Updated September 2020 | Written by the Public Education Committee
Exercise
As we age, lack of activity 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 exercise.
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. 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!
Nutrition
Many bariatric surgeons put their patients on 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.
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.
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 you can whatever and whenever you want. Healthier food choices are important for best results, but most patients still enjoy tasty food, and even occasional “treats”.
The National Institutes of Health (NIH) Expert Panel stated that, without surgery, long-term weight loss is nearly impossible for those affected by severe obesity. Studies show little long-term success with diet and exercise alone.(3) Weight loss surgeries are effective in maintaining long-term weight loss, in part, because these procedures change the body’s natural responses to dieting that make weight loss so difficult. When a person goes on a diet, their body produces more hormones that cause an increase in hunger and a decrease in calories burned. This decrease in calories the body burns is more than explained by the decrease in body size. Therefore, there are significant differences between someone who has lost weight by diet and someone of the same size who has never lost weight. For example, the body of the person who reduces their weight from 200 to 170 pounds burns fewer calories than the body of someone weighing 170 pounds who 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. Weight loss procedures, unlike diet, also cause biological changes that help reduce food intake. Energy (in the form of food) intake is decreased with surgery by restricting stomach size and limiting absorption. In addition, weight loss surgery changes the production of certain gut hormones (or signals) that communicate with the brain to reduce hunger, decrease appetite, and enhance the feeling of being full. In these ways, weight loss surgery, unlike dieting, produces long-term weight loss. (5)
Pregnancy
Most women are much more fertile after surgery, even with moderate weight loss.
Birth control pills do NOT work as well in patients who are overweight. 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!
After surgery, there is much less risk of experiencing problems during pregnancy and during childbirth. There are also fewer miscarriages and stillbirths than in women with obesity 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. There is also less risk of needing a C section.
Lifestyle
The reasons for hair loss are not totally understood. Even if you take all recommended supplements and meet protein requirements, hair loss will be noticed until the follicles come back. Adequate intake of protein, vitamins, and minerals will help to ensure hair re-growth, and avoid longer term thinning.
More than 95% of patients will successfully lose half of their extra body weight or more after surgery for weight loss.(1) Roux en Y gastric bypass patients, for example, on average lose approximately 70% of their extra body weight initially, and 2 years or more after surgery will regain approximately 5% of their extra body weight.(2) Compared to these results, patients who attempt weight loss without surgery, on average, are able to lose little weight and may gain weight in the long-term.(3)
Vitamins & Medications
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.
Weight loss surgery can lead to reduced amounts of vitamins and minerals because people eat less and may absorb less in the intestines. Weight loss surgeries have different effects on vitamins and minerals based on how much change in absorption they cause. Deficiencies in vitamins, minerals, and protein can negatively affect health causing:
* fatigue (feeling tired)
* anemia (low levels of red blood cells that carry oxygen through your body)
* bone and muscle loss
* impaired night vision
* low immunity (your body’s ability to stay healthy)
* loss of nerve function (can affect your senses such as touch, taste, and smell)
* mental function deficits (changes how clearly you think)
Fortunately, nutrient deficiencies following surgery can be easily avoided with a good diet and the use of supplements including vitamins, minerals, and sometimes protein supplements. Before and after surgery, patients are advised of the appropriate diet and vitamin supplement needed. Most weight loss surgery programs also require patients to have their vitamins and minerals checked on a regular basis after surgery. Nutrient deficiencies and any associated health problems are preventable with monitoring and patients following diet and supplement (vitamin and mineral) recommendations. Health problems due to deficiencies usually occur in patients who do not regularly follow-up to monitor healthy vitamin and mineral levels. Be sure you stay in touch with your weight loss surgery team for best results!
Mental Health
Although some people with obesity have eating disorders, such as binge eating disorder syndrome, most people have obesity caused by many factors. When treating addiction, such as alcohol and drugs, one of the first steps is to stop using drugs or alcohol. This does not work with obesity as we need to eat to live. Also, there may be other issues causing a person’s weight gain. Weight gain generally occurs when the amount of food eaten is greater than the number of calories burned. There are other conditions, however, that affect weight gain that do not involve too much eating or a less active lifestyle including:
* Poor sleeping habits
* Eating foods 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 mental distress
* Many types of medications
* Pollutants
Obesity also leads to more obesity, which is one of the reasons why the disease is considered progressive. Weight gain causes a number of signals (hormones) in the body that increase the risk for even greater weight gain and obesity. To make matters worse, obesity affects certain body functions that control 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 the disease of obesity is far more than just an ‘addiction’ toward food. The treatment of obesity only as an addiction may help for a very small percentage of individuals whose only underlying cause for obesity is excessive and addictive eating, but would be unlikely to benefit most people, particularly those individuals affected by severe obesity.
Recommended precautions after weight loss surgery:
* Avoid alcoholic beverages during the rapid weight loss period, and then drink only rarely
* Be aware that even small amounts of alcohol can cause intoxication (‘being drunk’)
* Avoid driving or operating heavy equipment after drinking any alcohol
* Remember that you may feel less intoxicated than you are, and will not be a reliable judge of whether it is safe for you to drive after drinking.
* Seek help if drinking becomes a problem.
If you feel drinking alcohol may be an issue for you after surgery, please contact your primary care doctor or surgeon and discuss this further. They will be able to help you identify resources available to address any alcohol-related issues.
It has been found in scientific research that a small percentage of weight loss surgery patients report having problems with alcohol after surgery (7-10%).(6) Many who abuse alcohol after surgery had problems with alcohol abuse at some time prior to surgery, but occasionally alcohol problems can arise in patients who never had such issues before their surgery. Alcohol sensitivity is increased after weight loss surgery so that the effects of alcohol are felt with fewer drinks than before surgery. Studies also find that with certain weight loss procedures (such as the gastric bypass or sleeve gastrectomy), 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 weight loss procedure. In addition, studies have found that alcohol takes much longer to clear out of a person’s system if they have had weight loss surgery, which can pose safety and legal hazards for driving. Furthermore, it has been found that some patients may feel as though they are sober (‘not drunk’) even when they are over the legal blood alcohol limit for driving. For all of these reasons, weight loss surgery patients are advised to take precautions regarding alcohol.
People affected by severe obesity who are seeking weight loss 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. Weight loss surgery results in significant improvement in mental health for the majority of patients. However, studies have found a small but significant increase in suicide following weight loss surgery.(7, 8) In some cases, these may have been patients with undiagnosed mental disorders, and in others, patients may have experienced major life stressors that can increase the risk for suicide, but in rare cases, the suicides are unexplained. For this reason, comprehensive bariatric programs require psychological evaluations prior to weight loss surgery. Many programs have therapists available for patient counseling after surgery. In addition, if a patient sees a psychologist or psychiatrist before surgery, they should continue seeing them after surgery.
Risks
A recent study of 209,116 patients found the risk of death from weight loss surgery was 0.16%, or approximately 1 in 600.(4) This rate is considerably less than most other surgeries, including gallbladder and hip replacement surgery. Large studies find that the risk of death from any cause is considerably less for patients after weight loss surgery than for those who have severe obesity and have never had the surgery. Patients who have weight loss surgery have a reduction in their risk of death by 40%. Death related to diabetes is reduced by more than 90% and from heart disease by more than 50% for patients after weight loss surgery.(3) The benefits of weight loss surgery far outweigh the risks. As with any serious surgical operation, the decision to have weight loss surgery should be discussed with your surgeon, family members, and loved ones.
References
- Herman KM, Carver TE, Christou NV, Andersen RE. Keeping the weight off: Physical activity, sitting time, and weight loss maintenance in bariatric surgery patients 2 to 16 years postsurgery. Obesity Surgery. 2014;24(7):1064-72.
- Puzziferri N, Roshek TB, Mayo HG, Gallagher R, Belle SH, Livingston EH. Long-term follow-up after bariatric surgery: A systematic review. JAMA. 2014;312(9):934-42.
- Courcoulas AP, Yanovski SZ, Bonds D, Eggerman TL, Horlick M, Staten MA, et al. Long-term outcomes of bariatric surgery: A National Institutes of Health symposium. JAMA Surgery. 2014;149(12):1323-29.
- Broderick RC, Fuchs HF, Harnesberger CR, Chang DC, Sandler BJ, Jacobsen GR, et al. Increasing the value of healthcare: Improving mortality while reducing cost in bariatric surgery. Obesity Surgery. 2015;25(12):2231-8.
- Thivel D, Brakonieki K, Duche P, Morio B, Boirie Y, Laferrere B. Surgical weight loss: Impact on energy expenditure. Obesity Surgery. 2013;23(2):255-66.
- King WC, Chen J-Y, Mitchell JE, Kalarchian MA, Steffen KJ, Engel SG, et al. Prevalence of alcohol use disorders before and after bariatric surgery. JAMA. 2012;307(23):2516-25.
- Adams TD, Gress RE, Smith SC, Halverson RC, Simper SC, Rosamond WD, et al. Long-term mortality after gastric bypass surgery. New England Journal of Medicine. 2007;357(8):753-61.
- Tindle HA, Omalu B, Courcoulas A, Marcus M, Hammers J, Kuller LH. Risk of suicide after long term follow-up from bariatric surgery. American Journal of Medicine. 2010;123(11):1036-42.