Most experienced bariatric surgeons work with a team of professionals to help manage patients both pre- and postoperatively. Usually, the team will consist of the surgeon, a physician, a dietician, an exercise therapist, and a social worker or other mental health professional. This team works together to help patients manage their body and mind as they notice rapid changes over the first year after surgery; all members of the team are essential to long-term success. The recommendations the team gives you about postoperative manage ment will depend on your overall health status and the type of surgery performed. However, here we will discuss general recommendations that pertain to most patients after weight loss surgery.
Diet
Right after surgery, your calories will be reduced significantly, usually to fewer than 1,000 per day, divided among five or more small meals and snacks. Patients are prescribed only liquids initially and are slowly advanced to pureed foods; they can eat solid foods later but must adjust gradually. After gastroplasty or RYGB, the gastric pouch is very small and can manage only a small amount of liquid or food at a time. Patients undergoing BPD or BPDDS surgeries can manage slightly more food, as their stomachs are not as small postoperatively, although they are at higher risk of malabsorption-related nutritional deficiencies.
A high-protein diet is important for at least the first six months following surgery because weight loss is rapid, and both fat and muscle stores are lost. It is very important to ingest at least 60 grams of protein per day to preserve muscle stores and prevent protein-calorie malnutrition. Often, patients are advised to drink large quantities of liquids. Sometimes patients need to drink liquids separately from eating solids to allow the maximum protein intake at meals. All patients need to take certain supplements and vitamins after surgery usually at least a multivitamin, calcium, iron, and a B-vitamin supplement. To prevent dumping syndrome after malabsorptive surgeries, it is important to avoid simple carbohydrates, high-fat foods, and sugars. Carbonated beverages are discouraged after all procedures because they cause uncomfortable bloating that can that can affect the size of the gastric pouch.
Exercise
You will be directed to exercise immediately after surgery. Most comprehensive teams include an exercise therapist and a structured exercise plan. This is important both to prevent complications related to immobility (partial lung collapse, deep vein thromboses, etc.) and to maximize weight loss while minimizing loss of muscle stores. It is also an important lifestyle change that elevates mood, minimizes the chance of weight re-gain, and improves lifelong health.
Overall Health
Your doctors should be monitoring your health closely. Frequent visits to the doctors and surgeons that help coordinate your care is often necessary immediately following surgery, with many physical exams, weight checks, and labs. Usually, the focus is on adjusting your treatment to address any chronic medical illnesses you might have (you may be able to reduce certain medications quickly after surgery), looking for surgical complications, and monitoring you for nutritional deficiencies. Your team will also be monitoring you for depression, anxiety, or other mental health changes you might experience as a result of changes in your body, lifestyle, and physical health. The changes you will undergo are big and will take some time to get used to. Some patients have more difficulty than others.
Potential Postsurgical Nutritional Deficiencies and important supplements to compensate:
Type of Deficiency
Calcium
Description
Fatigue, muscle twitches tingling, heart palpitations, poor bone health and osteoporosis.
Treatment/Prevention
Calcium citrate is preferred preparation should take 1200-1500 mg daily; may be adjusted if dietary intake is good.
Type of Deficiency
Electrolyte: potassium, magnesium, phosphorus
Description
Can lead to heart arrhyth- mias and other muscle problems; described in varying frequencies after weight loss surgery.
Treatment/Prevention
Immediate supplementation if prescribed.
Type of Deficiency
Folate
Description
Occurs less frequently than B12 deficiency but can also cause anemia, psychiatric changes.
Treatment/Prevention
Multivitamin; folic acid supplement may be prescribed.
Type of Deficiency
Iron
Description
anemia, psychiatric changes Anemia, fatigue, paleness; more common in menstru- ating women.
Treatment/Prevention
Daily multivitamin with iron and possibly iron supplement.
Type of Deficiency
Proteincalorie malnutrition
Description
A severe form of macronutrient deficiency that can result in muscle loss, low albumin levels, swelling in the ankles, and when severe, heart problems or even death.
Treatment/Prevention
Attention to optimal protein intake before and especially after surgery.
Type of Deficiency
Vitamin A
Description
Vision changes, night blind- ness, dry eyes, dry skin.
Treatment/Prevention
A multivitamin and dietary changes usually suffice to prevent.
Type of Deficiency
Vitamin B1 (thiamine)
Description
Usually manifests as head- aches, irritability, and fa- tigue. Can cause Beriberi (cardiovascular changes, neurologic/sensory changes), Wernicke’s encephalopathy (clumsy gait, nystagmus, or rapidly vacillating eye movements, and sometimes memory changes); in rare cases leads to neurological damage and/or death
Treatment/Prevention
Immediate treatment with thiamine; may need treatment in a hospital.
Type of Deficiency
Vitamin B6
Description
Skin inflammation, sore tongue, depression, confu- sion, and convulsions, anemia.
Treatment/Prevention
A multivitamin and dietary changes usually suffice to prevent.
Type of Deficiency
Vitamin B12 (cobalamin)
Description
Occurs in > 30% of patients after malabsorptive proce-dures, including RYGB. Can cause fatigue, anemia, numbness, tingling, confusion, mental slowing.
Treatment/Prevention
Vitamin B12 supplement in daily or monthly injections.
Type of Deficiency
Vitamin D
Description
Muscle weakness, bone pain, poor bone health, rickets, osteoporosis.
Treatment/Prevention
Multivitamin, dietary intake of dairy if tolerated; may need ergocalciferol or other vitamin D preparation.
Type of Deficiency
Vitamin E
Description
Neurological changes, heart problems, confusion, weak- ness, blindness.
Treatment/Prevention
A multivitamin and dietary changes usually suffice to prevent.
Type of Deficiency
Vitamin K
Description
Bleeding difficulties.
Treatment/Prevention
A multivitamin and dietary changes usually suffice to prevent.
Nutritional Deficiencies
Unfortunately, postsurgery vitamin and nutrient intake and deficiencies have not been well studied after weight loss surgery. Severe protein malnutrition is uncommon with the VBG, lap-band, and RYGB but does occur after the BPD and BPDDS, both of which cause more malabsorption and thus can result in protein malnutrition. Vitamin and mineral deficiencies can occur after the RYGB, BPD, BPDDS, and any surgery with a malabsorptive component; they have occasionally been reported after VBG as well. Multiple types of deficiencies, including of vitamins A, D, E, K, B1, B6, B12, folate, and iron, have been described.