When can I start exercising after surgery?
Right away! To start, you will take easy, short walks while you are in the hospital. The key is to start slow. Listen to your body and your surgeon. If you lift weights or do sports, stay “low impact” for the first month.
Will I have to exercise after the procedure?
For many patients, exercise is important for stress control and appetite control, as well as burning off calories.
work with your surgeon’s program to find a variety of activities that can work for you. There is no “one-size-fits-all” plan. Expect to learn and change as you go!
Will I have to go on a diet before I have surgery?
We put our patients on a special pre-operative diet, usually 2 or 3 weeks just before surgery. The reason for the pre-operative diet is to shrink the liver and reduce fat in the abdomen. This helps during the procedure and makes it safer.
These diets are very different from the short-term diets and usually are more about food education and showing a willingness to complete appointments and to learn.
Will I have to be on a diet after the surgery?
No. Most people think of a “diet” as a plan that leaves you hungry. That is not the way people feel after surgery.
Eventually, most patients get some form of appetite back 6-18 months after surgery. Your appetite is much weaker, and easier to satisfy than before.
This does not mean you can whatever and whenever you want. Healthier food choices are important for best results, but most patients still enjoy tasty food, and even occasional “treats”.
When can I get pregnant after weight loss surgery?
We advise waiting 12-18 months after surgery before getting pregnant.
Most women are much more fertile after surgery, even with moderate weight loss.
Birth control pills do NOT work as well in patients who are overweight. Birth control pills are not very reliable during the time your weight is changing. For this reason, having an IUD or using condoms and spermicide with ALL intercourse is needed. Menstrual periods can be very irregular, and you can get pregnant when you least expect it!
Will the baby be healthy?
Yes.
After surgery, there is much less risk of experiencing problems during pregnancy and during childbirth. There are also fewer miscarriages and stillbirths than in women with obesity who have not had surgery and weight loss.
Kids born after mom’s surgery are LESS at risk of being affected by obesity later, due to activation of certain genes during fetal growth. There is also less risk of needing a C section.
How long after weight loss surgery will I have to be from work?
After surgery, most patients return to work in one or two weeks.
Will I lose my hair after surgery?
Some hair loss is common between 3 and 6 months following surgery but almost always temporary.
The reasons for hair loss are not totally understood. Even if you take all recommended supplements and meet protein requirements, hair loss will be noticed until the follicles come back. Adequate intake of protein, vitamins, and minerals will help to ensure hair re-growth, and avoid longer term thinning.
Will I need to have plastic surgery after weight loss?
Some patients may choose to have plastic surgery, but this depends on many factors. we provide plastic surgeon too.
Do most people who have weight loss surgery regain their weight?
No. A small number of patients can regain their weight but the vast majority lose significant weight and keep this weight off.
More than 95% of patients will successfully lose half of their extra body weight or more after surgery for weight loss. Compared to these results, patients who attempt weight loss without surgery, on average, are able to lose little weight and may gain weight in the long-term.
Can I go off some of my medications after weight loss surgery?
Many patients are able to stop using some medications.
Will I have to take vitamins after surgery?
You will need to take a multivitamin for life.
You may need higher doses of certain vitamins or minerals, especially Iron, Calcium, and Vitamin D. You will also need to have at least yearly lab checks.
Do weight loss surgery patients have serious health problems caused by vitamin deficiency?
As long as patients take their appropriate vitamins, it is rare to have health problems from vitamin deficiency.
Weight loss surgeries have different effects on vitamins and minerals based on how much change in absorption they cause. Deficiencies in vitamins, minerals, and protein can negatively affect health causing:
- fatigue (feeling tired)
- anemia (low levels of red blood cells that carry oxygen through your body)
- bone and muscle loss
- impaired night vision
- low immunity (your body’s ability to stay healthy)
- loss of nerve function (can affect your senses such as touch, taste, and smell)
- mental function deficits (changes how clearly you think)
Fortunately, nutrient deficiencies following surgery can be easily avoided with a good diet and the use of supplements including vitamins, minerals, and sometimes protein supplements.
Is obesity caused by food addiction, similar to alcoholism or drug dependency?
“Food addiction” as a cause of obesity is extremely rare.
Although some people with obesity have eating disorders, such as binge eating disorder syndrome, most people have obesity caused by many factors. When treating addiction, such as alcohol and drugs, one of the first steps is to stop using drugs or alcohol. This does not work with obesity as we need to eat to live. Weight gain generally occurs when the amount of food eaten is greater than the number of calories burned. There are other conditions, however, that affect weight gain that do not involve too much eating or a less active lifestyle including:
- Poor sleeping habits
- Eating foods that may increase body fat (sugar, high fructose corn syrup, trans fat, processed meats and processed grains)
- Low intake of fat-fighting foods (fruits, vegetables, legumes, nuts, seeds, quality protein)
- Stress and mental distress
- Many types of medications
- Pollutants
Obesity also leads to more obesity, which is one of the reasons why the disease is considered progressive.
Does weight loss surgery increase the risk for suicide?
People affected by severe obesity who are seeking weight loss surgery are more likely to suffer from depression or anxiety and to have lower self-esteem and overall quality of life than someone who is normal weight. Weight loss surgery results in significant improvement in mental health for the majority of patients. However, studies have found a small but significant increase in suicide following weight loss surgery.
Is the chance of dying from weight loss surgery more than the chance of dying from obesity?
No. Weight loss surgery is very safe and decreases the chance of dying from obesity. In fact, weight loss surgery is safer than removing the gallbladder or having a knee replacement.
Obesity is no longer considered a cosmetic issue that is caused by overeating and a lack of self-control. The World Health Organization (W.H.O.), now recognize obesity as a chronic progressive disease resulting from multiple environmental and genetic factors.
The disease of obesity is extremely costly not only in terms of economics, but also in terms of individual and societal health, longevity, and psychological well-being. Due to its progressive nature, obesity requires life-long treatment and control.
The body mass index (BMI) is another measure used to define overweight and obesity.
Body size categories using BMI have been based upon the ranges of BMI associated with a certain risk for mortality. The categories and respective BMI categories are:
| Category | BMI Range |
| Normal Size | 18.9 to 24.9 |
| Overweight | 25 to 29.9 |
| Class I, Obesity | 30 to 34.9 |
| Class II, Serious Obesity | 35 to 39.9 |
| Class III, Severe Obesity | 40 and greater |
According to the W.H.O., 65 percent of the world’s population lives in countries where overweight and obesity kills more people than underweight. Approximately 500 million adults in the world are affected by obesity and one billion are affected by overweight, along with 48 million children.
Not only has the obesity epidemic increased in number throughout the past two decades, but also in severity.
Progressive Nature of the Disease of Obesity
Obesity is considered a multifactorial disease with a strong genetic component. Acting upon a genetic background are a number of hormonal, metabolic, psychological, cultural and behavioral factors that promote fat accumulation and weight gain.
Weight gain is yet another contributor to weight gain or, in other words, obesity ‘begets’ obesity, which is one of the reasons the disease is considered ‘progressive’.
A low calorie diet is the primary treatment for overweight and obesity, but, dieting is also a contributor to obesity progression. Dietary weight-loss causes biological responses that persist long-term and contribute to weight regain. One of these responses affects energy balance. When a person loses weight, the body ‘thinks’ it is starving and energy expenditure is reduced in order to conserve calories. The reduction in energy expenditure with dietary weight-loss requires that, in order to maintain weight-loss, the dieter eat even fewer calories than someone of equal body size who has never been on a diet. However, eating less is difficult following a diet because there are long-term changes in regulators of appetite that increase the desire to eat and the amount of food that can be consumed. Such diet-induced changes favor a positive energy balance and weight regain and, because the conditions responsible for the reduction in energy expenditure and increased drive to eat persist long-term, an individual will often not only regain all of their lost weight, but even more.
Another biological response that occurs with dieting involves changes in fat metabolism that reduce the body’s ability to burn fat and increase the capacity for fat to be stored in adipose depots (fat storage depots). With dietary weight-loss, the amount of dietary fat the body burns is reduced by approximately 50 percent. In addition, dieting reduces the amount of fat the body burns for fuel during low-grade activity such as walking, cleaning the house, fixing dinner, or working on a computer. The reduction in the amount of fat that is burned for fuel following a dietary weight-loss makes more fat available to be taken up by fat storage depots, and dieting increases the capacity for fat depots to store even more fat than before a diet. Altogether dietary weight-loss reduces the use of fat for fuel and increases the capacity for the fat that is not utilized to be stored. These changes lead to a progressive increase in fat accumulation even if the individual is not overeating.
Obesity is when your body weight is above normal. Obesity is a disease which can result in a lot of damage to your body. People with severe obesity are more likely to have other diseases.
Obesity is a major cause of Typt 2 Diabetes. People affected by obesity are about 10 times more likely to have high blood sugar . Diabetes can nearly double the risk of death . Type 2 diabetes can lead to:
About three out of four patients with high blood pressure have obesity. High blood pressure increases the risk of other diseases such as heart disease, congestive heart failure (CHF), stroke, and kidney disease.
Heart disease kills about 600,000 people every year . People with severe obesity are at a higher risk having a heart attack.
People with obesity have reduced breath capacity. They are not able to breathe in as much air in and out. These people are at higher risk for respiratory (lung) infections, asthma, and other respiratory disorders. Asthma has been shown to be three to four times more common among people with obesity .
More than half of those affected by obesity (around 50 to 60 percent) have obstructive sleep apnea (OSA). In cases of severe obesity, this figure is around 90 percent. OSA is a very serious breathing disorder. It occurs when extra fat in the neck, throat, and tongue block air passageways during sleep. This blockage causes apnea, which means a person stops breathing for a time.
OSA may lead to high blood pressure, pulmonary hypertension, and heart failure. OSA can cause sudden cardiac death and stroke. Because apnea episodes interrupt the normal sleep cycle, you may not reach restful sleep. This can lead to fatigue (tiredness) and drowsiness. If untreated, this drowsiness may raise your risk of motor vehicle accidents.
Obesity is believed to cause up to 90,000 cancer deaths each year. These cancers include:
For people with severe obesity, the death rate increases for all types of cancer. The death rate is 52 percent higher for men and 62 percent higher for women.
Obesity puts a strain on your whole circulatory system, which carries blood through your body through your vessels (arteries and veins). This strain increases your risk for stroke and vessel damage in the brain. Stroke risk factors include heart disease, hypertension, high cholesterol, type 2 diabetes (called metabolic syndrome when someone has three or more of these diseases) and obstructive sleep apnea .
GERD or heartburn, causes stomach acid or intestinal secretions to damage your esophagus. Common GERD symptoms include heartburn, “indigestion”, throwing up food, coughing (especially at night), hoarseness, and belching. Nearly two of every 10 people experience GERD symptoms regularly.
Obesity has been associated with higher risk of GERD, inflammation of the esophagus and rarely, esophageal cancer.
Obesity contributes to bone and joint issues. These issues can increase the risk for accidents and personal injury. Bone and joint issues can include:
Obesity can have a dramatic impact on your body. The conditions related to obesity can be detrimental to your health. However, many of these complications can be avoided or cured through weight loss.
Qualifications for bariatric surgery in most areas include:
Bariatric surgical procedures cause weight loss by restricting the amount of food the stomach can hold, causing malabsorption of nutrients, or by a combination of both gastric restriction and malabsorption. Most weight loss surgeries today are performed using minimally invasive techniques (laparoscopic surgery).
The most common bariatric surgery procedures are gastric bypass, sleeve gastrectomy, adjustable gastric band, and biliopancreatic diversion with duodenal switch. Each surgery has its own advantages and disadvantages.
The Roux-en-Y Gastric Bypass – often called gastric bypass – is considered the ‘gold standard’ of weight loss surgery.
Most importantly, the rerouting of the food stream produces changes in gut hormones that promote satiety, suppress hunger, and reverse one of the primary mechanisms by which obesity induces type 2 diabetes.
The Laparoscopic Sleeve Gastrectomy – often called the sleeve – is performed by removing approximately 80 percent of the stomach. The remaining stomach is a tubular pouch that resembles a banana.
The Adjustable Gastric Band – often called the band – involves an inflatable band that is placed around the upper portion of the stomach, creating a small stomach pouch above the band, and the rest of the stomach below the band.
The Biliopancreatic Diversion with Duodenal Switch – abbreviated as BPD/DS – is a procedure with two components. First, a smaller, tubular stomach pouch is created by removing a portion of the stomach, very similar to the sleeve gastrectomy. Next, a large portion of the small intestine is bypassed.
Why Surgery?
Surgery can be the most effective treatment.
Many patients with obesity have tried to treat this on their own, with diet and exercise. Many have had some success, only to have weight regain. More often, patients have little to no success with diet and exercise alone. This is not a result of lack of willpower or the wrong diet. When a patient has a BMI greater than 35, their chances of reaching a normal body weight for a lasting period of time is less than 1%. That’s why surgery is an option for patients with severe obesity. Unfortunately, many patients who could benefit from surgery don’t know if surgery is right for them. Only about 1% of people who qualify actually get surgery in any given year.
Weight loss surgery does not just treat the disease of obesity, but it treats other conditions like diabetes, heart disease, high blood pressure, arthritis, and acid reflux. In addition, surgery greatly reduces the risk of death from cancer, diabetes, heart disease, and other diseases.
How Does Weight Loss Surgery Work?
Weight loss surgery, also known as bariatric surgery, such as gastric bypass, sleeve gastrectomy, and duodenal switch work by changing the anatomy (or position) of the stomach and small intestines. This causes changes in appetite, satiety (feeling full), and metabolism (how the body burns calories).
Many of the hormonal signals that cause weight gain or inability to lose weight are affected by these procedures, and it becomes easier to lose weight. But this still requires a healthy diet and a good exercise routine. These procedures are tools to treat a chronic disease, and cannot work alone.
Long Term Weight Loss
Around 90% of patients after bariatric surgery lose 50% of excess body weight and keep this extra weight off long-term.
When patients start to lose weight after surgery, they also feel more energetic, less pain, and more enthusiasm for doing things they have not done in years. The significant and rapid weight loss after surgery can lead to changes in hormones and lead to even more weight loss. Staying consistent with an exercise routine can improve weight loss and weight stability after surgery.
Living Longer After Weight Loss Surgery
In large scientific studies of hundreds of thousands of patients, weight loss surgery has been shown to lower a person’s risk of death from any cause by over 40 percent.
Decades ago, weight loss surgery was seen as high risk and the rewards were seen as mostly cosmetic. This is completely incorrect. The risk of death due to surgery is very low in the first year after surgery, about the same as gallbladder surgery. Surgery for weight loss lowers the risk of death related to many diseases including heart disease (40% lower), diabetes (92% lower), and cancer (60% lower) are also significantly reduced. Comparing the risks of surgery to the benefits of surgery makes the decision for surgery much easier to make.
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