Common Questions and Answers

For many patients, exercise is important for stress and appetite control, as well as burning off calories. As we age, lack of activity can lead to being frail or fragile, which is quite dangerous to overall health. Maintaining healthy bones and avoiding muscle loss partly depends on frequent exercise.

Most patients also think of exercise as something that must be intense and painful (like “boot camp”). Regular, modest activity is far more useful in the long term. Even elite athletes can’t stay at a “peak” every week of the year. Instead, 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!

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 eat whatever and whenever you want. Healthier food choices are important for best results, but most patients still enjoy tasty food and even occasional “treats”.

Many people who suffer from obesity find it hard to lose weight and keep the weight off with diet and exercise alone. This is likely due to foods available and genes.

The National Institutes of Health (NIH) Expert Panel stated that, without surgery, long-term weight-loss is nearly impossible for those affected by severe obesity. Studies show little long-term success with diet and exercise alone. (3) Weight-loss surgeries are effective in maintaining long-term weight-loss, in part because these procedures change the body’s natural responses to dieting that make weight-loss so difficult. When a person goes on a diet, their body produces more hormones that cause an increase in hunger and a decrease in calories burned. This decrease in calories the body burns is more than explained by the decrease in body size. Therefore, there are significant differences between someone who has lost weight by diet and someone of the same size who has never lost weight. For example, the body of the person who reduces their weight from 200 to 170 pounds burns fewer calories than the body of someone weighing 170 pounds who has never been on a diet. This means that in order to maintain weight-loss, the person who has been on a diet will have to eat fewer calories than someone who naturally weighs the same. Weight-loss procedures, unlike diet, also cause biological changes that help reduce food intake. Energy in food intake is decreased with surgery by restricting stomach size and limiting absorption. In addition, weight-loss surgery changes the production of certain gut hormones (or signals) that communicate with the brain to reduce hunger, decrease appetite and enhance the feeling of being full. In these ways, weight-loss surgery, unlike dieting, produces long-term weight-loss.

Yes. After surgery, there is much less risk of experiencing problems during pregnancy and childbirth. There are also fewer miscarriages and stillbirths than women with obesity who have not had surgery and lost weight. 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.

Many people who suffer from obesity find it hard to lose weight and keep the weight off with diet and exercise alone. This is likely due to foods available and genes.

The National Institutes of Health (NIH) Expert Panel stated that, without surgery, long-term weight-loss is nearly impossible for those affected by severe obesity. Studies show little long-term success with diet and exercise alone. (3) Weight-loss surgeries are effective in maintaining long-term weight-loss, in part because these procedures change the body’s natural responses to dieting that make weight-loss so difficult. When a person goes on a diet, their body produces more hormones that cause an increase in hunger and a decrease in calories burned. This decrease in calories the body burns is more than explained by the decrease in body size. Therefore, there are significant differences between someone who has lost weight by diet and someone of the same size who has never lost weight. For example, the body of the person who reduces their weight from 200 to 170 pounds burns fewer calories than the body of someone weighing 170 pounds who has never been on a diet. This means that in order to maintain weight-loss, the person who has been on a diet will have to eat fewer calories than someone who naturally weighs the same. Weight-loss procedures, unlike diet, also cause biological changes that help reduce food intake. Energy in food intake is decreased with surgery by restricting stomach size and limiting absorption. In addition, weight-loss surgery changes the production of certain gut hormones (or signals) that communicate with the brain to reduce hunger, decrease appetite and enhance the feeling of being full. In these ways, weight-loss surgery, unlike dieting, produces long-term weight-loss.

Most groups 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!

Some hair loss is common between three and six 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 regrowth and avoid long-term thinning.

Some patients may choose to have plastic surgery, but this depends on many factors.

Most groups 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!

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 or more of their extra body weight after weight-loss surgery. (1) Roux en Y gastric bypass patients, for example, on average lose approximately 70% of their extra body weight initially, and will regain approximately 5% of their extra body weight 2 years or more after surgery. (2) 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.

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 one lab check per year. Insurance almost never pays for vitamin and mineral supplements but usually does pay for labs. You can pay for supplements out of a flex medical account.

As long as patients take their appropriate vitamins, it is rare to have health problems from vitamin deficiency.

Weight-loss surgery can lead to reduced amounts of vitamins and minerals because people eat less and may absorb less in their intestines. 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. Before and after surgery, patients are advised of the appropriate diet and vitamin supplements needed. Most weight-loss surgery programs also require patients to have their vitamins and minerals checked on a regular basis after surgery. Nutrient deficiencies and any associated health problems are preventable with monitoring and patients following diet and supplement (vitamin and mineral) recommendations. Health problems due to deficiencies usually occur in patients who do not regularly follow up to monitor healthy vitamin and mineral levels. Be sure you stay in touch with your weight-loss surgery team for best results!

There is a small group of patients after weight-loss surgery who have a problem with alcohol abuse. Most of those people, but not all, already had experiences with alcohol abuse before surgery.

Recommended precautions after weight-loss surgery:

• Avoid alcoholic beverages during the rapid weight-loss period, and then drink only rarely
• Be aware that even small amounts of alcohol can cause intoxication (“being drunk”)
• Avoid driving or operating heavy equipment after drinking any alcohol
• Remember that you may feel less intoxicated than you are, and will not be a reliable judge of whether it is safe for you to drive after drinking.
• Seek help if drinking becomes a problem

If you feel drinking alcohol may be an issue for you after surgery, please contact your primary care doctor or surgeon and discuss this further. They will be able to help you identify resources available to address any alcohol-related issues.

It has been found in scientific research that a small percentage of weight-loss surgery patients report having problems with alcohol after surgery (7-10%). Many who abuse alcohol after surgery had problems with alcohol abuse at some time prior to surgery, but occasionally alcohol problems can arise in patients who never had such issues before their surgery. Alcohol sensitivity is increased after weight-loss surgery in that the effects of alcohol are felt with fewer drinks than before surgery. Studies also find that with certain weight-loss procedures (such as the gastric bypass or sleeve gastrectomy), drinking an alcoholic beverage increases blood alcohol to levels that are considerably higher than before surgery or in comparison to the alcohol levels of individuals who have not had a weight-loss procedure. In addition, studies have found that alcohol takes much longer to clear out of a person’s system if they have had weight-loss surgery, which can pose safety and legal hazards for driving. Furthermore, it has been found that some patients may feel as though they are sober (“not drunk”) even when they are over the legal blood alcohol limit for driving. For all of these reasons, weight-loss surgery patients are advised to take precautions regarding alcohol.

After surgery, most patients have improved mental health, but there may be a small increase in the risk of suicide. This is why patients are required to have a mental health screening before surgery.

People affected by severe obesity who are seeking weight-loss surgery are more likely to suffer from depression or anxiety and have lower self-esteem and overall quality of life than someone who is of 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. (7, 8) In some cases, these may have been patients with undiagnosed mental disorders, and in others, patients may have experienced major life stressors that can increase the risk for suicide, but in rare cases, the suicides are unexplained. For this reason, comprehensive bariatric programs require psychological evaluations prior to weight-loss surgery. Many programs have therapists available for patient counseling after surgery. In addition, if a patient sees a psychologist or psychiatrist before surgery, they should continue seeing them after surgery.