Bariatric surgery can bring about many positive changes in a person's life, including improving type 2 diabetes, liver health (from non-alcohol related liver diseases), and heart health, allowing for greater mobility and activity, and improving self-esteem and mental health. Before choosing bariatric surgery, however, some patients may wonder about the toll that bariatric surgery can take, especially during recovery in the first year. Here are some answers to commonly asked questions about life after bariatric surgery.
What is the basic diet after bariatric surgery?
Bariatric procedures will (and are meant to) completely change a person's relationship with food—for the better! Specific details can vary depending on the procedure—whether gastric sleeve or bypass—but in general, I have my patients follow a three-stage diet after surgery.
Patients start with a full liquid diet, then progress to pureed foods (anything that can flow through a funnel), followed by soft foods, such as foods that can be easily cut with just the side of a fork, like runny eggs, baked salmon, etc. During these first weeks, it is important to ensure you are hitting your fluid goals (minimum 64 fluid ounces, preferably water) and protein goals (60 to 80 mg of protein) every single day, as it is much easier to get dehydrated with a significantly smaller stomach, and you need protein to heal.
Generally after the first month, patients can start on a post-bariatric surgery diet. This entails five to six small meals a day that prioritize protein and minimize fat and carbs. After gastric sleeve a patient’s stomach is a long skinny tube, while after gastric bypass, a patient's stomach pouch is about 30 ounces (or about the size of an egg!) This means the stomach cannot hold the same volume of food and liquid that it could before surgery. Maintaining fluid intake remains important to avoid dehydration.
What kind of medications are prescribed after bariatric surgery?
All patients are prescribed multimodal pain medication and anti-nausea medication to get them through the immediate post-operative period. Some patients may also go home on extended blood clot prophylaxis medication if they are felt to be at high-risk of developing a blood clot, based on their history. They will also start on their bariatric vitamins immediately after surgery. For the first month, I recommend a chewable bariatric vitamin. After that, most patients may switch to a one-a-day pill variety.
It is particularly important for gastric bypass patients to take their vitamins lifelong, as their new anatomy makes them more susceptible to multiple vitamin deficiencies. In addition to vitamins, all patients need to take calcium supplements. All patients will take an acid-reducing medicine, such as Omeprazole, after bariatric surgery. Bypass patients can expect to take this medication for six months after surgery, whereas sleeve patients are prescribed the medication for at least one month.
Lastly, rapid weight loss, like the kind we see after bariatric surgery, makes people more susceptible to gallstone formation. Sometimes these gallstones can lead to painful symptoms, and sometimes these symptoms require emergency surgery. Because of this, I recommend all bariatric patients take a medication called Urisodiol for a few months after surgery, to decrease the risk of gallstones and a painful gallstone attack.
What does a general recovery timeline look like? How soon can bariatric surgery patients go back to work?
Patients who undergo bariatric surgery usually stay in the hospital for one or two nights. After that, many patients return to work two to four weeks after surgery, depending on their unique recovery journey.
When can I start resuming exercising or lifting weights after bariatric surgery?
We aim to get all patients up and walking the day of their surgery! Our nurses will work with you to ensure you hit this milestone, as it will help your gastrointestinal tract recover and help prevent complications such as pneumonia and blood clots. Once home, we advise that you continue daily walking.
Before bariatric surgery, talk with your surgeon about your level of exercise and what kinds of exercise you enjoy doing, and how you long you need to reduce or avoid those activities after surgery. For example, for someone who likes to lift weights, we ask that they not lift anything heavier than 10 to 15 pounds for six weeks after to prevent post-operative hernias.
How soon after bariatric surgery can you have sex? Can you get pregnant after bariatric surgery?
There are no specific restrictions on sexual activity after bariatric surgery, other than no strenuous activity or heavy lifting for six weeks after your operation. Patients should return to intimate activities when they are feeling up for it.
Women of childbearing age will experience an increase in their fertility after bariatric surgery. Because pregnancy after bariatric surgery can increase risk of prenatal complications, we require women of childbearing age to commit to using contraception for the first two years after surgery.
What are some unexpected or less common issues after bypass surgery?
Some unexpected or uncommon issues that can arise after bariatric surgery include hair loss or thinning, gallstone formation, acid reflux, ulcer formation, anastomotic leak, vitamin deficiencies and bowel obstructions. Your bariatric surgery team will follow up with you regularly to monitor you for these issues and work with you if they arise.
What kind of follow up with my surgeon or care team happens after surgery?
We see our patients in follow-up appointments at two weeks, six weeks, three months, six months, one year after surgery, and then annually after that. These visits are the perfect time to discuss any health changes you're noticing and ask questions.
What kind of support resources are available after surgery?
Beyond following up closely with your bariatric surgeon, you will follow up regularly with our nutrition team to keep you on track. We are committed to helping you both in the early days and long term.
The Miriam Hospital offers monthly in-person information sessions on topics related to the weight loss journey for pre- and post-operative patients. There's also a Facebook group you can join.
Wherever you are in your healthy weight journey, the team at the Center for Medical and Surgical Weight Loss can help. Visit us online to learn more.
Find a Doctor
