1. You will be successful at losing weight.

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2. The amount of weight loss will depend on the procedure that your team decides on. Generally, patients at a BMI above 50 and patients with a significant sweet eating disorder or night eating disorder, should undergo a Bilio-Pancreatic-Diversion (BPD) with a Duodenal Switch for a favourable long term outcome. Currently two surgeons are accredited to perform this procedure in South Africa. Attempts should be made by your in-house psychiatrist to control bipolar disease that mostly accompanies night eating disorder.

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3. You will have fewer co-morbidities. 

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4. Diabetes resolution or near resolution can be expected within 48 hours to 12 weeks, depending on the degree of severity. The mechanism of resolution is not primarily through weight loss, but through modification of certain gut peptides, notably GLP-1 and GIP. Other co-morbidities will improve in a similar manner.

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5. You will have a greater sense of satiety. This is as a result of the altered cross talk between the stomach/gut and the pituitary centre in the brain where the appetite centre is located. Not understanding these new signals, and what to avoid or react to, is paramount in how well you will perform post-operatively. 

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6. You will have a better quality of life at many levels.

 

7. How extensive this improvement will be will depend on how well you understand your new ‘built in tool’. You need to be aware of whether you are using it correctly; or whether you are abusing it inappropriately. It essential that your family and friends aid you in understanding your needs and changed lifestyle. After all, you will not be chasing around two peas in a plate, but eating correctly (probably for the first time in a long time). You should take the lead in setting the example to those around you who are still following an unhealthy lifestyle.

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8. You will prolong your life by many years.

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9. You will experience side effects and complications if you push the boundaries.

 

10. Your ‘tool’ has been designed to help you lose weight in a healthy, controlled manner. If you experience persistent dumping, diarrhoea or bloating- you are reverting to old habits instead of carefully listening to your tool and your team. Having a diet that consists of crisps, chocolates and popcorn cannot be good for any stomach; so how would it be good for the newly created pouch?

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11. You will not be able to abuse alcohol. Alcohol breakdown requires an enzyme called alcoholic dehydrogenase secreted by your stomach. Your pouch will secrete a far lesser amount of this enzyme and therefore having an excessive amount to drink is as good as pouring pure alcohol into your blood stream.

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12. You will have to take vitamin supplements. This should be done in a controlled and scientific manner by your endocrinologist. These supplements are not given to ‘make you feel better’. They are critical to your well-being and in preventing the onset of deficiencies. It is paramount to understand that we replace only those elements and vitamins that would normally have been absorbed from your food by the greater curve of your stomach and the first 80 cm after the gastric outlet. You cannot take yourself to the chemist and follow your own shotgun approach.

 

13. You will have to exercise restraint. This is true in the beginning when the pouch is still swollen, but it is even more true for when you reach goal weight. It is a misnomer to think that you can “stretch” the pouch. In the beginning the pouch has a smaller volume as it is swollen from the surgery. Gradually it settles down to the required size over three months at which time you should be able to consume a small plate of the correct food four times a day. It is during this time that you are required to watch your protein intake carefully and go through the various stages of liquid and soft diets. Very few patients will not be able cope with this period of dietary adjustment if they have been counseled correctly. Overeating beyond this point results from ignoring your own body’s signals of satiety. Food will either be stored back up the oesophagus or the outlet stapling will be stretched. Weight maintenance, once you have reached goal weight, is no less a challenge than it would be for any other person, even if they have never been overweight. The operation is for your weight loss assistance. Weight maintenance will depend on how much effort you are prepared to put into the process. So don’t be deluded into thinking that the tool will continue to deal with an adverse lifestyle for life.

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14. You will always have to listen to the prophets of doom and those begrudging you your success. This attitude stems mostly from an extreme lack of knowledge, even within the medical community, as well as outdated common views on the old jejeno-ileal bypass, an unaccredited procedure that was finally banned in South Africa many years ago.

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15. Your self- perception, interaction with other people and levels of confidence may change drastically. Let your in-house team psychologist guide you with regards to this. It is important for your  psychologist to know you before the operation in order to give you the needed advice; as your life situations may change afterwards. Many of these changes may be for the better and may be long overdue. Nevertheless, they may be intimidating to deal with, without the needed support.

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16. If you are at an extreme weight, you almost certainly will have loose skin to remove. You embarked on this road to improve your health and longevity. Removing the excess skin should be seen as the last stretch on a very productive walk to freedom. Don’t feel intimated by the prospect, but make sure you discuss the option of an appropriate plastic surgeon with your endocrinologist, as not all plastic surgeons are experienced in dealing with the kind of surgery you may need.