Bariatric Surgery FAQs
How long after metabolic and bariatric surgery will I have to be out from work?
After surgery, most patients return to work in one or two weeks. You may have low energy for a while after surgery and may need to have some half days, or work every other day for your first week back. Your surgeon will give you clear instructions. Most jobs want you back in the workplace as soon as possible, even if you can’t perform ALL duties right away. Your safety and the safety of others are extremely important – low energy can be dangerous in some jobs.
Many patients are worried about getting hernias at incisions. That is almost never a problem from work or lifting. We recommend no lifting greater than 30lbs for the first 2 weeks. Hernias are more often the result of infection. You will not feel well if you do too much.
When can I start exercising again after surgery?
Right away! You will take gentle, short walks even while you are in the hospital. The key is to start slow. Listen to your body and your surgeon. If you lift weights or do sports, stay “low impact” for the first month (avoid competition, think participation). Build slowly over several weeks. If you swim, your wounds need to be healed over before you get back in the water, usually takes 7-10 days.
Can I have laparoscopic surgery if I have had other abdominal surgery procedures in the past, or have a hernia, or have a stoma?
The general answer to this is yes. Make sure to tell your surgeon and anesthesiologist about all prior operations, especially those on your abdomen and pelvis. Many of us forget childhood operations. It is best to avoid surprises!
Sometimes your surgeon may ask to see the operative report from complicated or unusual procedures, especially those on the esophagus, stomach, or bowels.
Does type 2 diabetes make surgery riskier?
It can. Be sure to follow any instructions from your surgeon about managing your diabetes around the time of surgery. Almost everyone with Type 2 Diabetes sees big improvement or even complete remission after surgery. Some studies have even reported improvement of Type 1 Diabetes after bariatric procedures.
Can I have laparoscopic surgery if I have heart disease?
Yes, but you may need medical clearance from your cardiologist. Bariatric surgery leads to improvement in most problems related to heart disease including:
- High Blood Pressure
- Lipid problems
- Heart enlargement (dilated heart, or abnormal thickening)
- Vascular (artery and vein) and coronary (heart artery) disease
During the screening process, be sure to let your surgeon or nurse know about any heart conditions you have. Even those with atrial fibrillation, heart valve replacement, or previous stents or heart bypass surgery usually do very well. If you are on blood thinners of any type, expect special instructions just before and after surgery.
When can I get pregnant after metabolic and bariatric surgery? Will the baby be healthy?
Most women are much more fertile after surgery, even with moderate pre-op weight loss. Birth control pills do NOT work as well in heavy patients. Birth control pills are not very reliable during the time your weight is changing. For this reason, having an IUD or using condoms and spermicide with ALL intercourse is needed. Menstrual periods can be very irregular, and you can get pregnant when you least expect it!
Most groups recommend waiting 12-18 months after surgery before getting pregnant.
Many women who become pregnant after surgery are several years older than their friends were when having kids. Being older when pregnant does mean possible increased risks of certain problems. Down’s syndrome and spinal deformities are two examples. The good news is that, after surgery, there is much less risk of experiencing problems during pregnancy (gestational diabetes, eclampsia, macrosomia) and during childbirth. There are also fewer miscarriages and stillbirths than in heavy women who have not had surgery and weight loss.
Kids born after mom’s surgery are LESS at risk of being affected by obesity later, due to activation of certain genes during fetal growth (look up “epigenetics” – for more information). There is also less risk of needing a C section.
Will I need to have plastic surgery? Does insurance pay for plastic surgery?
Most patients have some loose or sagging skin, but it is often more temporary than expected. You will have a lot of change between 6 and 18 months after surgery. Your individual appearance depends upon several things, including how much weight you lose, your age, your genetics and whether or not you exercise or smoke. Generally, loose skin is well-hidden by clothing. Many patients wear compression garments, which can be found online, to help with appearance.
Some patients will choose to have plastic surgery to remove excess skin. Most surgeons recommend waiting at least 18 months, but you can be evaluated before that. Plastic surgery for removal of excess abdominal and breast skin is often covered by insurance for reasons of moisture, hygiene and rash issues.
Arms and other areas may not be covered if they are considered “purely” cosmetic by your insurer. Some of these “less invasive” operations can be done in the clinic, however – so they can be much more affordable!
Will I lose my hair after bariatric surgery?
Some hair loss is common between 3 and 6 months following surgery. The reasons for this are not totally understood. Even if you take all recommended supplements, hair loss will be noticed until the follicles come back. Hair loss is almost always temporary. Adequate intake of protein, vitamins and minerals will help to ensure hair re-growth, and avoid longer term thinning. We recommend BARITRACK powder vitamins for the first 3-6 months at least.
Will I have to take vitamins and minerals after surgery? Will my insurance pay for these?
You will need to take a multivitamin for life. You may need higher doses of certain vitamins or minerals, especially Iron, Calcium, and Vitamin D. You will also need to have at least yearly lab checks. Insurance almost never pays for vitamin and mineral supplements but usually does pay for labs. You can pay for supplements out of a flex medical account.
If my insurance company will not pay for the surgery, are payment plans available?
There are loan programs available to cover the cost of health expenses such as metabolic and bariatric surgery. Appeals to insurance companies or directly to your employer may reverse a denial of coverage. Metabolic and Bariatric surgery is a health expense that you can deduct from your income tax.
If you are not able to qualify for a loan, the Obesity Action Coalition (OAC) produces a helpful guide titled “Working with Your Insurance Provider – A Guide to Seeking Weight-loss Surgery.” This guide can help you work with your provider and advocate for your surgery to be covered. You can view the OAC guide on their website.
If I am self-pay but I have health insurance, will my insurance company pay the cost of post-operative complications?
Complications are often reported under a separate medical billing code. The insurance company may not cover these costs. Appeal is often very helpful, and direct contact with your hospital can make a big difference for final costs. Many surgeons also offer a special insurance policy to cover unexpected additional costs.
Will I have to go on a diet before I have surgery?
Yes there is a special pre-operative diet, usually 2 or 3 weeks just before surgery. The reason for the pre-operative diet is to shrink the liver and reduce fat in the abdomen. This helps during the procedure and makes it safer. The high protein low calorie low carb liquid diet is described in another document and will be discussed during your pre operative dietary visits with a Registered Dietician.
Some insurance companies require a physician-monitored diet three to six months prior to surgery as part of their coverage requirement. These diets are very different from the short-term diets, and usually are more about food education and showing a willingness to complete appointments and to learn.
Will I have to diet or exercise after the procedure?
No and Yes.
Most people think of a “diet” as a plan that leaves you hungry. That is not the way people feel after surgery. Eventually, most patients get some form of appetite back 6-18 months after surgery. Your appetite is much weaker, and easier to satisfy than before.
This does not mean that you can eat whatever and whenever you want. Healthier food choices are important to best results, but most patients still enjoy tasty food, and even “treats.”
Most patients also think of exercise as something that must be intense and painful (like “boot camp”). Regular, modest activity is far more useful in the long term. Even elite athletes can’t stay at a “peak” every week of the year. Sometimes exercise is work, but if it becomes a punishing, never-ending battle, you will not keep going. Instead, work with your surgeon’s program to find a variety of activities that can work for you. There is no “one-size-fits-all” plan. Expect to learn and change as you go!
For many patients (and normal weight people, too) exercise is more important for regular stress control, and for appetite control, than simply burning off calories. As we age, inactivity can lead to being frail or fragile, which is quite dangerous to overall health. Healthy bones and avoiding muscle loss partly depends on doing weekly weight bearing (including walking) or muscle resistance (weights or similar) exercise.
I am unable to walk.
Almost everyone is able to find some activity to “count” as moderate exercise, even those who are partially paralyzed, or who have arthritis or joint replacement or spine pain. Special therapists may be needed to help find what works for you.
How do I get a letter of necessity?
Some insurance requires this type of letter from either your surgeon or primary care provider before final approval for surgery. Many will just accept your surgeon’s consultation summary note. It is best to ask your insurer directly. Most companies want information pertaining to current weight, height, body mass index, the medical problems related to obesity, your past diet attempt history and why the physician feels it is medically necessary for you to have bariatric surgery. Your bariatric surgeon will often have a sample letter of necessity for you to take to your primary care physician.
Can I go off some of my medications after surgery?
As you lose weight, you may be able to reduce or eliminate the need for many of the medications you take for high blood pressure, heart disease, arthritis, cholesterol, and diabetes. If you have a gastric bypass, sleeve gastrectomy or a duodenal switch, you may even be able to reduce the dosage or discontinue the use of your diabetes medications soon after your procedure.
When deciding where to have metabolic or bariatric surgery, patients have many options. One significant choice to make is whether you will have your surgery at an accredited or a non-accredited facility. In making this choice, it is critical for patients and referring physicians to understand what makes a facility “accredited”, and why that accreditation is so important.
The bariatric and metabolic surgery accreditation process is called MBSAQIP, which stands for Metabolic and Bariatric Surgery Accreditation and Quality Improvement Program. MBSAQIP was developed jointly by the American College of Surgeons and the American Society for Metabolic & Bariatric Surgery, to foster patient safety and surgical excellence. To become accredited, a facility undergoes a rigorous process of evaluations to ensure their level of quality across safety, training, followup, and surgical volume standards.
Importance of Accreditation
A recent study showed that the mortality rates at non-accredited facilities are on average three times greater than the mortality rates at accredited facilities.
Accreditation is an important, life-saving process and we encourage patients and referring physicians to seek out those facilities that meet these rigorous standards. You can find accredited facilities can be found through the
Bariatric Surgery Misconceptions
Misconception: Most people who have metabolic and bariatric surgery regain their weight.
As many as 50 percent of patients may regain a small amount of weight (approximately 5 percent) two years or more following their surgery. However, longitudinal studies find that most bariatric surgery patients maintain successful weight-loss long-term. ‘Successful’ weight-loss is arbitrarily defined as weight-loss equal to or greater than 50 percent of excess body weight. Often, successful results are determined by the patient, by their perceived improvement in quality of life. In such cases, the total retained weight-loss may be more, or less, than this arbitrary definition. Such massive and sustained weight reduction with surgery is in sharp contrast to the experience most patients have previously had with non-surgical therapies.
Misconception: The chance of dying from metabolic and bariatric surgery is more than the chance of dying from obesity.
Truth: OUR PROGRAM RISK OF DEATH IS ZERO% SO FAR.. COMPLICATION RATE OF 0.1-0.2%
As your body size increases, longevity decreases. Individuals with severe obesity have a number of life-threatening conditions that greatly increase their risk of dying, such as type 2 diabetes, hypertension and more. Data involving nearly 60,000 bariatric patients from ASMBS Bariatric Centers of Excellence database show that the risk of death within the 30 days following bariatric surgery averages 0.13 percent, or approximately one out of 1,000 patients. This rate is considerably less than most other operations, including gallbladder and hip replacement surgery. Therefore, in spite of the poor health status of bariatric patients prior to surgery, the chance of dying from the operation is exceptionally low. Large studies find that the risk of death from any cause is considerably less for bariatric patients throughout time than for individuals affected by severe obesity who have never had the surgery. In fact, the data show up to an 89 percent reduction in mortality, as well as highly significant decreases in mortality rates due to specific diseases. Cancer mortality, for instance, is reduced by 60 percent for bariatric patients. Death in association with diabetes is reduced by more than 90 percent and that from heart disease by more than 50 percent. Also, there are numerous studies that have found improvement or resolution of life-threatening obesity-related diseases following bariatric surgery. The benefits of bariatric surgery, with regard to mortality, far outweigh the risks. It is important to note that as with any serious surgical operation, the decision to have bariatric surgery should be discussed with your surgeon, family members and loved ones.
Misconception: Surgery is a ‘cop-out’. To lose and maintain weight, individuals affected by severe obesity just need to go on a diet and exercise program.
Individuals affected by severe obesity are resistant to long-term weight-loss by diet and exercise. The National Institutes of Health Experts Panel recognize that ‘long-term’ weight-loss, or in other words, the ability to ‘maintain’ weight-loss, is nearly impossible for those affected by severe obesity by any means other than metabolic and bariatric surgery. Bariatric surgeries are effective in maintaining long-term weight-loss, in part, because these procedures offset certain conditions caused by dieting that are responsible for rapid and efficient weight regain following dieting. When a person loses weight, energy expenditure (the amount of calories the body burns) is reduced. With diet, energy expenditure at rest and with activity is reduced to a greater extent than can be explained by changes in body size or composition (amount of lean and fat tissue). At the same time, appetite regulation is altered following a diet increasing hunger and the desire to eat. Therefore, there are significant biological differences between someone who has lost weight by diet and someone of the same size and body composition to that of an individual who has never lost weight. For example, the body of the individual who reduces their weight from 200 to 170 pounds burns fewer calories than the body of someone weighing 170 pounds and has never been on a diet. This means that, in order to maintain weight-loss, the person who has been on a diet will have to eat fewer calories than someone who naturally weighs the same. In contrast to diet, weight-loss following bariatric surgery does not reduce energy expenditure or the amount of calories the body burns to levels greater than predicted by changes in body weight and composition. In fact, some studies even find that certain operations even may increase energy expenditure. In addition, some bariatric procedures, unlike diet, also causes biological changes that help reduce energy intake (food, beverage). A decrease in energy intake with surgery results, in part, from anatomical changes to the stomach or gut that restrict food intake or cause malabsorption of nutrients. In addition, bariatric surgery increases the production of certain gut hormones that interact with the brain to reduce hunger, decrease appetite, and enhance satiety (feelings of fullness). In these ways, bariatric and metabolic surgery, unlike dieting, produces long-term weight-loss.
Misconception: Many bariatric patients become alcoholics after their surgery.
Actually, only a small percentage of bariatric patients claim to have problems with alcohol after surgery. Most (but not all) who abuse alcohol after surgery had problems with alcohol abuse at some period of time prior to surgery. Alcohol sensitivity, (particularly if alcohol is consumed during the rapid weight-loss period), is increased after bariatric surgery so that the effects of alcohol are felt with fewer drinks than before surgery. Studies also find with certain bariatric procedures (such as the gastric bypass or sleeve gastrectomy) that drinking an alcoholic beverage increases blood alcohol to levels that are considerably higher than before surgery or in comparison to the alcohol levels of individuals who have not had a bariatric procedure. For all of these reasons, bariatric patients are advised to take certain precautions regarding alcohol:
- Avoid alcoholic beverages during the rapid weight-loss period
- Be aware that even small amounts of alcohol can cause intoxication
- Avoid driving or operating heavy equipment after drinking any alcohol
- Seek help if drinking becomes a problem
If you feel the consumption of alcohol may be an issue for you after surgery, please contact your primary care physician or bariatric surgeon and discuss this further. They will be able to help you identify resources available to address any alcohol-related issues.
Misconception: Surgery increases the risk for suicide.
Individuals affected by severe obesity who are seeking bariatric and metabolic surgery are more likely to suffer from depression or anxiety and to have lower self-esteem and overall quality of life than someone who is normal weight. Bariatric surgery results in highly significant improvement in psychosocial well-being for the majority of patients. However, there remain a few patients with undiagnosed preexisting psychological disorders and still others with overwhelming life stressors who commit suicide after bariatric surgery. Two large studies have found a small but significant increase in suicide occurrence following bariatric surgery. For this reason, comprehensive bariatric programs require psychological evaluations prior to surgery and many have behavioral therapists available for patient consultations after surgery.
Misconception: Bariatric patients have serious health problems caused by vitamin and mineral deficiencies.
Bariatric operations can lead to deficiencies in vitamins and minerals by reducing nutrient intake or by causing reduced absorption from the intestine. Bariatric operations vary in the extent of malabsorption they may cause, and vary in which nutrients may be affected. The more malabsorptive bariatric procedures also increase the risk for protein deficiency. Deficiencies in micronutrients (vitamin and minerals) and protein can adversely affect health, causing fatigue, anemia, bone and muscle loss, impaired night vision, low immunity, loss of appropriate nerve function and even cognitive defects. Fortunately, nutrient deficiencies following surgery can be avoided with appropriate diet and the use of dietary supplements, i.e. vitamins, minerals, and, in some cases, protein supplements. Nutrient guidelines for different types of bariatric surgery procedures have been established by the ASMBS Nutritional Experts Committee and published in the journal, Surgery for Obesity and Other Related Disorders. Before and after surgery, patients are advised of their dietary and supplement needs and followed by a nutritionist with bariatric expertise. Most bariatric programs also require patients to have their vitamins and minerals checked on a regular basis following surgery. Nutrient deficiencies and any associated health issues are preventable with patient monitoring and patient compliance in following dietary and supplement (vitamin and mineral) recommendations. Health problems due to deficiencies usually occur in patients who do not regularly follow-up with their surgeon to establish healthy nutrient levels.
OUR PROGRAM OBTAINS BLOOD WORK EVERY 3 MONTHS FOR THE FIRST YEAR AND EVERY 6 MONTHS THERE AFTER
Misconception: Obesity is only an addiction, similar to alcoholism or drug dependency.
Although there is a very small percentage of individuals affected by obesity who have eating disorders, such as binge eating disorder syndrome, that may result in the intake of excess food (calories), for the vast majority of individuals affected by obesity, obesity is a complex disease caused by many factors. When treating addiction, such as alcohol and drugs, one of the first steps is abstaining from the drugs or alcohol. This approach does not work with obesity as we need to eat to live. Additionally, there may be other issues affecting an individual’s weight, such as psychological issues. Weight gain generally occurs when there is an energy imbalance or, in other words, the amount of food (energy) consumed is greater than the number of calories burned (energy expended) by the body in the performance of biological functions, daily activities and exercise. Energy imbalance may be caused by overeating or by not getting enough physical activity and exercise. There are other conditions, however, that affect energy balance and/or fat metabolism that do not involve excessive eating or sedentary behavior including:
- Chronic sleep loss
- Consumption of foods that, independent of caloric content, cause metabolic/hormonal changes that may increase body fat (sugar, high fructose corn syrup, trans fat, processed meats and processed grains)
- Low intake of fat-fighting foods (fruits, vegetables, legumes, nuts, seeds, quality protein)
- Stress and psychological distress
- Many types of medications
Obesity also ‘begets’ obesity, which is one of the reasons why the disease is considered ”progressive.” Weight gain causes a number of hormonal, metabolic and molecular changes in the body that increase the risk for even greater fat accumulation and obesity. Such obesity-associated changes reduce fat utilization, increase the conversion of sugar to fat, and enhance the body’s capacity to store fat by increasing fat cells size and numbers and by reducing fat breakdown. Such defects in fat metabolism mean that more of the calories consumed are stored as fat. To make matters worse, obesity affects certain regulators of appetite and hunger in a manner that can cause an increase in the amount of food eaten at any given meal and the desire to eat more often. There are many causes for obesity and that the disease of obesity is far more than just an ‘addiction’ toward food. The treatment of obesity solely as an addiction may be beneficial for a very small percentage of individuals whose only underlying cause for obesity is excessive and addictive eating, but would be unlikely to benefit the multitudes, particularly those individuals affected by severe obesity.
Life After Bariatric Surgery
Bariatric surgery is a major event in a patient’s weight-loss journey, but the event is best seen as a new beginning. Obesity is a lifelong disease and there is no operation, diet or medication that can by itself offer a permanent cure. Surgery with good aftercare and moderate lifestyle changes can give wonderful long-term results for health and weight.
Nutrition (food and supplements) and Fluids
In the weeks after surgery, your surgeon will have a plan for you to follow, including instructions for nutrition and activity. This may include a liquid diet for a period of 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 hard to get enough fluid. Most surgeons advise a goal of 64oz or more of fluids daily to avoid dehydration, constipation, and kidney stones. You will also need a lifelong habit with daily supplements, usually including:
- Vitamin D
- Vitamin B12
The American Society for Metabolic and Bariatric Surgery (ASMBS) has specific recommendations on the recommended doses, but be sure that you follow your surgeon’s advice.
Healthy lifestyle choices give the best results for health and Quality of Life after surgery. Protein-rich foods are important, with patients advised to take in 60-100g of protein daily, depending on their medical conditions, type of operation and activity level. The ASMBS warns patients to avoid excessive carbohydrate intake, such as starchy foods (breads, pastas, 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.
Q: Which vitamin and mineral supplements should I expect to take after weight-loss surgery?
A: Multivitamin, calcium with vitamin D, and in some cases, an iron and/or vitamin B12 supplement. Sometimes Vitamin A is added to the regimen depending on the operation’s degree of malabsorption. A chewable form is recommended, at least initially after surgery. Be sure you are using a vitamin appropriate for adults, not a children’s multivitamin.
Q: How long will I need to take vitamin supplements?
A: Vitamin supplements will be a lifelong requirement.
Q: How much protein do I need daily?
A: Most patients get 60-80 grams daily, but some may require more depending on their response to surgery or their type of operation. Your dietitian can provide more detailed information.
Q: Can I take all of the protein in one dose?
A: Protein should be taken in multiple doses, across multiple meals or healthy snacks. The body cannot absorb more than approximately 30 grams at once. Also, protein is a nutrient that helps us feel fuller, longer. If we try to include proteins in each of our meals or healthy snacks, we’re less likely to feel hungry when it’s not time to eat.
Q: How should I get my protein? With shakes? Bars? What if I’m a vegetarian?
A: There are many options even for those with special dietary needs or preferences. Your dietitian can provide additional information on protein sources. Meats, eggs, dairy products, and beans are common protein sources in everyday foods. Protein extracts made from soy, brown rice and whey are commonly sold in stores. Protein shakes or bars may offer additional ways to meet your protein needs. You may find it helpful to calculate your daily protein intake to be sure you’re not falling short. As you are able to tolerate more regular foods, you get a higher portion of the requirement during regular meals and supplements become less necessary.
Q: What happens if I don’t take in enough protein?
A: The body needs additional protein during the period of rapid weight loss to maintain your muscle mass. Protein is also required for your metabolism to occur. If you don’t provide enough protein in your diet, the body will take its protein from your muscles and you can become frail.
Q: Do I need to avoid caffeine after bariatric surgery? A: Caffeine fluids have been shown to be as good as any others for keeping you hydrated. Still, it is a good idea to avoid caffeine for at least the first thirty days after surgery while your stomach is extra sensitive. After that point, you can ask your surgeon or dietitian about resuming caffeine. Remember that caffeine often comes paired with sugary, high-calorie drinks, so be sure you’re making wise beverage choices.
Q: Why is fluid intake important?
A: Dehydration is the most common reason for readmission to the hospital. Dehydration occurs when your body does not get enough fluid to keep it functioning at its best. Your body also requires fluid to burn its stored fat calories for energy. Carry a bottle of water with you all day, even when you are away from home; remind yourself to drink even if you don’t feel thirsty. Drinking 64 ounces of fluid is a good daily goal. You can tell if you’re getting enough fluid is if you’re making clear, light-colored urine 5-10 times per day. Signs of dehydration can be thirst, headache, hard stools or dizziness upon sitting or standing up. You should contact your surgeon’s office if you are unable to drink enough fluid to stay hydrated.
Many Americans with obesity have severe health problems such as diabetes, high blood pressure, elevated cholesterol and coronary heart disease. Patients who undergo bariatric surgery and successfully lose weight see these health conditions improve, and they may be able to stop some medications with their doctor’s advice.
Taking fewer prescription medications doesn’t always mean “no more pills,” though. Good health is the goal, not fewest pills. Many people actually take more pills, as they follow vitamin and mineral plans, and have better awareness of benefits.
Q: What effect does weight loss surgery have on my medications?
A: Prescription or over-the-counter drugs may be absorbed differently after surgery, depending on the type of procedure. Your medication therapy may be affected by this change. In the early period right after surgery, larger tablets or capsules may not be recommended by your surgeon so that pills do not become stuck. Because of this, your surgeon may recommend that you take medications different forms, such as crushed, liquid, suspension, chewable, sublingual or injectable. Some long-acting medications and “enteric coated” medication may not be crushable. Some medication may be crushed and administered with food.
Sleeve gastrectomy and adjustable gastric banding tend to have little to no change in the absorption of medications. Roux-en-Y gastric bypass and duodenal switch can have more significant changes in how medications are absorbed. Check with your surgeon and pharmacist about how you should take each of your medications. Some patients need a higher dose of anti-depressants to have the same effect. This is not a complication, but you need to be aware of how you feel, and speak up with all your caregivers.
Q: Will my medications change after bariatric surgery?
A: Maybe. Some doses may change (see the previous question). Some medication doses may decrease as the obesity-related health conditions improve. For example, diabetic patients often require less insulin or other diabetes medications after surgery because glucose control can improve quickly. Patients who take high blood pressure and cholesterol medication can see their doses lowered if these disease states improve. Any changes in prescription medication should be overseen by your doctor; this is not something that you should do yourself.
Q: Which medications should I avoid after weight loss surgery?
A: Your surgeon or bariatric physician can offer guidance on this topic. One clear class of medications to avoid after Roux-en-Y gastric bypass is the “Non-steroidal anti-inflammatory drugs” (NSAIDs), which can cause ulcers or stomach irritation in anyone but are especially linked to a kind of ulcer called “marginal ulcer” after gastric bypass. Marginal ulcers can bleed or perforate. Usually they are not fatal, but they can cause a lot of months or years of misery, and are a common cause of re-operation, and even (rarely) reversal of gastric bypass.
We advise limiting the use of NSAIDs after sleeve Gastrectomy and adjustable gastric banding as well. Corticosteroids (such as prednisone) can also cause ulcers and poor healing but may be necessary in some situations. Some long-acting, extended-release, or enteric coated medications may not be absorbed as well after bariatric surgery, so it is important that you work with your surgeon and primary care physician to monitor how well your medications are working. Your doctor may choose an immediate-release medication in some cases if the concern is high enough. Finally, some prescription medications can be associated with weight gain, so you and your doctor can weigh the risk of weight gain versus the benefit of that medication. There may be alternative medications in some cases with less weight gain as a side effect.
Q: Are there any additional prescription medications I will have to take after bariatric surgery?
A: Some patients may require anti-acid medications, either temporarily or indefinitely. Some surgeons prescribe a temporary medication for gallstone prevention if you still have a gallbladder. Ask your surgeon if these will be needed.
Q: Are all medications crushable?
WE USUALLY DON’T RECOMMEND CRUSHING PILLS UNLESS THEY ARE LARGE IN SIZE. CAPSULES CAN BE TAKEN INTACT.
Not all medications are crushable. Whether or not a medication can be crushed would depend on the drug formulation. In general, non-coated, immediate release tablets may be crushed. It is important that you are VERY careful with medications, so please always check with your surgeon, primary physician, or pharmacist prior to making medication decisions. An online list of non-crushable medications is available at http://www.ismp.org/tools/donotcrush.pdf.
Physical activity is very important for long-term weight management. Different patients may have different needs and abilities. As you progress in your fitness program, your body becomes more efficient at the same activity, which means that you tend to burn fewer calories. As you lose weight, the number of calories burned per hour tends to decrease as well. And so, throughout time, it is necessary to gradually increase the intensity or length of your fitness activities. Your surgeon or fitness instructor may have specific recommendations for you in this regard.
Q: How much exercise should I get?
A: Current recommendations for activity are 150 minutes of moderate activity each week such as brisk walking, jogging, Zumba, swimming, or using exercise machines. Please note that the ability to safely tolerate exercise differs from person to person. Please make sure that your chosen exercise and amount will be safely tolerated by you.
Q: How soon after surgery can I exercise?
A: That depends on the type of exercise. You should begin walking while still in the hospital, unless instructed otherwise. As you heal, begin to increase your exercise time and intensity. Your doctor will release you to increase your activity based on your progress. After surgery, exercises such as weights, sit-ups, pull-ups, or any abdominal straining should wait until you get the go-ahead from your doctor.
Q: What type of exercise should I do?
A: Include aerobic (“cardio”), resistance (strength) and flexibility exercise into your routine for best results. Try different exercise programs to find what is right for you. Learn what is available in your community through your bariatric program, local fitness centers, and fellow patients. Warm water exercise (such as lap swimming or water aerobics) is excellent for those with joint pain. Home exercise videos are another option if you do not have access to a nearby gym.
Learn more: http://www.cdc.gov/physicalactivity/everyone
Not surprisingly, When a person goes through major lifestyle and body changes after surgery, major adjustments occur 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. Strong relationships can become stronger as those involved communicate and work through these changes. Weak relationships can fracture and suffer as a result of these changes. Your workplace dynamics can change; 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 it’s interpersonal conflict, marriage stress, a surgical complication, or a plateau in weight-loss.
Eating habits are 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 or not hungry, you should seek additional help from your surgeon, qualified psychologists, or behavioral therapists. These issues can be successfully treated to get patients back on track if identified.
Once you have had surgery, your life will be forever different. 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 created an unhealthy “weight set point” where your body has likely been stuck or hovering around, almost like a thermostat that is set too high. Your body is very effective at trying to maintain that weight and preventing change. As you lose weight, it is important to know that your body will try to establish a new set point. This leads to periodic plateaus in weight. This is normal and expected. Do not allow yourself to be discouraged when you reach a plateau, as these are normal and necessary parts of the weight-loss journey.
Learn more from articles written by the Obesity Action Coalition at http://www.obesityaction.org/educational-resources/resource-articles-2/weight-loss-surgery.
Sleep and Stress
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, and 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 few hours before bed), and creating a peaceful bedroom environment that is quiet, not too bright, and comfortable. Also, many patients have sleep apnea before 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 post-operative 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 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.
Learn more about support groups at http://www.obesityaction.org/advocacy/support-groups.
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.
Q: Why do I have to quit smoking or using tobacco before surgery?
A: Smoking or chewing tobacco leads to decreased blood supply to your body’s tissues and delays healing. Smoking harms every organ in the body and is been linked to:
- Blood clots (the largest cause of death after bariatric surgery)
- Marginal ulcers after gastric bypass
- Heart disease
- Chronic obstructive pulmonary (lung) disease
- Increased risk for hip fracture
- Cancer of the mouth, throat, esophagus, larynx (voice box), stomach, pancreas, bladder, cervix, and kidney.
Q: How soon do I have to quit smoking before surgery?
A: Six weeks is needed to reduce the risk of fatal blood clots and pneumonia. Stopping just a week or two before can even make some risks worse; this is not unique to bariatric surgery. Your surgeon will have specific guidelines on how long you must be tobacco-free before surgery, and many will reschedule surgery until you are “clean.” There are blood tests that can show if you have been smoking, even if you are on a nicotine patch or gum, so don’t cheat!
Q: Where can I get help to help me quit?
A: Talk to your primary care practitioner; they would be glad to help! You can also call 1-877-44U-QUIT (1-877-448-7848) or 1-800-QUIT-NOW (1-800-784-8669), or log on to http://www.smokefree.gov.
Q: Can I drink alcohol after surgery?
A: Alcohol is not recommended after bariatric surgery. Alcohol contains calories but minimal nutrition and will work against your weight loss goal. For example, wine contains twice the calories per ounce that regular soda does. The absorption of alcohol changes with gastric bypass and gastric sleeve because an enzyme in the stomach which usually begins to digest alcohol is absent or greatly reduced.
Alcohol may also 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.
Pregnancy After Bariatric Surgery
Q: Is it safe to get pregnant after I have bariatric surgery?
A: It is recommended you avoid getting pregnant for 12-18 months after surgery. This allows you to have maximum weight loss and reach a stable weight. You will also be very limited in your nutrient intake for quite some time after surgery.
Q: I’ve never been able to get pregnant anyway, so I won’t need to worry about avoiding pregnancy after surgery, will I?
A: You can experience a boost in fertility quite soon after surgery, so it is important to use a barrier method of birth control such as IUD, or condoms and spermicide to ensure you do not become pregnant. Birth control pills are much less effective patients with obesity and in the phase of rapid weight loss. If you do become pregnant, please contact your bariatric surgeon and your obstetrician to monitor your progress. You will need to closely monitor your nutrient intake and be evaluated for vitamin deficiencies.
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.
Many studies show that we’re all more likely to engage in better habits when we know that someone will be regularly checking in with us. For this reason, most bariatric surgery programs plan for long-term follow-up visits with a healthcare provider experienced with obesity management. These follow-up visits may be the surgeon, a physician assistant or nurse practitioner, dietitian, mental health professional, exercise specialist, or a medical weight-loss specialist (bariatrician). The most important thing is that you find a bariatric surgery program that provides for this long-term care, so that any problems or concerns that develop over time can be addressed by an experienced team.
Medical professionals are not replaceable, but joining with others on the journey can be just as important. Support groups can be a great way to learn, and to share in a safe setting.
Most programs are very sensitive to the fact that patients feel vulnerable to criticism and bias. You need to be able to feel safe to share 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, and that life changes and the body adapts over time. “Tune-ups” are possible, and useful.
Congratulations on taking such an important step toward a healthier life! Life after bariatric surgery is not all easy, but strong planning, appropriate education, and determination can help as you make this journey.