Life After Bariatric Surgery

Bariatric surgery is a major event in your weight-loss journey — life after bariatric surgery is best seen as a new beginning.  Because obesity is a lifelong disease, there is no operation, diet, or medication that can by itself offer a permanent cure. However, surgery — combined with good aftercare and moderate lifestyle changes — can give you wonderful long-term results for your health and weight.

Many studies show that we’re all more likely to engage in better habits when we know someone will regularly check in with us. For this reason, most bariatric surgery programs plan for long-term follow-up visits with a healthcare provider experienced in obesity management. These follow-up visits may be with your surgeon, a physician assistant or nurse practitioner, a dietitian, a mental health professional, an exercise specialist, or a medical weight-loss specialist (bariatrician).

Medical professionals aren’t replaceable, but finding others who can help support you on your weight-loss journey can be just as important. Support groups can be a great way to learn and share in a safe setting.

Most programs are very sensitive to patients feeling vulnerable to criticism and bias. You need to feel safe sharing your challenges and struggles so that you can get help when you need it most. Your caregivers understand and expect that ups and downs happen, that life changes, and that the body adapts over time. “Tune-ups” are both possible and useful.

Congratulations on taking such an important step toward a healthier life! Life after bariatric surgery isn’t all easy, but strong planning, appropriate education, and determine can help as you make this journey.

In the weeks after surgery, your surgeon will have a nutritional and activity plan for you to follow.

Your surgeon’s aftercare plan for you following your weight-loss surgery may include a liquid diet for some time, followed by a progression to soft or pureed foods — and eventually more regular food. While you are healing in the first few months, it is extra difficult to get enough fluids. Most surgeons advise a goal of 64oz or more of fluids daily to avoid dehydration, constipation, and kidney stones. You will also need to be a lifelong habit of daily supplements, usually including:

• Multivitamins
• Vitamin D
• Calcium
• Iron
• Vitamin B12

The American Society for Metabolic and Bariatric Surgery (ASMBS) has specific recommendations for dosages, but be sure that you follow your surgeon’s advice.

Healthy lifestyle choices give you the best chance at improved health and quality of life post-surgery. Protein-rich foods are important — patients are advised to eat 60-100g of protein daily, depending on medical condition, type of operation, and activity level. The ASMBC warns weight-loss surgery patients against excessive carbohydrate intake, including starchy foods (bread, pasta, crackers, refined cereals) and sweetened foods (cookies, cakes, candy, or other sweets). Limiting carbohydrates to 50 grams per day or less helps avoid rebound hunger problems, which can lead to weight regain.

Not surprisingly, when you go through major lifestyle and body changes after surgery, there are major adjustments in how we think about ourselves and how others think of us. Some patients gain much more confidence as they successfully change their lifestyle and manage their weight. Others struggle with continuing to see themselves as affected by obesity.

Marriages and relationships can be strained with the adjustments that occur, although strong relationships can become stronger as those involved communicate and work through these changes. Your workplace dynamics can change as well; some of your teammates at work may support and cheer you on, while others may be less supportive. For all of these reasons, access to an experienced mental health professional can be an important part of postoperative recovery.

Above all, each patient should be prepared for “bumps in the road” along the journey, whether those are interpersonal conflict, marriage stress, a surgical complication, or a plateau in weight loss.

Eating habits are also frequently affected by emotions, stress, boredom, mindless eating, or even eating disorders. These are very common — but not always obvious. If you find yourself eating to relieve stress or eating when you are full and not hungry, you should seek additional help from your surgeon, qualified psychologist, or behavioral therapist. If identified, these issues can be successfully treated to get patients back on track.

Once you have surgery, your life will be different forever. Your body has now been modified to give you a better chance to overcome the underlying genetic, metabolic, environmental, and lifestyle-induced state of obesity. These are powerful forces that create an unhealthy “weight set point” where your body has likely been stuck at or hovering around, almost like a thermostat that’s been set too high.

Your body is very effective at trying to maintain that weight, preventing change. As you lose weight, it’s important to know that your body will try to establish a new set point — this can lead to periodic plateaus in weight. This is normal and expected. Don’t allow yourself to be discouraged when you reach a new plateau, as these are normal and necessary parts of your weight-loss journey.

A healthy sleep pattern (called “sleep hygiene”) is another key to successful weight management. Setting a regular bedtime is not just for kids! Even adults benefit from regular sleep times, as well as from setting aside enough time to sleep. Inadequate sleep has been identified as one contributing factor in weight gain. As you seek to improve your sleep habits, there are techniques that can help: avoiding evening caffeine, exercising earlier in the day (not in the hours before bed), and creating a peaceful bedroom environment that is quiet, not too bright, and comfortable.

Many patients have sleep apnea before their bariatric surgery. While sleep apnea can improve with weight loss, it is important to continue your treatment for sleep apnea. You should discuss the appropriateness of changing sleep apnea treatment with your doctor before you make any modifications.

Successful stress management is another pillar of postoperative success. We know that unmanaged stress can lead to poor choices which can derail your weight-loss attempts. Stress can stifle your success if it is not acknowledged and managed. Even before surgery, it is important to cultivate habits and relationships that relieve stress.

Strong relationships with open communication, regular exercise, and calming habits such as meditation or yoga are all ways to deal with stress. Support groups are also readily available in many weight-loss programs. These provide a venue to interact with your healthcare providers and with other patients to share stories, lend support, and to continually be educated with the latest developments in the rapidly evolving field of obesity medicine.

To have a lower risk of complications with weight-loss surgery, almost every bariatric surgery program will recommend that you quit smoking or using chewing tobacco prior to your surgery. Hopefully, this can be an opportunity for you to kick the habit for good.

Alcohol may be absorbed more quickly into the body after gastric bypass or gastric sleeve. The absorbed alcohol will be more potent, and studies have demonstrated that obesity surgery patients reach a higher alcohol level and maintain the higher levels for a longer period than others. In some patients, alcohol use can increase and lead to alcohol dependence. For all of these reasons, it is recommended to avoid alcohol after bariatric surgery.

Overall, pregnancy after weight loss surgery can be done safely, by taking steps to minimize risks to your body and to the developing fetus. Studies demonstrate a decreased risk of pregnancy-induced hypertension (high blood pressure) and a decreased risk for gestational diabetes. For best outcomes, discuss your options with your surgeon and obstetrician.