first band fill. This is done under x-ray to make sure it is working correctly. After this further band fills are carried out in a general surgical outpatient appointment. 5 6

Diet after surgery Stage 1 Initially after surgery you will be given 30-60ml (1-2 medicine cups) of water to sip. When the team are happy, you can progress to free fluids. This means you can sip as much water (or no added sugar squash), tea and coffee as you can manage. Usually, the first day after surgery you are given some clear soup at lunch. Take your time and eat what you can; you are not expected to have it all. If you can tolerate this you can then progress to the recovery diet. Recovery diet: After your operation you will need to follow a diet which will help you to heal but also result in weight loss. It has three stages lasting for 2-3 weeks depending on the surgery (see table below): Surgery / Diet Liquid Puree Soft Band (Weeks) 2 2 2 Sleeve (Weeks) 3 3 3 Bypass (Weeks) 3 3 3 Do not rush through the stages; it will take time for your body to get used to the operation. Everyone is different, so if you think it was too soon for you to progress, go back a step for a couple of days before trying again. From the day of your operation you have to try and clear your mind of what you were able to eat before - things will be very different from now on. Taste changes are common. Remember, this is an opportunity to change your relationship with food. Surgery will help you reduce your portion size; you must make the right food choices to lose weight. Surgery will not cause long lasting weight loss on its own; you will have to work with it to achieve that. That starts with the Liquid diet. Surgery will not affect emotional eating. If you are struggling with emotional eating, please contact any of the team who can refer you to a psychologist if necessary. Liquid diet (for 3 weeks): Upon discharge you will be allowed a liquid only diet. This means you can have any liquid (unless told otherwise), provided it meets the following 5 rules: 1) It is thin enough to be sucked through a straw 2) You should be able to pass it through a sieve (no lumps or bits ) 3) It must be low in fat and sugar 4) free from alcohol and 5) not fizzy It is very important to have enough protein after surgery to help with recovery, keep your immune system strong and prevent hair loss. Try to have a nourishing drink every 2-3 hours with other fluids in between (see below). Aim to drink a minimum of 2 litres of fluid per day, but monitor your urine colour, aiming for a pale straw colour. TIP l Aim to include at least 1 pint of milk every day l To increase your protein intake add 4 tablespoons of skimmed milk powder (e.g. Marvel or supermarket own brand) to one pint of milk l You can use this enriched milk to make a latte or add some sugar free flavouring to make a milkshake High protein liquids: Semi-skimmed or skimmed milk (preferably with added milk powder) Low fat/diet yoghurts (no lumps or bits) Blended and strained high protein soups (including meat, fish, chicken or pulses) Smoothies made with milk/ yoghurt and fruit (no lumps or bits). No more than 125mls per day 7 8

Other liquids: Fruit juice (limit to 1 portion per day - small glass of approx. 125mls) Sugar free squash (or no added sugar ) Water / flavoured water (still, not sparkling) Sugar free jelly Low fat ice cream Tea / coffee Horlicks / Ovaltine (light options) Hot chocolate (light options) Oxo / Bovril / Marmite Liquids to avoid: Fizzy, sparkling drinks Alcohol High fat liquids High sugar drinks Any liquids with bits or lumps Sample menu for liquid stage: Breakfast: Latte made with 1/3 pint semi-skimmed milk (with added milk powder) Mid-morning: 1 diet yoghurt (dilute with milk if needed) Lunch: 1/3 pint home-made chicken and vegetable soup (blended and strained) Mid-afternoon: Latte made with 1/3 pint semi-skimmed milk (with added milk powder) Evening meal: 1/3 pint tomato and bacon soup (blended and strained) Supper: 1/3 pint semi-skimmed milk (with added milk powder) During the day: Drink 1000ml water, 2 cups of tea and 125ml orange juice Alcohol We advise that you should stay away from alcohol completely for the first 6 months after your operation. After 6 months, if you would like to drink alcohol, then drink small amounts with caution. Remember alcohol is very high in calories and can prevent weight loss. It is also absorbed by your body more quickly after some operations and you could get drunk a lot faster. Therefore you need to take care and not drive after any alcohol. Go to: www.drinkaware.co.uk for more details. Stage 2 Pureed diet: The second stage is designed to reintroduce food in a way that: l Continues the healing process l Helps you to avoid vomiting l Begins to educate your mind about how your new pouch deals with food Pureed food should be the consistency of baby food or smooth applesauce. It should have no lumps in it. You will only be able to manage very small amounts at each meal (1-2 tablespoons over 20 minutes). If you try to eat much more than this it may make you uncomfortable or sick. As you progress through the pureed stage you may eat a little more than when you started. To puree foods you will need a food processor or hand held blender. Puree food with extra gravy, milk or sauce and flavour with herbs and (mild) spices. 9 10

Each food should be pureed separately rather than together - this way food will look more attractive on the plate and individual foods will be tasted. Things to remember on the pureed diet: l Try cooking in bulk and try freezing small portions of pureed meat, fish, vegetables, stews or soup for convenience. Ice cube trays are handy l Keep in some baby food as useful standbys l Try not to have foods high in fat and/or sugar as they can cause dumping syndrome. See section on dumping syndrome on page 18) l If you have problems with a particular food, stop eating it for a few days and then try again Planning your days intake Protein: Introduce foods high in protein first. High protein foods include meat, chicken, fish, beans, pulses and dairy products. They are very important for healing and should be taken at each meal and snack. If you find it difficult to eat pureed meat and fish, have more protein from milk or dairy products - but low fat versions. If you are a vegetarian, go for vegetarian sources of protein including quorn, lentils or pulses. Try to include one of these high protein servings at each meal or snack: l 1/3 pint of milk - skimmed or semi skimmed l 1 diet/light yoghurt l 1 fromage frais l 1oz pureed meat - beef, pork, turkey, chicken, lamb l 1oz pureed fish (fresh or tinned) - e.g. haddock, cod, tuna, salmon, mackerel, sardines tinned in brine or tomato sauce l 1oz low fat cream cheese l 1oz grated low fat cheese, mixed in hot food e.g. mashed potato l 3 tbsp custard made with semi skimmed milk l 1-2oz pureed lentils or beans l 2-3 tbsp pureed casserole l 2-3 tbsp pureed cottage or fish pie l 250ml blended meat, chicken or fish based soup Once you can tolerate some high protein foods at each meal, try introducing some vegetables and fruit. Suitable options include: l 125mls vegetable juice or fruit juice (unsweetened) l 1 tbsp pureed vegetable e.g carrots, cauliflower, cabbage, swede, turnip, courgette, broccoli l 1 tbsp stewed fruit with sweetener if necessary l 1 tbsp fresh soft (blended) fruit e.g. bananas, strawberries, raspberries You can also include some starchy foods from this list, if you are not feeling too full: l 250ml pureed soup of any kind l 2 tbsp fine ground porridge (e.g. ready brek) made with milk (puree if too lumpy) l 1/2 weetabix or wheat biscuit (use plenty of milk to make it soggy) l 1 tbsp pureed potato / sweet potato / plantain l Puree any nourishing tinned soups such as lentil or pea and ham or make your own! l 1 tbsp pureed pasta and sauce l 1 tbsp (over-cooked) pureed rice 11 12

Sample menu for pureed stage: Breakfast: 2 tbsp cooked porridge 1 tbsp pureed banana Mid-morning: 1 diet yoghurt Lunch: 1 tbsp mashed potato 1 tbsp carrots 1oz meat / fish Mid-afternoon: 1/3 pint semi- skimmed milk Evening meal: 1oz tuna 1 tbsp pureed rice 1 tbsp puree broccoli Supper: 1 tbsp tinned peaches 1/3 pint semi-skimmed milk During the day: Drink water and 1/3 pint semi skimmed milk Foods to avoid during the pureed stage These foods will not liquidise properly so try not to have them: Eggs Dry or tough meat Ordinary bread or toast Most breakfast cereal Raw or salad vegetables Celery or stringy beans Fruit pips, seed, pith and skins Dried fruit Biscuits, crackers, crisp & nuts Sweets and chocolate Pastry dishes Meal ideas: l 2 tbsp tinned tuna blended with onion, tinned tomato and herbs, served with 1 tbsp sweet potato puree l 2 tbsp slow cooked chicken pureed in gravy, served with 1 tbsp puree carrot and 1 tbsp smooth mashed potato Stage 3 Soft Diet (re-introducing normal textures): The progression from pureed food to a normal diet should take around 3 weeks, starting with foods that are easiest to digest gradually introducing more solid foods. Remember everyone is different with the foods they can tolerate. It is normal to tolerate a food one day and not the next day. If this happens, leave that particular food and try again at a later stage. Start by introducing very soft foods such as: l Soft cooked egg: 1 poached or soft scrambled l Cottage cheese: 2oz/50g l Tender fish in sauce 1oz/25g l Minced meat/quorn in gravy 1oz/25g If these foods cause no vomiting, heartburn or indigestion, move onto foods that need a little more chewing such as: l 1oz/25g tender chicken, turkey, beef, pork, lamb l 1 slice toasted bread (leave un-toasted bread until the very end) l Raw fruit e.g. 1 small peeled apple l Small cup of breakfast cereal e.g. bran flakes l 3 tbsp cooked rice or pasta l Raw vegetables l Salads 13 14

Remember the following points: l Continue to have 3 regular meals per day with optional snacks if needed. l Include some protein at each meal l Remember to have a variety of foods in your diet, and keep trying different things l Keep working on your eating habits (see page 17) l If you find a food difficult to tolerate, leave it and try again after a while. You may be able to manage it eventually Problem foods: Certain foods often cause problems and you may never be able to eat very much of them. We recommend you introduce these foods with caution, paying extra attention to your bite size and chewing. These include: l Soft doughy bread (try toast, wraps, pitta or crisp bread as alternatives) l Pasta and rice l Tough / dry meat, chicken and fish (try slow cooking or cooking in a sauce) You may experience problems with other foods as everyone is different. Example of a menu when you are eating food of normal consistency: Wake up: Small glass of orange juice with supplements Breakfast: Small bowl of cereal + 1/3 pint of semi-skimmed milk Mid-morning: 1 diet yoghurt Lunch: 2oz tuna with ½ medium jacket potato Small salad Mid-afternoon: Piece of fruit Evening meal: 2oz cooked meat and vegetables in a sauce 3 tbsp cooked rice During the day: 1/3 pint semi-skimmed milk during the day in drinks Example of a menu when you are eating food of normal consistency: Aim to eat regularly - 3 meals a day You will be able to eat a larger portion of soft textured food. You should choose challenging textures that require chewing, so that you continue to feel full from small portions Always include at least a portion of protein at each main meal. Choose small portions and use small plates Try not to have high fat high sugar food and drink Take care with alcoholit s high in calories and is easily absorbed. It can also increase your appetite Work on your eating habits (see page 17) 15 16

Eating habits Dumping syndrome It is essential to get into good eating habits after surgery. Good eating habits: l Prevent vomiting and pain l Improve food tolerance l Help you recognise when you are full (prevent overeating) l Enhance weight loss and l Prevent weight regain Drinking just before a meal can reduce your food intake, which may mean you are missing out on important nutrition. Drinking with food or too soon after food can make you sick. Therefore, as a guide, we advise no drinking 15 minutes before and 30-45 minutes after eating. Make sure that you drink in between meals instead. Get into the habit of sipping instead of gulping fluids because your stomach has reduced a lot in size. Good eating habits include: The Rule of 20 l 20p coin sized bites of food (5p if struggling) l 20 Chews per bite l 20 seconds rest between bites (try putting your cutlery down) l Stop eating after 20 minutes Additional good eating habits l Stop when you are full (most important!) - don t return to food and graze or nibble on it l Separate eating and drinking - don t drink 15mins before and 45mins after eating l Sip fluids regularly throughout the day l Eat regularly, do not go for long periods of the day without eating This is caused when too much fat or sugar enter the gut too quickly. This is more of a feature after gastric bypass, though it does occur sometimes after sleeve gastrectomy. You may experience diarrhoea, bloating, discomfort, dizziness, light headedness, sweating, shaking and vomiting up to 3 hours after eating. Try not to have: l Foods high in sugar e.g. sweets, chocolates, biscuits, cakes l Foods high in fat e.g. fried food, pies and pastries, takeaway foods, snack foods like peanuts and crisps l Drinks high in fat and sugar e.g. milk shakes, full fat milk, ordinary fizzy drinks and squashes These foods not only cause dumping syndrome, they make it more difficult for you to reach your target weight. If you continue to suffer with these symptoms despite following the advice above, please speak to a dietitian or a specialist nurse who can advise you further. Rarely, medications might be required to control low blood sugars. And, in extremely exceptional circumstances your surgeon might have to consider reversal of the gastric bypass. 17 18

Food labels What is classed as low fat? What is classed as low sugar? Look at per 100g on the food label, and use the guide below to identify whether a food is low in fat or sugar. Try to choose Low fat / sugar foods as often as you can. Sugars Fat per 100g 5g or less 3g or less Nausea and Vomiting If you feel sick, or are sick, this may be caused by: l Eating too much l Eating too fast l Gulping instead of sipping drinks l Drinking too soon before, with or after meals Remember, your stomach pouch is very small and can fill up very easily. Vomiting is a sign that you are filling your pouch too much, or too quickly. If you do not change your eating habits, this can result in stretching your pouch, which may cause your weight loss to be less successful. Usually, vomiting can be avoided by improving your eating habits. This is why working on your eating habits (outlined on page 17) is so important. But if your nausea or vomiting does not improve even after following the eating habit guidelines for a few days, please contact a member of our team (see section at the end of this booklet for contact details) or your GP for further advice. Constipation Due to the changes in diet and fluid intake it is common to experience constipation. It is important that you do not strain when opening your bowels. If you are constipated, first ensure that you are having a minimum of 2 litres of fluid every day. Make sure that your intake of fruit and vegetables is as described in this booklet. This should ensure adequate fibre and fluid intake. If you still remain constipated discuss this with the specialist nurse or your GP for advice. You may require medications to help such as lactulose, fybogel, movicol or senna. 19 20

The Liver Reducing Diet The liver is the largest organ in the body and sits across the upper part of your digestive system (see the diagram below). Following this diet will reduce the size of your liver making the surgery easier and less likely to have complications. Diaphragm Liver Large Intestine Stomach It is recommended that a very restricted diet; one that is low in fat, sugars and starch, be followed for TWO WEEKS or longer prior to surgery. By following this eating plan the energy supply in your liver is used up, causing it to shrink. This eating plan is only recommended prior to surgery and it is NOT TO BE FOLLOWED AFTER THE OPERATION. It is possible that you will lose a lot of weight on this diet, but it will mainly be water loss. Please ensure that you have plenty to drink throughout the day; it will not prevent you from losing weight. Use the following tables to help you to choose the right amount of each food. You can have any 3 servings from this list per day. Porridge oats or sugar free muesli Breakfast cereal Bread Pasta or Noodles Rice Crispbread Cracker Oatcake Starchy Foods Pitta, Chapatti, Wrap Baked or boiled Potato (with skin) Cous Cous, pearl barley, quinoa 1 Serving is Equal to: 1 heaped tablespoon (uncooked) 3 level tablespoons OR 1 wheat / oat biscuit 1 medium slice OR ½ roll ½ large OR 1 medium 1 small potato ½ large potato 2 egg size potato 2 tablespoons cooked 1 tablespoon uncooked 2 tablespoons cooked 1 tablespoon uncooked 2 tablespoons cooked 1 tablespoon uncooked 2 2 1 21 22

You can have any 2 servings from this list per day. Fruit 1 Serving is Equal to: Banana 1 small Large fruit e.g. melon, pineapple 1 slice Medium fruit e.g. apple, pear, orange 1 fruit Small fruit e.g. plums, Satsuma 2 fruits Grapes / Cherries Approximately 14 Berries e.g. strawberries 1 large handful Tinned/stewed fruit (unsweetened) 3 tablespoons Please avoid dried fruit and fruit juice as they contain a lot of sugar. You can have any 2 servings from this list per day. Dairy Products 1 Serving is Equal to: Milk (semi-skimmed or skimmed) 200ml OR 1/3 pint Soya Milk 200ml OR 1/3 pint Diet Yoghurt 1 small pot (125-150g) Cottage Cheese (low fat) 2 tablespoons Cream Cheese (low fat) 1 tablespoon Low Fat Cheese Matchbox sized piece You can have any 2 servings from this list per day. Chicken / Turkey Beef / pork / lamb White fish Oily fish Lean bacon Eggs Cooked meat slices Beans, Pulses, Lentils Tofu, quorn, soya You can have any 2 servings from this list per day. Butter or Margarine Low fat spread Cooking Oil Mayonnaise, salad cream, oil based dressing Reduced fat / Light Mayonnaise, salad cream, oil based dressing Thickened Gravy Unthicken Gravy Protein Foods Foods High in Fat 1 Serving is Equal to: 50g (2oz) cooked OR 100g (4oz) raw 50g (2oz) cooked OR 100g (4oz) raw 125g (5oz) cooked 50g (2oz) cooked OR 100g (4oz) raw 2 grilled rashers (remove visible fat) 2 medium eggs 2 medium slices OR 4 wafer thin slices 4 heaped tablespoons cooked 100g (4oz) 1 teaspoon 2 teaspoons 1 teaspoon 1 teaspoon 2 teaspoons 1 Serving is Equal to: 1 tablespoon 4 tablespoons 23 24

Alongside this, you can have an unlimited amount of most vegetables and salad so fill yourself up with these. They should cover over half of your plate. Avoid adding fat when cooking/at the table. You should avoid the following vegetables for now as they contain too much starch; l Beetroot l Parsnip l Peas l Sweetcorn l Squash A typical day might look like this: Sample meal plan: Breakfast: l 3 tablespoons of low sugar cereal e.g. porridge OR l 1 slice of toast with a scraping of low fat spread Mid-morning: 1 Portion of fruit Lunch: l Unlimited non starchy vegetables or salad l 1 slice of toast with a scraping of low fat spread l a small portion (2oz or 56g) of lean meat, fish or cheese Mid-afternoon: 1 Portion of fruit Evening meal: l Unlimited non starchy vegetables or salad l 2 egg sized potatoes or 1/2 a jacket potato l A small portion (2oz or 56g) of lean meat, fish, cheese, tofu or quorn based dish Supper: 1 low fat, low sugar yoghurt During the day: 1/3 pint milk (for cereal and in cups of tea/coffee) Suitable drinks include: l Tea l Fruit teas l Coffee l Oxo / Marmite / Bovril l Horlicks / Ovaltine (light options) x1 per day l Low fat hot chocolate x1 per day l Water l Sugar free flavoured water l Low sugar cordial l Diet drinks Tips for success with the liver reducing diet l Use smaller plates, bowls, knives and forks than you usually do. This will help you to control your portion size l Aim for half a plate of vegetables or salad at mealtimes; this will fill you without giving you too many calories l Eat slowly and aim to make your meal last 20 minutes. Chew you food well and put your knife and fork down between mouthfuls l Include plenty of drinks. This can help to fill you up and reduce your appetite l Choose wholemeal cereal, bread, pasta and rice. It will fill you up for longer l You should now be eating less than you did before, so you will want to make the most of it. Eat without distractions and enjoy each bite 25 26

Frequently asked questions When will I know when to start the diet? You will be given a date for surgery about 4-6 weeks before the operation. Start the eating plan 2 WEEKS before the date of your surgery. Are there any side effects to following the diet? Most people follow the eating plan very well without any problems. You may feel hungrier or possibly lacking in energy. However, these feelings mean you are not giving the body with the energy it needs, which ends up with you losing weight. If you are still concerned you can contact the dietitians for more help. If you have diabetes, see the next question. I am on medication to control my diabetes, will it need to be adjusted? It is likely that you will need change the amount of medication you have whilst following the eating plan. Make sure that you seek advice from your Diabetes Care Team before you start so that you are ready to make the right changes. If you have a blood glucose testing device, check your blood sugars regularly. If you have diabetes but are not on medication, make sure you continue to have starchy foods at every meal as outlined in this plan. Becoming pregnant after surgery Obesity can cause infertility, but following weight loss surgery ovulation and periods can recommence. Pregnancy is safe after surgery, reduces the risk of miscarriage, high blood pressure and diabetes. However patients are advised not to get pregnant for the first 12 months after surgery, to allow the weight loss to slow down and establish a regular eating pattern. If you were to get pregnant it is advised that you should your dietician and G.P to ensure that you are having all the nutrients you and your baby require. Once you become pregnant you are advised seek medical advice on the medications you are taking to ensure they are suitable for pregnancy. There is no reason why you should not have a normal delivery and be able to breast feed after surgery. What if my liver does not reduce in size? In the few cases where the liver has not reduced in size it is usually due to the person not following the eating plan fully. Unfortunately, if this happens the surgery may have to be cancelled. Remember that this does not happen very often if you follow the dietary advice. Where can I get further information and support? For further help you can access relevant websites, phone, email or write to us (see page 29 or go to our drop in sessions at the Hospital. The drop-in sessions are run by the dietetic team every Friday afternoon from 12.30-3pm in the Diabetes Centre (Ground floor of the purple zone off the main corridor) at Salford Royal. If you want to see one of us please contact us before coming. 27 28

Further information: You can contact our team at Salford Royal NHS Foundation Trust. If you have any questions, please do not hesitate to contact us: Specialist Bariatric Dietitians 0161 206 1223 Specialist Upper GI / Bariatric Nurses 0161 206 5062 Weight Management Dietitians Department of Nutrition and Dietetics Salford Royal NHS Foundation Trust Stott Lane Salford, M6 8HD weightmanagement@srft. nhs.uk Useful websites: British Obesity Surgery Patient Association (BOSPA) www.bospauk.org 08456 020 446 British Obesity and Metabolic Surgery Society (BOSS) www.bomss.org.uk 02073 044 786 Weight Loss Surgery Information and Support (WLSinfo) www.wlsinfo.org.uk 0151 222 4737 Weight Loss Resources UK www.weightlossresources. co.uk 01733 345 592 Drinkaware - alcohol advice www.drinkaware.co.uk 020 7766 9900 Salford Royal Bariatric Service http://www.srft.nhs.uk/ bariatric/ Notes 29 30

G14040704. Design Services Salford Royal NHS Foundation Trust All Rights Reserved 2014 This document MUST NOT be photocopied Information Leaflet Control Policy: Unique Identifier: SURG37(14) Review Date: August 2016 For further information on this leaflet, its references and sources used, please contact 0161 206 5062 Copies of this information are available in other languages and formats upon request. If you need this interpreting please telephone In accordance with the Equality Act we will make reasonable adjustments to enable individuals with disabilities, to access this treatment / service. Under the Human Tissue Act 2004, consent will not be required from living patients from whom tissue has been taken for diagnosis or testing to use any left over tissue for the following purposes: clinical audit, education or training relating to human health, performance assessment, public health monitoring and quality assurance. If you object to your tissue being used for any of the above purposes, please inform a member of staff immediately. Salford Royal operates a smoke-free policy. For advice on stopping smoking contact the Hospital Specialist Stop Smoking Service on 0161 206 1779 Salford Royal NHS Foundation Trust Stott Lane, Salford, Manchester, M6 8HD Telephone 0161 789 7373 www.srft.nhs.uk If you would like to become a Foundation Trust Member please visit: www.srft.nhs.uk/ for-members If you have any suggestions as to how this document could be improved in the future then please visit: http://www.srft.nhs.uk/ for-patients