What You Should Know Before Undergoing Bariatric Surgery

By Carol Rose Adkisso, MA, LMFT | Published 1/31/2018 7

Woman measuring her waist. 2000 x 1333

After months or years of attempting to lose weight and keep it off, you may be considering bariatric surgery.

Before you can decide whether this is a good choice for you, you need to know the facts. Though bariatric surgery is safe and generally successful in achieving weight loss, to be a good candidate, you must be prepared to deal with both physical and emotional issues.

Seven years ago, I had a gastric bypass and went from being barely able to function to living a magnificent life as an authentic and productive person. (I tell my story in more depth at Medium and in my book Recovering My Life: A Personal Bariatric Story.)

To be clear, I speak as a clinician (I am a licensed Marriage and Family Therapist) and as someone who has been through weight-loss surgery and the difficult process of recovery. I am not a nutritionist or medical practitioner.

But my experience and research have taught me that successful bariatric surgery requires preparation, long-term recovery, and lifelong changes in your relationships with your body, food, and the people in your life.

What is bariatric surgery?

Bariatric surgery is not a cosmetic procedure. We may hope to look better after losing weight, but the best reasons for undergoing this major surgery are to extend and improve our lives.

The most common procedures are lap band, with a success rate of 47%; gastric sleeve, with a success rate of 80%; and gastric bypass, which has an 85% success rate. These procedures support weight loss while requiring lifestyle changes.

There’s a common misconception that most patients who have bariatric (weight-loss) surgery regain their weight. The truth is, most bariatric surgery patients maintain successful weight loss long-term.

Patients who undergo bariatric surgery and follow all treatment guidelines can expect to lose weight and improve the quality of their lives. More than 85% of patients lose and maintain 50% of their initial weight loss.

Physical and emotional issues

If you’re thinking about bariatric surgery, it’s important to get all the information you need—including the physical and emotional ups and downs.

Though bariatric surgery is safe and less life-threatening than obesity, it is major surgery. You will have to deal with physical pain, medication, possible complications, and all the to-be-expected problems associated with surgery. More, you will face dietary restrictions, some of which are ongoing, like not drinking with meals.

Perhaps the greater challenge is dealing with the mental and emotional issues. For years, you have used food as a means of coping.

Changing that complicated relationship goes far beyond getting back to “normal” after surgery. The new normal will be a novel approach to and understanding of food, your body, and other people.

The challenge of preparing for surgery

Persuading and advocating

You must be absolutely sure that this is the best path for you because you’ll have to convince others: your family, your doctors, and your insurance carrier.

To be considered for the surgery, your doctor must recommend it. Then, you must provide at least six months of records showing your weight and your attempts to lose weight. Once you have the doctors on board, your medical insurance provider must authorize payment.

Advocating for yourself means educating yourself, planning, and learning how to speak up for yourself.

Planning and building support

Once you’ve been approved, you need to build a support system. One of the most important decisions you’ll make is choosing your team. The family members, friends, acquaintances, and professionals on your team must respect and support your decision.

You’ll need to make plans for an extended recovery. Beyond help with childcare, household chores, and transportation during and after hospitalization, you will need help adjusting to the changes in your life and the emotions that accompany those changes.

Your surgeon is likely to require you to follow a weight-loss regimen for about six months before surgery to ensure you are committed and as healthy as possible before surgery.

You’ll need to deal with fears and frustrations. Support from a therapist or support group and family is as important now as it will be later.

The challenge of recovery

Recovery from the surgery itself is just the beginning.

Physical recovery

Your doctors will advise you about the physical challenges that may follow bariatric surgery: constipation, dumping syndrome (nausea, vomiting, and weakness caused by eating high sugar meals, sodas, and fruit juices), possible infection of the wound, and possible leaks in the new connections.

Physical changes may include body aches or fatigue (vitamin or mineral deficiency may be the cause). You may feel cold. Dry or sagging skin, hair loss or thinning, and the inability to process certain vitamins (B12 and D) and minerals (iron, folate, calcium) may cause problems.


Managing your pain medication is another challenge. The early stage of recovery can last from one to six weeks. You will need to taper off from prescription pain meds. Don’t go cold turkey!

Follow your doctor’s advice on medication. Stopping without medical approval can cause serious complications, even hospitalization.

Be aware that bariatric patients should not take NSAIDs (nonsteroidal anti-inflammatory drugs) like ibuprofen. NSAIDs are not safe for people who have undergone bariatric surgery. Even one use can cause “marginal ulcers”, that is, sores or holes in the stomach pouch. If it is necessary to take an NSAID, take it with a proton pump inhibitor (PPI) medication, such as Prilosec or Nexium.

Emotional side effects

Medical advice may not give you the information you need about the emotional side effects of your surgery. You may lose your appetite, or you may feel hungry. You’ll be on a liquid diet at first, and that can be stressful.

You may experience “food grief”. Food has a special meaning for people who suffer from morbid obesity, and “mourning for lost foods is a natural step in the re-birth process after weight loss surgery.”

Emotional issues like self-doubt and mood swings may arise. Weight loss will be dramatic at first, but there may be setbacks—reaching a plateau or regaining some weight.

It may take time to get used to your new body. Keep your expectations realistic. Focus on the improvement in your health.

Ask for help. Take time for self-care. Keep friends who support you close. Avoid the ones who don’t. Use your support system.

Other risks

Alcohol use

Some patients who have undergone weight-loss surgery struggle with alcohol and substance abuse. One explanation is “addiction swapping”. No longer able to use food as an addiction, the patient may be drawn to alcohol or other substances as substitutes.

Also, weight-loss surgery is known to change alcohol sensitivity because the alcohol goes through the stomach and into the small intestine more quickly. You feel even small amounts more rapidly.

Eating disorders

Ironically, you may be at risk of developing an eating disorder after bariatric surgery. Having trouble eating because you don’t have an appetite may lead to “the type of disordered eating that can turn into bulimia or anorexia.”

After surgery, eating too quickly or not chewing thoroughly can cause vomiting. Another unhealthy habit is chewing and spitting out food, which can lead to an eating disorder.

Learning new eating habits

Eating out may be a challenge after bariatric surgery. Avoid high-calorie drinks, like lattes and sodas. Select meals with a balance of protein, fiber, and healthy fats. Don’t be afraid to create your own dish, ask for a half portion, or take leftovers.

New eating habits to acquire:

  • Chew every bite thoroughly
  • Eat slowly
  • Eat six small meals instead of three big ones
  • Stop eating when you feel full
  • Drink lots of water (8 cups per day)

Be prepared for change

Bariatric surgery, even when successful, mandates changes in many areas of life. Many of these, like better health, more energy, and better self-esteem, are positive.

But even though your body may be in better health, emotional challenges may remain.

  • Missing food and the rituals that surround it, missing old habits, the stress of the surgery, and postoperative complications may trigger depression in some patients.
  • Anxiety after surgery is not uncommon.
  • Patients may find themselves focusing on one body part or experiencing Body Dysmorphic Disorder (obsessing about appearance).
  • Health problems like regaining weight, the weight loss plateau, and complications from the surgery may arise.
  • Hypoglycemia (low blood sugar), nutritional deficiencies, and dehydration may cause uncomfortable symptoms and require treatment or changes in diet.

It’s up to you to manage the physical and emotional challenges. With the help of your medical team and your support group, you can weather these storms and live the magnificent, productive life you are meant to live.

Ongoing recovery

Successful bariatric surgery means making lifelong changes to your lifestyle. Taking on the physical and emotional work to make these changes requires total commitment to your health. Are you ready to meet these challenges? Then you’re ready for bariatric surgery.

Carol Rose Adkisso, MA, LMFT

Website: https://caroladkisson.com/

Carol Adkisson is an author and licensed therapist with a specialty in working with weight-loss patient both pre- and post-bariatric surgery.


  • Carol, this wolnderful article. I have undergo bariatric surgery abroad (Poland) and I do think there is nothing to add. Treatment is a very long journey and surgery is just the beginning. Thank you!

  • Thank you for such a great article! Bariatric surgery changed my life, and I wish more people would take it seriously. It’s not a “quick fix” and requires a life long commitment. After having to go through so many steps and clearances to get surgery, literal blood, sweat, and tears, I’m not sure why people go back to their old habits that led to obesity in the first place. Either way, we need to continue supporting each other and encouraging each other to make healthy decisions to live our best lives.

  • I really have been thinking about going in for this type of surgery. As you said, I would probably have to develop new eating habits if I did decide to go through with the surgery. Knowing that there would be a lot of change would make me want to do some more research on it before I make a final choice.

  • Thank you for sharing your experiences and information. I have just been diagnosed with NASH. Having discovered this now, I can completely reverse this fatty liver disease. My Gastroenterologist strongly suggests bariatric surgery. Currently my BMI is 43. It’s been climbing little by little for years now. The majority of my weight gain had started after I had a car accident 12 years ago. I suffered with a broken neck in two places. Along with degenerative disc disease. Moving in so difficult most days. But, I’ve made the decision to have bariatric surgery. I need to lose the weight to not only live longer. But, I’m trying to avoid needing a liver transplant. Now, that I’ve called my insurance company and found out that they are now willing to cover the surgery (with the recommendation from my physicia) it’s becoming a little real. I’ve been wanting this for almost 20 years now. And now that it’s here, I’m feeling all sorts of feelings. Frustration, excitement, confusion and yes, scared. Like everyone in the battle of the bulge, I have tried diet out there. And I know that it’s time. What I’m afraid of is sabotage from others. Sabotage from co-workers who don’t understand my struggles and my husband whom is large himself as well. I’ve decided that I want to either do the Lap-band or gastric sleeve. Lap-band is reversible and the sleeve has more success. How did you decided on the type of bariatric surgery to have? I like the idea of it being reversible. But, love the thought of a higher success rate and the hunger hormone is completely removed. Can you give me any advice on which you think would be a better route to go?

  • My Name is Cynthia Monroe I am a 53yr old Mother of 5and a Grandmother of 41/2I use to weight 192,142,185 then the children started coming and up to 225 then222,,350,308.2 then 308 that’s what I am now and that is still too much weight on me my body is hurting so bad and they want to do to knee surgery which means replacing my knees and I’m going to rehabilitation and I’m doing pool therapy and I have sleep apnea I have COPD I have edema in my legs I have arthritis and my knees and my legs and I have a very bad lower back pain and I have shakes and never know when they’re going to happen to me sometime I’m in the store and my body just star shaking I have two walkers 2 Kane

  • Thank you for pointing out that you need to get educated about the surgery. My mother is needing to get weight loss surgery and we need to find the best place for her to do this. I’ll have to do some research and see if we can find the best surgeon for her.

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