Healthy Diets -  Dubai General Medicine Clinic

• Do not eat animal meat every day, and eat only small portions.
• Limit tea, coffee, and alcohol intake.
• Eliminate or reduce takeaway foods (high in salt and fat). Limit to once a week.
• Eat fish* at least twice a week, preferably daily.
• Fruit is good for you—have it as part of breakfast.
• Limit cheese and ice cream to twice a week.
• What you usually eat matters most, not what you occasionally eat.
• Avoid regularly eating larger fish known to have high mercury levels (e.g. swordfish, tuna).

Fattening foods

It is essential to cut down on high-kilojoule foods. These include:

• Fats (e.g. oils, butter, margarine, peanut butter, and some nuts)
• Refined carbohydrates (e.g. sugar, cakes, soft drinks, sweets, biscuits, white bread).

A good rule is to avoid ‘white food’—those containing lots of refined sugar or flour. Instead, go for complex carbohydrates—grains, and vegetables.

Weight loss and surgery

Bariatric–Metabolic surgery indicates maximal weight loss of 20–32% was achieved at 1–2 years after surgery. Weight loss was sustained at 18% even after 20 years. The weight loss seen after adjustable gastric banding is slow and gradual, whereas rapid weight loss can be expected with sleeve gastrectomy and Roux-en-Y gastric bypass.

Improvements after weight loss post-surgery include:

• Better glycaemic control and reduced medication burden
• Type 2 diabetes remission in some cases
• Reduction of cardiovascular morbidity >50% (compared with BMI-matched and age-matched controls)
• Improved liver histological appearance in non-alcoholic fatty liver disease
• Potential regression of established non-alcoholic fatty liver disease
• Significant improvement in apnoea–hypopnea index
• Remission of obstructive sleep apnoea in some cases.

The choice of surgical procedure is guided by the individual’s characteristics, aims of therapy, and available surgical expertise. Roux-en-Y gastric bypass produces the largest amount of weight loss and may be appropriate for individuals with a very high BMI.

Adjustable gastric banding has a higher rate of re-operation for inadequate weight loss and thus may be suitable for older individuals or those at lower BMI ranges. Roux-en-Y gastric bypass provides the greatest rate of diabetes remission and treatment of gastroesophageal reflux disease (GORD).

Sleeve gastrectomy and adjustable gastric banding may exacerbate gastro-oesophageal reflux disorder.

Long-term complications include iron-deficiency anemia, vitamin B12 and thiamine deficiency and complications, dumping syndrome, weight regain, and an over-restricted gastric band (for adjustable gastric banding).

Physical activity, including strength training, is recommended. In patients with type 2 diabetes, a reduction in doses of glucose-lowering medications is often necessary, and withdrawal can be considered if glycated haemoglobin (HbA1c) is normal for at least six months. Lipid-lowering medications should not be lowered unless clearly indicated. The effect on blood pressure is variable and occasionally transient.