Bariatric surgery is not a cure for obesity, but more a tool to help you lose weight to live a healthier, longer and more fulfilling life. When you leave the hospital, you will receive a proper guidlines for life after surgery that you should follow. Success depends on your ability to follow guidelines for diet, exercise and lifestyle changes.
The first weeks after weight loss surgery are a little different and it would be good to plan them in advance. You should make changes to the daily tasks, such as work or child care, so that you can heal normally and without complications.
Talk to your employer well before your surgery to arrange the schedule that fits the healing process. You need to be aware of what kind of physical limitations there will be and evaluate the time to recovery.
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Physical activity after surgery
Exercise is an essential component of success after surgery.
Although heavy activity right after surgery is not allowed, the light activity, such as walking is recommended already next day after surgery. The goal is to walk more on the next day, and progressively more every day , including the first few weeks at home until we are able to take 1-1.5 hour walk.
Some patients who have severe knee problems can’t walk well, but may be able to swim or bicycle. Swimming or water exercise is allowed after 3 weeks.
After six weeks, it’s time to start more intense regular exercises, which include muscle strengthening and flexibility and endurance training. Practice at least three times a week and at least three hours a week (Nordic walking, cycling, swimming, fitness).
After weight loss surgery, you lose weight because the amount of food energy (calories) you are able to eat is much less than your body needs. Therefore the body has to burn reserves. Your body will tend to burn any unused muscle before it begins to burn the fat. If you do not exercise daily, your body will break down your unused muscle and you will lose muscle mass and strength. Daily aerobic exercise for 20 minutes is necessary to burn the fat instead of muscle mass.
Regular physical activity after surgery helps to increase weight loss and keep weight off. Studies show that patients who do physical exercises at least 120 minutes per week, have lost an average of 4 kg more weight than those who do not. In addition to weight loss, physical activity has many other positive health effects.
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Recovery diet after surgery
As your body recovers from surgery, it’s essential that you follow the specific eating guidelines given to you by our team. Your recovery diet will slowly progress from clear liquids to full liquids, pureed food, soft foods, and then you will finally be able to start eating solid foods. You should take vitamins and mineral supplements on a daily basis to prevent nutrient deficiencies.
1-14 days after the operation: only liquid or pureed food, 2-3 tablespoons at a time every 1-1.5 hours. There are no restrictions on ingredients, but we recommend pureed meat, cottage cheese and other protein-rich foods. You should drink at least 1,200 ml per day, and in hot weather, 2,000 ml a day. Drink one sip at a time and frequently – up to 200 ml per hour. After eating, wait 20 minutes before drinking.
15-30 days after the operation: Besides pureed food, eat soft food or food that has been chopped into small pieces (such as sauces with minced meat, stewed vegetables, soups and chicken and fish), but these must be chewed thoroughly before being swallowed. Eat 4-6 times a day, gauging how you feel (i.e. until you feel full), usually 70-100ml at one sitting.
More than 30 days after the operation: At this point, we advise switching away from liquids and pureed foods and consuming more solids. You should eat 4-6 times a day — slowly, and chewing very thoroughly. It is not advisable to drink liquids with your meals. Rather, drink 20 minutes after eating. Your daily protein consumption should be a minimum of 80 grams. Protein-rich foods include meat, fish, dairy products such as cottage cheese, and eggs. For instance 180 g of beef contains 80 g of pure protein.
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Supplemental vitamin therapy
All patients undergoing surgery are advised to take multivitamins and minerals for the rest of their lives in order to compensate for possible decreased consumption and absorption of food after surgery.
We recommend the following substitution treatment for our patients:
Since the first day home:
- 20 mg one tablet a day of Tab omeprazole 8 weeks (stomach protection, digital prescription);
- Clexane injections 40mg (1 syringe) once a day 10 days.
Since the sixth day home:
- Multivitamins 1 tablet twice a day
Since 14th day of being home and afterwards:
- Multivitamins 1 tablet twice a day,
- Omeprazole 20mgx1 until 8 weeks since after the surgery
- Calcium citrate or calcium carbonate (Calcichew) 1000mg a day always with vitamin D3 at least 100 microgram (4000U) a
- Elemental iron at least 50mg (100mg for women in childbearing age) a day
- B12 vitamin injections, 1 mg, one injection every three months (prescription medication) or oral B12 at least 350 micrograms per day.
See also: special bariatric mutltitabs:
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Follow-up and lab work
In the first year after the operation, the frequency of visits to the doctor and blood work will be determined by the operating surgeon based on the specific operation and the patient.
Patient can always contact with our dietitian or surgeon by e-mail or phone as long as needed. Patient is always welcome back to our clinic to meet surgeon or nutritionist personally.
The blood work should be made at least twice in the first year, for instance at the 6-month and 12-month mark. Later once the once a year to check the balance of vitamins and minerals.
Necessary analyzes 6-month after surgery:
- full blood count
- glucose, HbA1c (for diabetics)
- albumin, total protein
- ferritin, iron
- folate
- vitamin B12, vitamin D3 25 (OH), folic acid
- ionized calcium iCa
Necessary analyzes once a year, starting from 12-month after surgery:
- full blood count
- glucose, HbA1c (for diabetics)
- albumin, total protein
- ferritin, iron
- folate
- vitamin B12, vitamin D3 25 (OH), folic acid
- parathormone (PTH), Ca, iCa, Na, K
- potassium
- sodium
- kidney function (creatinine, urea)
- glychemoglobin HbA1c
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Pregnancy after surgery
On the basis of studies and our surgeon’s personal clinical experience, 70%-80% of women, who have failed to get pregnant before surgery, become pregnant after weight loss surgery because the obesity is one of the reasons for infertility.
Pregnancy risks after weight loss surgery are lower because obesity increases the risks of pregnancy and when the weight falls, the risks are lower (fetal macrosomia, cesarean risk, maternal gestational diabetes and eclampsia, etc.).
Pregnancy is not recommended before 18 months from operation, because during first year after surgery your calorie intake is low and you don’t get enough nutrients from food – this and also quick weight loss is stress for your body and this can affect the baby. The best time to get pregnant is when weight loss is stopped and weight stabilized. Before a pregnancy we recommend to visit nutritionist and have blood tests done to assess the nutritional status
Absorption of oral contraceptives might not be effective after surgery, and therefore a sufficient concentration of the active ingredient is not achieved in the blood. It is therefore recommended to use alternative options, e.g. transdermal patches or intrauterine devices.
