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Wednesday, July 13, 2011

10+ Expectations for Newbies: LONG POST!!

10 Expectations for Newbies Having Gastric Bypass

Remember to always go by the instructions of your surgical centre. I am not a surgeon and do not give medical advice. This is a rehash of what I talked roughly about at my last WLS support meeting:

1.Expect to lose a lot of weight your first year.

The first year is crucial for how you will do. It is a predictor of your success. The more you follow the rules, the better off you'll be and generally the more you will lose. The more you cheat and go off program early out, the more you'll probably struggle down the line. Your first year will have your greatest loss and is called your “window of opportunity”. Typically after that weight loss does dramatically begin to stop. Most people lose their lowest weight at the 1.5-2 year mark. After that your body is “just like everyone elses” and you may possibly gain a little “bounceback” due to the loss of malabsorption.
Expect to minimally lose 50-60% of your excess weight.
If you are 100 lbs overweight, it means around 60 lbs.
If you are 150 lbs overweight, it means 90 lbs.
If you are 200 lbs overweight, it means 120 lbs.

These figures are conservative. Some people lose more, some lose less. If you want higher numbers, you'll need to work at it more (think: exercise), watch the processed food (you should be primarily eating “clean” from the outside of the supermarket: dairy, fruits and veggies & meat. Protein first generally, veggies second and carbs generally last (smaller portion). Work your new “tool” the first year and you could be one that has a huge payoff losing 80-100% of your weight.

2. Expect to come off your medications but also expect to supplement religiously for the rest of your life.

Most people right away come off medications, even diabetes medication from the day that they have their surgery.

But you will trade this for a lifetime of vitamins and supplementing for the rest of your life. Most common are all b vitamins, iron, vitamin a, d, calcium etc.

Expect to get your bloodwork done regularly – usually every 3 months the first year, at least one or twice a year after that. Supplement according to your surgeon. You can always choose to supplement more – but be VIGILANT with your blood work. That's the key!!! Get tested every 3 months the first year out and at least 1-2 times a year for life. If you go through a period of feeling especially tired or draggy, then get it tested too.

Blood work is CRUCIAL. Playing “catch up” with a nutritional deficiency can be an awful thing and may even require you to take off time from work! So you need to be SUPER VIGILANT about your blood work and following your surgeon's program. All you have to do is talk to one person that has had a SERIOUS deficiency and you'll know why it is so important to deal with your issues in your blood work right away!!!As well, it is a good idea to get a bone density scan at the year out mark to make sure your calcium levels are good especially if you've been on medications that predispose you to bone issues such as Depo Provera.

3. Expect that you may have a complication at some point.

The term “complications” always brings up scary thoughts doesn't it? A complication doesn't have to be a total nightmare. Expect them and be pleasantly surprised if you don't experience them.

Most Common: Infections, strictures, ulcers, gallstones, kidney stones, bowel obstruction, reactive hypoglycemia. We rerouted our natural plumbing – so expect issues now and again. You should be familiar with what all these things are – there are lots of great books such as WEIGHT LOSS SURGERY FOR DUMMIES that give you great basic info. If you expect and watch for issues, then you will be ready for them mentally when they occur then if you are oblivious to them (education goes a long way with surgery!).

If you don't have any issues (and many ofpeople don't) you'll be pleasantly surprised!

ANOTHER KIND OF COMPLICATION: The other “loss” is often relationships change, friendships change. But be prepared to lose a friendship or two or to have one or two family members tell you that surgery is going to be a terrible thing for you.
BE AWARE THAT THE MORE PEOPLE YOU TELL ABOUT WANTING TO HAVE SURGERY, the more negative you will hear before surgery. Most people tell people after they've had surgery.


4. Expect to have a hard time eating and expect to have dumping syndrome.

Surgery changes our relationship with food. Everything we did before surgery will be different after surgery.

We used to wolf down food. Now we have to chew, chew and chew.
We used to eat a lot of carbs. Now it's protein, protein, protein.
We used to drink while eating and we could get a lot of food stuffed in there.
Most of us ate a lot of carbs that helped us gain weight, now it's all about focusing on protein.

For most people eating after surgery is not a fun activity. It is NOT enjoyable in the least. It is your daily duty and your daily job. That sums it up!! You must force yourself to eat even on the days that you really aren't even remotely interested in food. Yes, that is often the case!!!!!

Early out, you may find that foods that you liked before surgery, you no longer like or they do not agree with you. This is extremely common as your “taste buds” seem off. It doesn't last forever. Think of this as power over food. Your first year is amazing for this. If you can “take it or leave it” leave the junk food off your plate as long as you can. It's a powerful thing to say NO!

In addition, some things may make you vomit, some may make you feel ill. You may become lactose intolerant. Expect the unexpected – a food you have one day can totally not agree with you the next.

Expect to read labels of every food you eat.

Dumping syndrome is basically a negative reaction to high levels of sugar and fat in your diet. Know your limits well and do not test those limits. The people that have the most success with surgery are generally those who eat like they “dump” - ie. They avoid simple sugars. They eat very little processed foods. Don't test the waters too much especially your first year.

You'll experience much more success (and weight loss) and you'll avoid the constant craving for carbs if you keep the simple sugars away. Most people do who dump do so only in their first year and it is a terrible terrible thing if you've experienced it. Eat within the sugar guidelines as suggested by your dietician. Set yourself up for success as much as possible!

Surgery changes our relationship with food especially for the first year (unfortunately it doesn't last forever!). It may mean for the first time in life, you don't like eating anymore. It becomes boring, regulated, the joy is gone. Eating becomes our job. It becomes not exciting anymore. It is routine and boredom. Some days you'll have to force yourself.

It's changing from live to eat, to eat to live.

Many people for this reason have “buyers remorse” - they experience depression after surgery – they have lost their best friend. Some people feel great after surgery, others feel like they have been hit by a mack truck. For some people it will take 6 weeks before they feel 100% back to normal and they feel like the food issues are more tolerable.

Remember that your water and protein goals are only goals and you may not consume enough for a while. Some people get in only half their protein and water initially. The key will be pushing yourself to take in a little more each day and eventually get to the point that you are reaching goals.

Also: your pouch will make a lot of noise especially initially out from surgery. (mine does to this day). You'll hear lots of gurgling inside. Do not confuse this with the “growling” of hunger as many do. It's gas and air.

5. Expect that your journey will be different than others.

You will lose different numbers than others even if you had the surgery the same day! You will lose it from different places. Your body is a very unique thing. As a general rule of thumb, the older you are the slower your metabolism may be. The more you lose before surgery, the slower your loss may be (just initially) and men tend to lose faster than women due to their muscle mass.

EXPECT STALLS! It's normal. First one usually at 3-6 weeks out and then every so often on your way. Absolutely normal and be prepared: Some stalls can last a month or more!

Don't compare – your journey is your journey.

Don't EXPECT TO LOSE THE WEIGHT OVER NIGHT. Remember 2, 3 and 4 lbs a week over time adds up!!!!!!! Remember losing 2 lbs a week x 52 week in a year is 104 lbs!!!!!!!

When the scale, stops use alternate ways of measuring success. Keep a log of all the things you want to be able to do – make it while you are pre op. Then cross them off the list as you do them (Eg. Cross your legs). Use the tape measure to measure your success too. As well keep one of your biggest shirts and pairs of pants. It's a great thing later on to try them on and “see” where you have come from. Take a lot of awful “before” pictures – trust me, you'll learn to love them later!

6. Expect to be your own advocate.

You need to read, read and read some more. Studies abound online, there are many books. Do not depend on the bariatric centre to tell you everything and hold your hand during this process – you will need to do reading beyond what they give you. You should spend as much time researching your surgery and reading about your surgery as you can.

You need to be an expert in your new body.

You will need to also do your own research. There is a HUGE LEARNING curve with surgery and the more you know, the more successful you'll generally be in the long term. You need to embrace this surgery, and study your surgery– and know everything about it.

You should know that you had a ROUX EN Y GASTRIC BYPASS. Not an RYN and not a “gastric bypass”. You need to know the name and what you had done!You need to ask every time a doctor prescribes you something “is that an NSAID?”. To make sure that it is not. Never assume they'll remember!

You may want to invest in a medic alert bracelet or necklace your first year out or at least a “fake” that way your information will always be on you your first year.   Although some programs recommend them, it's generally overhyped.  Just put your surgery type and date on it.  Please see my post about medical alert bracelets as there are some things I would never put on mine that many do.

You NEED TO KNOW THE INS and OUTS of this surgery. THE INS and OUTS of how to read a label. If you are online, there are many sources of great information. is one of them.

7. Expect to have a surge in confidence.

The first year is amazing – you'll learn to love clothes shopping, looking in mirrors, seeing the weight come off, and you'll generally feel empowered and ready to take the world on at your one year out mark. (Yes the first few months can be tough but the pay off is big by one year out).

Be careful though about assuming that your surge of confidence is going to be forever. Be careful especially if you are on medications for depression. Some people take themselves off medications during this “high phase” only to come crashing down at a later date. Please don't take yourself off of medications – only do so when a doctor tells you and make sure you are being monitored closely. Losing weight does not mean that your hormones and body is going to fix itself even if you are feeling in a somewhat “good place” with your weight loss.

"Bariatric surgery does not cure depression, and these patients need treatment for depression," --There are studies that warn about this because there can be a high rate of suicide for these people. You may find that after a while old issues come back, you are struggling with your food addiction and may need therapy after a year or two. This is quite normal for many of us that have been overweight for a long time. Seek help from the support group if you need resources in your community or consult the experts at the Bariatric Centre.

The high of the first year or so will dissipate once you start having issues with food again. Your issues WILL come back. Surgery fixes our body, not our head.  Please look into your eating issues before surgery. 

8. Expect to attend support group meetings

Zirui Song, et al published an article in the ASMBS publication Surgery for Obesity and Related Diseases (SOARD) in 2006 entitled: "Association between support group attendance and weight loss after Roux-en-Y gastric bypass."

Results: Patients who attended more than 5 support meetings within the first year lost 55.5% of their excess weight. Patients who attended less than 5 meetings lost 47.1%. So by attending meetings, they lost an additional 8.4% of their excess weight.

In real world numbers that would mean:300-pound pre-op weight, with 135-pound ideal weight = 165-pound excess weight
>>  47.1% EBWL = 77lbs lost
>> 55.5% EBWL = 92lbs lost

Why support groups important:
network with people going through issues
you refocus yourself and your thinking
you are reminded constantly about what constitute success
you get feedback, suggestions from others
it is “you” time. It's about refocusing on your journey again.

And yes sometimes its hard to do!!!!!!!!!!!!!!!! Sometimes the hardest thing to do is come to meetings when you are ashamed or struggling. Trust me everyone has been there. We all struggle with our weight EVERY SINGLE day even those who have gotten to a normal weight. You'd be surprised how many people struggle with still psychologically feeling fat or with their body image. You are never alone in this journey.

9. Expect to exercise regularly.

You don't need to belong to a gym once you have surgery. Walking is generally free although I highly suggest buying a GOOD pair of properly fitted shoes – well worth the investment.

Exercise should be a part of your life from the time you get home and start walking. Within a few weeks, you should be regularly walking. Try to find a walking buddy and even if you feel like sitting on the couch, you need to find someone to push you off that couch! Recovery will be faster if you push through the feeling of “blah I want to sit on the couch”. Push yourself through the tough time and tell your supporters not to baby you but to encourage you and walk with you.

The Bariatric Centre wants you moving as much as you can.

That doesn't mean kickboxing or Tai Kwon Do.....but just walking and moving your body. As long as you are moving it doesn't matter what pace. Go slow and when you can, adjust accordingly. As Nike says JUST DO IT!

Expect to need cardio and strength training. (toning). Toning won't necessarily make that skin look beautiful but it should make you a little less jiggly!

In a 1999 study of successful gastric bypass patients: Successful patients exercised regularly to maintain their weight an average of 4 x a week for at least 40 mins. Patients reported exercise as a key factor in their ability to maintain their weight after the initial loss.

10. Expect to deal with your addiction again and the possibility of bounceback/regain.

Eventually the weight loss stops, the scale stops moving, the craving comes are going to need to deal with your addiction at some point again. That's when you might consider therapy, overeaters anonymous, BANA, private counselling, and even support groups again like Weight Watchers. That's when you need to make a point of coming back through our doors again.

Most patients hit their lowest on the scale at 1.5-2 years out.

Most gb patients regain 10 – 15% of their weight loss in 2nd- 3rd year out from surgery. (“bounceback”). Be careful of the phrase: “x amount of lbs gone forever” because they can come back.


Eventually the weight loss stops, the scale stops moving, the craving comes are going to need to deal with your addiction at some point again. That's when you might consider therapy, overeaters anonymous, BANA, private counselling, and even support groups again like Weight Watchers. That's when you need to make a point of coming back through our doors again

Some people are just not successful with surgery. You've heard about them too -A study in 1999 The most common was lack of exercise, poorly balanced meals, constant grazing and snacking, and drinking carbonated beverages. The first postoperative year is a critical time that MUST be dedicated to changing old behavior and forming new lifelong habits.

I see people often bragging about what they CAN eat the first year out.  "Hey I just ate two tacos!!" at a month out.  Okay, just because you CAN eat it, doesnt mean you SHOULD.  Often these people down the line are the ones saying "OMG I stretched my pouch!!!!!!".  You need to preserve the pouch as much as possible.  Keep it small. Try not to let your eyes get in the way of your stomach.  Respect the smallness of the pouch as much as possible.  It's a tool that CAN BE UNDONE.


1. Expect Gas.

I found gas extremely painful initially after surgery. They pump you full of fluids too so there's lots of gas floating all over your body after surgery. I found the shoulder to be particularly painful. My pain meds were used for that more than for an incision! Gas X strips are really great. The other kind of gas (flatulence) is also extremely common. Yes, you might not know initially – but you'll find as you add carbs that's often where it comes in. A few hints: “Just a drop” is found at Walmart and is great for those post-toilet smells.

2. Expect to be cold.

It's true. It doesn't happen overnight that you'll be cold...but you may find that a month, or two or even after 6 months, you'll find that you are always cold. This is normal. Remember how when you were at your heaviest weight, you tended to overheat? It's the reverse for thin people. They are usually often cold. Welcome to the polar bear club! Bring lots of extra sweaters!

3. Expect to lose hair.

It is very normal. At about the 3rd-7th month will be the big period of hair loss. Things should slow down after that. Unless you have very thin hair to begin with, you should be fine. I was the only one who noticed my hair loss. Sure people will notice your hair in the bath tub, in the shower, in the pool....but they won't necessarily notice your lack of hair on your head. They'll just know you are shedding by your evidence that you leave. Many people swear by supplementing Biotin or by using Nioxxin shampoo or Maxxi Hair (found at Betterhealth Nutrition in the US). I just rode it out. I found I had a lot of breakage and did choose to do the chop to a bob hair cut so as to avoid more loss from breakage (I have very coarse hair that tangles easily so just combing I'd lose some hair). The bob cut really helped. Hey, isn't it great to update your look anyway?


1 comment:

  1. Hey Dawn, I found this link off a thread in OH and this is really helpful! Thanks for writing it and I'm definitely bookmarking to read again after I've had surgery!