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How to manage medication-related and post-surgery weight gain
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How to manage medication-related and post-surgery weight gain

Keeping a watch on the medication, maintaining a healthy diet and bringing about positive lifestyle changes could keep those extra kilos at bay
postsurgeryweighgain
Anantha Subramanyam K

That certain medications could lead to weight gain is a fairly well-known fact. Also, a major concern post-surgery is often how to avoid putting on a few extra kilos. While some medications and surgeries do, indeed, lead to an increase in weight, what comes as a relief is that there are ways of combating this issue.

Medicines and weight

Reena’s diabetes diagnosis did not come as a shock to her. Her genetic profile predisposed her to diabetes and her sedentary lifestyle did not help matters. The 45-year-old mother of one had always been slightly overweight but soon after she was diagnosed with the condition and put on medication, her weight shot up.

“I am watching my diet and have also started hitting the gym, so why is my weight out of control?” she had asked her doctor.

In some cases, diabetes medication could be the culprit. The culprit in her case was the medicine she had been prescribed to increase her insulin sensitivity. She has now been prescribed a different combination of drugs that works on her insulin resistance while also countering the weight gain side effect.

Prof Dr Anil Arora, Chairman and HOD, Institute of Liver Gastroenterology and Pancreaticobiliary Sciences, Sir Ganga Ram Hospital, New Delhi, explains, “Certain types of diabetes is treated with a class of medicines called pioglitazones, which work by combating insulin resistance. These do tend to lead to weight gain. So generally, when prescribing these medicines, doctors need to take this side effect into account and may avoid it in case an individual is already obese and diabetic.”

After Reena’s medication was changed and she made healthy lifestyle changes, her weight has been under control.

Corticosteroids to blame too

Deepak feels that he has been given a second chance after his severe COVID-19 experience. “I was certain I would not survive. Thanks to the doctors and modern medicine that I am alive today,” he says. The only drawback for him has been the sudden weight gain. In his case, the steroids used in his treatment were held responsible for the weight gain.

“Corticosteroids are life-saving drugs,” agrees Prof Arora. “But they do have many side effects, weight gain being one of them.”

However, these miracle drugs are often the only solution for certain critical conditions as well as for some chronic ailments. Corticosteroids are often prescribed for long-term usage in cases of asthma, rheumatoid arthritis and other autoimmune disorders.

“The treatment protocol when cortico steroids are mandated, generally speaking, is – minimum dosage for minimum duration. But this has to be decided on a case-to-case basis because the first priority is saving the life,” adds Prof Arora.

Are anti-depressants the culprit?

Another category of long-use medication that can lead to weight gain is anti-depressants. “Certain depression medication has a component that suppresses the satiety receptors of the brain. This often leads to the person overeating and consequently gaining weight,” Prof Arora explains.

Post-surgery weight gain

While a lot of people do tend to gain weight after surgery, Dr B B Agarwal, gastrointestinal (GI) surgeon at Sir Ganga Ram Hospital, New Delhi, feels that this is a myth. “Post-surgery weight gain has nothing to do with the surgery per se. It is a misconception to say that a person has gained weight because of the surgery. Surgery is a means of correcting a sickness. Its aim is to lead an individual to a healthy lifestyle. If a person balances caloric intake with output after the surgery, there is no reason why they should put on weight.”

The blame for gaining weight after surgery should be put on all the myths associated with “healthy foods” – which translates to lots of ghee and other high-calory comfort foods. “Another factor is that people often fear physical activity immediately after surgery and tend to overindulge in comfort foods,” said Dr Agarwal.

“Let’s take the example of, say, gall bladder surgery – a common form of surgery worldwide. Prior to the surgery, with a sick gall bladder, an individual suffers from digestion issues and is unable to eat properly, and often develops a fear of eating because of the discomfort. Once the problem is removed, their appetite returns and following the traditional wisdom of ‘resting’ after surgery, they start gaining weight,” explains Dr Agarwal.

A, B, C, D, E, F of recovery

The days when surgery necessitated long periods of bed rest and a lot of post-operative care are now a thing of the past. With modern surgical techniques like keyhole surgery, people can get back to their regular life at the earliest with minimal hospital stay.

“I prescribe the A, B, C, D, E, F protocol for most people I treat for the condition. A for activity, B for bath, C for commitment to yourself, D for diet, E for exercise and F for family life. A to D can start within hours of the surgery,” says Dr Agarwal.

According to him, except for certain specific kinds of surgery (cardiac, brain, cancer), which require graduated rehabilitation, most people can follow the above protocol.

Prehabilitation

Dr Agarwal, in fact, suggests prehabilitation for those going in for planned surgery. “I suggest people that they try and build up their fitness level before the surgery as this helps in smooth recovery,” he says.

Social perceptions

“Any weight gain post-surgery is a product of social perceptions and fears. For most people ‘eat healthy’ means a rich diet full of energy foods and ghee. When we say healthy diet, we mean nutritious in the scientific sense. There are fears that if you start moving about soon after a surgery, the stitches will tear, the recovery will be hampered. But recovery is a natural process and will happen in due course. Some amount of exercise and yoga may actually help in the recovery as opposed to complete bed rest – unless of course, advised by the attending doctor,” he adds.

Dr Abhimanyu Singh, Consultant Orthopaedician at ONGC Hospital, Dehradun, adds, “Often people take to the bed after an orthopaedic surgery. While the aim of surgery is to get the person mobile, they do the opposite. It is a cultural thing. Most people think that after a surgery, they should rest, not move and let the bones set. These are myths. We encourage even people who have undergone a joint replacement to get mobile at the earliest. In fact, people who follow a strict physiotherapy plan recover much faster than those who just ‘rest’.”

Healthy post-operative diet

Preeti Dhiman, nutritionist and naturopath, recommends the following post-operative diet:

  • Fresh fruits and steamed vegetables
  • A lot of hydration (water) and coconut water for potassium
  • Whole foods and plant-based diet
  • Anti-inflammatory foods like turmeric, berries, pomegranate, ginger and garlic

Weight management after surgery

For weight management after surgery, she recommends:

  • Easily digestible light meals
  • Avoiding refined and processed foods
  • Making healthy lifestyle changes by eating right at the right time
  • Graduating slowly to high protein diet with light exercise

How to remain physically active post-surgery

The most important thing to remember before getting back to physical activity post-surgery is to follow your doctor’s advice. The level of activity will, of course, depend on the kind of surgery you have got done.

When Sumitra, an 80-year-old grandmother, underwent a knee replacement surgery, she was encouraged to take a few steps on the same day her surgery took place. The number of steps were increased incrementally over the next week, and by the time she was sent home, she was able to walk from her hospital room to her car with the help of a walker.

Vani Bhalla Pahwa, a medical fitness and rehab expert, who helps all kinds of people with movement, also advises following the doctor’s orders. “Wait for your doctor’s green signal and follow the rehab advice. Take professional help,” she says.

Taking the middle path

Vani’s mantra when it comes to physical activity post-surgery is one of moderation. “Too fast too soon or too little too late – both are a recipe for disaster. How much you need to push yourself depends on your individual case,” she says.

However, with the permission of the doctor, she recommends that people in recovery may start with smaller movements. Even if the person is in bed, he can wriggle his toes and flex his fingers. “Small movements are essential for blood circulation. You can make small arm and leg movements even in bed. Start small and gradually build up,” she says.

She emphasizes techniques of functional movement that can help reduce pain while getting up from bed or walking to the washroom post-surgery as essential for putting one on the path to recovery. “Often people do not want to move more out of the fear of pain than the pain itself. So, if they fear getting up from bed because of the pain that may come with the movement, they need to be taught the right way of getting up from a lying position. They need to first turn on their side, then use their elbow for support and slowly raise their body to a sitting position before gently moving their feet off the bed,” she explains.

Once an individual sees that they can move independently and relatively painlessly, they can increase their activity.

Of course, the key to preventing post-surgery weight gain remains eating in accordance with the medication, giving your body time to heal and getting back to mobility gradually.

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