What To Expect After Bariatric Surgery

If you’re considering bariatric surgery, you probably have an idea of what pre-surgery preparation looks like. But what will life look like afterwards?

There are a variety of bariatric surgical procedures. The most common are the gastric sleeve, gastric bypass, and duodenal switch. Each procedure has its pros and cons. Some provide more weight loss than others, or are more effective at reducing or eliminating certain other medical conditions you may have. Regardless of which type of surgery you have, you will have to make several lifestyle changes in order to achieve your best result.

Diet After Bariatric Surgery

After surgery, your body will need time to rest and heal. Depending on the type of surgery you have, there may be new connections in your digestive tract, and there will be a staple line along your stomach. You do not want to put extra stress on these areas during healing. This means you will be on what is known as a “full liquid diet.” This includes foods that have the consistency of pudding. Often, there is a focus on protein shakes and drinking water at this point. As your body progresses and heals from surgery, your diet will advance to pureed foods, soft foods, and ultimately, back to regular consistency foods.

“After bariatric surgery, you will have to change how you eat, how much you eat, and what you eat,” shares Alon Geva, MD, bariatric surgeon with ProMedica Weight Loss Surgery. This means you will need to be cautious of your portion sizes after surgery. In the early months, you will likely feel full early or have very little appetite. This is a normal part of adjusting to your surgery.

After this “honeymoon phase,” you may feel as though you are able to eat larger amounts than you could before. “This is where self-control comes in to play,” says Dr. Geva. “Even if you feel you can eat more, you should never eat more than one cup of food by volume in any one sitting. This is to make sure you do not stretch out your surgery and do not get more calories than you need.”

Foods To Focus On

There are a lot of theories on the best foods to eat after bariatric surgery, but there are a few simple rules that can help you make good food choices to maximize your weight loss. Generally, you should focus on high protein, low carbohydrate, and low fat foods.

Protein

Your body needs protein for a variety of reasons. It is a source of fuel, a building block of muscles, and helps you feel full after a meal. There are many ways to get your protein, and some are better than others.

According to Dr. Geva, early after surgery, you will need to focus on good protein drinks. These are drinks that have 30 or more grams of protein and only 2 or less grams of sugar. Once you can tolerate regular foods, Dr. Geva recommends getting most of your protein from lean meats where possible. This is because lean meats contain higher amounts of protein compared to nuts or beans, have no carbohydrates, and tend to have less fats. They are also a complete protein source, meaning they contain all of the essential amino acids your body needs to function. Nuts and beans tend to be incomplete protein sources, meaning you will have to mix and monitor more carefully in order to make sure your body gets all of its essential amino acids.

Hydration

Another very important part of your diet after surgery is hydration. “This can be hard to do, especially in the first few days following surgery,” Dr. Geva shares. You will not be able to drink large amounts of water quickly after surgery. Focus on a slow and steady approach, taking a sip of water every five minutes throughout the day.

If you are someone who gets very focused on other tasks and is prone to forgetting, try setting a phone alert or get a water bottle that shows your progress to remind you to drink water. Remember that staying hydrated after surgery is a marathon, not a sprint. Multiple slow and steady sips throughout the day are the best way.

Vitamins and Minerals

Finally, bariatric surgery changes the way your body absorbs some vitamins and minerals. This means you will need to take a bariatric multivitamin every day after surgery to make sure you do not fall behind.

Foods To Avoid

In general, it’s best to avoid sugar, carbohydrates, alcohol, tobacco and marijuana.

Sugar and Carbohydrates

We know that eating too much sugar or carbohydrates, especially refined or processed sugars like those found in junk food and candy, can lead to weight gain. But after bariatric surgery, eating too many simple sugars or complex carbohydrates in one meal or snack may cause dumping syndrome. Dumping syndrome can be “early” or “late,” depending on how long after your meal you begin to experience symptoms. Generally, dumping syndrome causes diarrhea, nausea, sweating, lightheadedness and vomiting.

Alcohol

In general, alcohol is alright in moderation. However, there are a number of things you need to pay attention to concerning alcohol consumption after surgery. “A little bit of alcohol goes a long way after bariatric surgery,” Dr. Geva shares. This means you are more susceptible to the effects of alcohol. A small amount may make you much more intoxicated after surgery than it would before.

If you choose to drink, especially if it is your first time trying alcohol after surgery, try a little bit in a safe place so you have a better idea of how it will affect you. Do not make a habit of drinking regularly. This is both because of the effects of chronic alcohol use, and because alcohol has no nutritional value. Alcoholic drinks are “empty calories.” They do not give you any nutrients, vitamins or minerals that your body needs in order to function properly.

Tobacco and Cannabis

Patients should avoid tobacco and cannabis. “Tobacco raises the risk of every surgical complication, cancer, heart and vascular disease, and more,” Dr. Geva shares. “Nothing good comes from tobacco.”

While data is conflicting on the risks of cannabis, Dr. Geva recommends avoiding it. “Exposing your lungs to super-heated vapors does not do them any good. Plus, cannabis stimulates your appetite, often resulting in what is commonly known as ‘the munchies.’ This can lead to overeating, keeping you from achieving your weight loss goals.”

Exercise After Bariatric Surgery

After surgery, your goal should be to walk at least 10,000 steps per day. Additionally, you should get at least 30 minutes of moderate exercise five times a week. This should ideally be a mix of cardio and weightlifting or resistance training.

Maintaining Weight Loss After Bariatric Surgery

If you stick with diet and exercise protocols, you likely will not have any issues with maintaining your weight loss. “Oftentimes, I see patients follow the protocol right after surgery, but as time goes by, they get relaxed with the rules. Surgery is a tool. If you do not use it correctly, it will not work,” Dr. Geva shares.

For long-term success, it is important that you continue to watch what you eat, monitor your portion sizes, and continue exercising regularly.

Weight Goals After Surgery

Everyone always asks: How much weight can I lose with surgery?

First, set your expectations appropriately. Having bariatric surgery is not always about having a Hollywood body. The main goal of bariatric surgery is to help cure obesity and the health conditions and comorbidities that come along with it. “If you start at 500 pounds, do not expect to drop down to 110. That is not realistic. But if you start at 500 pounds, lose 200, and come off of medications for high blood pressure, high cholesterol, diabetes, and improve your quality of life, I would call that surgery a success,” stresses Dr. Geva.

Next, remember that muscle weighs more than fat. Do not fixate on a number on the scale. If you notice that you are doing everything right, and your weight is not budging, but your clothing sizes are shrinking, that is still good news. It means you are exchanging bulky, unhealthy fat for lean, toned, healthy muscle! Pay more attention to inches lost than pounds.

Addressing Weight Gain

Even if you do not follow all of the advice we have discussed and end up regaining some weight, all is not lost. There are a few strategies to lose that weight again.

The first step is to do a reset diet and get back on track. This means going back to the liquid diet you did just before and after surgery and advancing yourself back to regular food. This will help with reducing the amount of calories you eat. At the same time, you should be getting back to your exercise routine and re-establishing good daily habits.

In some cases, you may discuss adding a weight loss medication after surgery to help maximize the effects of surgery. Although there are a number of new medications on the market for weight loss these days, they are not a magic pill that can fix everything on their own. If you are having trouble losing weight after surgery and are still suffering from obesity-related conditions, you and your surgeon may decide to trial one of these medications.

Finally, weight loss surgery can result in excess skin. Your body will do its best to pull back extra skin as you lose weight, but it may not be able to pull it all back, especially if you start your journey at a higher weight than other patients. Most people do not realize just how much all of that extra skin weighs. If you are 20 or 30 pounds away from your personal goal, you may consider an abdominoplasty or other cosmetic procedure where the extra skin can be removed. This can help you achieve your goal weight and boost your self-confidence.

To Sum It Up…

Life will different after bariatric surgery. You will have to adjust how you eat, how you drink, and how you exercise. But with dedication to the protocol, the proper diet, and the right amount of exercise, you can experience lifelong weight loss success!

Alon Geva, MD
Dr. Geva is a board-certified surgeon specializing in bariatric and minimally invasive surgery. View his profile.