Memorial Hermann Memorial City Medical Center

Weight Loss Surgery (Bariatrics)

Life After Surgery

Your life will be different after weight loss surgery.

You'll eat and drink differently, you'll have to make the necessary changes to maintain a healthy lifestyle, and you must dedicate yourself to following some proven guidelines for long-term success. While it will be a challenge at first, committing to some basic but important guidelines will help you enjoy the maximum benefits of your surgery.

Memorial Hermann Memorial City Medical Center's bariatric team has developed a program designed to anticipate – and address – virtually every issue you are likely to face in the months and years after surgery. These include:

• Diet
• Returning to work
• Exercise
• Sex, birth control and pregnancy
• Long-term follow-up
• Cosmetic surgery

Diet
It's important to remember that the changes in your gastrointestinal tract will require significant – and permanent – changes in your eating habits.

You will start with a liquid diet, followed by soft foods and finally a normal diet. This step-by-step plan gives your body the time it needs to heal. It takes about 12 weeks to move from the liquid-only diet to normal foods. Once on a normal diet, your focus must be on healthy, low-fat, low-calorie foods.

Your doctor will develop a set of guidelines especially for you. Here are some basic guidelines to follow for long-term success:

• Do not drink fluids while you're eating, as this will push food through the pouch, allowing you to consume more.
• When you do start eating food, chew it thoroughly.
• Eliminate desserts and other foods with high sugar content from your diet.
• Do not drink carbonated beverages, high-calorie nutritional supplements or milk shakes.
• Be careful about consuming milk products. They contain lactose, which is not easily digested and can produce gas, cramps and diarrhea. Many lactose-free milk products are now available in most supermarkets.
• Do not eat high-fat foods.
• Avoid alcohol for the first year. After that, with your doctor's approval, you may be able to enjoy a glass of wine or small cocktail.
• Avoid snacking between meals.
• Avoid red meat for the first 12 months after surgery, as it is difficult to digest and easily causes small bowel obstructions.
• Proteins – including chicken, turkey, fish, tofu, eggs, low-fat cottage cheese, and low-fat cheese – and other low-fat foods should make up about 50 percent of your intake. You should aim for 50 to 65 grams of protein per day.
• Cook food without fat and season it to taste.
• Limit sauces, gravy, butter and margarine and avoid junk foods.
• Drink at least 64 ounces of non-carbonated, decaffeinated, sugar-free fluids daily, and drink slowly. This will help the body get rid of waste products efficiently and promote better weight loss. It also fills your stomach, and can reduce the desire to eat between meals.
• You must commit to taking nutritional supplements for the rest of your life. These include a multi-vitamin twice a day and possibly calcium, iron, vitamin B-1, B-12 and/or a super B complex. You will need to monitor your labs closely with your PCP to determine what your specific needs are.

Returning To Work
Your timetable for going back to work will depend on the progress of your recovery, your physical condition, the kind of work you do, and the type of weight loss surgery you had. Most patients return to work within 10-14 days.

Exercise
Appropriate physical activity is critical to the recovery process. Your exercise routine will start right after surgery – on the same day. You will be expected to walk every two hours during normal waking hours to avoid pulmonary embolus.

Daily exercise sends a message to your body that you're using those muscles and thus forces it to burn fat. It will also preserve your muscle mass and help get your strength back.

You should work toward getting in 30 minutes of walking every day. This can include a 1-mile walk, bike riding or stair-climbing. Then, when your doctor approves, you can add weight training, resistance training and cardio.

Sex, Birth Control, and Pregnancy
If you are a woman of child-bearing age, we strongly recommend that you use at least two forms of birth control in the first 18 to 24 months after surgery. At that point, your body should be stable enough to carry a fetus to term.

If you're planning to become pregnant, please consult with your surgeon. Patients can return to routine sexual intimacy when the healing process and declining discomfort of surgery allow.

Long-Term Follow-Up
Maintaining the proper body weight is more than just a function of bariatric surgery. It is a lifelong commitment that goes beyond adjusting your lifestyle and sticking to a healthy diet.

While surgery has become a preferred option for morbidly obese individuals, there are still some uncertainties about the long-term impact of the procedures on nutrition and body systems. As such, patients will need ongoing nutritional counseling and periodic checks for anemia (low red blood cell count), B-12, folate, protein, calcium and iron levels.

Initially, these tests will be conducted every three to six months or as needed. After that, they will be required at a minimum of once a year.

Cosmetic Surgery
Bariatric procedures should never be considered cosmetic surgery. However, cosmetic or plastic surgery may be necessary or desired after significant weight loss to remove excess skin or to reconstruct the body for a more normal appearance.

Cosmetic procedures are best undertaken when you've lost within 10 pounds of your ideal goal – generally at least 24 months after bariatric surgery. The timing is critical: a cosmetic procedure performed too soon will produce less-than-satisfactory results and require further operations.

It is also important to note that your insurance typically will not pay for cosmetic surgery. However, in a small number of cases where the excess skin in some way affects the patient's health or ability to function normally, insurers have covered some plastic surgery procedures.

We can make recommendations of board certified plastic surgeons who specialize in reconstructive procedures for bariatric patients so that you get the best results possible from any reconstructive procedures you may choose to undergo.