Amanda Interviews Dr. Botezelli
Bariatrics and Exercises – What is the importance of Physical Exercise after Bariatric Surgery?
Amanda: Hello everyone, Amanda here, CEO and Co-Founder of Bari Better, Inc. where we provide online Bariatric Coaching in English, Spanish and Portuguese and today, I am interviewing Dr. Jose Diego Botezelli (he has a PhD in Metabolism and Physiology) and today we are talking about Bariatrics and exercise. Thank you so much for being with us in our second segment of today’s interview and I would like to talk to you and ask what is actually the importance of physical exercise now after clients have already gone through the Bariatric surgery, no matter what kind of Bariatric surgery you had done.
Dr. Botezelli: Essential! You can not have a successful strategy after Bariatric surgery if you don’t do exercise and the reason is when you do the Bariatric surgery, what happens is you lose a lot of weight, but as you’re not eating that much you start to lose muscle. So, if you don’t do exercise to prevent this muscle loss, what happens is your metabolism will start to reduce. Our muscles are like our engines, like a car engine (bigger your muscle, more fuel you consume). So, imagine if you see a bodybuilder: they guy is pretty big, like 300 pounds of pure muscle, they need to eat like 5,000, 6,000, 7,000 (thousand) calories a day. If you don’t start to exercise after a Bariatric surgery, your metabolism will start to decrease. Why? You start to lose muscle. Our muscles, we need to exercise them to keep them. This is really easy to see if you break a bone, or you see someone who breaks a bone and puts a cast. After just four weeks, when they set up the cast in the hand for example or in the arm, the cast is pretty tied. After 2 weeks, you can see that you can stick like two fingers between the cast and the arm, why? Because you are losing muscle mass, because you are not using that muscle. And then we started to reduce our metabolism. So, in one of our first conversations, you send me your Bioimpedance, which is an analysis that will check your body fat.
Amanda: Please, elaborate a little bit more on Bioimpedance, because a lot of my clients say they had their Bioimpedance done or they say they had something done, and a lot of times they don’t have the explanation, or they don’t have the deepest understanding about it. So, as general information I remember one of the sessions I had with you, you went over with me, I totally understood my numbers and that made so much sense to me and then we totally revamped my exercise program and I needed it because I was losing a lot of muscle mass and then you went into details and explained to me. Please, clarify to our viewers and listeners, because people need to know that.
Dr. Botezelli: So, in this kind of analysis, we check the amount of fat, muscle and water, pretty much. Some of them check other things like bone density and those things, but usually the main numbers are body fat and lean mass. So, body fat: our fat doesn’t spend that much calories per day, it is almost nothing, because it’s just storage, it should not spend energy. You don’t want to store energy inside of a place, in a cell where you spend energy. The more fat mass you have, usually lowers your metabolism. Higher lean mass, higher metabolism. So, what happens after a Bariatric surgery? Usually, because people starts losing a lot of weigh (if they lose like 30 kilos for example, usually this would be 15 kilos of muscle and 15 kilos of fat, or 20 kilos of fat and 10 kilos of muscle), so you are reducing your metabolism and it gets harder and harder and harder. So, if you read your Bioimpedance and your level of fat it’s over 30%, means that you are obese. And for a man over 20% of fat means you are obese, and over 30% of fat for women, means obesity. I see clients, not Bariatrics, but I see many clients who are lean in weight, but when I check their body fat, it is 34-35%, actually they are obese, because obesity is not your weight. If I get a bodybuilder, for example again, he’s pretty big, the guy may be like 200 pounds. Me, for example, when my weight reaches like 185 pounds, I’m considered myself (using the BMI, overweight, because of my height), but my excess of weight is not fat, is just muscle so I’m still healthy, but if I’m leaner and have more fat, this is the bad scenario. So, the Bioimpedance is so important because it will show how much fat you have and how much muscle you have. Everybody wants to lose fat! People don’t want to lose muscle, because muscle is so hard to get (you need to workout, you need to eat properly, you need to eat clean, you need to do exercise all the time). But fat is pretty easy, you just need to sit in front of your TV and eat, that is how easy it is to get fat and we want to lose fat. So, the exercise after the Bariatric surgery will prevent this muscle loss. When we started our strategy, you weight was pretty stable for like six months, but your measurements, your clothes were always reducing, why? because muscle is way more dense than fat, so you start to get smaller and smaller. Because you muscle mass was pretty good, and this is not just you, this is normal, many Bariatric patients that I have, usually when they come to me they say they have done Bariatric surgery years ago and now reached a plateau and can’t lose weight anymore. What I say using Bioimpedance or Adipometer (another measurement that I have), is because they have too much fat and almost no muscle anymore, because they are starving themselves, they are not doing exercise. I am pretty honest, I say we’re doing this strategy, don’t look at your scale for now and you see in 4, 5 months your scale won’t change that much, but your clothes are your best friend, they will show that you’re losing weight.
Amanda: Not only that, but I have to say something: I remember when I met you, we were talking about my muscle loss (that was really impressive for me, just like sitting on the chair was hurting my bones, I could feel my bones), and I remember working with you getting better protein intake and strategies that use with my plan, huge difference, absolutely.
Dr. Botezelli: And that is good training after. It’s good to have Aerobics, like endurance exercise (so it could be a walk, a walk at a fast pace, especially in the first months), because if you went through a Bariatric surgery, it means that your weight is higher, so it’s better if you do spinning, elliptical, equipments that will not have impact (like walking or running would, which will overload your knees or hips). This is actually a good point for the previous interview topic on why you should exercise before the Bariatric surgery? To prepare your body, right? So, if you do the exercise and then you do the surgery, like two months later, you get back on track to the exercise, your body’s already kind of prepared for that, you have a muscle memory, a joint memory there that will improve pretty fast, you will gain muscle pretty fast again and this will protect you against those plateaus that we see all the time (like people lose weight and then they can’t lose weight anymore). I have a client, I am not kidding, she was not eating 800 calories a day, she was eating nothing per day, and she was not losing weight anymore, why? because she did not have muscle, she could not spend energy, her metabolism was so low that even eating so little amount of food, she was not losing weight.
Amanda: Right! And that is why I always tell my clients that Bariatric surgery is not a miracle, it is a tool, and a lot of people thing that after they have the surgery done, they can eat whatever they want, or some people they say “well I’m not going to eat, because then I will release the weight” and that is also not the fact, just like you are saying. Very important to know what to eat and eat right.
Dr. Botezelli: Your body will start to become a Toyota Prius, like super super super efficient, you don’t spend energy anymore, it’s a pretty small engine. Evolutionary speaking, this is reasonable, this is what evolution would like to do with us, because in nature usually I say you don’t have a grocery store across the street. In nature, your body wants to hold energy all the time, your body doesn’t want to spend energy, you don’t have food all the time. If you want food in the nature, go camping and don’t bring food, you need to find your food, you will see how hard it is to just feed yourself for the day, you will sleep hungry, because you need to hunt, and all the food that you see 9like plants, herbs, fruits, they are so tiny, they are so small, they don’t have sugar, it is super hard to eat. We have this mechanism that helps us to get here, where we are now, but saving energy. It’s so important for us, it’s evolutionary, it is a survival process that will try to hold up energy all the time. And with exercise, you keep your muscles, so you want to lose muscles, and you will also spend more calories, this will help you to lose weight in a really healthy and stable way. You will see we will boost your losses. And then we have protein synthesis, you will have parasignaling, your hormones will start to work better, our muscles release hormones that would help your metabolism, so all those things will make you happier, more efficient, stronger. Remember, Bariatric surgery, as Amanda said, is just a tool to make things happen, but you need to make things happen.
Amanda: Yes, and nobody can do that for you, but you, absolutely!
To close up this segment, I want to remind people about the Bioimpedance, because it is so important. I had the knowledge about it and for me was very important that I actually had my Bioimpedance done before my surgery and I remember having my Bioimpedance done again even a year after my surgery (when I kept going to my postop, and I tell my clients to check with their Doctors regarding your exercise possibilities, and to keep going with your Bariatric multidisciplinary team, because they know your goals, they know where you have to be), and then we will follow through with Bariatric Coaching, and with people like you, helping with the exercise and nutrition planning. It’s very important that people understand about Bioimpedance. Just in case you don’t know what a Bioimpedance is, or if you don’t know if you had it done, mine was actually done on a scale (I actually stepped on a scale at my Bariatric surgeon’s clinic, I had to put my hands on the handle and the machine checked all these numbers in my body, I am just saying in a general way for people to understand), some places have a smaller machine.
Dr. Botezelli: Buy one, buy one online, they are super cheap, you pay like $40, $35 Dollars, they’re not as accurate as the ones in the clinic, but they do the job, you have a deviation (like a 3%, 4% error, that’s almost nothing), you have an App in your phone, most of these new scales now they connect with your phone, and the phone will show if you are obese, how is your fat, it will give you the levels and everything and this is amazing for us, we will give you the interpretation, it is just an App and it is $40 Dollars. These clinical scales cost like $4,000 Dollars, do you need them? no! Just go online, super easy, it is a Bioimpedance scale or type body fat scale, it is amazing!
Amanda: And after I had my sessions with you, I do have this scale at home and that is how I weigh myself and you can get all my numbers. That is the beauty of online services, I can send it to you no matter what part of the world you are, you can see, and you can give my exercises accordingly, which is so important. Everybody keep up, exercise if you can! And don’t forget: preop and postop after bariatric surgery! Thank you so much Dr. Botezelli for this segment, I appreciate your time, thanks for being with us today.
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