Weight-loss surgery is not a cure for obesity, but rather a tool to help you lose weight to live a healthier, longer and more fulfilling life. Success depends on your ability to follow guidelines for diet, exercise and lifestyle changes.

The UCSF Bariatric Surgery Center offers comprehensive follow-up care, including a support group, dietitian services and continuing education to help you achieve long-term success. If you live too far away to attend our support group at UCSF, we recommend joining a support group in your community or online. Your chance of maintaining a healthy weight will increase if you have a network of people who can offer encouragement and help you stay on track.

Medications

When you leave the hospital, you will be given prescriptions for several medications. Some of these medications you will only take for a few months after surgery, and others you will take for life. One of these medications is an acid reduction medication that helps to prevent uclers, called a "proton pump inhibitor" (PPI) such as Omeprazole (Prilosec). If you still have your gallbladder, you will be prescribed a medication called Ursodiol to help prevent formation of gallstones. All of your pills should be crushed and capsules opened. You are not able to absorb whole pills as well as before surgery and they can have difficulty passing through your new anatomy.

After surgery you should resume taking your usual medicines for other medical conditions. Check-in with your primary care provider frequently to make sure that you are on the correct dose. You may begin to need less and less of medications you take for medical conditions that are related to obesity. In addition, any extended release medications will no longer be absorbed properly and should be substituted for a medication that does not have a time-release component.

You should not take any non-steroidal anti-inflammatory drugs (NSAIDs) anymore for the rest of your lifetime. Examples of NSAIDs are Asprin, Ibuprofen, Advil, Motrin, Aleeve, Naprosyn, Vioxx and Celebrex. These medications increase your risk of ulcer formation. After bariatric surgery, ulcers are more difficult to diagnose and treat. Check with your primary care provider or pharmacist, when starting a new medication.

Vitamins and Supplements

You are required to take the following vitamins and supplements on a daily basis to prevent nutrient deficiencies.

Multivitamin

Take daily high potency chewable multivitamin and mineral supplement containing a minimum of 18 mg of iron, 400 mcg of folic acid. selenium, copper and zinc. Brands which contain this formula include Trader Joe’s and Centrum adult chewable multivitamin. Take two tablets daily until at least three months after your surgery, and then one tablet daily for life.

Calcium supplement.

Take 1200 to 2000 mg daily to prevent calcium deficiency and bone disease. In order to enhance absorption, take the calcium supplement as two to three divided doses throughout the day (for example, 500-600 mg three times a day). Calcium citrate is the preferred form of calcium.

Vitamin D supplement.

Take a total of 800-1000 International Units (IUs) of vitamin D each day. This total amount should be taken as 400-500 International Units (IUs) twice a day with your calcium supplement. If you prefer, you can take a combination calcium-vitamin D supplement (as long as it contains the proper dosages) to avoid taking multiple pills.

Vitamin B12 supplement

Take 500 mcg daily of vitamin B each day. This can be taken as a tablet or sublingual (under the tongue). Remember, whole pills must be crushed. You are not able to absorb whole pills as well as before surgery and they can have difficulty passing through your new anatomy.

You may also need additional folic acid or iron supplements, particularly if you are a female and still menstruating. Your dietitian will discuss this with you.

Birth Control and Pregnancy

We advise women of childbearing years to use effective birth control for the first two years after bariatric surgery. The physical demands of a pregnancy on your body could lead to fetal compromise and birth defects, so we strongly recommend against pregnancy for two years after bariatric surgery. In addition, your ability to take in normal quantities of a balanced diet and rapid weight loss will impact your nutritional status.

Returning to Work

Your recovery and when you can return to work will depend on your general state of health and physical condition before surgery. Many patients return to work two weeks after their surgery with no activity restrictions. However, some people need an additional two weeks. Returning to your full strength varies for each person and usually takes about six weeks.

Diet

Diet guidelines limit the amount of calories you consume while providing you with balanced meals to help prevent nutritional deficiencies and preserve your muscle tissue. Each patient tolerates suggested foods differently.

Daily calories should be between 400 to 900 for at least the first 12 months after surgery, and never exceed 1,000 calories a day. Follow a diet low in calories, fats and sweets. Your goal should be a minimum of 65-75 grams of protein per day. Do not worry if you cannot reach this goal in the first couple months after your surgery. High protein foods include eggs, meats, fish, seafood, tuna, poultry, tofu, milk, soy, cottage cheese, and yogurt. You will be most successful in following your dietry guidelines if you keep a daily record of food portions and calories and follow-up with a dietitian regularly.

Here are some eating guidelines:

• Eat slowly and chew small bites of food thoroughly.
• Avoid rice, bread, raw vegetables, fresh fruits, and meats that are not easily chewed such as pork and steak. Ground meats are usually better tolerated.
• With soft and solid foods, take only three bites at one sitting, then wait a minimum of 20 minutes before eating more.
• Eat balanced meals with small portions.
• Avoid the use of drinking straws and carbonated beverages, chewing gum and ice because they can introduce too much air into your pouch and cause discomfort.
• Avoid sugar, sugar-containing foods and beverages, concentrated sweets, and fruit juices

Over time, increase the variety and consistency of the foods in your diet. Some foods may be poorly tolerated initially such as red meats, chicken, breads, high fiber fruits and vegetables. This will improve over time. It is very important that you stay well-hydrated; you should drink around 1.5 to 2 liters of fluids daily, unless otherwise restricted by a medical condition.

Alcoholic beverages will have a more profound effect and should be avoided or consumed with caution.

Exercise

You should aim to exercise for 30 to 45 minutes a day, with cardio or aerobic activity three to five times a week. Initially, we recommend walking five minutes in the morning and five minutes in the late afternoon. As tolerated you should increase these intervals by five minutes until you are walking at least 15 minutes twice per day. After that, you can add variety to your exercise, such as a light jogging, swimming, or using a stationary bike.

If you feel you've reached a plateau, revise your exercise pattern by trying new activities, adding in more strenuous exercises and increasing duration. Alternating between walking and jogging in two to five minute intervals can help break a plateau and burn fat. For more of a challenge, you can try alternating between jogging and sprinting.

Resistance training will help build muscle and burn calories. This will help in weight loss maintenance since a bigger muscle mass uses more calories even at rest. Start with a light weight, such as two to five pounds, and do 10 repetitions of the exercise, completing three sets of 10. As you feel your strength increasing, add more weight.

Lifestyle

You have undergone a major surgery to help achieve weight loss and a healthy body mass index (BMI). That was a big decision and now you have a commitment to a new way of life. Our hope is that the practices you put in to play early on after your surgery, such as calorie counting and regular exercise, become routine in your life.

Every day should be a reflection of a new attitude that you're important and your health matters. Be proud of every day that you maintain this commitment to yourself. Stay involved in hobbies you enjoy, activities and groups. Regularly attend your local weight-loss or bariatric support group. The key is to stay engaged in as many activities, behaviors, and groups that remind you of your weight loss goals and encourage your new lifestyle.

Support Groups

The UCSF Bariatric Support Group is a free service offered as part of the UCSF Bariatric Surgery Program for pre-operative and post-operative patients, as well as their family members and other interested people. The group meets at 6pm on the third Wednesday of every month. It takes place on the sixth floor at the UCSF Surgery Faculty Practice lobby waiting area at 400 Parnassus Avenue. If you would like to subscribe to our support group mailing list, please send an email to BariatricSupport@ucsfmedctr.org. Registration is not necessary to attend, but subscribing will allow you to receive reminders of upcoming meetings and support group topics.

Support groups provide weight-loss surgery patients an opportunity to discuss personal and professional issues. The majority of patients find that ongoing support helps them achieve the greatest long-term success.

Long-Term Follow-Up

The long-term effects of bariatric surgery are still being studied. It is known that nutritional deficiencies can arise over time. You will need periodic blood tests to help ensure nutritional balance. We recommend that you have a series of tests every three months for the first year and then annual tests for the rest of your life.

In addition to a complete bood count (CBC) test, you will have other tests that will measure your levels of alanine aminotransferase (ALT), albumin, alkaline phosphatase, aspartate aminotransferase (AST), calcium, cholesterol panel, direct and total bilirubin, electrolytes, fasting glucose, ferritin, folate, hemoglobin A1c, iron saturation and transferring, magnesium, phosphorus, total protein and Vitamin B12. You may also have tests to measure your levels of thiamine and vitamin D.

More Information

• Bariatric Surgery Overview
• Dietary Guidelines After Bariatric Surgery
• Bariatric Surgery Procedures

Reviewed by health care specialists at UCSF Medical Center.
Last updated May 16, 2012

This information is for educational purposes only and is not intended to replace the advice of your doctor or health care provider. We encourage you to discuss with your doctor any questions or concerns you may have.