Surgical Frequently Asked Questions

As with any medical procedure, there are always risks involved. When considering bariatric surgery, we encourage you to ask questions about all aspects of your surgery and recovery. The more you educate yourself about the risks and benefits of the entire procedure, the more comfortable you will be throughout the process.

The Bariatric Program is dedicated to providing you with all the answers you need to make an informed decision. We believe understanding all aspects of the procedure is invaluable, which is why we have specialists on staff that can assist you with every part of your journey—through making a decision, to surgery and then recovery.

Which Operation is best for me?

• It is important to discuss with your surgeon the reasons why you want to have Bariatric Surgery. No one operation is perfect, and each type of procedure has its own risks and benefits.

How much food will my new stomach hold?

• When your new stomach pouch has healed, an average meal will be about ½ to 1 cup of food or liquid.

What kind of nutrition program will I have after surgery?

• First, you will be on a special eating program designed to allow your stomach to heal, while you receive the protein, vitamins and minerals you need. You will begin with liquids and then progress to pureed, soft and, finally, solid foods. A patient will usually be permitted to add solid foods to their eating plan about six weeks after surgery. Your surgeon and dietitian will help guide your eating plan throughout your recovery and will teach you about your new eating program.

Can I be healthy while eating smaller amounts of food and fewer calories?

• Family members may voice concern about the small amounts of food and fewer calories that patients eat after bariatric surgery. However, this low-volume, low fat and low sugar-eating program is designed to meet your body’s nutritional needs. You will learn how to keep protein in your eating plan and about the multivitamins you will need to take. A well-balanced nutrition program is very important after surgery because your stomach will be smaller and hold less. Our dietitian will work with you pre and post operatively to teach you about your nutrition plan.

Are there any foods that I will never be able to eat after Bariatric Surgery?

• Food tolerance is very individual. Some people eat almost everything they ate before surgery that is low in fat and sugar. However, they chew more carefully and eat smaller portions. Occasionally, patients find there are a few foods they do not tolerate well after surgery. This usually happens as they reintroduce solid foods into their eating program. Foods that can provide difficulty include red fibrous meat, doughy bread, raw fruits, vegetables, and pasta. If you find a particular food difficult to digest, avoid it for a while, then try it again later. Over time, your tolerance for these foods may increase.

How will surgery change my eating habits?

• The surgery will change the way you eat and will reinforce a new eating plan. Because your new stomach is smaller, you will feel full after eating less food. Your new meals will also be smaller and more frequent. Your new stomach pouch will not be able to grind food as it once did, so you will need to eat small bites and chew food very well. You may choose not to eat certain foods because they require too much chewing, or they may no longer taste good to you. In addition, foods high in fat and sugar will not be tolerated well and can cause a reaction called the "dumping syndrome".

What is the "Dumping Syndrome"?

• After gastric bypass, your body will be less able to tolerate "refined" sugars or high amounts of fats. When these foods are eaten, your pancreas is signaled to secrete insulin and cause fluids to be drawn into the intestine. This causes a reaction called the "dumping syndrome". Common symptoms include sweating, nausea, dizziness, tiredness, cramps, vomiting and diarrhea. These symptoms typically last about 60-90 minutes, depending on what and how much the person has eaten. The symptoms can mimic the flu.

Will the stomach pouch stretch so that the lost weight is regained?

• In most patients, the pouch will stretch some with time. Weight loss is usually maintained except in those cases where people persist in eating large quantities of high caloric fluids. It is more important to avoid stretching the stoma of the new stomach by persistently overeating, or by not chewing food well enough. This does not occur easily, but occurs only by persistently overeating over a long period. The surgery is a tool to help you achieve weight loss, but you must follow the nutritional recommendations for long-term success.

Why do I need to drink 64 ounces of water daily?

• Drinking water keeps you from becoming dehydrated. This is particularly important after gastric surgery. You see, many of the foods we eat have a high water content. For example, vegetables are 80-90 percent water, and chicken contains about 60 percent water. As your food portions are smaller after surgery, you will not obtain as much water from food. You will need to drink more water to make up the difference. Drinking plenty of water may also reduce food cravings. Since you will not be able to drink water quickly as your stomach heals from surgery, you will need to sip small amounts of water throughout the day. Carry a water bottle for convenience and to remind you to keep sipping. The water bottle should become a familiar sight in and out of your home. If you do not like your tap water, treat yourself to bottled water. A slice of lemon can add flavor. Also, consider sucking on ice chips.

Can I drink coffee and soft drinks for my fluid requirements?

• Do not substitute caffeinated drinks for water since these only dehydrate your body. They act as a diuretic and may stimulate your appetite. Also, always avoid carbonated beverages. Carbonation can cause gas that can be painful. You may drink diet, decaffeinated soft drinks, but you should let them "go flat". Avoid the use of straws. With a straw, you can drink large amounts of fluid without realizing it and overfill your stomach pouch. In addition, you can swallow air that can cause discomfort.

Can a person drink alcohol after gastric exclusion surgery?

• Alcohol can slow down a patient’s weight loss. It contains a lot of calories, and is not nutritional. After gastric bypass surgery, alcohol enters the blood stream more quickly than before surgery. The intoxicating effects of alcohol occur sooner than before surgery and after smaller amounts are ingested. It is best to avoid drinking alcohol since it can be irritating to the stomach pouch. Also, remember a person must not drink and drive.

Can I smoke after surgery?

• This is not advisable. Smoking stimulates gastric secretions that can irritate the lining of the stomach. This irritation can cause chronic gastritis and ulcers in the stomach and small intestine. Patients who smoke after bariatric surgery have a higher likelihood of developing ulcers in the pouch, which can be difficult to treat.

Why do I need to take chewable multivitamins on a regular basis?

• Vitamin and mineral supplements are necessary for the rest of your life. Less food and smaller amounts of vitamins and minerals are entering your system. With malabsorptive procedures you only absorb a portion of the vitamins and minerals that you eat. Our program has specific recommendations for vitamin and mineral supplements. Your dietitian will teach you which ones are necessary for you. You may purchase these supplements at our office or from our Estore.

I have already had my surgery, but I do not seem to be hungry. Why?

• Patients report different reactions to food after surgery. Some find that they are not hungry for the first several weeks and have to "force" themselves to eat the number of recommended meals. Remember, the size of your stomach is smaller after surgery, so it will take less food to make you feel full. Your first nutritional goal is to drink 64 ounces of fluid daily. Your second goal will be to meet your daily goal for protein grams. This will become important when you begin the full liquid stage of your eating program. Remember too, that fluids can be good sources of protein. The recipes you receive for the full liquid phase of the nutrition program are designed to contain concentrated sources of protein. These should help you meet both your protein and fluid requirements. You might also find it helpful to give yourself cues on when to eat. Some people set the alarm on a wristwatch as a reminder of a mealtime.

What if I am feeling hungry?

• The feeling of hunger immediately after surgery can indicate that the liquids are not remaining in your stomach long enough for you to feel "full". However, it is important that you follow the nutritional guidelines that allow your pouch to heal from the surgical procedure. If you are hungry, once you are on pureed, soft and solid foods, it could mean that you are spacing your meals too far apart, and you may need to eat more frequently. It should also take less food at each meal for you to feel full than before surgery. Remember that hunger can be a subjective sensation.

How can I tell when I have had enough food?

• If you have trouble telling when you are getting full, make sure you are following the recommended portion sizes provided by your dietitian. Once you have attained your weight goal, your dietitian can answer any questions you might have about your food selection to help you maintain your weight level.

Why do I think about the high fat and high sugar foods that will not be a part of my new eating program?

• A craving for a particular food is usually triggered by an emotional or hormonal need. Sometimes after surgery, patients grieve over losing the freedom of food choice that they had before surgery. It can be difficult emotionally to have a restriction on the kind and amount of food you can eat. Feelings of loss must be dealt with as part of the healing process in your path to recovery. To prevent cravings, you may need to space your meals more evenly throughout the day. If thirst triggered the craving, make sure you drink enough water. If you are bored, distract yourself with some exercise or activity. When you increase your activity level, glucose is released into your system and oftentimes may end your craving. In addition, participating in an activity you enjoy may distract your craving. If you wish to learn new coping and problem solving skills, you may want to schedule additional appointments with your licensed professional counselor. You also may find participation in a support group helpful after your surgery.

When should I weigh and measure myself?

• We recommend that you only weigh and measure once a week, on a regular schedule, at the same time of day and in similar clothing.

Will my weight loss ever hit a plateau?

• Eventually you will hit a weight loss plateau when you notice you are no longer losing weight. Your body may simply be adjusting to the chemical and biological changes that occur during weight loss. During this time, you may still need to change the size of your clothing as your weight redistributes itself. If plateaus continue for more than a few weeks, review your nutrition plan and activity level. Are you following the nutrition guidelines for portions, protein and fluid intake and limiting fats and sugars in your food selections? Decreasing your activity level can also contribute to a weight plateau. Review your activity level and see if your level of physical activity can be increased. If you are weight training (with your doctor’s approval), remember that muscle weighs more than fat, and this may temporarily slow down your weight loss. If you are building muscle, you probably are losing inches even though you are not losing pounds. Our dietitians are always available to speak with you about any concerns you have and for more ideas on the best way to end a plateau.

Why is activity so important or me after surgery?

• Exercise maximizes weight loss and helps to maintain a healthy body. After surgery, you not only need good nutrition, you need to take the time for regular activity. You can build exercise into your daily schedule, or it can be as easy as walking to do your errands. Here are some reasons why physical activity is important to you:
  • Increases your metabolic rate, which can help you lose weight faster
  • Burns fat
  • Improves your mood and feeling of well being by secreting endorphins (chemicals) into your body
  • Decreases appetite
  • Increases muscle tissue, which, unlike fat, constantly burns calories
  • Decreases muscle breakdown while losing weight
  • Alleviates constipation
  • Improves sexual activity
• There are many more reasons for exercise. Why not consider the benefits of joining an aerobic fitness program? Use your increasing energy to discover (or rediscover) some new, active interests.

What will my rate of weight loss be after surgery?

• Patients do not lose pounds and inches at the same pace from week to week. Weight loss is greatest in the first three months after surgery.

How does a menstrual cycle affect a woman’s weight loss?

• Women should consider their normal menstrual cycle when they weigh themselves. If you typically gained weight during your period before surgery, you will probably continue this pattern after surgery. This fluctuation of water in your body due to your menstrual cycle may result in a temporary slowing of, or slight gain in, your weight.

Will surgery affect a woman’s chances of pregnancy?

• We recommend that women avoid pregnancy for the first two years after surgery. After that period, you should have a normal pregnancy. It is essential to discuss any plans for pregnancy with your surgeon and dietitian, as well as an obstetrician, before surgery. An obstetrician and a dietitian must follow your pregnancy closely.

I have heard that some people experience hair thinning or loss after gastric exclusion surgery. Will this happen to me?

• Major surgery, rapid weight loss and changes in eating behavior and activity level can produce stress on the body. Hair loss may be a reaction to this stress. Patients who experience some hair loss usually notice it occurs three to five months after surgery. This is temporary, and you will not lose all of your hair. It will grow back. However, you can minimize chances of hair loss by taking the recommended amounts of vitamins, minerals and protein.

How often will I follow up in the office with progress checks after surgery?

• Most patients have their first appointment seven to ten days after surgery. The next follow-up appointment occurs at four weeks. After the first month follow up your appointments will be scheduled based on your type of procedure. Laboratory analysis of your blood is done at scheduled intervals after your surgery.

How often do I follow up with my therapist?

• If you were receiving treatment from a therapist before surgery, we advise you to continue keeping your appointments after your hospitalization.

Can I take my antidepressant or anti-anxiety medication?

• If you were taking an antidepressant or other psychopharmacological medication before your surgery, we recommend you resume use in consultation with your surgeon and prescribing doctor. You may need to cut some medications into pieces before swallowing, or they may be available in an elixir.