What are the Results of Surgical Weight Loss?

Most weight loss surgery patients will lose about 60 to 80 percent of their excess body weight with the gastric bypass procedure.  Substantial weight loss occurs 18 to 24 months after surgery; some weight regain is normal and can be expected at 2 to 5 years after surgery.

In addition to weight loss, surgery has been found to have a beneficial effect on many medical conditions such as:

• diabetes 
• hypertension
• acid reflux
• sleep apnea
• polycystic ovary syndrome (PCOS)
• urinary stress incontinence
• low back pain, and many others
• In addition, many patients report an improvement in mood and other aspects of psychosocial functioning after surgery

The overall quality of life is improved. Many weight loss surgery patients express elation on being able to do things that may seem trivial to the non-obese person, such as, going to the store, playing with their children, getting in and out of a car, riding a roller coaster, shopping for regular sized clothes…the list is endless.
Typically, weight loss surgery is performed laparoscopically (minimal invasive surgery).  Patients will often experience shorter hospital stays, smaller incisions and quicker recovery periods.

Medical conditions that may be greatly improved after surgery includes:

• High blood pressure

At least 70 percent of patients who have high blood pressure, and who are taking medications to control it, are able to stop all medications and have a normal blood pressure, usually within two to three months after surgery. When medications are still required, their dosage can often be lowered, with reduction of medication side effects.

• High cholesterol.

More than 80 percent of patients will develop normal cholesterol levels within two to three months after the operation.

• Heart disease.

Although we can't say definitively that heart disease is reduced, the improvement in problems such as high blood pressure, high cholesterol, and diabetes certainly suggests that improvement in risk is very likely. In one recent study, the risk of death from cardiovascular disease was profoundly reduced in diabetic patients who are particularly susceptible to this problem. It may be many years before further proof exists, since there is no easy and safe test for heart disease.

• Diabetes.

More than 90 percent of Type II diabetics obtain excellent results, usually within a few weeks after surgery: normal blood sugar levels, normal Hemoglobin A1C values, and freedom from all their medications, including insulin injections. Based upon numerous studies of diabetes and the control of its complications, it is likely that the problems associated with diabetes will slow in their progression when blood sugar is maintained at normal values. There is no medical treatment for diabetes that can achieve as complete and profound an effect as surgery - which has led some physicians to suggest that surgery may be the best treatment for diabetes in the seriously obese patient. Abnormal glucose tolerance, or "borderline diabetes," is even more reliably reversed by gastric bypass. Since this condition becomes diabetes in many cases, the operation can frequently prevent diabetes as well.

• Asthma.

Most asthmatics find that they have fewer and less severe attacks, or sometimes none at all. When asthma is associated with gastroesophageal reflux disease, it is particularly benefited by gastric bypass.

• Respiratory insufficiency.

Improvement of exercise tolerance and breathing ability usually occurs within the first few months after surgery. Often, patients who have barely been able to walk find that they are able to participate in family activities, and even sports.

• Sleep apnea syndrome

Dramatic relief of sleep apnea occurs as our patients lose weight. Many report that within a year of surgery, their symptoms were completely gone, and they had even stopped snoring completely—and their spouses agree. Many patients who require an accessory breathing apparatus to treat sleep apnea no longer need it after surgically induced weight loss.

• Gastroesophageal reflux disease

Relief of all symptoms of reflux usually occurs within a few days of surgery for nearly all patients. We are now beginning a study to determine if the changes in the esophageal lining membrane, called Barrett's esophagus, may be reversed by the surgery as well—thereby reducing the risk of esophageal cancer.

• Gallbladder disease

When gallbladder disease is present at the time of the surgery, it is "cured" by removing the gallbladder during the operation. If the gallbladder is not removed, there is some increase in risk of developing gallstones after the surgery, and occasionally, removal of the gallbladder may be necessary at a later time.

• Stress urinary incontinence

This condition responds dramatically to weight loss and usually becomes completely controlled. A person who is still troubled by incontinence can choose to have specific corrective surgery later, with much greater chance of a successful outcome with a reduced body weight.

• Low back pain, degenerative disk disease, and degenerative joint disease.

Patients usually experience considerable relief of pain and disability from degenerative arthritis and disk disease and from pain in the weight-bearing joints. This tends to occur early, with the first 25 to 30 pounds lost, usually within a month after surgery. If there is nerve irritation or structural damage already present, it may not be reversed by weight loss, and some pain may persist.

What can I expect After Surgery?

If you have any questions or concerns once you are home, you should call your surgeon. Specifically, call your doctor if you experience any of the following:

• Persistent nausea or vomiting
• Vomiting a bright red or dark brown liquid (go to the emergency room)
• Increased redness, swelling or foul-smelling discharge at incision site
• Increased soreness or pain in your incision(s)
• Any new or unusual pain in your abdomen, chest or legs
• Temperature higher than 101°F
• Passage of very dark stool
• Acute depression or negative emotions

Eating

At home, you will need to follow specific eating guidelines that your dietitian will have explained to you. For the first six weeks after surgery, your diet will consist of liquid/pureed food. This includes foods that are liquid to soft in consistency. Examples of soft consistency foods are scrambled eggs, cottage cheese, sugar-free yogurt, hot cereal and mashed potatoes. You also can drink non-carbonated fluids that are sugar-free and caffeine-free. Good choices are water, milk, sugar-free flavored drinks and high-protein liquid supplements. Your dietitian will recommend liquid supplements to meet your nutritional needs during this time. As your tolerance builds, you will progress to a soft diet and then to regular foods.

Your “new” stomach is roughly the size of an egg. It will stretch to the size of a cup in about a year. You can avoid discomfort and complications if you do the following:

• Eat small, frequent meals (five or six) throughout the day. (Your stomach will be too small to hold large meals.)
• Chew all foods slowly and thoroughly. (It may take you up to an hour to complete your meals and snacks.)
• Drink fluids 30 minutes after your meal. Be sure to drink in sips.
• Do not drink fluids with your meals. Your smaller stomach may not be large enough to hold fluids and food at the same time.
• Do not eat sweets.

Avoid foods that cause any discomfort. You might consider keeping a diary of the foods you eat, as well as any foods that are difficult to tolerate. Your diary will help you identify which foods cause discomfort. During follow-up visits, you can use your diary to report any foods you cannot tolerate.

Your dietitian will help you plan healthful, appropriate meals. You also will be guided in selecting a variety of foods that are rich in vitamins, minerals and protein so you will stay well nourished. Your dietitian will recommend a multivitamin/mineral supplement.

Digestive distress, such as gas and constipation, is common in the first few weeks following bariatric surgery. Unless your physician instructs you otherwise, you can use over-the-counter gas relief medications and stool softeners. If you are constipated, you can add extra fiber to your diet by eating applesauce, oatmeal, and pureed prunes.

Dumping Syndrome

Dumping syndrome is fairly common following bariatric surgery, particularly if you don’t follow all of the special dietary instructions given to you. The signs of dumping syndrome are:

• Nausea
• Vomiting
• Bloated stomach
• Diarrhea
• Excessive sweating
• Increased bowel sounds
• Dizziness
• Emotional reactions

These symptoms need to be addressed during initial follow-up with endocrine, nutrition, behavioral health and surgery.
To prevent dumping syndrome, DO NOT eat or drink the following:

• Beverages containing caffeine such as coffee, tea or chocolate
• Citrus food or juices such as orange, grapefruit, lemon or lime
• Carbonated beverages
• Sugar and sweeteners such as dextrose, fructose, mannitol, sorbitol, white sugar, brown sugar, syrup, molasses, candy, jelly, desserts, jams or preserves
• Alcohol
• Sweetened beverages including regular soda, coolers, drink mixes, Kool-Aid, fruit punch or undiluted fruit juice

In addition:
• Eat only canned or very tender, well-cooked fruits and vegetables.
• Do not eat any raw fruits or vegetables, except bananas.
• Do not eat the skins of any cooked vegetables or fruit.

Bariatric surgery will change your eating habits quite a bit. Rely on close family members and friends for support and encouragement, as this may be an emotional time in your life. It is important that you keep a healthy mind and body. Keep your follow-up appointments, exercise and learn to cope with emotional difficulties. Your health care team will also be there to guide you after your surgery.

Activity Restrictions

Avoid any strenuous activity until you are healed, but do not avoid walking! Walking is a required activity at this stage of your recovery. Don’t drive if you are taking pain medication other than Tylenol. At your first follow-up visit, your doctor will determine when you can return to work.

Incision Care

Even though you may have staples or steri-strips on your incision when you are discharged, you may wash your abdomen with mild soap and water in the shower. Do not take a tub bath or use a Jacuzzi, pool or hot tub until your incision is fully healed.
Call your doctor if you experience any of the following:

• Increased redness, swelling or foul-smelling discharge at incision site
• Increased soreness or pain in your incision
• Temperature higher than 101°F
• Any new or unusual pain in your abdomen, chest or legs

Exercise

After you have healed, we encourage you to embark on a physical fitness program. Exercise will keep you feeling well and energized. Always discuss exercise options with your doctor so you know what type of exercise is most appropriate for you. Choose an exercise that you will enjoy and look forward to doing. In fact, for many people, returning to physical exercise is an important step toward feeling better.

Avoid Pregnancy

If you are a woman of childbearing age, you MUST not get pregnant within the first 18 months to 2 years following surgery. The rapid weight loss and nutritional deficiencies associated with bariatric surgery make pregnancy very dangerous for you and for a developing fetus. Take special precautions to prevent an unsafe pregnancy, particularly because weight loss after bariatric surgery tends to increase fertility.

Follow-up Visits

Regular follow-up visits are scheduled during the first year after surgery to check your overall physical and mental health, metabolism and nutritional status. It is crucial to your health that you keep these follow-up appointments.

Many patients will need plastic surgery one to two years after weight loss to remove skin folds around the abdomen.
Your first follow-up visit with the surgeon will be seven to 10 days after discharge. Subsequent visits are scheduled for one month, three months and every three months there after for the first year.  After the first year, follow-up visits are required on a yearly basis.  You also will be scheduled to see the dietitian and psychologist about one month following discharge and for regular follow-up visits to help you adjust to life after bariatric surgery.