Life After Bariatric Surgery
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.
When you leave the hospital, you will receive prescriptions for several medications. Some of these medications will be taken for a few months after surgery, and others you will take for life. One is an acid reduction medicatio, called a "proton pump inhibitor" (PPI) such as Omeprazole (Prilosec), helps prevent uclers. If you have a 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 will not be able to absorb whole pills as well as you did before surgery, and pills may have difficulty passing through your new digestive system.
After surgery, you should resume taking your usual medicines for other conditions. Check-in with your primary care doctor frequently to make sure you are taking the correct dose. You may a smaller dose of your medications for medical conditions related to obesity.
Extended release medications will not be absorbed properly and should be substituted for medications that don't have a time-release component.
Don't take non-steroidal anti-inflammatory drugs (NSAIDs) such as asprin, ibuprofen, Advil, Motrin, Aleeve, Naprosyn, Vioxx and Celebrex. These medications increase your risk of developing ulcers. After bariatric surgery, ulcers are more difficult to diagnose and treat. Check with your primary care doctor or pharmacist, when starting a new medication.
Vitamins and Supplements
You must take the following vitamins and supplements on a daily basis to prevent nutrient deficiencies.
Take a high-potency, chewable multivitamin and mineral supplement, containing a minimum of 18 mg of iron, 400 mcg of folic acid. selenium, copper and zinc, daily. Brands that contain this formula include Trader Joe's and Centrum adult chewable multivitamins. Take two tablets daily until at least three months after your surgery, and then one tablet daily for life.
Take 1,200 to 2,000 mg daily to prevent calcium deficiency and bone disease. To enhance absorption, take the calcium supplement as two to three divided doses throughout the day. For example, take 500 to 600 mg tablets three times a day. Calcium citrate is the preferred form of calcium.
Take 800 to 1,000 international units (IUs) of vitamin D daily. This total amount should be taken as 400 to 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.
Take 500 mcg of vitamin B daily. This can be taken as a tablet or a tablet or liquid under the tongue. Remember, whole pills must be crushed.
You may 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. Your ability to take in normal quantities of a balanced diet and rapid weight loss will impact your nutritional status. We strongly recommend against pregnancy for two years after bariatric surgery.
Returning to Work
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 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 guidelines limit the 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 to 75 grams of protein a day. High protein foods include eggs, meats, fish, seafood, tuna, poultry, tofu, milk, soy, cottage cheese, and yogurt. Don't worry if you can't reach this goal in the first couple months after your surgery.
You'll be most successful 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.
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.
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.
The UCSF Bariatric Surgery Program offers a free support group for pre-operative and post-operative patients. Support groups provide weight-loss surgery patients an opportunity to discuss issues they face after surgery. 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. For more information, please visit our Support Group page.
If you live too far away to attend our UCSF support group, we recommend joining a support group in your community or online.
The long-term effects of bariatric surgery are still being studied. Nutritional deficiencies can arise over time. Periodic blood tests are required 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), other tests 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 have tests to measure your levels of thiamine and vitamin D.
UCSF Health medical specialists have reviewed this information. It is for educational purposes only and is not intended to replace the advice of your doctor or other health care provider. We encourage you to discuss any questions or concerns you may have with your provider.