Life after weight loss surgery isn't always what patients expect. In a discussion on Facebook, one patient put it bluntly, "if you do not make radical changes to your mindset, you will regain (the weight)." The radical changes she refers to include changes to your diet, your lifestyle, your social life, your relationships and your emotions. Sometimes, the changes come as a surprise to patients who hoped that weight loss surgery might offer an easy way out of their weight loss predicament.
Many studies have indicated that patients enjoy an improved quality of life after bariatric surgery. But as many physicians and patients will tell you, the positive changes come with some drawbacks and hurdles as well. Before you choose the weight loss surgery option, be sure you consider the positive as well as the negative changes you might undergo.
Changes After Bariatric Surgery
- Workload. Weight loss surgery isn't an alternative to diet and exercise; it is an addition to diet and exercise. In fact, good eating habits and regular exercise become even more important after bariatric surgery. "You need to spend each day practicing healthy behavior. You have to journal your food, read books and internet web sites," said one patient. For some, the commitment is more than anticipated.
- New Social Habits. The activities you enjoyed prior to surgery may not be activities that you continue to participate in after surgery. Dr. Ninh T. Nguyen, MD, President-elect, American Society for Metabolic and Bariatric Surgery (ASMBS) says that this can present significant problems for some patients. He explains, "you may not be able to take part in social situations that revolve around food and instead learn to schedule social outings that involve physical activity instead."
- Lost/Difficult Relationships. Your changing social habits may frustrate and even alienate the friends you had prior to surgery. "You need to work with your family and friends to accept the new behaviors, because they want life to stay what it was," explains one patient. And as Dr. Nguyen adds, many patients create a completely new social circle with completely new friends.
- Emotional Disappointment. If you expect weight loss surgery to solve social or emotional problems and make life better, you may end up disappointed. Some people who gain weight use food for emotional comfort. This isn't a problem that surgery can solve. If emotional issues are present prior to surgery, they are likely to be present after surgery as well.
- Excess Skin. Your weight loss may provide positive results on the scale, but you still may not like what you see in the mirror. Excess skin is a problem for many patients who lose weight. Dr. Nguyen says it is a significant hurdle for many bariatric surgery patients. Solutions for loose skin may include additional surgery and exercise.
- Alcohol Abuse. Some patients who undergo surgery, particularly gastric bypass and sleeve gastrectomy, experience alcohol use disorders in the years after surgery. A recent study published in the Journal of the American Medical Association found that because the procedures alter the way alcohol is processed in the body, some patients may be at higher risk for abuse.
- Weight Regain. While the success rates for weight loss surgery continue to improve, some weight regain in the years after bariatric surgery is very common. According to ASMBS, patients lose the most weight in the first two years after surgery. At the five-year mark, some weight regain is typical, with patients maintaining an average of 50% of their excess weight loss.
Is Weight Loss Surgery Worth it?
Considering all of the potentially negative outcomes, is weight loss surgery really worth it? The answer depends on you. For a committed patient, weight loss surgery is an effective tool for losing weight. It has also shown to be effective at reducing the impact of many obesity-related conditions such as type 2 diabetes, sleep apnea and heart disease
But it is also important to do your homework prior to surgery. Dr. Nguyen says that most of his patients come to him with reasonable expectations about their life after surgery. He says that in this day and age almost everyone knows someone who has had a bariatric procedure so it's easier to find someone to talk to. Even so, he spends almost three months preparing his patients for the physical and psychological changes that they will undergo.If you are considering surgery, learn as much as you can about the procedure itself and the changes you'll have to make to your life. Talk to friends and family, your primary care provider and a board certified surgeon before making a final decision.
Access to Care. Morbid Obesity and Metabolic and Bariatric Surgery Fact Sheet. American Society for Metabolic & Bariatric Surgery. Accessed: July 12, 2012. http://asmbs.org/
Joshua B. Alley, M.D., F.A.C.S., Stephen J. Fenton, M.D., F.A.C.S., Michael C. Harnisch, M.D, Donovan N. Tapper, M.D, Jason M. Pfluke, M.D., Richard M. Peterson, M.D., M.P.H., F.A.C.S. "Quality of life after sleeve gastrectomy and adjustable gastric banding." Surgery for Obesity and Related Diseases March 5, 2011.
American Society for Metabolic and Bariatric Surgery. Accessed: July 12, 2012. http://asmbs.org/
Wendy C. King, PhD; Jia-Yuh Chen, MS; James E. Mitchell, MD; Melissa A. Kalarchian, PhD; Kristine J. Steffen, PharmD, PhD; Scott G. Engel, PhD; Anita P. Courcoulas, MD, MPH; Walter J. Pories, MD; Susan Z. Yanovski, MD. Prevalence of Alcohol Use Disorders Before and After Bariatric Surgery Journal of the American Medical Association June 20, 2012.
Nguyen, Ninh T., MD, President-elect, American Society for Metabolic and Bariatric Surgery. Interview. July 16, 2012