Life after weight-loss surgery

As you lose weight quickly over the first 3 to 6 months, you may feel tired or cold at times. You may also have:

• Body aches
• Dry skin
• Hair loss or hair thinning
• Mood changes

These problems should go away as your body gets used to the weight loss and your weight becomes stable. It is important that you follow your health care provider's recommendations for eating enough protein and taking vitamins.

You may become sad after having weight-loss surgery. The reality of life after surgery may not exactly match your hopes or expectations before surgery. You may be surprised that certain habits, feelings, attitudes, or worries may still be present, such as:

• 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.

Complications, or a slow recovery from surgery, or all the follow-up visits may conflict with the hope that everything was going to be better and easier afterward.

You will be on a liquid or puréed foods diet for 2 or 3 weeks after surgery. You will slowly add soft foods and then regular foods to your diet. You will likely be eating regular foods by 6 weeks.

At first, you will feel full very quickly, often after just a few bites of solid food. The reason is that your new stomach pouch or gastric sleeve will hold only a small amount of food soon after surgery. Even when your pouch or sleeve is larger, it may not hold more than about 1 cup (240 milliliters) of chewed food. A normal stomach can hold up to 4 cups (1 liter) of chewed food.

Once you are eating solid food, each bite must be chewed very slowly and completely, up to 20 or 30 times. Food must be a smooth or puréed texture before swallowing.

• The opening for your new stomach pouch will be very small. Food that is not chewed well can block this opening and may cause you to vomit or have pain under your breastbone.
• Each meal will take at least 30 minutes.
• You will need to eat 6 small meals throughout the day instead of 3 big meals.
• You will need to avoid snacking between meals.
• Some foods may cause some pain or discomfort when you eat them if they are not chewed well. These include pasta, rice, bread, raw vegetables, or meats, and any dry, sticky, or stringy foods.

You will need to drink up to 8 glasses of water or other liquids that do not have calories every day.

• Avoid drinking anything while you are eating, and for 60 minutes before or after you eat. Having liquid in your pouch will wash food out of your pouch and make you hungrier.
• Like with food, you will need to take small sips and not gulp.

Weight-loss surgery can help train you to eat less. But surgery is only a tool. You still have to make the right food choices.

After surgery, your doctor, nurse, or dietitian will teach you about foods you can eat and foods to avoid. It is very important to follow your diet. Eating mostly protein, fruits, vegetables, and whole grains will still be the best way to lose weight and keep it off.

You will still need to stop eating when you are satisfied. Eating until you feel full all the time may stretch out your pouch and reduce the amount of weight you lose.

You will still need to avoid foods that are high in calories. Your provider or dietitian will likely tell you:

• Do not eat foods that contain a lot of fats, sugar, or carbohydrates.
• Do not drink fluids that have a lot of calories or that contain sugar, fructose, or corn syrup.
• Do not drink carbonated drinks (drinks with bubbles).
• Do not drink alcohol. It contains a lot of calories and does not provide nutrition.

It is important to get all of the nutrition you need without eating too many calories. Because of the quick weight loss, you will need to be careful that you get all of the nutrition and vitamins you need as you recover.

If you have gastric bypass or vertical sleeve surgery, you will need to take extra vitamins and minerals for the rest of your life.

You will need regular checkups with your provider to follow your weight loss and make sure you are eating well.

After losing so much weight, you can expect changes in your body shape and contour. These changes may include excess or saggy skin and loss of muscle mass. The more weight you lose, the more excess or saggy skin you will 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 as well. Talk with your provider about options for reducing the excess skin.

American Society for Metabolic and Bariatric Surgery website. Life after bariatric surgery. asmbs.org/patients/life-after-bariatric-surgery. Updated February 2021. Accessed April 20, 2023.

Mechanick JI, Apovian C, Brethauer S, et al. Clinical practice guidelines for the perioperative nutritional, metabolic, and nonsurgical support of patients undergoing bariatric procedures - 2019 update: cosponsored by American Association of Clinical Endocrinologists/American College of Endocrinology, the Obesity Society, American Society for Metabolic & Bariatric surgery, Obesity Medicine Association, and American Society of Anesthesiologists - executive summary. Endocr Pract. 2019;25(12):1346-1359. PMID: 31682518 pubmed.ncbi.nlm.nih.gov/31682518/.

Richards WO, Khaitan L, Torquati A. Morbid obesity. In: Townsend CM Jr, Beauchamp RD, Evers BM, Mattox KL, eds. Sabiston Textbook of Surgery. 21st ed. St Louis, MO: Elsevier; 2022:chap 48.

Updated by: John E. Meilahn, MD, Bariatric Surgeon, Philadelphia, PA. Review provided by VeriMed Healthcare Network. Also reviewed by David C. Dugdale, MD, Medical Director, Brenda Conaway, Editorial Director, and the A.D.A.M. Editorial team.