In China, where bariatric surgery is becoming increasingly popular for cosmetic reasons, the BMI rule is often broken. As in Yang’s case, some surgeons tell patients to binge eat to meet the requirements for surgery.
The hospital did not agree to do the gastrectomy for Yang until she repeatedly promised that she knew the risks and would bear the consequences. The hospital even agreed to do an additional duodenal-jejunal exclusion, a procedure that shortens the route between the stomach and the intestine to reduce absorption of food.
“Compared to obese people and big eaters, a sleeve gastrectomy’s effect on slight people and light eaters like me is limited, so I added the [duodenal-jejunal exclusion] surgery to reduce absorption as well,” she said.
Undergoing a bariatric procedure does not mean one no longer needs to diet. They must completely change their former eating habits. They have to go on a liquid diet and meal replacements for at least two months post-surgery. Since they can only eat such small amounts, they feel hungry more quickly and have to eat often, about 4-5 meals per day.
“They can’t gulp down food or drink after surgery. They have to chew carefully and swallow very slowly like it’s a [traditional] tea ceremony,” Zhang Nengwei, a member of the Endocrinology Committee of the Chinese Medical Association, told NewsChina.
Some hospitals suggest chewing each mouthful up to 30 times and taking 30 minutes to finish a meal, or they could suffer heart palpitations or nausea. This is one of the main side effects of the gastrectomy, as a narrowed stomach causes food to enter the intestines more quickly and thus changes the environment of the gut.
Many interviewed patients told NewsChina that they often vomit and have diarrhea even a year after the surgery and they have to take breaks during meals.
Snacks and other foods high in fat, oil, sugar and spice are hard to digest, as well as foods that are too chewy, hot or cold. Post-surgery, patients must take vitamin supplements and protein powder for at least a year to prevent malnutrition.
Li Xinran, who had a sleeve gastrectomy and weighed 100 kilos pre-surgery, said she began to eat hotpot a week after the surgery. She largely ignored the recommended dietary instructions, eating whatever she fancied. It did not always go her way. She vomited straight away after eating a few noodles, and she realized she could not tolerate anything glutinous or hard to chew and digest, such as beef, mutton and fibrous vegetables like celery.
“I’d just throw up these soft and glutinous foods as soon as they went down my throat,” she told NewsChina.
A sleeve gastrectomy reduces the stomach by about 75 percent. Patients differ in how their appetite changes, so they each must find their own ways to adapt. Li said that soon after the surgery, there was a delay in her brain telling her she was full. She often felt like the “food was piling up in her throat.”
“It’s like if you hiccup, you’ll throw up right away,” she said.
Liu Fei, who weighed 85 kilos before having the same surgery as Li, strictly followed the dietary recommendations, but her body did not adapt to her new stomach well even one year later. “I could only eat tiny amounts of food at a time for five months after the surgery, like just one dumpling, but I had to spit the skin out... I had to gradually increase the amount bite by bite,” she said. “Later, I could eat four dumplings, two to three strands of noodles and four to five pork ribs,” she said.
In theory, people should no longer feel hungry post-surgery, since the procedure cuts off the upper part of the stomach that secretes ghrelin, commonly referred to as the “hunger hormone.” Ghrelin levels in the blood increase before eating and lower after meals. But Liu said that she never felt satiated after the surgery.
“It’s a very weird feeling. You feel stuffed after several bites, but in your mind you feel like you haven’t eaten enough,” she said.
Li said the same. She craved certain foods, but she never felt satisfied as her stomach was full after just a few mouthfuls.