Life After Surgery
Bariatric surgery is not a quick fix. It's an ongoing journey toward weight loss through lifestyle changes. After surgery, the difference in your body makes it physically easier to adjust your eating and lifestyle habits. Fortunately, you will not have to go through the process alone. A team of professionals will be there to support your efforts. Positive changes in your body, your weight, and your health will occur, but you will need to be patient through the recovery process.
Permanent changes you will have to make following bariatric surgery include the following:
The following are some of the generally accepted dietary guidelines for a healthy diet after bariatric surgery:
- Eat very slowly, taking very small bites and chewing foods thoroughly.
- Stop eating as soon as you begin to feel full.Include protein with all meals and snacks; aim for 60 to 80 grams of protein every day.
- Choose foods and beverages with less than 14 grams of sugar and less than 5 grams of fat per serving to avoid empty calories and help prevent dumping syndrome.
- Don't drink fluids with meals.
- Stop drinking 30 minutes before eating and wait 30 minutes after eating before having something to drink.
- Drinking fluids while eating will make you feel full before you have eaten enough protein, can cause vomiting and dumping syndrome, and can cause you to feel hungry sooner after a meal.
- Stay hydrated! Aim for 64 ounces of calorie-free, carbonation-free, and caffeine-free fluids a day. Sip fluids throughout the day in order to reach this goal.
- Avoid alcohol.
- Take vitamin and mineral supplements as recommended for your specific surgery. Keep in mind, these supplements may not be covered by insurance, but without them you could develop micronutrient deficiencies. Eating after bariatric surgery will be much different than before, but our registered dietitians are here to support you as you make these changes.
Eating after bariatric surgery will be much different than before, but our registered dietitians are here to support you as you make these changes.
Your ability to resume pre-surgery levels of activity will vary according to your physical condition, the nature of the activity and the type of weight loss surgery you had. Most patients return to work and are able to exercise within one to three weeks after their laparoscopic gastric bypass. Patients who have had an open procedure do so about six weeks after surgery.
It is strongly advised that women of childbearing age use the most effective forms of birth control during the first 16 to 24 months after weight loss surgery. The added demands pregnancy places on your body and the potential for fetal damage make this a most important requirement.
Although the short-term effects of weight loss surgery are well understood, there are still questions to be answered about the long-term effects on nutrition and body systems. Nutritional deficiencies that occur over the course of many years will need to be studied, and can depend on your diet after bariatric surgery. Over time, you will need periodic checks for anemia (low red blood cell count) and Vitamin B12, folate and iron levels. Follow-up tests will be conducted at least yearly and more often as indicated.
The widespread use of support groups has provided weight loss surgery patients an excellent opportunity to discuss their various personal and professional issues. Most learn, for example, that weight loss surgery will not immediately resolve existing emotional issues or heal the years of damage that morbid obesity might have inflicted on their emotional well-being. Our surgeons have support groups in place to assist you with short-term and long-term questions and needs, including the most effective exercise and diets after bariatric surgery. Most bariatric surgeons who frequently perform weight loss surgery will tell you that ongoing post-surgical support helps produce the greatest level of success for their patients in their life after bariatric surgery.
Most patients go home one or two days after laparoscopic bariatric surgery. You may feel a little worse the first day at home, with a bit more fatigue and pain, but you should feel better day by day after that. You will be provided with phone numbers to access your surgeon and team members at any time. Make sure you have these numbers available and access to a phone at all times. You will not be able to drive after surgery, for as long as you are taking pain medication, generally for 10-14 days- make sure you have family members to drive you home and available to drive you back to the hospital in the first two weeks in the rare instance that a problem arises.
For the first three weeks after surgery, you should eat a liquid diet. We recommend clear liquids for 1-3 days, followed by transition to full liquids within 1-3 days, remaining on full liquids for three weeks. Clear liquids include water, juice (sugar-free ideally), JELL-O, thin soups, broth. Full liquids include thicker soups, blenderized foods (no meats or breads, even if blenderized), pudding, and yogurt. We generally recommend that patients eat 1000-1400 calories per day and 50-70 grams of protein per day after surgery, but it is important to realize that patients will not meet calorie and protein goals for at least 1-2 months after surgery- these calorie and protein goals will be achievable after 1-2 months. The primary goal during the first 1-2 months is to drink enough fluids to stay hydrated. Your body will tolerate 1-2 months of lower calorie and protein intake without problems. Problems with pills are uncommon- most patients can go back to taking pills immediately unless they are very large. Discuss any concerns about specific pills with your surgeon.
Recovery after laparoscopic surgery is usually rapid. It is important to be up and about walking immediately after surgery. Patients should be able to get around the house, prepare meals, and do simple tasks. You may feel some fatigue for a few days, weeks, or even months after surgery - take it easy, avoid exercise beyond walking short distances for the first 2-3 weeks. Watch your balance and makes sure you walk with assistance or near railings or other handholds. Everyone is different- listen to your body, and discontinue activities that cause pain, discomfort, or significant fatigue. Recovery is longer after an open operation.
Complications are rare after laparoscopic bariatric surgery. Most serious complications will occur in the first 2 weeks - during this time, have a low threshold for calling your surgeon if problems or concerns arise. Pain, especially pain that does not improve daily or is severe, fevers, significant nausea, vomiting, and inability to pass gas or stool should prompt a call to your surgeon. Mild nausea, pain that is not severe and improves daily, and constipation are common after surgery and usually not worrisome. Redness or drainage from wounds should be evaluated as well, although this is often not a serious problem. Any problem that arises that worries patient or family members in the first two weeks after surgery should prompt a call to your surgeon.
Most patients should restart all medications they were taking prior to surgery within 1-2 days after surgery. This includes diabetes medications, although patients should check their blood sugars at least daily after surgery. For patients with sleep apnea who use CVPAP, it is important that you continue your CPAP before and after surgery. Patients should check in with their primary care provider within a week of surgery and receive advice on mediation. Avoid aspirin and NSAIDS (e.g., ibuprofen, naproxen) for as long as possible after surgery, but ideally for at least one month.
For laparoscopic operations, you may shower immediately, but keep your back to the water and keep your incisions as dry as possible. After about one week, you can let the incisions get wet, but do not submerge in a bath or pool, and dry them immediately. By three weeks, bathing or pool activity is fine. Occasionally an incision will open up -- this is not a major problem -- call your surgeon, but usually covering the incision with a bandage is all that is necessary. Less frequently, incisions may become infected. Signs of infection are redness around the wound, or drainage of fluid, and less commonly fevers. Call your surgeon if this problems arises. Wound infections are generally easily treated.
Patients should slowly transition to solid foods beginning at 3 weeks after surgery. This is a process- begin with small amounts of solid foods such as eggs, fruit, cereal at first, always test a small amount, chew carefully and pay attention to sensations. If a particular food feels like it goes down too slowly or gets "stuck" for a while, put that food aside, and try others- you can retry that food in another couple weeks. If all goes well, introduce meats, starting with chicken and moving to beef and pork, vegetables, breads, and other solids, with the same precautions. By 1-3 months, most patients are eating solid foods. One in twenty patients may develop an intolerance to specific foods especially to meats, rice and breads, that may last longer, and may need to avoid those foods. Persistent or frequent vomiting is not normal and should prompt a call to your surgeon. We generally recommend that patients eat 1000-1400 calories per day and 50-70 grams of protein per day after surgery, but it is important to realize that patients will not meet calorie and protein goals for at least 1-2 months after surgery- these calorie and protein goals will be achievable after 1-2 months..
During this period, patients may begin to see improvement in obesity related disease such as diabetes, hypertension, hyperlipidemia, and sleep apnea. It is important that you work with your PCP to slowly reduce your medications and CPAP settings during this period. Your PCP plays a critical role in this process
Patients can slowly begin exercise 2-3 weeks after surgery. Ease back into exercise. Begin with walking, listen to your body and reduce activity if you feel pain, discomfort6, or significant fatigue. By 4-5 weeks, most patients are back to usual activity and exercise levels.
By 3 months after surgery, most patients are eating solid foods and are able to consume about 900-1,200 calories and at least 50 grams of protein per day. This ability will increase with time. Calorie counting should begin at this point. Most successful patients are eating 1,200-1,400 calories per day months and years after surgery. Some patients may need to diet a bit in addition to their operation, which is "doable" after bariatric surgery, unlike before surgery. With calorie counting and monitoring their weight, most patients can maintain weight loss for years after bariatric surgery. Ideally, exercise levels will increase after surgery as you lose weight. In the absence of significant disability or osteoarthritis, you should be exercising more by 6-12 months after surgery than you were before surgery. Water aerobics and cycling are good options for those with arthritis or joint problems. Brisk walking is a great lifelong exercise. Talk with your primary care physician before initiating or increasing any exercise program and ease into any increased activity to avoid injury. Follow-up after bariatric surgery is lifelong. You should see your surgeon annually. You should see your primary care physician at least annually. Infrequent long-term complications such as hernias, ulcers, nutritional issues, and gallstones may require treatment months or years after bariatric surgery. Any new problems that involve your health in any way and especially your gastrointestinal tact, including abdominal pain, should be discussed with your surgeon.
Meeting with your OHSU Dietitians prior to surgery is an important component of helping you prepare for surgery. We will focus on helping you lose any weight that is required by your insurance/ MD prior to surgery, working to help you establish a healthy dietary routine. We will also focus on preparing you for what your diet will look like after surgery and making sure you have the tools to prepare for your post-surgery diet.
At our initial meeting we will:
- Review your current diet
- Review tools to help you with behavioral and lifestyle changes pre and post surgery
- Develop and individual nutrition plan to help with any needed weight loss prior to surgery and help you transition to post-surgery dietary habits
- Review dietary progression after surgery
- Provide written instructions with lists of appropriate foods and sample menus for each dietary stage
- Review dietary supplements needed post op and provide several options for each In follow up meetings prior to surgery we will continue to provide support for weight loss goals and review post-surgery information as needed
Nutrition during the first three months after surgery will help with recovery and give long-term health benefits, read more about how OHSU is here to help.
Regular meetings with your OHSU Dietitians during the first 3 months is important to help you progress through the initial stages of your post-bariatric diet. We will focus on how you are tolerating your current diet and continue to work to help you establish a healthy dietary routine.
At each meeting we will:
- Review your current diet
- Help troubleshoot any food/nutrition problems you are having currently
- Work with you to make sure you are meeting your protein and fluid goals
- Make sure you are taking the right vitamins and that you are taking them at the right time
- Give you instructions on how to advance to the next diet stage including what foods to add and those to continue to avoid
- We encourage you to and are available for you to contact us with any questions in between visits
For long term success after bariatric surgery it is important to follow a balanced and to include a variety of food and food groups.
Tips to keep in mind:
- Continue to reach daily protein (60-80 grams) and fluid goals (64 oz). Keeping food logs can help you track your intake and can be done on paper or online (fitday.com, myfitnesspal.com)
- Continue to practice mindful eating, use smaller plates, baby-spoons or chopsticks to help slow down your eating
- Take your time incorporating foods into your diet plan, add only 1 new food at a time to better understand which foods you can and cannot tolerate
- Continue to take as directed, your multivitamin/mineral, calcium with added Vitamin D, and vitamin B12 supplements. It is ok to switch to non-chewable if desired
- Continuing to focus on meeting protein goals is important. We recommend choosing lean meats and low fat/non-fat dairy products the majority of the time
Other components in a healthy diet include:
- Whole grains, fruits and vegetables
- Continue to choose low sugar and low fat foods
- Everyone's needs will vary, but once you reach a weight maintenance phase you will likely be eating:60-80 + grams of protein including 2-3 dairy per day (8 oz = 1 serving)3-5 vegetables/fruits per day (1/2 cup = 1 serving)3 grains per day (1/2 cup or 1 slice = 1 serving)
It is important to keep yourself involved in support groups and to schedule regular visits with the Dietitians and other members of the OHSU team according to the post-op visit guidelines or any additional visits as often as you feel they are needed.We encourage you to contact us with any questions and are always able to schedule appointments as needed to help.
After your clinician approves it, we encourage you to participate in cardiovascular exercise and weight training. A combination of aerobic activities like walking, biking, or water aerobics along with strength training has been shown to have many health benefits, including weight loss. Try to aim for at least 30 minutes of moderate activity most days of the week or 250 min/week or 10,000 steps per day (measure with a pedometer)
Ideas for starting an exercise program can be found Active At Any Size
Week 1 ¼ mile a day –
4 blocks total 5 min leisurely pace
Week 2 ½ mile a day –
8 blocks total 10 min leisurely pace
Week 3 ¾ mile a day –
12 blocks total 15 min leisurely pace
Weeks 4 & 5 1 mile a day –
16 blocks total 20 min leisurely pace building up to moderate pace
Week 6 1¼ miles a day –
20 blocks total 20 min moderate pace
Week 7 1½ miles a day –
24 blocks total 25 min moderate pace
Week 8 2 miles a day –
32 blocks total 30 min moderate pace
After 8 weeks, you can increase your distance by ¼ mile per week. It is best for your health if you are eventually walking at least 30 min a day.