Gastric Plication

Contents
What is gastric plication? What you can expect after surgery New eating habits

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1st stage liquid diet Sample menu for liquid diet for 1 day 2nd stage pure diet Sample menu for pure diet for 1 day Diet after the end of the liquid and pure stages (from the 6th week after surgery) Food pyramid

Physical activity

Exercise at least 3 times a week Move about every day Anaerobic activities Aerobic activities Combine aerobic exercises with strengthening ones

Your notes Notes

Prof.MUDr.Martin Fried, CSc.

Head of Clinic Dear Mr/Mrs/Miss, On behalf of the whole team, I would like to thank you for choosing OB klinika for your treatment. We are extremely pleased about it and our team of specialists is ready to help you achieve the desired results of treatment and improve your quality of life. We have an individual approach to every patient, which is why your specific treatment programme will be tailored to your health needs, and will be put together in such a way that it meets your expectations as closely as possible. OB klinika offers you the experience of several leading specialists obesity physicians, diabetologists, psychologists, nutritional therapists, endocrinologists, gastroenterologists, surgeons and more. The clinic uses the best equipment and offers care of the highest European standards. However, it should be acknowledged that surgery and treatment are just the start of the process, the aim of which is to improve your overall health. To fulfil this goal in the ideal way, it is necessary for you to acquire new eating habits and comply with the recommended lifestyle changes. On the following pages, we would like to introduce the general dietary principles and the necessary physical activity. We would also like to acquaint you briefly with the nature and course of the treatment and the recommended post-operative regimen that you should follow. As was mentioned in the introduction, your specific treatment programme will be tailor-made according to your needs. The purpose of the information given in this brochure is not to replace the opinions or advice of a qualified medical personal, but to provide you with a brief guide and help to complement the medical recommendations. In the event of any more detailed questions or uncertainties and problems, you must always contact a doctor as soon as possible. We hope that the information contained in this material will be useful for you, and we trust that together we can improve your health and change your life. 3

What is gastric plication?

The surgery is based on decreasing the stomach volume by its wall sinking (filling, inverting) inside the stomach space. The new shape of the stomach is secured using non-absorbent stitches or special small staples. The result of the surgery is not just decreased volume, but also restricted ability of the stomach to stretch. It probably also leads to change in creation of digestive hormones. The advantage of the operation is that it is not necessary to introduce (implant) any foreign materials for the long term, nor is it necessary to irreversibly remove a large part of an otherwise healthy stomach, as is the case, for instance, with a similar obesity operation the so-called sleeve gastrectomy. After plication, the whole stomach is kept, which means a further benefit to this surgery, which is the possibility to return it to the original state (reversibility). Usually, gastric plication is intended for people for whom conservative treatment has failed repeatedly, and who have a BMI (body mass index) over 40. It is also for people with a BMI between 35 and 40, who suffer from diseases associated with obesity, such as diabetes, high blood pressure, etc.

Reduced space in the stomach The wall is sunk (filled, inverted) inside the stomach space

Shrunken stomach after plication

What you can expect after surgery

The immediate recovery period after surgery is relatively short. You may feel light contractions in your stomach or nausea and vomiting immediately after the operation. These symptoms can be easily reduced with medication. Your hospital stay will not usually be longer than 24-48 hours. After going home, one of the most important prerequisites for successful treatment is the long-term adjustment of your diet and lifestyle. The results appear relatively quickly, and you will usually lose about 30kg in the first year after the surgery. However, you must realise that the actual weight loss (decrease in kilogrammes of weight) is not the most important factor. The aim of obesity treatment is primarily improving your overall health and also preventing improving or fully curing certain serious diseases connected with obesity. In the first two years, you can expect fundamental improvements, e.g., for type 2 diabetes, high blood pressure, increased cholesterol, and sleep disorders. The ideal results only appear if you keep to the lifestyle changes, including physical activity and new eating habits. The most important step on the path to weight reduction is the change in your energy balance. Energy balance is the ratio between the amount of energy you take in and the amount of energy your body gives out.

Energy balance =

Energy intake Energy expenditure

New eating habits

1st stage liquid diet
You must always carefully measure individual portions to make sure they do not exceed 150ml per dose. 150ml of milk 150ml of juice fruit (without pieces of fruit, pulp, etc., just clear fruit juice, e.g., apple) vegetable juices (without pieces of vegetables, e.g., carrot) 150ml vegetable/meat broth strain through a sieve, only drink clear broth without pieces of vegetables or meat, only liquid! 150ml unsweetened plain yoghurt without cereals, pieces of fruit, etc. 150ml protein drink e.g., Nutridrink, Prosure, Nutricomp, Dr.Stank-DietLine shake, Modifast shake, drinks made from whey, Nutriline shake, soured drinks, kefir and soured buttermilk All liquids for drinking should be non-caloric, non-carbonated, and non-alcoholic. Drinking water and tea is particularly suitable. The rule for drinks is also a maximum of 150 ml of liquid in one go. You should keep to the rule drink more often and from small glasses. At the beginning drink from teaspoons, with a straw, or take sips. You must separate food (energy-dense liquids broth, milk, juice, etc.) and drink (water, tea), to ensure the maximum amount of one portion is 150ml. You should drink last non-caloric liquids (water, tea) 30 minutes before food (broth, milk, juice, etc.). Then you should eat, wait 30 minutes, and then drink freely (water, tea) to ensure you drink up to 2.5 litres per day. Not more at this stage! If you use any MEDICINES regularly, you must remember to CRUSH all medicines used during the liquid stage! During this stage IT IS NOT SUITABLE for you to use other FOOD SUPPLEMENTS or VITAMINS. Fizzy preparations in particular are not suitable! They can cause a feeling of fullness, nausea and vomiting. After a gastric plication, we recommend you keep to this regimen for 2 weeks.

Sample menu for liquid diet for 1 day

Breakfast 6am Snack 9am Lunch 12pm Snack 3pm Dinner 6pm 150ml of apple juice 7am 75ml of tea 7.30am 75ml of tea 8am 75ml of water 150ml of milk 10am 75ml of water 10.30am 75ml of water 11am 75ml of water 150ml of clear broth 1pm 75ml of tea 1.30pm 75ml of tea 2pm 75ml of water 150ml of Nutridrink plain 4pm 75ml of tea 4.30pm 75ml of water 5pm 75ml of water 150ml of vegetable juice 7pm 75ml of water 7.30pm 75ml of tea 8pm 75ml of tea

Total liquids:

1,125ml
5 meals per day

2nd stage pure diet

You must always carefully measure individual portions to make sure they do not exceed 150ml per dose. You can repeat foods from the liquid diet stage, but you should already expand your menu to include more food. However, only with a pured consistency.

You can include, for example: Mashed potato Minced meat mixed into mashed potato Broth (if vegetable, then liquidised) Vegetable soup (e.g. spinach, vegetable, LIQUIDISED) Grated apple, mashed banana, childrens fruit snacks (without pieces of fruit), steamed fruit (only liquidised) Steamed grated carrot Childrens food (ready liquidised foods, e.g., Hami, HiPP) Avoid foods which cause flatulence, such as broccoli, cauliflower and pulses. Also avoid carbonated drinks and alcohol. All liquids for drinking should be non-caloric, non-carbonated, and alcohol-free. Water, tea (black, green, white or fruit), ersatz coffee, water with sugar-free fruit squash. The rule for drinks is also a maximum of 150ml of liquid in one go. You should keep to the rule drink more often and from small glasses. You must separate food (energy-dense liquids broth, milk, juice, etc.) and drink (water, tea) to ensure the maximum amount of one portion is 150ml. You should drink last non-caloric liquids (water, tea) 30 minutes before food. Then you should eat, wait 30 minutes, and then drink freely (water, tea) to ensure you drink at least 2 litres per day.

After a gastric plication, we recommend you keep to this regimen for 3 weeks.

Sample menu for pure diet for 1 day

Breakfast 6am Snack 9am Lunch 12pm Snack 3pm Dinner 6pm 150ml of apple fruit snack 7am 75ml of tea 7.20am 75ml of tea 7.40am 75ml of tea 8am 75ml of water 8.20am 75ml of water 8.40am 75ml of water 150ml of plain yoghurt 10am 75ml of water 10.20am 75ml of water 10.40am 75ml of water 11am 75ml of water 11.20am 75ml of water 11.40am 75ml of water 100ml mashed potato, 50 ml of minced meat mixed into mashed potato 1pm 75ml of tea 1.20pm 75ml of tea 1.40pm 75ml of water 2pm 75ml of water 2.20pm 75ml of water 2.40pm 75ml of water 150ml of milk or yoghurt milk without pieces of fruit! 4pm 75ml of tea 4.20pm 75ml of water 4.40pm 75ml of water 5pm 75ml of water 5.20pm 75ml of water 5.40pm 75ml of water 150mlof spinach soup 7pm 75ml of water 7.20pm 75ml of tea 7.40pm 75ml of tea 8pm 75ml of tea 8.20pm 75ml of tea 8.40pm 75ml of tea 9pm 75ml of water

Total liquids:

2,325ml
5 meals per day

Diet after the end of the liquid and pure stages (from the 6th week after surgery)

The transition to a normal diet should be gradual. Gradually include 1 new food each day (i.e., one you include after surgery the first time).

Wait until the next day and if the food does not give you digestive problems (nausea, heartburn, heavy feeling, etc.), you can continue to include it.

Do not use irritating spices or carbonated drinks. You can include everything, but you must chew every mouthful enough. Watch out for

hard peel, seeds, and large mouthfuls. whole fruit.

Squeeze citrus fruit for 2 months after the surgery, then after that you can include the

Stick to the principles of a reduction diet (avoid fried foods, cream sauces, dumplings,

cakes, pies, biscuits, sweet lemonades, cream, and fatty cheeses; white bread should be replaced with wholemeal; include in the menu fish, 1-2 pieces of fruit per day, enough vegetables, low-fat dairy products, etc.).

Keep to a drink diet of 2.5 litres of non-caloric liquids and more (a maximum of 150 ml in one go). Keep a three-hour gap between meals. Have your last meal 2-3 hours before going to bed. Start to do sports as soon as your doctor allows it. Make sure the portion size is 150ml!

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Food pyramid

The food pyramid shows which foods should form the basis of your diet and which, on the contrary, you should avoid. Fruits and vegetables form the base of the whole pyramid. They are a source of vitamins, minerals, and fibre. All these elements are beneficial for reducing your weight as well as for your overall health. You should only include fruit in the first half of the day, then vegetables at any time of day. Bread, pasta, rice, cereals, and pulses, which form the second level of the pyramid, are a necessary source of energy and fibre. They should constitute part of your menu every day. Another essential part of your diet is protein, which forms the third level of the pyramid. Proteins are found in meat, milk, dairy products, egg white, and fish. You should choose lean meats especially (lean beef, lean veal, poultry, fish). You should only include milk and dairy products with a fat content up to 3%. You should concentrate on soured dairy products. Select those cheeses which have 30% fat in dry matter. You can eat a maximum of one whole egg per day (yolk and white), because the yolk contains a lot of fat and cholesterol. The top of the pyramid is made up of foods which are a source of fat and simple sugars sweet foods. These foods should constitute the smallest part of your menu.

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Physical activity

Your weight is significantly affected by both the food you take (energy intake) and the amount of movement you make (energy expenditure). So-called basal expenditure is the energy which the body requires to cover basic life functions, e.g., energy used at rest, without activity. This represents approx. 70% of the total daily energy expenditure. For the remaining 30% you can either make up with active movement or sport, thus setting the wheel of metabolism in motion, or you can stay with basal metabolism and lose weight more slowly. If your intake of food is suddenly restricted, very soon (in the space of weeks or months), your body will adapt to the low energy intake with reduced basal expenditure and the diet will become ineffective. This process starts every time the reduction diet is not accompanied by increased physical activity. The effect of the reduction diet itself may last a maximum of 3-6 months. The only way you can prevent a fall in basal expenditure is regular physical activity. Physical activity is an important part of treatment for many diseases, and is also most effective for prevention. The effect of physical activity is not just due to weight loss, but also due to the change in body composition (the proportion of lean body mass and body fat). Actual physical activity without keeping to the basic dietary principles at least will not lead to longterm weight loss. When selecting physical activity, you must determine what your main goal is. Whether you want to lose weight, improve your physical condition, or increase muscle mass. You will exercise with different intensity if you wish to lose weight, and with different (greater ) intensity if you wish primarily to improve your physical fitness. It is very important that you select the kind of physical activity that you will enjoy, that will suit you, and will correspond with your health (weight, pressure on joints, high blood pressure, diabetes, etc.). You must also think about the intensity of the exercise. If you are unused to exercise, start very carefully. Regularity of movement is also very important, because it is the only way that you will gradually improve and physical activity will be more effective. The heart rate is an indicator which gives an idea whether your selected activity has an aerobic nature and whether it breaks down fat. For younger people, it should not exceed 140 beats/minute, for middle aged people 130 beats/minute and for older people, 110 beats/minute. 12

Exercise at least 3 times a week

Experience and expert literature agree that regular exercise every other day is best. If you have breaks between physical activity longer than three days, in essence you are starting from the beginning. The length of the physical activity is just as important. It is enough for you to exercise around 40 to 50 minutes each session. At first you must extend the time for physical activity gradually, e.g., by five minutes each week, with a very low intensity. Only then is it worth you increasing the intensity of your activity.

Move about every day

Physical activity does not just mean sport. This is all your physical activity per day, which you should gradually increase. An example could be a sufficiently long brisk walk, as long as you do not put too much pressure on joints and tendons, which is very effective and sufficient for your goal. You could also try Nordic walking.

Anaerobic activities
Anaerobic activity is exercise during which the body works with insufficient oxygen intake. This is high performance during a short period, when the bodys oxygen reserves are used up and an oxygen debt is created. The activity is focused on strength. This includes, for example: exercise at a gym with weights pilates body building yoga Not only does anaerobic exercise increase strength, but also stamina. During anaerobic exercise, the body burns carbohydrates primarily. It is suitable as an additional exercise for different types of sport. And, most of all, very important for strength endurance training.

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Aerobic activities
It is physical activity during which the work of muscles and metabolic processes take place with sufficient oxygen supply. Aerobic activity is any exercise carried out with low to medium intensity for a longer time and with increased heart rate (pulse) frequency. For exercise lasting longer, the body begins to use fat stores as a source of energy. This includes, for example: aerobics jogging cycling spinning swimming (even in warm water) zumba walking Nordic walking
running

ball games skiing golf

in-line skating

oriental dance

Aerobic physical exercise strengthens the heart and is most effective for burning fat. It is important to improve overall health, and also the most suitable for weight loss.

Combine aerobic exercises with strengthening ones

You may have already posed the question of whether it is possible to lose weight without excessive sports activity. It is possible, but weight loss will take place relatively slowly and unevenly. Even gentle growth of muscle mass caused by physical activity increases basal metabolism (resting energy expenditure). This means that you start to use energy received from your food more quickly and effectively. You will maintain the lower weight obtained through regular physical activity with ease. However, exercise must go hand in hand with a healthy lifestyle, i.e., with an adjusted diet. You should not just exercise, but eat healthily and regularly. With unsuitable exercise or too much pressure on certain parts of the body, you can incur health problems. You must gradually and evenly increase your condition. Sometimes you get new muscle mass through sport, but the fat only disappears very slowly. Paradoxically, your weight will then increase. A combination of aerobic exercise (with a low to medium intensity) with strengthening ones is ideal. After greater weight loss, you may need cosmetic treatment, especially around the abdomen, legs and arms. The folds of loosely hanging skin created can be removed with plastic surgery individually devised by a plastic surgeon. You can also undergo this surgery at OB klinika. 14

Your notes
It is useful to keep notes about the most important parameters of your health, i.e., your weight, blood pressure, and heart rate. Through them you will get a picture of your successes and progress made. Check your weight once a week. Size of loss of weight depends on various factors, which are initial weight, gender, metabolic rate, and volume of muscle mass. Blood pressure and heart rate are the most important indicators of health and we recommend checking them regularly.

Emergency phone number for clients after operations: 255725125 initial state before surgery

date of operation

weight before surgery

blood pressure

resting heart rate

Notes on operation checks

Weight (kg) 1st week 2nd week 3rd week 4th week Loss of weight (kg) Total loss of weight (kg) Pulse frequency at rest mood or

Weight loss after 4 weeks

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Weight (kg) 5th week 6th week 7th week 8th week

Loss of weight (kg)

Total loss of weight (kg)

Pulse frequency at rest

mood or

Weight loss after8 weeks

Weight (kg) 9th week 10th week 11th week 12th week

Loss of weight (kg)

Total loss of weight (kg)

Pulse frequency at rest

mood or

Weight loss after12 weeks

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Weight (kg) 13th week 14th week 15th week 16th week

Loss of weight (kg)

Total loss of weight (kg)

Pulse frequency at rest

mood or

Weight loss after16 weeks

Weight (kg) 17th week 18th week 19th week 20th week

Loss of weight (kg)

Total loss of weight (kg)

Pulse frequency at rest

mood or

Weight loss after20 weeks

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Weight loss after 26 weeks (6 months)

Weight loss after 52 weeks (1 year)

Weight loss after 78 weeks (18 months)

Weight loss after 104 weeks (2 years)

final state after surgery

Date of operation

Weight after surgery

Blood pressure

Resting heart rate

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Notes

Written by: the OB klinika team Prof.MUDr.Martin Fried, CSc., prim. MUDr.Petra rmkov, Veronika Jirkalov Centre for the treatment of obesity and metabolic disorders OB klinika a.s. Address: Pod Krejcrkem 975, 13000 Praha 3 Phone number to reception: 255725111 Emergency phone number for clients after operations: 255725125 E-mail: info@obklinika.cz

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