Life after surgery
Emotional Well-Being
After surgery you will need to help to address the psychological and behavioural aspects of bariatric surgery and then deal with attitude, emotional and behavioural factors associated with the successful transition to a very different lifestyle.
Prior to surgery, you were using food for various other reasons, not just as fuel: reward, comfort, socialisation, to combat boredom etc. After surgery, even though you can’t and won’t feel like eating for a while, when the situation arises where food used to be the answer, the desire for food may suddenly raise its head again. This may be quite sudden, and may either be easily dealt with by common sense, or may produce a sense of “buyer’s remorse”- what have I done?, accompanied by an acute emotional response. This is very normal, and can usually be coped with, but it can all become too overwhelming, and this is where our counsellors and psychologists can provide support.
Over the first few weeks after surgery, a number of strange emotions will be felt, including a sense of unreality. This is where the support of those you trust around you is needed, to ground you, to help you realise that your future dreams are indeed possible, and to keep you focused on the rules. The things that have been discussed with our therapists will become a reality, and it is worth continually revising what you talked over with them during this time.
We also have our 4-day residential retreat program (Foundations of Healthy Living) as a complementary adjunct to your emotional well-being during your bariatric surgery process alongside The PACE program, which is an on-line version of the face to face program.
Telling People You Have Had Bariatric Surgery
Deciding whether or not to tell others about your surgery is a personal choice and there are pros and cons of sharing your surgery decision with others. There is an article outlining this available in the patient manual. Please feel free to discuss this with any member of the team.
Exercise / movement
After your surgery, making a habit of regular intentional exercise or movement can be one of the most important changes you can make to lose and maintain weight. Exercise increases your energy, increases strength and muscle tone, helps joints stay loose and supple, and helps you to develop good body posture. It also helps you sleep and rest more peacefully, improves circulation, heart and lung function and can provide an outlet from the stresses often experienced in everyday life. It increases the ability to concentrate and learn and can make you happy and feel good.
Any form of physical activity will use calories, and you can learn how much exercise you need to balance the amount of calories you consume. It is recommended that you do 150 minutes of some form of medium-intensity exercise per week for good health, but you may prefer to do more for good fitness and weight maintenance. We provide an at-home exercise programme post-operatively that can assist you to keep fit, work on your strength (core and muscular) and provide the dopamine or feel good kick! This programme progresses as you do, providing a challenging and effective workout.
One great advantage of exercise for weight loss and maintenance is that while you are exercising you are not eating and you are distracted from food. Making the most of this, and exercising when you would normally be snacking out of habit can help to break this habit, reducing your food intake. You may find this particularly helpful in the evenings if you would usually be watching TV, as food and television often go hand-in-hand. This way, not only are you decreasing your food intake, you are decreasing your inactivity and gaining good health.
Fluids
After surgery it will be especially important for you to be aware of your fluid intake. You will not be able to drink large amounts of water all at once to re-hydrate you when you are thirsty. You should be aiming to drink 1.5 - 2 litres (6-8 glasses) of fluid each day.
Fluid plays a part in every system of the human body, and therefore it is crucial that you drink enough of it. It regulates your body temperature, hydrates your skin, hair and nails, removes toxins and waste products from your body, carries nutrients and oxygen to cells, cushions joints, prevents constipation, and dissolves many nutrients for the body to use. Fluid can also assist weight loss.
Alcohol
The bariatric surgery patient should absolutely NOT drink alcohol:
During the first 12 months following your surgery
Especially if you are not taking vitamin and mineral supplements, or
If you are vomiting frequently.
In addition to anatomical changes, the gastric bypass patient may be more sensitive to the intoxicating effects of alcohol because of the reduced calorie intake that occurs after surgery. A number of studies have found that alcohol absorption is far higher if fasting or when consumed on an empty stomach than if provided with a meal or drank soon thereafter.
Drinking alcohol in the early postoperative period may have adverse effects on health. Frequent vomiting, low calorie intake, not taking multivitamins and malabsorption may cause a number of vitamin and mineral deficits, including thiamine (vitamin B1).
In many ways, consuming alcohol defeats the purpose of bariatric surgery. Alcohol converts readily into blood sugar that can slow down weight loss and can cause dumping syndrome (which is when food is emptied into the small intestine too soon) and can cause vomiting or diarrhoea. Alcohol has no nutrient benefits and contains high numbers of calories that may cause weight gain or prevent weight loss.
Addiction transfer is yet another precaution to be considered with regard to alcohol. The prevalence of food addiction and associated eating abnormalities, i.e. binge eating, carbohydrate cravings, are high among individuals with morbid obesity.
With bariatric surgery, the addictive tendencies for food and irregular eating behaviour are considerably improved. However, individuals with addictions often transfer their addiction to yet another substance, such as alcohol. According to the findings of one study, addiction transfer may occur in up to 25% of bariatric surgery patients.
Abstinence after bariatric surgery is really the only treatment option if alcohol use disorder becomes prevalent.
Nutrition
The success of any bariatric operation requires you to take responsibility for your eating and exercise patterns. Therefore you will need to follow some guidelines:
Eat three regular nutritious meals each day, with preferably no snacks in between
Take your time and chew food really well. Eat mindfully and stop when you are comfortable
Eat only good foods that help meet all of your nutritional requirements
During the initial phase of “new” eating patterns, you may have occasional episodes of vomiting if you eat the wrong type of food or if you eat too quickly. With time, you will learn to identify those foods that cause you problems, however if you eat slowly, eat small amounts, chew really well and take your time; you can avoid some of these difficulties. Your eating pattern will steadily improve and 9-12 months after your operation, and you will be eating a wide range of high protein, moderate fat, low carbohydrate foods, in socially adequate amounts.
As your food intake will be restricted by your operation, it is important to eat wisely and ensure adequate nutrition. Protein supplementation is essential to your health after bariatric surgery and promotes healing. When your intake advances to more normal foods post-operatively, protein becomes very important and patients should try to take in 60-80 grams per day minimum. This may require continuing to take in supplemental protein, such as protein powder and protein bars.
Due to the reduction in the quantity of food you can eat and associated malabsorption with some bariatric surgery procedures, it is very difficult to eat enough of the right foods in order to get the quantity of nutrients your body requires. This makes taking your vitamin and mineral supplements crucial for the rest of your life. These supplements can range from basic multivitamins for the non-absorptive procedures like the Gastric Band, and includes iron, folic acid, calcium and B group vitamins for the procedures that involve some malabsorption such as the bypass and sleeve gastrectomy.
The importance of eating small quantities, eating slowly, chewing very well and listening to your body’s satiety signals will be outlined and reminded to you strongly throughout our process.
Smoking
Illness resulting from tobacco usage is the single greatest cause of disease and premature death in New Zealand. It is also the most preventable. We are committed to helping our patients improve their overall health, so we make a thorough effort to not only address your weight loss needs but also to encourage and assist you in quitting smoking.
We are genuinely concerned about these potential complications and strive to ensure our patients have minimal on-going problems after surgery therefore we will encourage smokers to partake in a comprehensive smoking-cessation program. Completion of such a program is mandatory for bariatric surgery candidates who smoke, a minimum of four weeks prior to surgery, but preferably prior to your initial consultations.
Your surgery will be postponed, or you could be released from consideration for surgery altogether if you continue to smoke. You will not be rescheduled for surgery until you have been tobacco (nicotine)-free for three months (including vaping with nicotine). In the event of any complications that occur as a result of smoking, the subsequent treatment involved in this will be at the patient’s expense. Nicotine products include cigarettes, patches, gum and vapourisers.
Is your bariatric surgery not working for you?
Bariatric surgery has been around for many years now, but our understanding of how it works and how to get the best results from it have improved over time.
Also, there can be mechanical issues with some operations that mean that they are no longer effective. We understand this, and are always happy to see our own or other surgeons' patients back for an assessment of where they are, what is happening with their previous surgery, and options for the future.
If you have watched the videos on the causes of obesity (on our Understanding Excess Weight page), you may realise that you need help with how you react to life.
If you have never had good education about food, you may need some nutritional advice and guidance. If you have had a previous operation, you may need a physical assessment of this, and even revision surgery. This has been true since the beginning of bariatric surgery, and even now, we do not have a perfect operation. All operations are only an aid to change a lifetime of habits- we can't cure anyone, but we can try and make further weight loss possible.
If you are unhappy with your outcome, please first watch the video on our understanding of the causes of obesity. Then email us a summary of your surgical history, with a comment about whether you are happy for us to get more information from your surgeon. We can then arrange an appointment with a surgeon for an initial assessment of your situation.