Life After Surgery

What do I need to do to be successful after surgery?

Making lasting lifestyle changes is the key to success after surgery.
Important Guidelines to Eating Healthy
1.    Choose Fresh Foods

It’s important for the food you eat to be healthy and nutritious. Choose foods high in protein and rich in vitamins/minerals, such as lean poultry and fish, fresh fruits, and fresh or frozen vegetables.

2.    Avoid High Fat and Sugary Foods

Needless snacking on poor quality, non-nutritious foods (i.e. potato chips, cookies, cakes, ice cream, etc.) is a major reason for failure to lose weight and weight regain.

3.    Prepare Meals Before Eating

These are the steps to take to make sure your food is ready for you to eat:

•    Use measuring cups, spoons, and/or a food scale to measure foods

•    Put foods on a small plate, such as a salad or dessert plate

•    Cut all foods into small, diced, pea-sized pieces

•    Use small toddler utensils to make it easier to take small bites

4.    Keep Foods Moist

Dry foods can get stuck, leading to pain and regurgitation. Be sure to use low calorie (30 calories or less) condiments/dressings/sauces to moisten your foods. Some examples are salsa, light mayonnaise, light salad dressings, mustard, tomato sauce, fat-free gravy.

5.    Eat Protein Foods First at Meals

Protein is important to prevent muscle and hair loss and slowing metabolism during weight loss. In order to consume enough protein to meet your body’s needs you should consume protein at each meal in the form of a protein-rich food or a protein drink. The doctor, nurse practitioner and/or dietitian will give you a specific daily protein goal.

6.    Eat Slowly and Chew Foods Thoroughly

Meals should last approximately 30 minutes. This can be achieved by following these steps:

•    Chew small bites thoroughly (15-20 chews per bite)

•    Swallow each bite before taking another

•    Put the fork or spoon down between bites

•    Use a timer or stopwatch to keep track of your eating pace

7.    Stop Eating Before You Feel Full

Once the stomach is nearly full, the brain receives a signal that enough food has been eaten. Take time to recognize the feeling of satiety (lack of hunger without feeling uncomfortably full). Eating too much food may cause nausea, vomiting, and/or pain, and could lead to damage to your stomach.

8.    Drink Plenty of Hydrating Fluids

Aim to consume 64 or more ounces of fluids daily, unless otherwise directed by your doctor. Choose only very low or no calorie non-carbonated fluids.   Drinking high calorie/sugary fluids can lead to weight gain and/or dumping.   Drinking carbonated fluids can cause pain and stretching in the stomach. Ideal fluid choices include water, sugar-free flavored waters, and diet iced tea.

9.    Sip Fluids Slowly

Drinking too quickly can cause reflux, discomfort, and possible stretching of your stomach and/or esophagus.  Immediately after surgery you should drink at a rate of 1 ounce every 20 minutes.  Once you start Phase I and from that point forward the proper “speed limit” for drinking is 1 ounce every 5 minutes, as tolerated.

10.    Avoid Drinking While Eating and for 1 Hour After

Drinking with foods can cause them to flush too quickly through the stomach, causing you to eat larger portions and/or feel hungry sooner after meals. Alternatively, drinking with foods or too soon after can cause the stomach to overfill, resulting in pain, reflux and possible stretching of the stomach or esophagus. LAGB patients may drink right before meals, while LSG and RYGB patients should stop drinking 30 minutes prior to eating to allow the fluids to empty out of the stomach.

11.    Avoid Stress or Distractions When Eating

Your stomach is a muscle and will react to stressful situations, causing tightness and possible difficulty eating. Distractions may cause you to forget your proper eating techniques, resulting in food intolerances. Meal times should be quiet, uninterrupted and stress-free. If this is not possible, adjust your meal times and/or use a protein shake instead as liquids are more easily tolerated.


What's so important about exercise?

Bariatric surgery is a wonderful tool that helps patients with clinical obesity lose weight and gain their lives back. Physical activity plays an important role in helping patients find success.

In order to lose your maximum amount of weight and to maintain that weight loss, it is extremely important to incorporate exercise into your daily routine. Remember that exercise doesn’t just include going to the gym. There are many ways to get a great workout that can be enjoyable at the same time.

Getting Started

Your activity will be restricted to no strenuous activity for the first three weeks after surgery. You may walk and perform light household duties; however, heavy lifting and strenuous exercise is discouraged during this time as your body is healing. It is recommended that you engage in frequent walks of short duration as tolerated. By the time you are six weeks post-op, you should be walking regularly unless you have specific problems with your weight bearing joints.

Types of Exercises

1. Cardiovascular

Cardiovascular exercise is called aerobic exercise.  Aerobic means "with oxygen." When the muscles are engaged for a long period of time, they demand oxygen from the blood in order to continue working. This type of exercise forces your body to use oxygen more efficiently which will deliver maximum health benefits to your heart, lungs, and circulatory system. Examples of cardiovascular exercises include walking, jogging, swimming, and biking. At least 20 minutes of cardiovascular exercise 3-4 days per week should be enough to maintain a good fitness level, however, to lose weight, you will need to work up to 30-45 minutes (or longer) for 5 (or more) days per week.

2. Strength Building

Strength-building exercises are also known as anaerobic exercises. Strength building exercises such as weight lifting make your bones and muscles stronger, which will increase your metabolism. Strength-building exercises should be performed 2-3 times per week for optimal benefits.

3. Flexibility

Flexibility exercises such as stretching can tone and prevent muscle and joint problems.

Warming Up

Every exercise should begin with a warm-up. Muscles that are warmed and stretched are less likely to become injured during exercise. A warm-up should last 5-10 minutes. Some examples of warm-up exercises include marching in place, arm swings, or other light cardiovascular exercises.

Beginning Exercise

  • Low impact exercises can improve your health and lower your risk of heart disease without harming weight-bearing joints.
  • Walking is a great place to start since you do not need any fancy equipment, just a good pair of walking sneakers. Other popular low-impact exercises include step aerobics, stretching, cross-country ski machines, rowing machines, cycling, swimming, aqua aerobics, Pilates, and yoga.
  • Start with 2-3 days a week of your chosen activity with a rest day in between workouts.
  • You may only be able to exercise for a few minutes at a time when first beginning, but with consistency, that will gradually change.
  • Each week, try increasing your workouts by a few minutes until you can work out continuously for 30 minutes a session.
  • After 4-6 weeks, try adding another day of exercise, and/or increasing your pace/intensity, and increasing the amount of time you exercise.
  • Exercising for 30 minutes a day, 3 days a week is the best way to improve your heart fitness. Exercising longer (up to 60 minutes) is more helpful in weight reduction.

Cool Down

Cool down is just as important as warm-up. To cool down, decrease the intensity of your exercise for 5-10 minutes. Stretching exercises should also be done to improve your flexibility and prevent muscle soreness and tightness.

Benefits of Exercise

Exercise has been shown to:

•    Diminish the rate of coronary artery disease (CAD).        

•    Decrease the risk of strokes.        

•    Decrease the risk of Type 2 Diabetes.        

•    Decrease the rate of hypertension.   

•    Decrease bad cholesterol (LDL).    

•    Increase healthy cholesterol (HDL).        

•    Decrease the risk of developing Metabolic Syndrome.        

•    Decrease the risk of colon cancer.        

•    Decrease the risk of breast cancer.        

•    Decrease the risk of developing Alzheimer's.        

•    Decrease osteoarthritis.        

•    Decrease osteoporosis.        

•    Diminish depression.

•    Increases immunity.

Bariatric surgery has been proven to be a wonderful weight loss tool, however, proper nutrition and physical activity also play a crucial role in your weight loss journey.

Can I get pregnant after weight loss surgery?

Fertility may be increased with weight loss. Women of childbearing age are strongly advised to use the most effective forms of birth control during the first 24 months after weight loss surgery. We strongly discourage women from purposefully attempting to become pregnant for the first two years after surgery since we want both you and the baby to be healthy and safe. The added demands pregnancy places on your body and potential for fetal damage make this a most important requirement.  Once a stable weight is reached, many women go on to conceive and deliver healthy babies.

What if I have had a previous weight loss surgical procedure and I'm now having problems?

Contact your original surgeon - he or she is most familiar with your medical history and can make recommendations based on knowledge of your surgical procedure and body. If you need routine follow-up care or unsure if another bariatric surgery is an option contact the Surgical Weight Loss Institutes bariatric surgeons program. 

With the Gastric Bypass what happens to the lower part of the stomach that is bypassed?

The stomach is left in place with intact blood supply. The lower stomach still contributes to the function of the intestines even though it does not receive or process food - it makes intrinsic factor, necessary to absorb Vitamin B12 and contributes to hormone balance and motility of the intestines in ways that are not entirely known.

How big will my stomach pouch really be in the long run?

In the Roux-en-Y gastric bypass, the stomach pouch is created at one ounce or less in size (15-20cc). In the first few months it is rather stiff due to natural surgical inflammation. About 6-12 months after surgery, the stomach pouch can expand and will become more expandable as swelling subsides. Many patients end up with a meal capacity of 3-4 ounces.

What will the staples do inside my abdomen? Is it okay in the future to have an MRI test? Will I set off metal detectors in airports?

The staples used on the stomach and the intestines are very tiny. Each staple is a tiny piece of stainless steel or titanium so small it is hard to see other than as a tiny bright spot. Because the metals used (titanium or stainless steel) are inert in the body, most people are not allergic to staples and they usually do not cause any problems in the long run. The staple materials are also non-magnetic, which means that they will not be affected by MRI. The staples will not set off airport metal detectors.

What if I'm not hungry after surgery?

It's normal not to have an appetite for the first month or two after weight loss surgery. The most important aspect is consuming adequate fluids and protein to promote healing and weight loss. Actually scheduling meals maybe necessary do to a decreased physical appetite. Please keep in mind there is a difference between physical and mental hunger. 

Is there any difficulty in taking medications?

 Medications are prescribed for various reasons and come in many different forms. Some medications may not be absorbed correctly after bariatric surgery or may cause damage to your bariatric surgery. The best way to know about the interaction of any medication after weight loss surgery is to discuss your medications with your bariatric surgeons or their Nurse Practitioners.

Is there a difference in the outcome of surgery between men and women?

Both men and women generally respond well to this surgery. In general, men lose weight slightly faster than women do.

Will I be asked to stop smoking?

Yes, all patients are asked to stop smoking prior to bariatric surgery.

If I continue to smoke, what happens?

Smoking increases the risk of lung problems after surgery, can reduce the rate of healing, increases the rates of infection, and interferes with blood supply to the healing tissues. Your bariatric surgeon may not perform surgery if you have not stopped smoking. 

How can I know that I won't just keep losing weight until I waste away to nothing?

Patients may begin to wonder about this early after the surgery when they are losing 10 to 20 pounds per month, or maybe when they've lost more than 100 pounds and they're still losing weight. Two things happen to allow weight to stabilize. First, a patient's ongoing metabolic needs (calories burned) decrease as the body sheds excess pounds. Second, there is a natural progressive increase in calorie and nutrient intake over the months following weight loss surgery.  The bottom line is that, in the absence of a surgical complication, patients are very unlikely to lose weight to the point of malnutrition. Once a patient reaches their ideal body weight they work even closer with the Registered Dietitian to bring in certain healthy food choices and start to learn about maintenance. 

What can I do to prevent lots of excess hanging skin?

Many people heavy enough to meet the surgical criteria for weight loss surgery have stretched their skin beyond the point from which it can "snap back." Exercise, strength training, and toning of muscles do help to some degree. Some patients will choose to have plastic surgery to remove loose or excess skin after they have lost their excess weight. Insurance generally does not pay for this type of surgery (often seen as elective surgery). However, some do pay for certain types of surgery to remove excess skin when complications arise from these excess skin folds.

What if I am really hungry?

This is usually caused by the types of food you may be consuming, especially starches / carbohydrates (rice, pasta, potatoes). Carbohydrates are easily converted to sugar in our bodies, which is then stored as fat. Eating a high carbohydrate diet is a common cause of weight gain. High carbohydrate foods increase blood sugar levels, which causes a rise in insulin levels, which, in turn, can lead to food cravings and increased physical hunger. Many carbohydrate-based foods are high in calories, sugar and fat and low in vitamins and minerals. These foods add “empty” calories to our diet. After surgery, eating a high carbohydrate diet can cause you to become full on carbohydrate foods, preventing you from being able to eat adequate amounts of protein.  Be absolutely sure not to drink liquid with food since liquid washes food out of the pouch.

Will I have to change my medications?

Medications are prescribed for various reasons and come in many different forms. Some medications may not be absorbed correctly after bariatric surgery or may cause damage to your bariatric surgery. The best way to know about the interaction of any medication after weight loss surgery is to discuss your medications with your bariatric surgeons or their Nurse Practitioners. Medications that should be used only in consultation with your bariatric surgeon are NSAID's, aspirin, steroids, and time released medications. NSAID's are over-the counter pain medicines (ibuprofen, naproxen, etc.) may create ulcers What is a hernia and what is the probability of an abdominal hernia after surgery?

A hernia is a weakness in the muscle wall through which an organ (usually small bowel) can advance. Approximately 20% of patients develop a hernia with the gastric bypass surgery. Most of these patients require a repair of the herniated tissue. The use of a reinforcing mesh to support the repair is common.

Is blood transfusion required?

Infrequently: If needed, it is usually given after surgery to promote healing.

What is phlebitis and is it preventable?

Undesired blood clotting in veins, especially of the calf and pelvis. It is not completely preventable, but preventive measures will be taken, including:

1.    Early ambulation

2.    Special stockings

3.    Blood thinners

4.    Pulsatile boots

Will I lose hair after surgery? How can I prevent it?

Many patients experience some hair loss or thinning after surgery. This usually occurs between the fourth and the eighth month after surgery. Consistent intake of vitamins and minerals, protein and water. Some individuals have found the use of biotin helps. Most patients experience natural hair regrowth after the initial period of rapid weight loss.

What are adhesions and do they form after this surgery?

Adhesions are scar tissues formed inside the abdomen after surgery or injury. Adhesions can form with any surgery in the abdomen. For most patients, these are not extensive enough to cause problems.

What is the "Candida Syndrome?"

Some patients have a type of yeast present on the surface of their skin, intestine or vagina at the time of surgery. This leads to overgrowth in certain circumstances. A whitish coating may occur on the tongue or throat. This syndrome is associated with a frothy mucous, nausea, difficulty swallowing, sore throat, loss of taste and appetite, and occasionally abdominal bloating and diarrhea.

What causes it to appear?

It is promoted by the use of most antibiotics and some other medications, by stress, by reduced immune response, and by diabetes.

Can it be cured?

There are several effective medications now available for treating the overgrowth of Candida.

What is sleep apnea (SA)?

It is the interruption of the normal sleep pattern associated with repeated delays in breathing. Sleep apnea often shows rapid improvement after surgery. In most patients, there is a complete resolution of symptoms.