Bariatric surgery is often portrayed as a miracle or a massive shortcut. The truth lies somewhere in between, but the result most often lies in the hands of the would-be patient. Bariatric surgery is not a stand-alone treatment in and of itself. The patient must commit to the process before, during, and after the surgery. Patients who approach the surgery as the first step in a long-term treatment plan do much better than those who see it as a magical operation that will cure their weight woes. Understanding the role the surgery plays relative to other aspects of weight loss management makes it clear why some patients succeed long term while others do not.
The Surgery is Not the End, But the Beginning
The best bariatric surgery patients understand that the operation helps create an environment where maintaining a healthy lifestyle is much easier, but it does not end the need for work by the patient. During the bariatric procedures, the function and physical structure of the stomach undergoes significant change. In some cases, this can even change hormone release patterns that effect appetite. But what does not change is the habits of a lifetime. The surgery does not make good nutritional choices or exercise decisions for the patient. Those decisions must still be made every day by a patient who understands what happens when he or she does not.
The surgery can be viewed as resetting the biological playing field. A person who once had difficulty losing weight despite Herculean efforts no longer has to fight against his or her biology, which instead now works with him or her. But daily nutritional and exercise decisions still must be made to stay on this successful path.
Pre-Surgery Nutritional Changes that Last Forever
The steps taken to prepare for bariatric surgery are not steps taken only before the operation. Adopting these changes is an important aspect of a long-term weight loss strategy. Most bariatric surgery programs require patients to demonstrate that they have been able to lose some weight before surgery. The goal is not to assess if they are worthy of the procedure, but instead to ensure that they are able to follow a long-term strategy after.
Patients often undergo months of diet and exercise training before they are eligible for surgery. Learning how to control serving sizes, healthy eating patterns, and preventing emotional eating are all skills that may need to be followed for the rest of their lives. Patients may be required to increase their protein consumption prior to surgery; become accustomed to eating regularly on a set schedule; and learn how to avoid snacking between meals. Procedures like a gastric band work best after patients have already learned how to manage these steps; this type of surgery then works to reinforce these positive behaviors.
The patients who take this pre-surgery aspect seriously often report the best long-term outcomes. They have already practiced what they will be required to do after surgery.
Post-Surgery Nutritional Changes
Bariatric surgery has significant changes on what patients can physically consume. Post-surgery nutritional changes focus as much on what patients eat as it does on how much they eat. The altered stomachs have limited capacities, so every piece of food counts. Protein becomes especially important because as weight is lost, it becomes more difficult to obtain needed vitamins through other forms of food consumption.
The need for vitamin consumption increases as increased food intake has decreased ability to meet these needs on its own. Post-operative contact with registered dietitians can assist patients in adjusting to these changes. What one can tolerate during the first weeks or months after the surgery may change over time. Learning how to recognize fullness with an altered digestive system can take practice; learning how to take advantage of nutritional benefits from smaller portions will have to be guided.
In some cases, patients may need adjustments in vitamin or mineral supplements based on blood levels; this may take time to regulate and adjust rather than being immediately set long term.
Physical Activity After Surgery
Bariatric surgery makes it easier for patients to move after they lose weight, but they still need to actively include physical activity into their daily lives. Many people who eventually turn to bariatric surgery have not been able to exercise or engage in physical activity for years; joint pain, back pain, knees with limited mobility are all-too-familiar obstacles. As they lose weight, however, their physical ability to move increases.
Bodily changes can take weeks or even months after surgery, but physical activity programs do change; they simply have to be followed at different stages of the process. Once it becomes easier to move through activities of daily living, exercise programs often begin slowly (approximately 10-15 minutes) and increase from there.
Muscle retention becomes important once patients begin to lose weight; strength training can be used for this purpose rather than engaging in traditional cardiovascular exercise patterns. The metabolism-enhancing muscle levels that are built can then be used as a support system for binge eating patterns later on .Fitness programs often change over time; programs that work for someone four months after surgery may differ significantly from programs that apply two years after surgery.
Mental Health Management
The psychological component of bariatric surgery is perhaps one of the most important aspects of post-surgical life. After years of different types of eating patterns, each patient has likely developed a complicated relationship with food. Food was soothing when someone was stressed or anxious. Soothing mechanisms may have turned food into a coping mechanism for celebrating or avoiding difficult situations.
People who engage in even successful surgery do not automatically overcome these complicated relationships with food and addressing these issues may need assistance long after the initial post-operative period.
Support groups can be offered through bariatric surgery facilities and provide forums where successful patterns can be shared; questions can be asked; modifications can be suggested; and many experiences noted.
Ongoing medical monitoring
Patients who receive bariatric surgery often receive regular medical checkups for life that focus on more than just their weight (which can slowly come down). Regular physician visits examine diverse components of overall medical health; these include nutrient levels, bone density levels (and subsequent pathologies), and cardiovascular issues.
Some patients may need medication adjustments for conditions like diabetes that may react differently as they lose weight. Other patients may develop deficiencies despite taking supplements; these conditions can be monitored regularly so as not to develop into severe issues.
Physical changes may occur due to fat retention and behavioral dysregulation at various stages of their journey.
Bariatric surgery works best as part of a long-term dietary and exercise program (the new lifestyle) that includes nutritional counseling, regular physical activity patterns that change over time, behavioral support mechanisms (such as groups), and regular medical appointments and assessments. The actual surgical procedure is merely one component of an extensive treatment plan designed for long-term results rather than short-lived “quick fixes”.
