Diabetes Forecast

5 Tips to Keep in Mind After Weight-Loss Surgery

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1. Know What to Expect

With any type of bariatric surgery (for weight loss), your doctor will determine the details of your recuperation. Hospital stays of two to five days are typical.

Expect to see a profound effect on your blood glucose levels within 24 hours of surgery. By the time you leave the hospital, your need for insulin and other diabetes drugs should be significantly reduced or, if you have type 2 diabetes, possibly eliminated. But don’t change your regular monitoring schedule, says Samar Hafida, MD, an endocrinologist who specializes in obesity and clinical nutrition at the Joslin Diabetes Center in Boston. Keep normal watch on your blood glucose levels for at least four weeks, or until you follow up with your doctor. This will help determine your medication needs.

As for your weight, expect to see the most dramatic loss in the first six months, says Kamran Samakar, MD, a specialist in bariatric surgery at the University of Southern California’s Keck School of Medicine. Your weight will continue to drop, though more slowly, over the next year, after which it will likely plateau. Samakar says his patients typically regain 10 to 30 percent of their original weight, often because they return to old eating habits or become less physically active. He recommends support groups, which can help you connect with others facing similar struggles.

2. Discuss Loose Skin

As you gain weight, your skin stretches to accommodate your increasing size. Lose a significant amount of that weight quickly, and the excess skin will remain with you. This is particularly true in older people, whose skin has less elasticity, says Hafida.

Removing the hanging skin often requires plastic surgery after your weight stabilizes. One common target: the area around your abdomen. Surgeons remove the excess skin and fat around your middle, sides, and back. Other areas that may require the procedure include your upper arms, breasts, buttocks, and thighs.

Insurance rarely covers these procedures because they’re considered cosmetic rather than medical. However, loose skin can cause irritation and infections, particularly around your abdomen, says Hafida. If you can document a pattern of infections following weight-loss surgery, most insurance companies will cover surgery to remove skin around the abdomen.

Insurers are less likely to cover other areas. Building and maintaining muscle can help reduce hanging skin, particularly if you start before bariatric surgery. “I recommend resistance exercises to everyone who has bariatric surgery,” says Hafida.

3. Redefine Eating

Your doctor will determine the appropriate eating plan for you. Here’s a typical timeline: You’ll drink only clear liquids for the first few days and then switch to protein shakes and similar beverages for two weeks. That’s followed by about a month of pureed foods, after which you can start to eat small meals of soft foods. Around the eight-week mark, you’ll graduate to solids, but your portions will be much smaller than you’re used to; fortunately, your appetite will be, too.

At every meal, chew slowly and thoroughly to ensure that what you eat passes easily through your new digestive tract. And to avoid dehydration and constipation, drink at least 64 ounces of water a day.

You may find that certain foods taste different after surgery, and some of your favorites may no longer appeal to you, at least temporarily. Hafida says red meat is an example of something many people no longer desire. Chicken, fish, beans, tofu, and nuts are good alternative sources of protein. Food aversions can also be a good thing. Sugary foods often lose much of their appeal after surgery.

4. Be Active

Most people can and should start walking before they leave the hospital, says Samakar. At home, plan to take short strolls several times a day and resume normal activities, such as shopping and dog-walking, as soon as possible. Physical activity not only promotes fitness, but it also helps prevent dangerous blood clots, which are more likely to occur post-surgery when you are sedentary. But it’s important to pace yourself. “Your energy will wax and wane for the first month or so,” Samakar says. Consult with your doctor before increasing your exercise to include more demanding cardio workouts such as running and cycling. To give your body time to heal from surgery, wait one to two months before you lift weights or do other strength-building exercises.

5. Learn to Cope

Most people who undergo bariatric surgery see dramatic improvements in their quality of life. Surgery frequently leads to remission of type 2 diabetes, and with better health often comes a welcome drop in anxiety.

But some people will struggle. For example, weight-loss surgery has been linked to a heightened risk of addiction. In a study published in 2017 in Surgery for Obesity and Related Diseases, researchers reported that 20 percent of people who had undergone a common type of bariatric surgery—Roux-en-Y gastric bypass—had symptoms of alcoholism within five years of treatment, while nearly 8 percent used illicit drugs. Though it’s unclear why this occurs, Hafida says other vices may replace food as a coping mechanism. Alcohol is a particular concern because your body will absorb it more readily after surgery, and it will take fewer drinks to intoxicate you.



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