Life after weight loss surgery: 5 things you might not expect

In recent years, bariatric surgery has garnered some serious attention, and for good reason. Research suggests weight loss procedures are effective not only for weight loss, but also improving and even reversing certain obesity-related conditions, like diabetes and heart disease.

Following surgery, patients may experience pain or discomfort as the body heals, and should expect to adhere to a healthy life-long eating plan. But, there's so much more. The body goes through a multitude of changes, some you may not even anticipate.

Dr. Steven Webb, MD, a bariatric surgeon with Memorial Hospital Jacksonville in Jacksonville, Florida weighs in on what a patient may experience after surgery.

He notes: "Much of any good bariatric surgical program is aimed toward making certain patients know what they need to know about surgery." But, it's possible some information slips through the cracks.

There are different types of weight loss procedures, each of which affects the body, including the bowels, in a different way. Some surgeries may increase a person's risk of constipation, characterized by fewer than normal bowel movements, or difficulty passing stool for weeks at a time.

"The thing I most commonly see after the sleeve and the gastric bypass is that folks will complain of constipation," Webb says.

Constipation can be caused by a number of factors, including dehydration and a low-fiber diet. It's not uncommon for doctors to recommend fiber supplements to patients who are struggling to go.

On the other hand, some patients, particularly those who've had sleeve gastrectomy with duodenal switch surgery, a procedure that shrinks the size of the stomach and bypasses much of the small intestine, will likely experience more frequent bowel movements.

"We have to make sure patients understand we're shortening the bowel, and they need to be prepared for two or three bowel movements a day," Webb says. "Not only may you have more frequent bowel movements, they'll also be very foul," he adds.

A lot of things can change after bariatric surgery, including your relationships—with your partner, your friends and even yourself.

One 2016 review of 13 studies suggests married men and women who underwent bariatric surgery lost fewer pounds than people who were single. The same research also revealed a potential for divorce following surgery. A 2018 Swedish study published in the JAMA Surgery suggests similar findings. Bariatric surgery patients in relationships were more likely to separate or divorce than overweight persons who didn't have the procedure.

Why? More research is needed to determine the exact reason, but researchers believe it may have something to do with mealtime. Families often spend much of their quality time around the dining table, and when eating habits change, relationships may, too. Another theory: Weight loss may give individuals the confidence they need to leave an unhealthy relationship. Researchers stressed that solid partnerships are less likely to be affected by weight loss following surgery than already troubled relationship. Most post-bariatric patients and their partners reported similar or improved relationships.

The opposite is true for singles who opt for these weight loss procedures. The same study suggests an association between bariatric surgery and a higher likelihood of finding a partner.

Negative self-talk, in your head or out loud, about a food you ate but shouldn't have, or the number of pounds you think you should be losing, can have a negative effect on the way you think about yourself.

Though the actual surgery takes place in the abdomen, the procedure affects your overall health, including your mental health.

Research suggests a link between obesity and depression. One such review of 15 studies supports this claim, though it's unclear whether weight is the catalyst for depression or depression the root of weight gain. One common and welcome result of weight loss surgery is the reduction of depression; people who were depressed before surgery tend to be less so afterwards.

But that’s not always the case. There is some research that suggests surgery can exacerbate symptoms of depression. According to one small 2014 study, of the 107 people who underwent bariatric surgery, some experienced symptoms of depression within the year following surgery. A majority of depressed patients showed signs between six and twelve months after surgery.

Another study even draws a connection between bariatric surgery and a higher rate of self-harm emergencies. The reasons for this are unclear. It's important to speak with your healthcare providers about any and all issues that arise after surgery. 

Your doctor will prescribe a strict diet prior to and immediately after the procedure, which may include only liquids for a period of time. While you won't be confined to a liquid diet forever, your eating habits will be much different after surgery than before, provided you follow the prescribed plan.

"They're going to tolerate smaller amounts of food, and they have to be prepared for that," Webb says. "They may not be able to eat more than 2 or 3 ounces of food at a time."

Bypass patients will want to avoid carbohydrate-heavy foods, like cookies and pasta, as they can cause dumping. Dumping syndrome is characterized by the rapid emptying of the stomach into the intestine, which can cause cramping, vomiting and diarrhea.

Not all food groups should be avoided. A protein-rich diet, between 60 and 80 grams a day, though some people may need more, will likely be recommended following any weight loss procedure. Sitting down and eating slowly is also recommended. Your doctor will also suggest you avoid consuming liquids with your meals, another habit that can cause dumping.

Most people who opt for weight loss surgery lose a considerable amount of their starting weight. But, just how much weight an individual will lose, and how quickly, is not an exact science. Trips to the mall for suitable clothing can become frequent and unpredictable.

One 2017 study suggests, of more than 1,100 obese adults, the 418 who underwent gastric bypass surgery, lost an average of 100 pounds over a two-year period.

Every surgery is a little bit different.

• The adjustable gastric band helps patients lose between 40 and 50 percent of excess weight, the pounds that exceed normal or ideal body weight.
• The sleeve gastrectomy typically results in an average of 50 percent of excess weight loss over a three to five year period.
• The biliopancreatic diversion with duodenal switch gastric bypass promotes excess weight loss between 60 and 70 percent.

"Weight loss surgery does not need to be looked at as a single event and then you're done," Webb says. "It needs to be looked at as one of the big milestones in a lifelong process of losing the weight and then keeping it off."