Bariatric Surgery: A Lifelong Journey
It is well understood that obesity is a chronic disease. Obesity is known to be caused by a wide variety of factors including: behavioral, genetic, environmental, and even our microbiome (bacteria in our gut). This means that despite diets, medications or even surgery, most patients will continue to struggle with obesity for their entire lives.
Despite this understanding, it is a common misconception that weight loss surgery is a “cure-all” operation. Many patients believe that weight loss surgery will result in rapid and permanent weight loss and resolution of their diabetes and other obesity-related co-morbidities. While this certainly can be true for many patients it requires long-term follow up with the weight loss surgery team and life-long commitment to dietary changes and exercise programs. Weight loss surgery only accomplishes 20 percent of the required work to meet a patient’s long-term weight loss goals. The remaining 80 percent requires long-term commitment on the part of the patient.
The “Honeymoon” is Just a Phase
Immediately after weight loss surgery many patients enter a “honeymoon” phase of their weight loss journey. It seems that no matter what they eat or how much exercise they get (or don't get) the weight keeps coming off. However, we know this only lasts six months to two years. After the honeymoon period is over many patients who do not follow the recommended diet and exercise plans begin to see the weight come back.
There are a number of behaviors that patients should aim to develop before and after weight loss surgery that can increase the odds of a successful weight loss journey and maintaining long-term weight loss goals. However, these behaviors may need to be individualized based on the surgery a patient received, a patient’s medical history, and several other factors. For this reason, it is important for patients to meet regularly with the weight loss surgery team and specifically discuss dietary and exercise recommendations. For those who have had weight loss surgery but are not eating appropriately, exercising regularly, or being seen regularly by the weight loss surgery team, it is important to change these behaviors before the weight gain begins.
Tips for Success After Weight Loss Surgery
- Eat three meals a day.
- Chew your food to a mush or puree consistency.
- Choose nutrient dense foods (vegetables, whole grains, fruits, lean meats).
- Eat a protein and carbohydrate at each meal. Start with the protein first.
- Eat slowly. It should take at least 30 minutes to finish your meal.
- Avoid snack foods (chips, cookies, crackers, pretzels, rice cakes, candy), ice cream, fatty meats, and fried food.
- Do not use straws.
- Drink at least 8oz. of skim or soy milk or light yogurt instead of having a snack.
- Avoid carbonated and sugary beverages.
- Avoid alcohol.
- Drink at least 6 glasses of water a day. Carry a bottle with you and sip throughout the day.
- Avoid drinking liquids for 30 minutes before, during , and 30 minutes after meals.
- Keep a food journal to review with your dietitian. There are a number of smartphone apps that can be helpful.
- Do not smoke tobacco or marijuana.
- Exercise for 30 minutes daily.
- Schedule and attend annual follow up with your bariatric surgery team.
If I regained weight what are my options?
Weight regain after weight loss surgery is devastating to most patients. For many patients, behaviors which have led to weight regain can be identified. Often times correcting these behaviors is sufficient to get the weight back off. However, for a few, weight regain may begin despite following all dietary and exercise recommendations. For these patients there are a number of interventions that may be tried.
- Dietary and behavior modification. Often times improvements can be made which may result in significant weight loss.
- Medications. There are a number of new medications which result in substantial weight loss.
- Revision surgery. Many times, for unknown reasons, the initial operation was not adequate. Meeting with your bariatric surgeon can help identify a number of problems with the initial operation which may be addressed with a second surgery.
Obesity is a life-long disease. Bariatric surgery is very effective in managing obesity and its co-morbidities; however, like most chronic diseases, continued success requires vigilance and life-long follow up.
About the Author:
Andrew Luhrs, MD
Dr. Andrew Luhrs is a bariatric surgeon in the Center for Bariatric Surgery.
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