Q & A
Frequently Asked Questions about Bariatric Surgery
In general, you must be 100 pounds overweight or have a body mass index (BMI) greater than 40 or a BMI greater than 35 with at least one obesity-related health problem (co-morbidity) and have been unsuccessful in sustained weight loss through diet, exercise and medication.
Co-morbidities include type 2 diabetes, sleep apnea, high blood pressure, heart disease, non-alcoholic fatty liver disease, high cholesterol and triglycerides, osteoarthritis, etc.
Most surgeons put their patients on a diet for two to three weeks before the procedure to shrink the liver and to reduce abdominal fat. Some insurance companies require a physician to monitor their patient’s diet for three to six months before surgery as a food education and medical compliance program.
How long you are in the hospital depends in part on which procedure you choose. Patients who have gastric bypass or gastric sleeve surgery typically stay in the hospital for two to three days.
Most people resume normal daily activities and return to work in two to three weeks. In the first week or so you may need to work short days or every other day until your energy level returns. Your doctor will give you guidance on this.
You should begin walking while still in the hospital. For the first month, do only low-impact exercise (such as walking or a stationary bike) and avoid lifting heavy objects for the first six weeks. You may swim after your surgical wounds have healed. Listen to your body and ask your doctor for guidance on appropriate exercise.
You will have a nutrition plan as part of your follow-up care. It may start with a liquid diet that progresses to soft and then regular food. In the first few months you will need to get lots of fluids, about 64 ounces per day, to avoid dehydration and constipation. You will also start taking daily vitamin supplements for the rest of your life. Eating high-protein foods is important to maintaining muscle mass, keeping up your strength and having a healthy metabolism as you lose weight.
Most studies show that people maintain a substantial weight loss after bariatric surgery. One review of 29 studies found that 95% of people who had gastric bypass or gastric sleeve surgeries lost more than 50% of their excess weight, with the average losing 65 percent of their excess weight. Many people gain a small amount of weight after several years, but generally maintain a loss of about 50% of their excess weight.
The review found that about a third of gastric band patients lost more than 50% of their excess weight; the average weight loss was 45% of excess weight.
You will want to develop a healthy lifestyle with appropriate food choices and portion size. You will eat much smaller meals and more frequently because your stomach is now smaller. Eating four small meals a day will help you keep up your energy and nutrient levels and prevent your metabolism from slowing down and contributing to weight gain. Continue to get a lot of protein (about 80 grams per day) and take multivitamins. Regular exercise is also important in maintaining healthy bones and muscles, controlling stress and sustaining your weight loss.
Physicians recommend waiting 12 to 24 months after bariatric surgery to get pregnant, so the fetus is not affected by the mother’s rapid weight loss and the woman can meet her weight-loss goals. Birth control pills don’t work as well after bariatric surgery, so women are advised to use another type of contraceptive.
The chances of problems during pregnancy such as gestational diabetes and eclampsia are significantly reduced once the woman loses much of her excess weight. Before and during pregnancy, she should be evaluated for any protein, vitamin or mineral deficiencies to ensure proper nutrition both for herself and for the developing baby. Labor and delivery should not be affected by the bariatric surgery.