Weight Loss Surgery: What to Expect the First Year

With bariatric surgery, the most dramatic changes happen in the first year. Here's what to expect.

From the WebMD Archives

If you're considering weight loss surgery, prepare to make changes that last a lifetime.

"When you're seriously overweight, it affects your social life, your health," says Atul Madan, MD, chief of bariatric surgery at the University of Miami School of Medicine. "This surgery helps people get past their cravings. They're much healthier, their social interactions get better. It affects them in so many ways."

But bariatric surgery is only one tool to help achieve weight loss. You’ll still need to make many lifestyle changes to stay healthy and keep the weight off.

"The most successful people do not look at this surgery as a quick fix," says Madelyn Fernstrom, PhD, director of the University of Pittsburgh Medical Center's Weight Management Center and a frequent contributor on NBC's Today Show. "It does not replace lifestyle. You've got to be willing to face lifestyle changes that last forever."

To make those changes successfully, it helps to understand the milestones you can expect three months, six months, or a year later. To learn about these, WebMD talked to the professionals, and to people who had bariatric surgery.

Preparing for Weight Loss Surgery

Well before having bariatric surgery, patients begin taking steps in the right direction. Most insurance companies now require six months of presurgical patient education to prepare them, says Fernstrom.

You must come to grips with eating patterns that have doomed you in the past, she explains. "Every severely obese person says they eat because it's fun, they're bored, they're at the movies and it's a social thing. They eat when they're happy, they eat when they're sad."

There is also the commitment to eating very small portions. If you overeat, you risk vomiting. Also, too frequent overeating can eventually stretch the new stomach pouch, which means you won't lose weight -- and could regain weight, explains Madan.

"It's not a punitive lifestyle ...You simply become a taster of many things," Fernstrom tells WebMD. "You find that you're perfectly full with one egg, maybe a couple of strawberries for breakfast. It's just enough."

  • Immediately After Weight Loss Surgery. For the first two weeks after surgery, Madan prescribes a liquid protein diet. Then, patients start eating pureed and soft food -- food the consistency of scrambled eggs.

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You'll start walking -- even just five minutes at a time, working up to 30 minutes a day, he says. "That can be a huge deal for some people." If you have arthritis, especially if it's in hips and knees, he advises water aerobics.

  • One to Three Months Post-Surgery. At this point, people start trying "regular food" to see what they can tolerate. The timing depends on the type of weight loss surgery. "Try different foods, to see what will go down easily," says Madan. "If it doesn't, just stay away from it for awhile. Wait a month and try again."

Don't set yourself up for disappointment, says Beverly P., a Memphis patient who lost 200 pounds with gastric bypass surgery. "It takes awhile to train your mind not to want much food. Don't fill up a big dinner plate, use a smaller plate. Eating can still be enjoyable -- but you don't need to eat enough to feed several more people."

  • Six Months Post-Surgery. At six months, you'll have lost a lot of weight. If you've had gastric bypass surgery, you will have lost about 30% to 40% of excess body weight. With gastric banding surgery, you lose 1 to 2 pounds a week -- so by six months, you'll have lost 25 to 50 pounds.
  • Nine Months Post-Surgery. If you had any problems at the six-month visit, your surgeon will want to see you at this milestone, too. Vitamin deficiencies or lack of sufficient weight loss are the typical issues being addressed at this point, says Madan.
  • One Year After Surgery. Between 12 to 18 months after surgery, you will have lost a great deal of weight, says Madan. With gastric bypass surgery, you likely are close to your goal. If you had gastric banding surgery, you should have lost over 100 pounds. If weight loss has lagged, it's important to find the cause -- like eating too many snack foods.

Medical Milestones After Weight Loss Surgery

Follow-up with your surgeon is critical after bariatric surgery, says Madan. "These checkups help to identify nutritional deficiencies and to ensure you're losing weight at a normal pace."

  • With gastric bypass surgery, visits are scheduled for the 3-month, 6-month, and 1-year mark (and possibly at the 9-month mark).
  • With gastric banding surgery, follow-up visits occur more frequently, typically monthly -- especially during the first year, says Madan. "We see patients often to make sure it's not too loose or too tight -- and to make sure they're eating right." If the band is too tight, it can cause vomiting.

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2 Keys to Surgery Success: Healthy Food and Exercise

Your food choices must change, too, to ensure that you're losing weight -- and that you're getting proper nutrition. Too much of a sweet, sugary food will move through the small intestine too quickly. This causes "dumping" -- running to the bathroom with diarrhea, or simply a feeling of nausea.

You can't ignore exercise any longer. "If you've always been a couch potato, you'll have to do things differently after surgery," she adds. "When you expend more calories, you keep weight off. We see people who have gotten their lives back. They're in aerobics classes, yoga classes. They become an inspiration to others."

Getting moral support is definitely a plus. Organize a circle of friends to cheer you along the way, advises Joy R., a member of WebMD's message boards. "My friends made it much easier ... just being there and telling me I was doing great!"

Your Relationships After Weight Loss Surgery

Be prepared to explain your new eating habits to family and friends, Madan says. "No matter what you tell Grandma, she's going to know better. Be respectful, but learn to ignore it."

  • Tell them: "Four ounces is the normal amount of food I can eat now. Be glad that I'm going to lose this weight. If I don't lose the weight, there's a good chance I'm going to get diabetes [if you don't have it already]."
  • Emphasize other positives: If you have sleep apnea, you likely won't have to deal with that anymore. If you've been too heavy to play with your kids, that will change.

If a friend or family member is overweight, you may feel their jealousy, Madan says. If your social life has been built around food, things will have to change.You may need new friends. You definitely will have to change your social activities.

  • Go to the movies instead of a restaurant. Find interests and activities that aren't focused on food. You can still dine out, but order an appetizer as your entrée -- or box most of your dinner to take home, he suggests.
  • Prepare for changes in intimate relationships. A bad relationship may get worse. A good one will become stronger. If your mate liked your old weight -- or liked the control they had because you were overweight -- he or she may feel insecure or jealous. You may need a counselor to deal with these changes.

Your children will be affected -- in a good way. "They develop healthier eating patterns, eat healthier food," Madan tells WebMD. "A teenager is smart enough to see that if Mom or Dad is going through major surgery to lose weight, they don't want to be there themselves."

WebMD Feature Reviewed by Brunilda Nazario, MD on February 12, 2009

Sources

SOURCES: Madelyn Fernstrom, PhD, director, University of Pittsburgh Medical Center's Weight Management Center. Atul Madan, MD, chief of bariatric surgery, University of Miami School of Medicine. WebMD Medical Reference in collaboration with Cleveland Clinic: "Gastric Bypass Surgery" and "Weight Loss: Restrictive Surgery."

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