Bariatric Weight Loss FAQs

When you have a weight loss surgery procedure, you lose weight because the amount of food energy (calories) you are able to eat is much less than your body needs to operate. It has to make up the difference by burning reserves or unused tissues. Your body will tend to burn any unused muscle before it begins to burn the fat it has saved up. If you do not exercise daily, your body will consume your unused muscle, and you will lose muscle mass and strength.

We’ll help you incorporate resistance training (weight lifting) along with daily aerobic exercise to tell your body that you want to use your muscles and force it to burn fat instead. Our team will create an exercise plan customized for you and your lifestyle.

Many patients are hesitant about exercising after surgery, but exercise is an essential component of success after surgery. Exercise actually begins on the afternoon of surgery – the patient must be out of bed and walking. The goal is to walk further on the next day, and progressively further every day after that, including the first few weeks at home. Patients are often released from medical restrictions and encouraged to begin exercising about two weeks after surgery, limited only by the level of wound discomfort. The type of exercise is dictated by the patient’s overall condition. Some patients who have severe knee problems can’t walk well, but may be able to swim or bicycle. Many patients begin with low stress forms of exercise and are encouraged to progress to more vigorous activity when they are able.

Yes, however it is imperative that women wait at least one year after the surgery before a pregnancy! Approximately one year post-operatively, your body will be fairly stable (from a weight and nutrition standpoint) and you should be able to carry a normally nourished fetus. You should consult your surgeon as you plan for pregnancy. Many women experience healthy pregnancies after weight loss. Our study shows there is a lower incidence of cesarean sections, gestational diabetes and gestational hypertension in post-operative women than in morbidly obese females.

Contact your original surgeon – he or she is most familiar with your medical history and can make recommendations based on knowledge of your surgical procedure and body. If you are not satisfied with that evaluation, a second opinion might be your best option and we are happy to provide this for you after you have obtained all your previous medical and surgical records for our review. This might give you a different direction but it might simply confirm the original recommendation. Either way there may be comfort in the assessment.

In the gastric bypass procedure, the stomach is left in place with intact blood supply. In some cases it may shrink a bit and muscle or lining (the mucosa) may atrophy, but for the most part it remains unchanged. Remember the stomach has two main functions. First it is a reservoir for food. Secondly, it is a chemical factory on the inside. The lower stomach still contributes to the function of the intestines even though it does not receive or process food – it makes intrinsic factor, necessary to absorb Vitamin B12 and contributes to hormone balance and motility of the intestines in ways that are not entirely known and also it produces a variety of hormones and enzymes necessary to aid in the digestion and absorption process. 

This can vary by surgical procedure and surgeon. We feel the size of the gastric pouch is  important to the overall success of the operation. Because we feel strongly about this, we measure the small stomach pouch in every case. The size starts at 30-50 ccs and over time will stretch slightly but not much. Like blowing up a balloon, the pouch is easier to distend if it is bigger. Even though the pouch stays small, patients will be able to eat more as the months go by because scars become more supple with time and the outlet will enlarge slightly giving the additional capacity needed so that patients can avoid the loss of too much weight and the risk of becoming malnourished. 

The staples used on the stomach and the intestines are very tiny in comparison to the staples you will have in your skin or staples you use in the office. Each staple is a tiny piece of stainless steel or titanium so small it is hard to see other than as a tiny bright spot. Because the metals used (titanium or stainless steel) are inert in the body, most people are not allergic to staples and they usually do not cause any problems in the long run. The staple materials are also non-magnetic, which means that they will not be affected by MRI. The staples will not set off airport metal detectors. For the most part, the staples are embedded in scar and cause no ill effects or reactions.

The operation works by having an impact on the appetite / hunger feelings. It’s normal not to have an appetite for the first month or two after weight loss surgery. If you are able to consume liquids reasonably well, there is a level of confidence that your appetite will increase with time.

Most pills or capsules are small enough to pass through the new stomach pouch or sleeved stomach, or they dissolve rapidly enough. At times it may be more convenient or more comfortable to take liquids but capsules are generally fine. We will review all of your medications at the time of surgery and give you detailed instructions on how to take each of your medications prior to your discharge from the hospital after surgery. 

Most patients have no difficulty in swallowing these pills.

Patients can return to normal sexual intimacy when wound healing and discomfort permit typically 3-4 weeks after surgery. Remember, it is normal for patients to have a generalized drop in desire following any surgery, for a period of time. 

Both men and women generally respond well to this surgery. In general, men initially lose weight faster than women do.

Patients are required to stop smoking at least one month before surgery. Smokers have significantly higher postoperative complications including pneumonia, stricture formation, and ulcers to name a few. In addition, some insurance plans will require you to stop smoking as many as six months prior to surgery before they will approve coverage.

Patients may begin to wonder about this early after the surgery when they are losing 20-40 pounds per month, or maybe when they’ve lost more than 100 pounds and they’re still losing weight. Two things happen to allow weight to stabilize. First, a patient’s ongoing metabolic needs (calories burned) decrease as the body sheds excess pounds. Second, there is a natural progressive increase in calorie and nutrient intake over the months following weight loss surgery. The stomach pouch and attached small intestine learn to work together better, and there is some expansion in pouch size / anastomosis over a period of months. The bottom line is that, in the absence of a surgical complication, patients are very unlikely to lose weight to the point of malnutrition.

Many people heavy enough to meet the surgical criteria for weight loss surgery have stretched their skin beyond the point from which it can “snap back”. This varies significantly, however. Remember that water intake and exercise may help in this process so do your part to minimize these effects. If you do have overhanging skin, you will know you have done all you can to prevent it. Some patients will choose to have plastic surgery to remove loose or excess skin after they have lost their excess weight. Insurance generally does not pay for this type of surgery (often seen as elective surgery). However, some do pay for certain types of surgery to remove excess skin when complications arise from these excess skin folds. Ask your surgeon about your need for a skin removal procedure.

Most patients say “NO”. In fact, for the first 4-6 weeks many patients have almost no appetite. Over the next several months the appetite returns, but it tends not to be a ravenous type of hunger and “satisfaction” is gained by eating less.

This is usually caused by the types of food you may be consuming, especially starches (rice, pasta, potatoes). Protein tends to turn off hunger (offers more satisfaction) the best and the effect lasts the longest. Be absolutely sure not to drink liquid with food since liquid washes food out of the pouch.

Your doctor will determine whether medications for blood pressure, diabetes, etc., can be stopped when the conditions for which they are taken improve or resolve after weight loss surgery. For meds that need to be continued, the vast majority can be swallowed, absorbed and work the same as before weight loss surgery. Usually no change in dose is required. Two classes of medications that should be used only in consultation with your surgeon are diuretics (fluid pills) and NSAIDs (most over-the-counter pain medicines). NSAIDs (ibuprofen, naproxen, etc.) may create ulcers in the new stomach or the attached bowel. Most diuretic medicines make the kidneys lose potassium. With the dramatically reduced intake experienced by most weight loss surgery patients, they are not able to take in enough potassium from food to compensate. When potassium levels get too low, it can lead to fatal heart problems. Sustained release types of medications may need to be changed.

A hernia is a weakness in the muscle wall (actually the fascia or gristle layer of the abdominal wall) through which an organ (usually small bowel) can advance. The incidence of hernia formation after Laparoscopic Bariatric Surgery is less than 1%. Most patients who develop a hernia will eventually require a surgical repair. The use of a reinforcing mesh to support the repair may be needed but is decided case by case.

Infrequently; if needed, it is usually given after surgery to promote healing.

Many patients experience some hair loss or thinning after surgery. This usually occurs between the third and the sixth month after surgery. Hair grows on a three month cycle and the stress of surgery and the following starvation will result in hair loss three months later. Consistent intake of protein at mealtime is the most important way to at least be sure you have done everything possible to avoid excess loss. We may also recommend a daily zinc supplementation as well. Remember this is generally not an issue by the ninth month as stabilization occurs around month six and hair re-growth begins.

Most patients experience natural hair regrowth after the initial period of loss.

It is the interruption of the normal sleep pattern associated with repeated delays in breathing. Fat accumulation in the face and neck tend to obstruct the flow of air as the respiratory muscles relax during restful sleep. This causes patients to snore (often dramatically) as they fall asleep and then as they go into restful sleep the snoring, the breathing, stops. It leads to hypertension in some, sleep deprivation symptoms in many, enlarged hearts and sudden death in some. Sleep apnea often shows rapid improvement after surgery. In most patients, there is a complete resolution of symptoms by six months following surgery.