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