What to Expect After Bariatric Surgery

Life after bariatric surgery will be dramatically different than before your procedure, but that is a good thing. While the bariatric surgery itself is obviously the key component of the whole process, it’s how you handle yourself after the surgery that will determine your long term weight loss surgery success. If you neglect to do everything you are supposed to, you will not be able to see the full benefits of your bariatric surgery.

Diet after Bariatric Surgery

After your bariatric surgery procedure you can expect to have a much different diet. This is due to your stomach capacity being greatly reduced, depending on which procedure you opted for. The reduction in the size of your stomach means you physically can’t take in as much food anymore, which means you are prone to becoming full much quicker and can also experience nausea or side effects including “dumping syndrome”.

Immediately after your surgery you will be limited to a mostly liquid diet for the first few days. For the next two to four weeks after this you will be transitioned to a pureed/soft foods diet. This diet does not allow any solid pieces but it is ok to eat foods that can be blended. This can include:

  • beans
  • fish
  • egg whites
  • yogurt
  • cottage cheese

For the next few weeks you can move on to a mix of soft and solid foods. You want to ease in to eating solid foods, as they will be harder on your digestive system and it will take some time to see what your body can tolerate. Finally after about 2 months, you will be able to return to a normal solid food diet, but still at a much smaller scale than you ate pre-surgery.

The key to your diet is changing not only the quantity of food you eat but the quality. You want to focus your diet on healthy, low-fat foods that are low in sugar and that are high in protein. You want to avoid snacking throughout the day and make sure you eat consistent smaller meals.

Exercise after Bariatric Surgery

Exercise is a crucial component to your bariatric surgery success. It is crucial to start an exercise routine as soon after surgery as you can, but first ensure that you have the approval of your doctor to begin. Your doctor will want to ensure that you have healed properly from your procedure and that your body will be able to handle the physical exertion now that you aren’t taking in nearly as much food or calories. Exercise will help the body alter its metabolism and get it use to burning calories naturally and in a healthy manner. It has been proven in studies that patients who exercise after their surgery lose more weight and keep it off longer than those who don’t exercise at all.

Your doctor can help you find a physical therapist who can help you design an initial exercise plan that fits your needs and abilities. Below are some exercise ideas to help get you started:

  • Walking – Walking can be a great first step in to exercising as it something that you know how to do and can provide the cardio benefit that your body needs to help get in to shape.
  • Yoga – Yoga can be a great option for many people as it is a cardio exercise without the impact that running or walking can have on your joints.
  • Swimming – Similar to yoga, this is a low impact exercise that uses the resistance of the water to really give you a better than you’d expect workout.
  • Cycling – Cycling is a good option for people who may have sore feet or weak ankles who can’t jog or walk for long distance.

For more ideas on how you can start your exercise routine, check out our article on Exercising Ideas for People who Don’t Exercise.

Cosmetic Surgery after Bariatric Surgery

With time, after bariatric surgery many patients lose so much weight that they have a significant amount of excess skin that no amount of exercise will remove. This excess skin can appear on the arms, legs, buttocks or torso. Opting for cosmetic surgery is a choice that many people make as this is the only way to remove this excess skin. According to the American Society for Aesthetic Plastic Surgery, there are a variety of surgeries that are typical for post bariatric surgery patients who experience dramatic weight loss. These surgeries include:

  • Face & Neck Lift – After dramatic weight loss, the face skin can become flaccid, resulting in the cheek pads dropping, and jowls forming, resulting in the loss of a defined jaw line. Additionally, the neck can become loose and sagging.
  • Arm Lift – Upper arm excess skin occurs on a drastic weight loss patient and is when skin crosses the arm pit and involves loose skin that extends onto the chest region
  • Breast Lift – A breast lift will raise and firm sagging, flat breasts.
  • Panniculectomy – A panniculectomy is performed to remove the hanging pannus, or apron of skin, from the lower abdomen below the belly button.
  • Lower Body Lift – In one procedure, the sagging skin of the abdomen, outer thighs, buttocks, hips, and waist is corrected.

Mental and Emotional Support after Bariatric Surgery

Due to the drastic change in both your appearance and your lifestyle after bariatric surgery, it is highly recommended that you seek counseling either from a professional or through a support group of people who have gone through a similar experience and are also coping with the drastic body changes that you are experiencing.

Who is a Candidate for Bariatric Surgery?

Bariatric surgery is not for everyone. Even though it offers great potential, with that comes great risk. Bariatric surgery is a major medical procedure and surgeons must first be sure that patients are good candidates before moving forward with the surgery. The screening process for bariatric surgery is extensive and requires a lot of testing, both physically and mentally to be sure that the patient is indeed well prepared. Candidates are typically between the ages of 18 and 65, although some people younger may be eligible depending on conditions.

Primary Requirements

Here’s the primary criteria for potential weight loss surgery patients:

  • Have you made serious efforts to lose weight through healthy diet and exercise and been unsuccessful? Be prepared to discuss what you’ve tried with your doctor.
  • Is your Body Mass Index (BMI) greater than 40? Over 40 is considered extremely obese and could qualify you for surgical intervention.
  • Is your Body Mass Index below 40 but above 30 and you have a health problem related to your weight? Certain people can qualify if they have a weight-related medical condition but do not meet the BMI of 40 that is typically required for weight loss surgery.

Some of the typical obesity related conditions include:

  • High blood pressure
  • Diabetes
  • Arthritis
  • Sleep apnea
  • High cholesterol
  • Family history of heart disease
  • Obesity hypoventilation
  • Asthma
  • Disabling pain in your joints

Additional Factors Considered

If you’ve met the basic requirements above you will then need to meet with your doctor to review all of the potential risks and complications that can arise. Surgeons need to know patients can handle these risks and have well-managed expectations for how life will change following bariatric surgery in order to proceed with treatment.

Your doctor will evaluate you in the following areas

  • Your nutrition history and your weight level over time
  • Your overall medical condition. You may need to have a weight related medical condition to qualify for surgery but certain medical conditions can be made worse by having the surgery. It will be up to your doctor to make the determination on a case by case basis.
  • Your mental state. Patients will be evaluated to ensure that they are mentally prepared for all of the changes that will take place after the surgery. It will take a sound mind to be able to understand all of the changes and be able to properly stick to the necessary diet and exercise regimen that will come along with this surgery.
  • How long have you been obese? If you have been obese with a BMI near or over 40 for 5 years or more, your doctor may be more inclined to recommend surgery than if you have been obese for a shorter time frame. This is because your doctor wants to ensure you have tried all other methods of weight loss first before undergoing surgery.

Once you meet the established criteria for all patients, your doctor will look to assess you personally by asking you a series of questions. These questions from your doctor are intended to ensure that you are truly ready for all that comes along with weight loss surgery and are fully committed to everything you will need to do in order to make it successful.

What is Bariatric Surgery?

Bariatric surgery refers to a range of surgical procedures designed to help severely obese people lose weight. With some 15 million people in the United States suffering from severe obesity, the number of bariatric procedures has risen exponentially over the last two decades. According to the American Society for Metabolic and Bariatric Surgery, 220,000 people had bariatric surgery in 2009, compared to 18,000 procedures performed in the early 1990s.

These procedures can be categorized according to their modes of action. Some limit food intake, generally by decreasing the size of the stomach so that patients feel sated sooner than they did before surgery. Others restrict the body’s ability to absorb some components of food, including calories. A third category incorporates aspects of both methods.

Types of Surgery

While there are a variety of bariatric surgery options to choose from, some surgeries lose favor over time and others become more popular as technology changes and as studies are done measuring the long term success rates. The three surgery options below are more commonly performed today due to their effectiveness and overall patient outcome.

  • Vertical Sleeve Gastrectomy: The stomach is divided along its vertical access and stapled, reducing its volume by up to 85 percent.
  • Laparoscopic Adjustable Gastric Banding: The stomach is wrapped with a saline-filled silicone band in order to decrease its volume, and the surgeon can adjust the degree of restriction after surgery by changing the amount of saline in the band. This procedure and the Vertical Sleeve Gastrectomy are the purest examples of methods that work by limiting food intake.
  • Gastric Bypass: Perhaps the best-known bariatric surgery, a gastric bypass dramatically reduces the size of the stomach. It also relocates the stomach’s connection to the small intestine so that the duodenum and jejunum are “bypassed,” a change that reduces calorie absorption.

Bariatric surgery is performed both as a traditional open procedure and as a laparoscopic procedure in which small instruments and a miniature camera are inserted through a single abdominal incision. Laparoscopic surgery can offer a faster and less painful recovery than the traditional approach.

Surgical Criteria

The criteria for bariatric surgery generally revolve around an individual’s body mass index (BMI), a number obtained by dividing body weight by the square of a person’s height.

According to the National Institutes of Health, bariatric surgery is appropriate for patients with a BMI of 40 or greater and for patients with a BMI of at least 35 if there are additional obesity-related medical problems like diabetes, serious sleep apnea or hypertension. Recent research, however, has shown support for bariatric surgery when patients who are otherwise healthy have a BMI of at least 35 and when patients with additional medical issues have a BMI of at least 30.

Benefits and Risks

Regardless of the specific procedure, all types of bariatric surgery have been effective in achieving weight loss, with the majority of that loss occurring within two years of surgery. The purely restrictive procedures, like Vertical Sleeve Gastrectomy and Gastric Banding, tend to result in losses that are less dramatic than those obtained with combined procedures, but even those purely restrictive procedures result in losses that average 50 percent of excess weight.

Weight loss is only one of the surgery’s potential benefits. Almost all diabetic patients experience a significant improvement of the disease, with many obtaining a complete resolution. In more than 85 percent of patients, sleep apnea is resolved by surgery. Life expectancy increases by some 89 percent, the risk of developing heart disease is cut in half, and the risk of premature death is reduced by up to 40 percent.

Bariatric surgery is major surgery, done on an inpatient basis and requiring a hospital stay of up to two days, and, as such, it carries some degree of risk. Most of those risks are identical to those inherent in any major surgery, including infection and incisional hernia, but the medical consensus is that the benefits of bariatric surgery outweigh its risks. According to the federal government’s Agency for Healthcare Research and Quality, the risk of death is 0.1 percent and the risk of major complications is approximately four percent.

Patients should be aware that procedures that reduce absorption can result in deficiencies in vitamins and minerals, including calcium, iron and fat-soluble vitamins.

Costs

The cost of bariatric surgery ranges from $10,000 to $35,000, depending on the procedure and the patient’s location. Insurance coverage varies among insurers and among specific policy provisions.
Read more here about the cost of bariatric surgery.

Vertical Banded Gastroplasty

Vertical banded gastroplasty, also known as “stomach stapling” is a purely restrictive bariatric surgery procedure where the stomach is stapled and divided, forming a a small pouch and limits the amount of food that can be taken in. The outlet of this new pouch is restricted by a band that helps create a feeling of fullness and decreases appetite. The band used in this procedure is non-adjustable which is part of the reason why this form of surgery has been falling out of favor with bariatric surgeons in recent years. Newer procedures make use of adjustable bands and do not require staples making newer methods much safer options.

Advantages of Vertical Banded Gastroplasty

  • Patient avoids “dumping syndrome”
  • There is no nutritional deficiencies since this is not a malabsorptive procedure

Disadvantages of Vertical Banded Gastroplasty

  • Success based upon patients strict adherence to diet
  • Classified by the American Medical Association as a “Severely Dangerous” operation
  • High fiber foods and denser natural foods become harder to eat while highly refined junk foods are easier to digest, making adherence to a healthy diet more difficult
  • Reversal of procedure is very difficult
  • Band is not adjustable

While there are instances where vertical banded gastroplasty (stomach stapling) may be the best option for you, it has been falling out of favor in recent years for more effective and safer procedures. There are still many very reputable doctors and hospitals performing this procedure all around the country. You should discuss all of your options with your doctor before making your choice for bariatric surgery.