Diet and exercise after weight loss surgery

Whether you've just started to think about weight loss surgery or you've already had a procedure done, it is important to understand that there will be many other changes in your life, including the way you eat, what you eat, when you eat, how you feel about yourself, and much more.

Weight loss surgery is not the "easy way out" as some may perceive it to be. Bariatric surgeries can help you lose weight and improve or even eliminate many health care problems. They can help you to improve your quality of life and allow you to live longer, but your results will be directly related to the effort you are putting into your diet and exercise.

Weight loss surgery can help train you to eat less, but surgery is only one piece of the puzzle. You still have to make the commitment to make good choices every day.

What does rapid weight loss feel like?

As you lose weight quickly over the first 3-6 months, you may:

• Have body aches.
• Feel tired.
• Feel cold.
• Have dry skin.
• Have hair loss or thinning.
• Have mood changes.

The good news is that these problems should go away as your body gets used to your weight loss and your weight becomes stable. It is important that you are eating sufficient protein and taking your vitamins as directed.

In some cases, you may experience feelings of sadness after having weight loss surgery. The reality of life after surgery may not exactly match the hopes or expectations you had beforehand. You may be surprised that certain habits, feelings, attitudes, or worries may still be present.

Examples include:

• You thought you would no longer miss food after surgery, and the urge to eat high calorie foods would be gone.
• You expected friends and family would treat you differently after you lost weight.
• You hoped the sad or nervous feelings you had would go away after surgery and weight loss.
• You miss certain social rituals, such as sharing food with friends or family, eating certain foods, or eating out with friends.

We believe in the importance of having a strong support system in place, which is why a part of our education classes are taught by a psychologist who will help you find the right tools to navigate through these emotions, should they arise. We also hold support groups twice a month, in addition to an online patient support forum that will be available to you 24 hours a day, 7 days a week from the privacy of your home.

How will eating and drinking be different?

An average stomach without surgery is the size of a flattened football, and can hold up to approximately 4 liters at one time due to the stomach's ability to expand. After a gastric bypass surgery, the pouch is the size of an egg. After a sleeve gastrectomy, the stomach resembles that of a banana.

Food will slowly be introduced to you over the first 6 months post-op. You will start on the bariatric clear liquid diet for the first few days out of surgery. This will include:

• Water
• Broth
• Sugar-free jello
• Decaf Coffee (black and unsweetened)
• Decaf or Caffeine-free tea (black and unsweetened)

The goals of these first few days out of surgery are simple: staying hydrated and healing.

Solid food will begin approximately one week after your surgery. At that time, soft proteins, cooked vegetables, and peeled fruits will be introduced to you and explained in detail by a registered dietitian. Your first meal of solid food will be in a group setting with other patients and a dietitian present to walk you through the experience.

You will start with ¼ - ½ cup of food per meal. Your eating mechanics will be extremely important; therefore, these are things that are good to practice beforehand:

• Food must be chewed slowly and completely – up to 30 times. Food should be smooth and pureed before swallowing. Food that is not chewed well enough may cause pain or discomfort under your breastbone or may cause you to vomit.
• Each meal should last 20 minutes.
• You will stop eating when you are satisfied, which is something you will come to learn what that feels like exactly. It can be different for everyone. Eating beyond this point can result in discomfort, pain, or needing to vomit. Listening to your pouch or sleeve and responding to it appropriately will keep your meal experience pleasant.
• You will need to incorporate planned snacks throughout the day, with the goal being to avoid going longer than 4 hours without eating. This will entail 1-3 snacks per day depending on how long your day is. You will be provided with a list of recommended snacks.
• The first couple months can be considered a trial and error period. Some people may come across certain foods that simply do not sit well with them.
• Staying adequately hydrated is extremely important after surgery. You will need to drink a minimum of 64 oz of water per day.
• Water must be stopped 10 minutes prior to eating and can be resumed 30 minutes after you have finished eating. No liquids should be consumed with the meal. Eating and drinking at the same time in the early months out of surgery will fill you up too quickly and often causes discomfort. Over time, as your pouch or sleeve becomes more efficient, drinking with meals will wash your food through faster, resulting in larger portions and/or increased hunger.
• Like with food, you will need to take small sips of water throughout the day. Do not gulp.

Will I still need to worry about calories?

After surgery, your registered dietitian will give you specific guidelines on what foods you should eat and what foods you should avoid. You will be provided with specific foods lists, recipes, meal ideas, and grocery shopping lists. It is critical that you follow the recommendations to minimize the risk for complications, as well as to ensure successful weight loss. Your diet will consist of primarily protein, vegetables, and fruit.

The quality of your food choices is very important to ensure you receive the necessary nutrition on a daily basis. The idea that surgery allows you to eating anything you want but in smaller amounts is very far from the truth. Certain foods will need to be looked at as "treats" and kept to a minimum in order to lose weight and keep it off.

Your registered dietitian will help you find the right path for you. Nutrition is never a one-size-fits-all approach, so the goal is to find a balance between your nutrition and exercise that is realistic and sustainable, and at the same time, allows you to meet your health goals.

You will likely be told:

• NOT to eat foods that are high in sugar/refined carbohydrates.
• NOT to drink any calorie-containing drinks.
• NOT to drink carbonation.
• NOT to drink caffeine for the first 2 months (caffeine is a diuretic and may contribute to dehydration).
• NOT to drink alcohol.

Staying healthy

When the quantity of your food intake is low, it is critical that the quality remains high. It is important to get all of the nutrition you need without eating too many calories. In addition, you will need to take vitamins and minerals daily for life.

You will also need to maintain regular checkups with your surgical program in order to follow your weight loss and progress and to make sure you're on course with nutrition, exercise, and vitamin supplementation. Annual follow-ups are recommended for life.

Changes in your body

After losing a significant amount of weight, a number of changes in your body shape and contour can occur. These changes may include excess or saggy skin, as well as some loss of muscle mass. In general, the more weight you lose, the more excess or saggy skin that you can have. Excess or saggy skin tends to show most around the belly, thighs, buttocks, and upper arms. It may also show in your chest, neck, face, and other areas.