What most preoperative patients don’t recognize and many postoperative patients don’t expect is that the impact weight loss surgery has on your hunger, metabolism, ability to eat and weight loss changes substantially over time. I’ve broken these postoperative changes down to four stages, and added the equally important preoperative planning and decision making stage as well to describe the five stages of your life before and after surgery. Each stage offers unique opportunities that can help you make a lifelong change in your nutritional and exercise habits.
Stage 1: Preparing for Weight Loss Surgery
The first stage occurs before surgery and consists of the time spent making decisions about which surgeon to choose, whether to have surgery and which procedure you should choose. Just as importantly, there is a lot of preparation that goes into a successful surgery including changing your diet slowly over time so that you have a good sense of your postoperative nutritional plan, researching the financial obligations that surgery may present and working with your primary care doctor to optimize your health and medications. This stage is perhaps the most important since it sets the stage for all that will follow and provides you an opportunity to establish a well thought out plan for your success after surgery. Anyone who finds themselves in this stage should consider picking up a copy of my new book (available in late February, 2019) called “A Pound of Cure: Preop. Everything you need to know before undergoing weight loss surgery.”
Stage 2: Recovering from Surgery
The second stage occurs during the first month or so after surgery as you recover, start back on normal food and make plans to go back to work. While this stage is often the most anxiety provoking period of time, it’s probably the least important stage when it comes to ensuring your long term success. However, there is one very important skill that you can develop in the weeks after surgery that you can carry with you for the rest of your life: mindful eating. Because you must eat very carefully in the first few weeks after surgery, you are forced to pay close attention to every single bite of food. During this stage, the difference between a comfortable meal and one that causes nausea, pain and vomiting can be only one bite. How well you chew your food, how long you wait between bites and when you choose to stop eating are critical decisions that can have very unpleasant consequences if you go wrong. A mindful eating strategy is a requirement during this stage, but you shouldn’t look at this as a temporary obstacle, instead, it’s an opportunity to learn this valuable life long skill.
Stage 3: The Honeymoon Years
The Honeymoon Years refer to that wonderful period that starts around a month or so after surgery and lasts anywhere from 18 months to 5 years after surgery. A Gastric Bypass tends to offer a longer honeymoon period than a Sleeve Gastrectomy does. During this stage, you have excellent appetite control, lose weight easily and have tons of energy. The surgery is working in overdrive and you begin to feel that your weight loss struggles are finally over. Your body will never give you better feedback about what and how much to eat than it does during this stage. Food that is fried, greasy or sweetened is unappealing while you crave Pound of Cure friendly foods like fruit, vegetables, nuts, seeds and beans. You have two choices during this stage – you can embrace your new taste preferences and recognize them for what they are – a temporary gift that offers you a unique opportunity to change to a healthier diet, or you can fight them and falsely believe that the surgery only works by limiting portion size and resume your pre-surgical diet, just in smaller amounts (I refer to this as the Portion Control Trap). Your new, lower weight and your increased energy provides a great opportunity to start an exercise program as well.
Stage 4: The End of the Honeymoon
Unfortunately, all good things must come to an end and the Honeymoon years are no exception. Eventually, all weight loss surgery patients will experience a return in their appetite, food cravings and lack of enthusiasm for exercise – it usually doesn’t ever go back to where it was preoperatively, but there is definitely a distinct change (contrary to popular belief, It’s not caused by stomach stretching). It’s critical that you recognize that this is a normal part of the postoperative process, not than a sign of impending weight regain. This stage is a lot like when you first learned to ride a bike. You’d practiced your balance and got comfortable with the pedals and the feel of the bike, but it wasn’t until that person who was running along side you helping you balance finally let go that you really learned how to ride. This stage provides you an opportunity to demonstrate to yourself and the world that you can maintain your weight on your own when you get back on the plan you established before surgery and practice the good nutritional habits, exercise and mindful eating strategies that you learned in the previous stages.
Stage 5: Managing Weight Regain
Every postoperative patient will eventually struggle with weight regain. It’s very uncommon that it’s a substantial amount of weight, but struggling with 5, 10 or even 20 lbs. of regain is a reality for many patients. When weight regain happens, it’s an opportunity to intervene early and re-establish those habits that you promised yourself would change after surgery. When I work with patients struggling with weight regain after surgery, I find that a systematic approach is critical – often times there is a clear, understandable and often reversible reason for the weight regain. Getting back to good nutritional habits, as much exercise as possible and identifying all of the different reasons for weight gain can help you come up with a solid plan to get the scale to move in the right direction. Medications can often be helpful as well.
Understanding the different stages of life before and after weight loss surgery is the first step to finding success. The impact surgery has on your body changes over time and harnessing the power of these changes and recognizing their shortcomings is perhaps the most important component of long term success.