How life changes after weight-loss surgery

A growing number of Americans who are obese and not able to lose weight through diet and exercise alone are choosing to undergo weight-loss surgery (also known as bariatric surgery), such as gastric bypass, gastric sleeve, and gastric band procedures. In fact, in 2021, nearly 263,000 people in the United States underwent some type of bariatric surgery, up from 158,000 in 2011. These procedures are intended to help adults and teens who are severely obese shed excess weight and manage obesity-related health issues, which may include heart disease, sleep apnea, and type 2 diabetes.

Keep in mind, your weight-loss journey isn’t over after bariatric surgery. These procedures are considered major surgery and come with certain risks, such as bleeding, infection, and blood clots. Even after you recover, you’ll need to adopt some important lifestyle changes to help ensure that you can manage your weight in the long term and avoid possible complications, such as bowel obstruction, gallstones, and dumping syndrome, which occurs when food moves from the stomach to the small bowel too quickly.

Despite these significant adjustments, weight-loss surgery is a “fresh start” for many people who struggle with obesity, according to Mustafa Alibhai, MD, a bariatric surgeon in Dallas, Texas. But how will your life change, and how can you expect to feel afterwards? We spoke with Dr. Alibhai to learn more about what people can anticipate in the weeks, months, and years following a weight-loss procedure.

Some people may view weight-loss surgery as a cure for obesity. It’s often effective, but is it a cure-all?

Dr. Alibhai: What people need to understand is that obesity is a chronic disease that has to be consistently treated. Even if you have the best surgery in the world, there's still a risk of the disease coming back or recurring if you don’t properly care for your body by eating healthfully and getting regular exercise.

We recommend that patients stay engaged with their doctor, surgeon, or bariatric practice after surgery. We have very regimented follow-up appointments during the first year. After that, we see patients every six months for the second year, and once a year after that. If my patients experience any problems, notice weight gain or they’re nervous about something, I encourage them to come see us sooner so we can help them get back on track.

Recovery after weight-loss surgery varies. Generally speaking, how long does this process take?

Dr. Alibhai: It depends on which weight-loss surgery you had, but most patients spend one to two nights in the hospital and go back to work five to seven days after surgery. We often advise patients to consider taking two to three weeks off to fully recover from their procedure. Any type of surgery requires a physical recovery period.

Those who’ve had weight-loss surgery, in particular, may experience some pain and nausea for about one week. But recovery in the age of laparoscopic and robotic surgery is relatively quick. My patients usually get back to doing their normal activities within two weeks.

What about physical activity? How soon after surgery can people begin an exercise regimen?

Dr. Alibhai: I usually let patients play it by ear in the first two weeks, but I encourage them to try light exercises like walking, or any other activities they feel comfortable doing. After two or three weeks, I’ll meet with them and if they’re doing well, I’ll give them a clean bill of health so they can do whatever exercise they want to do.

Do patients who undergo a weight-loss procedure need to change their diet?

Dr. Alibhai: We want everything we’ve done surgically to heal properly, and we also want to make sure our patients stay hydrated. So, we have a very strict postoperative diet that everyone follows.

For the first week after surgery, patients should have only clear liquids, like water or broth. Then, they can switch to a full liquid diet for a couple of weeks, which means sticking to things like protein shakes. Then they’ll continue to gradually expand their diet.

By weeks five and six, they can actually start to return to a regular diet, eating thicker, more solid foods. Overall, we like patients to stick with a high-protein, low-carbohydrate eating plan. This type of diet helps the body regain some of the muscle that is lost as a result of the surgery. That means the liquids they consume should be sugar-free and high in protein.

After weight-loss surgery, it’s also important for patients to eat slowly, chew well, and eat smaller portions of food that their smaller stomachs can digest safely.

Do many people worry about how their life will change after weight-loss surgery?

Dr. Alibhai: I think a lot of patients worry that their life is going be very different after surgery. I would say that’s correct, but it’s a change for the better. During the first six months, you’re going to see your weight drop, you’re going to feel much better, and you’ll actually be able to see the physical changes. So, both mentally and physically, you should notice improvements.

Six months to a year after surgery, some people struggle because the weight loss won’t be as noticeable, and they may not see the same dramatic daily results that they did immediately after surgery. I also see some patients struggle with how to handle their new eating habits around family and friends. Loved ones may think they need to eat more or that they’re not eating enough. In reality, they’re getting the adequate nutrition they need to be healthy, but they have to deal with a lot of peer pressure as they navigate their new lifestyle. That’s one of the biggest emotional struggles because patients have to fight off everyone else’s interpretation of how they’re doing. We always recommend that patients try to build a strong support group after their surgery.

Do you recommend that patients who’ve undergone weight-loss surgery also seek counseling?

Dr. Alibhai: I definitely encourage counseling after surgery. When patients see a mental health provider or psychologist after their procedure, they usually do better with long-term weight maintenance. Support groups are also helpful. Patients are able to talk to other patients who are contemplating surgery or have already gone through surgery successfully. This gives them a different perspective on the whole process.

Aside from diarrhea, vomiting, and trouble swallowing, what side effects might people experience after surgery?

Dr. Alibhai: I tell my patients that no matter how young they are, there is a very high likelihood that they will have excess skin at the end of the weight loss process. If getting plastic surgery [to remove this excess skin] is going to help my patients feel better about themselves, I often encourage them to consider it. I also tell them it’s a good problem to have, because it means they have succeeded in their weight loss journey.

Most everyone will also lose some of their hair three to six months after surgery as the rapid weight loss causes their hormones to fluctuate. This isn’t permanent and often isn’t noticeable. We usually recommend supplements, such as biotin, to help with hair regrowth.

Will weight-loss surgery affect one's fertility or the odds of having a successful pregnancy?

Dr. Alibhai: Bariatric surgery and weight loss may be associated with increased fertility. Some women who have surgery have polyendocrine metabolic ovarian syndrome (PMOS), a condition previously known as polycystic ovary syndrome (PCOS). PMOS is an insulin resistance illness that causes weight gain and irregular menstrual cycles. When those patients lose the weight, many times they have more regular menstrual cycles, which positively effects fertility. It is safe to become pregnant after weight loss surgery, but we usually recommend patients wait about 12 to 18 months after surgery. That’s about the time their maximal weight loss has been achieved. We want them to get to the new normal in terms of weight. We also want to make sure that there are no nutritional issues for the baby.

The first laparoscopic weight-loss surgery was performed back in 1994. How have these procedures changed over time?

Dr. Alibhai: Bariatric surgery has come a long way over the last several years. We're still learning a lot about it and the long-term effects of it, but so far, there’s no question that the positive outcomes of these procedures outweigh any potential risks involved.

Laparoscopic and robotic procedures have really improved outcomes among patients, reducing pain and helping to avoid complications. Also, the American Society for Metabolic and Bariatric Surgery monitors the quality of care in all surgery facilities. Because of this, we've seen major improvements in overall risks. In some places, patients do not even need to stay overnight in the hospital and can go home on the same day that they have their surgery.

Based on what you’ve witnessed among your patients, can weight-loss surgery be life-changing?

Dr. Alibhai: I would absolutely say this surgery is life-changing. When I was deciding which field of surgery I was going into, a family member told me that I should chose something that I would recommend to my family. I chose weight loss surgery for this reason. In fact, I’ve recommended weight loss surgery to many of my family members and they’ve had the procedure. It has changed their lives in an extremely positive way.