The Weight is Over

Your Guide to Bariatric (Weight Loss)

Surgery
By Alma Orozco

Disclaimer
This book is for educational purposes only. The material enclosed is
considered to be accurate at time of publication, however, techniques,
and surgical instruments and supplies can change over time. Pre-op and
poste-op recommendations for diet and drugs can also change.
Therefore, it is not intended as a replacement for consulting with
your personal physician. It is strongly advised that before you
consider having bariatric (weight loss) surgery you consult your
physician in regard to your health and lifestyle and your prospects for a
successful outcome.

Copyright 2015 by Alma Oroczo

All Rights Reserved.

Table of Contents

Successful Weight Loss Surgery: Its Not Only for Celebrities

Am I a Candidate for Bariatric Surgery?

Types of Bariatric Surgery

Preparing for Bariatric Surgery

13

The Big Day is Here: What to Expect Before and After

Weight Loss Surgery

16

Post-Surgery Diet

19

Post-Surgery Diet Phases

22

The Importance of Protein for Bariatric Patients

26

Exercise, the Key to Becoming a Successful Bariatric Patient

30

Common Complaints, Risks and Complications Associated With

Bariatric Surgery

33

Bariatric Surgery FAQs

36

Successful Weight Loss Surgery:

Its Not Only for Celebrities
ouve heard the wondrous stories about celebrities who have successfully lost
hundreds of pounds through bariatric surgery and have seen the results. Women like
Sharon Osborne and Roseanne Barr come to mind. Star Jones had even more amazing
results, losing over 160 pounds in three years. As for male celebrities, John Popper, lead
singer of Blues Traveler, lost 200 pounds after having gastric bypass following a severe
heart attack. American Idol judge Randy Jackson lost 113 pounds following gastric
bypass surgery while television weatherman Al Roker dropped 100 pounds and was
healthy enough to run the New York City Marathon in 2010.

You may think that celebrities losing lots of weight is all fine and dandy, but will it work
for you? To help you decide, here are two success stories from patients who had weight
loss procedures done through Bariatric Mexico Surgery.

Lauras Story
Around 10 years ago, my mother had gastric bypass surgery and lost about 125
lbs. I wanted to have it done so badly, however, my insurance didnt pay for it. Fast
forward 9-1/2 years. I was on a plane with my daughter, who models, travelling to a
shoot in California when I was an ad in Delta Magazine advertising medical treatment out
of the country. I thought, Why havent I heard about this before? Once home, I
researched as much as I could on this option along with many different doctors, including
Dr. Fernando Garcia.
Within two months, I was back on a plane to California to have my dream surgery
with my mother accompanying me. We arrived in San Diego at 6 p.m. I was worried that
I would be nervous and scared, but I wasnt. I was just so happy that the time had finally
arrived. The driver who picked us up was so friendly and smelled nice. I remember him
laughing and said he was
happy that after the long
day that he had that he
still smelled good. I had
never been to Mexico
before and the driver
answered any question
on the ride to the hotel.
Once we arrived at the
Marriott, we were treated
like royalty. The beds
were heavenly. It was
wonderful. When we
arrived, there was a note
from the onsite I was
downstairs by 9 a.m. for
the ride to the hospital.
Once I arrived, we filled
out forms and did labs.
After I was settled in my room, several doctors talked to me while the nurse prepped me.
Dr. Garcia came in, wanted to know if I had questions for needed something to soothe
me. Since I was calm, he suggested that I take a nap. When it was my time, I told the
anesthesiologist, Lets get this show on the road! Afterward, I remember sleeping a lot,
and then walking a lot when I was awake. I have to say that I was never treated so well in
my life. It was an amazing experience that I would do again.
Within five months, I was able to do things I had not done in years, such as
working as the assistant cheerleading coach for my daughters group. I was able to walk
two miles and still breathe. I was able to run and play with my kids again. I had my
thyroid medications lowered.
I am once again happy and healthy after losing just over 86 pounds with 30
pounds to go. It is amazing and crazy at the same time. Thank you, Dr. Garcia and your
staff for all you did for me. You gave me the life I tried so hard to get back!

Jeffs Story
I was near death not long before my bariatric surgery. Hospitalized for an
infection, each of my legs had swollen to 24 inches in diameter. I could barely breathe
and my personal life and hygiene were at an all time low.
My friends and family watched me die as I weighed 250 pounds, then 275, 300,
350, 400, 450 and then the all time high of 489 pounds. At this point, I traveled to
Tijuana to interview six doctors before making the decision to trust Bariatric Mexico
Center to do the procedure.
Today I am a 270 lb. man who no longer has sleep apnea. I can tie my own shoes
and buy clothes at the same stores. I have 42-inch waist and wear a 2X shirt instead of a
6X. I owe all to the lifestyles changes afforded by you and your wonderful staff.
I have had the pleasure of bringing new patients to you, including a lady who has
gone from a size 18 to a size 4. Another woman I referred reached her weight goal in just
seven months, losing 98 pounds.
One time when I
visited your facility, I
shook hands with a man
who weighed nearly 500
pounds and was having
the procedure done that
day. I shared my story
and the two of us shed
tears. I know that
wherever he is, he is
happy and his life has
been changed.
In Tijuana,
bariatric surgery is all
you do. You have a less
than 1% infection rate
over your entire
services. I also learned
that you have a 0%
mortality rate. When researching the procedure, I was offered surgery next to a hardware
store, next to Office Depot and was even approached by someone who claimed he was a
doctor and would do the procedure in his garage. It was not difficult to choose your
hospital and staff. Your staff treats us wonderfully because you are focused on each
patient as an individual and the hotel provided is of highest American standards.
I am proud of the work you do and the skillful way your staff works on each
patient. I hope that everyone who fights obesity would choose to change his lifestyle and
visit you for the chance to be happy once more. Once again, thank you, you saved my
life.

Am I a Good Candidate for Bariatric Surgery?

eciding to have surgery to produce weight loss is a

serious matter. Many individuals come to a crossroads
to make this serious decision after failing to lose weight
through traditional diets, exercise and medication.
Obesity is a disease with many contributing factors
including genetics, environment, metabolism and eating
disorders. Because of its complexity, overcoming obesity can
be difficult. Excess weight, medications, genetics and an
inability to be active all contribute to make the weight loss
process extremely difficult, if not next to impossible.
Bariatric surgery is not a cosmetic procedure or a lazy way to lose weight.
Patients committing to one of the weight loss procedures must go through a disciplined
process and commit to lifestyle changes that will help them lose weight, keep it off, get
their health back, and enjoy a new lifestyle.

What is Obesity?
Obesity is defined as an excessive accumulation of adipose tissue to such an
extent that health is impaired. According to the National Institute of Health, an increase
of 20 percent or more above your ideal body weight is the point where excess weight
becomes a health risk. Adult obesity is commonly determined by the body mass index,
or BMI, determined by an individuals weight and height. BMI is used to help determine
eligibility for weight loss surgery because for most people, their BMI correlates with their
amount of body fat and thus is related to their risk factor for disease and death. To
determine your BMI, use this calculator in the footer of the Bariatric Mexico Surgery
website.

BMI
Under 18.5
18.5 - 24.9
25 - 29.9
30 - 34.9
35 - 39.9
40 and Over

Classification
Underweight
Normal Weight
Overweight
Obese
Severely Obese
Morbidly Obese

Health Risk
Minimal
Minimal
Increased
High
Very High
Extremely High

Obesity is one of the leading causes of preventable death. Today 97 million

Americans, more than one-third of the adult population, are overweight or obese. An
estimated five to ten million of those are considered morbidly obese. People with a BMI

of 20 to 25 have the lowest mortality risk. The higher your BMI, the greater your risk for
death. A BMI of more than 32 in women results in a double mortality rate. Obesity
causes an estimated 111,900 to 365,000 deaths per year in the United States and reduces
life expectancy by an average of seven years. A BMI of 30 to 35 reduces life expectancy
by two to four years. Morbid obesity with a BMI of 40 and over reduces life expectancy
by 10 years.

Determining Eligibility
BMI classifications help medical professionals ascertain whether patients will be
good candidates for bariatric surgery. Weight-loss surgery is recommended for
individuals with a BMI between 35 and 39.9 and one or more of the following obesityrelated health conditions:
Type II diabetes
Obstructive sleep apnea
Osteoarthritis
High blood pressure
Obesity hypoventilation syndrome
High cholesterol
Psudotumor cerebri
Family history of early coronary heart disease

Bariatric surgery generally provides good outcomes for individuals with the following
criteria:
More than 100 lbs. over ideal body weight
BMI of more than 40
BMI of over 35 with several accompanying negative health effects related to
being severely overweight
Between 16 and 70 years of age
Obesity-induced physical problems such as back or joint pain that interfere with
lifestyle
Body size problems that preclude or severely interfere with social life,
employment or ambulation
Unable to maintain healthy body weight even while on a medically supervised
diet
Aware of the risks and benefits of surgery and commitment to permanent
lifestyle changes
Please note that many doctors will perform surgery on patients with a BMI of
less than 35 (but not lower than 32) if certain medical criteria are met.
Women of childbearing age considering weight-loss surgery should not try to
become pregnant within the first 18 months to two years following surgery as the rapid

weight loss and nutritional deficiencies associated with the procedure make pregnancy
dangerous for the mother and the developing fetus.

Non-Surgical Treatment Options

Most patients unsuccessfully try several different non-surgical options to lose
weight before considering bariatric surgery. Exercise and diet is the most frequently used
option. Patients attempt to limit caloric intake while increasing activity. This option does
not work well in morbidly obese patients as they generally lose weight while on a
program but immediately regain weight and pack on additional pounds as soon as the
program ends.
Medications provide another treatment option even though not all patients will be
able to use them. Doctors generally prescribe medications for patients with a BMI of 30
or less or of 27 and higher if factors such as high blood pressure, diabetes or other risk
factors are present. The downside of weight-reduction medications is that they often have
side effects such as tachycardia (elevated heart rate), a rise in blood pressure and a
reduction in the absorption of fat-soluble vitamins. These medications only help while
patients use them. As with diet and exercise, many regain weight after treatment stops.
Additionally, some patients dont respond at all to weight-loss drugs.
While the FDA regulates prescription weight-loss medications in the United
States, most over-the-counter weight loss remedies are not regulated. Hundreds of these
medications or supplements are on store shelves. Since they are not subject to the same
rigorous standards for prescription medications, most have not been proven safe and
effective and may even be dangerous.

How Weight Loss Surgery Affects Health

The health consequences of severe obesity affect most of the organs in the body.
Obesity is a risk factor for cancer, heart disease and stroke in addition to many other
diseases. Studies show that the risk of death from these conditions returns to normal after
weight loss. Within the first six months of having weight loss surgery, many patients no
longer need to take medications for obesity-related conditions. In addition, women who
were struggling with infertility before surgery find that conception is possible after
surgery.

Statistics of patients undergoing weight-loss surgery typically have these results:

Type II diabetes resolved in 77% and improved in 86%
High blood pressure eliminated in 62% and improved in 79%
High cholesterol reduced by 70%
Obstructive sleep apnea resolved in 85%

Types of Bariatric Surgery

urgeons use several types of bariatric procedures to help patients lose weight. A
number of factors are taken into consideration, including the amount of weight you
want to lose, which health problems need improvement, risk level and overall cost.
Your bariatric surgeon will explain your options and help you decide which
procedure is best for your needs.
Bariatric surgeries fall
into three categories:
restrictive procedures that
shrink the size of the
stomach to limit the amount
of food it can hold,
malabsorption procedures
that reroute food through the
digestive system so that the
body is only able to absorb a
fraction of nutrients and
malabsorptive-restrictive
combination procedures that encompass both.

Laparoscopic Lap Band

This minimally invasive restrictive surgery is performed via laparoscopy. The
laparoscope is a long, thin tube with a high-intensity light and a high-resolution camera at
the front. The instrument is inserted through an incision in your abdominal wall.
Recovery is rapid from this reversible procedure whereby the surgeon places a band
around your stomach, just below the esophagus. The restraint creates a new stomach
pouch that controls the amount of food your body allows you to consume, but also slows
down the evacuation process, helping you to feel fuller for longer periods of time.
Attached to the band is a narrow tube connected to a port placed beneath the skin.
Doctors tighten or loosen the band by injecting
silicone into the tube to accommodate patient
needs. The fills begin approximately four to six
weeks after surgery and then at two- to threemonth intervals until the optimal level is
achieved. To prevent the band slipping out of
place, the surgeon secures both sides of the
stomach around the band.
The Lap Band is the least invasive
bariatric surgery. There is no rearrangement of the
digestive system and no malabsorption of
nutrients.

Gastric Sleeve Surgery

The Gastric Sleeve has recently
evolved into an increasingly popular option for
super-obese or high-risk patients. Also
performed through laparoscopy, the procedure
resections 60% to 80% of the stomach. The
portion that is left in place carries out all
necessary functions such as digestion acid
secretion, etc. No rerouting of the intestines is
involved, so food is completely digested and
nutrients are absorbed.
Following gastric sleeve surgery,
patients are only able to intake a small portion
of food. The remainder of calories needed come from fat stored in the body, resulting in
weight loss. An additional factor involves the reduction of a hormone called ghrelin, the
amino acid that signals hunger. The portion of the stomach removed produces the most
amount of ghrelin, thus, patients also feel significantly less hungry.

Gastric Sleeve Plication

This relatively new procedure is another restrictive approach to produce weight
loss. Plication refers to the rounded shape of he stomach made by folding it in layers.
During surgery, stomach volume is reduced by about 70% making the stomach able to
hold less. The outer edges of the stomach are folded around a calibration tube and then
stitched into place. There is no cutting, stapling or removal of the stomach or intestines.
Gastric Plication may be reversed or converted to another procedure if needed.
Gastric Plication does not cause decreased absorption of nutrients or bypass the
intestines. After eating, patients feel full quickly and continue to feel full for several
hours. The procedure may also cause a decrease in appetite.

Gastric Bypass
Also known as Roux-en-Y surgery, Gastric Bypass combines restrictive and
malabsorptive components. It involves multiple stapling of the stomach to form two
confluent pouches. The smaller pouch at the inlet of the stomach is attached to a
resected Y-shaped segment of the small
intestine where food is primarily drained.
The resection bypasses the duodenum and
the jejunum, the first two portions of the
small intestine where most food is normally
absorbed. This surgery is designed to limit
the amount of food intake as the stomach is
reduced to a small pouch, while the intestines
are also rerouted to intentionally prevent the
body from absorbing nutrients and calories.

Mini Gastric Bypass

Mini Gastric Bypass surgery, or the Bilroth II procedure, is a fast and efficient
laparoscopic surgery recommended for obese patients with concurrent diabetes
mellitus, hypercholesterolemia and uncontrolled hypertension. The Mini Gastric
Bypass was developed in 1997 to reduce operating time, simplify the procedure and
reduce complications.
The procedure involves dividing the stomach into two pouches, with the
upper pouch along the stomachs lesser curvature, and the lower pouch along the
greater curvature of the stomach. The smaller pouch partially absorbs incoming
food and then passes directly to the jejunum level of the small intestine, effectively
bypassing six feet of the intestinal track.
Mini Gastric Bypass is both
restrictive and malabsorptive as the
small stomach pouch necessitates
earlier satiety in patients. The
intestinal bypass causes food to skip
the duodenal column where the
majority is absorbed into the
bloodstream.
Generally surgeons prefer the
gastric bypass surgery over the mini,
but a consultation will confirm the
best option for you.

Duodenal Switch
As one of the more complicated bariatric procedures, the Biliopancreatic
Diversion with a Duodenal Switch (PBD-DS), commonly referred to as the Duodenal
Switch, involves three features. The first involves dividing the stomach into an
elongated connection between the esophagus and the small intestine. This step
makes patients feel full sooner as the stomach retains approximately 25% of its
original capacity.
The first step your surgeon will perform in duodenal switch surgery is to
divide your stomach into an elongated connection between the esophagus and the
small intestine, shaped like a banana. The unused portion of the stomach is removed
from the body. The second feature reroutes food away from much of the small
intestine as the smaller, gastric sleeve-like portion of the stomach is linked to a
short part of the duodenum, which is turn, is directly linked to a lower part of the
small intestine.
The distance between the stomach and the colon becomes much shorter, thus
limiting how food is absorbed. Because the stomach is simply reduced in size, its
function is not altered, helping to decrease the probability of dumping symptoms
(persistent vomiting, nausea and diarrhea).

Preparing for Bariatric Surgery

aving weight loss surgery isnt just a matter of showing up at the medical facility
once you have decided to undergo one of the procedures. In the days and weeks
leading up to surgery, its important to prepare your body and mind for the changes
ahead. Doing so will reduce stress, save money, minimize the risk of complications and
possibly even help increase the amount of weight you lose and keep off over the long
term.

Why You Should Begin Preparing Early

One of the best things patients can do for
themselves is to try to lose weight in the months before
surgery. Those who do, tend to lose more weight after
surgery and are less likely to experience complications.
A recent study conducted by the Stanford University
School of Medicine found that for every 1% of weight
loss before surgery, the average patient lost 1.8% more
weight in the year following the procedure. The same
study found that patients with pre-op weight loss
exceeding 5% spent 36 fewer minutes in the operating
room as lower weight made it easier for surgeons to
perform the procedure. Another study of gastric bypass
patients found a direct correlation between pre-op
weight loss and complication rates.
Perhaps the biggest reason for preparing early for bariatric surgery is long-term
success. Habits dont change overnight. Weight loss surgery will not work over the long
term if you dont make a commitment to change.
Think of it this way: just as athletes prepare for the biggest games of their careers,
so should those committed to having bariatric surgery prepare for it. The sooner one
starts, the more likely it is that they will establish the habits necessary to achieve longterm weight loss and health improvement goals.

Take Care of the Basics

Prior to surgery, you must deal with a variety of practical considerations. Plan to
take care of these tasks three to six months ahead of your scheduled surgery to ensure that
you have sufficient time to address any problems or changes that may arise.
Begin working with your coordinator at Bariatric Center Mexico as soon as
possible so you can fully understand the steps you need to take to successfully complete
your chosen surgery.

Tijuana, Mexico is a hot spot for bariatric surgery. If you are going to Tijuana,
arrange for flights or ground transportation if you are within driving distance. Your
coordinator will explain financing should you need this. Medical tourism insurance is
also available through our office to protect you against unforeseen circumstances.
Schedule your initial consultation with one of our coordinators to learn more about
what you can expect, as well as find out what paperwork youll need to move forward
with surgery. Be prepared to supply the following information:
A review and summary of your own medical history and that of your parents and
note any anesthesia complications
List prescription drugs, over-the-counter drugs and vitamin and herbal
supplement you take regularly
Write down questions and concerns about the procedure to discuss with your
surgeon
All information provided to your coordinator will be forwarded to your surgeon, who
may give you a recommended diet and exercise program to follow in the weeks before
your procedure to help you begin to lose weight. Make sure to schedule any requested
testing and physicals with your family doctor and forward the results to your coordinator
who will pass them along to your surgeon.

Make Lifestyle Changes

Follow your doctors recommendations for diet and exercise to improve your chances
for long-term weigh loss and health improvement following surgery. Begin post-surgery
lifestyle changes at least three months before the procedure. Tips for eating include:
Retraining your taste buds by eating for health and not just flavor and pleasure.
Your smaller, post-op stomach will prevent your body from processing large
amounts of food. If you fill up on junk food, your body wont get the nutrients it
needs, which can ultimately lead to complications.
Eat lots of protein as its essential for weight loss. Protein makes you feel fuller
sooner and for longer periods.
Eat slowly and watch portion sizes. The feeling of fullness takes 20 to 30 minutes
to reach your brain. Get in the habit of eating slowly and deliberately so you dont
stretch your new stomach and overeat after surgery.
Change your liquid intake. Begin eliminating liquids with your meals since after
surgery youll have to wait 20 to 30 minutes before or after meals before you
drink anything. Liquids can cause food to flush through your digestive system and
make you feel hungrier, leading to weight gain. Take coffee (decaf is best) only in
small amounts and try to eliminate sugar (or use a sugar substitute) and cream.
Eliminate or reduce sugary beverages and alcohol and drink more water. If you
dont have any liquid restrictions, try to drink 64 ounces of water per day, by
doing so you will feel full and lose weight. Keeping well-hydrated will also flush
your kidneys and reduce the chance of developing kidney stones which can
develop after rapid weight loss. Due to changes in your digestive system, your
body will react differently to alcohol; it will be easier to become intoxicated and

develop food cravings. Too much alcohol post-surgery can cause your blood
sugar to spike, resulting in weight gain and renewed health problems.
Increase your activity level per your surgeons suggestions. Exercise can be difficult,
but its attainable. Start slowly and increase your intensity in small steps by adding five to
10 minutes per session each week before surgery.
If you smoke, you need to stop four weeks prior to surgery. It is highly recommended
that you do not smoke for one to two months after your procedure. Of course, it is better
for your health that you quit smoking altogether and we recommend that you take this
opportunity to do so. Smoking increases the potential of complications following surgery,
delays healing, promotes infection and increases the risk for ulcers.

The Big Day is Here: What to Expect Before and

After Weight-Loss Surgery

Congratulations, youve committed to having bariatric surgery and the big day is
here. Its natural to feel nervous before having any kind of procedure, but dont
worry, before you know it youll wake up in the recovery room ready to begin your
new life. Although your experience may differ slightly, this flowchart (above) shows
what you can expect when arriving for bariatric surgery in Mexico.

Prepping for Surgery

Upon arriving at the hospital, the procedure will be similar to that for any other
surgery. Youll fill out some forms, possibly have a test or two performed, have your
vital signs taken and be asked to put on a hospital gown in preparation for your surgery.
A nurse will place an IV in your hand or arm to start intravenous fluids and to administer
antibiotics. It is recommended that you bring along a companion. Your companion will
be allowed to stay with you until you are called to the operating room and then they will
head to a waiting room until you are moved to your own room.

Surgery and Recovery Room

After your anesthesiologist administers the drugs that will make you fall asleep,
surgery will last between one and two hours depending upon your procedure. When you
are out of surgery, the surgeon will inform your companion that the procedure is
complete and you will be taken to the recovery room where you will wake up feeling
groggy, but happy, knowing that the surgery has been completed.
Your stay in the recovery room will last one to four hours. You may have little
recollection of time spent here, but the care team will work closely with you to monitor
your vital signs and to answer your questions. You may experience nausea and/or pain.
If you seem to be hooked up to lots of equipment, dont worry, its normal. When you are
fully awake you will be transferred to your own room where you will continue your
recovery.

The First 24 Hours

During the first 24 hours following surgery, you will continue to receive
medications and fluids through your IV. You will feel groggy and may drift in and out of
sleep for long periods. You may experience dry mouth, a byproduct of medication used
with the anesthesia during surgery. You may be allowed to brush your teeth and rinse
your mouth, but at first you will not be allowed to drink water.

Pain
Pain is usually moderate on the first day. The IV will still be connected, so it
will be easy to ask for and receive pain medication as needed. Typically, individuals
who will have the most pain are those who have significant portions of their
stomach removed. When in your hospital bed, you may also feel a sense of general
soreness across your abdomen.

Activity
Your surgeon will probably want you to get up and walk, but getting out of
bed will be difficult. It will hurt. However, the more you walk the better you will feel
the next day and the faster you will feel more like yourself. Walking will help
prevent blood clots. You will also be encouraged to sit up in a chair.

Mental State
You may feel elated, knowing that the surgery is over and that the next the next
stage of your life is about to begin. At the same time, you may feel some concern,
worrying that you will feel hungry yet be unable to eat. However, it wouldnt be pleasant
to eat or drink at this point because your throat will be sore and swollen from surgery.
Since a significant portion of your stomach will have either been removed or resected it
wont produce as much of the hunger hormone ghrelin, so you wont feel hungry.

The Day After Surgery

Many patients experience a restless night after sleeping a lot in the hours after
surgery, so expect to drift in and out of sleep. Your surgeon will order testing to ensure
that your stomach has healed enough to begin digesting foods and you may start your
liquid diet.

Pain
Pain is typically easier to manage at this point and will continue to be so as the
days pass. Expect different positions to offer different levels of discomfort, but keep in
mind why you had this surgery.

Diet
You will begin taking sips of water to accustom yourself to how much liquid and
how often you can have some following your weight-loss surgery. If you tolerate water
well, you will begin the first phase of your post-operative diet that is limited to clear
liquids such as gelatin, broths and teas.

Discharge
If everything goes well during post op, you can expect to be released anywhere
from 24 to 48 hours following your procedure. In the hours before your release expect
your surgeon to recommend a diet and activity plan that you should follow when you
return home. Usually, a nutritionist will also be involved to help you in your on-going
recovery.

Post-Surgery Diet

ongratulations! You have come through weight-loss surgery and are now ready to
begin the next phase of becoming the new you. The next three to six months will be
among the most important of your life as you relearn how to eat. You will experience
significant changes not only on how you eat, but on what you eat.
The greatest weight loss will occur in first four
to nine months following surgery and will slow
afterwards, although you will continue to drop pounds
for 12 to 18 months and sometimes longer. Plateaus,
an intermittent stalling of weight loss can occur during
this period for up to a month. Most patients will
experience a plateau after eight to 12 months following
surgery. The plateau is generally an indication that the
patient is consuming too many calories or
carbohydrates or that increased levels of exercise are
needed. After this period, weight loss will slow, but
can still occur for 12 to 18 months or even longer in
some individuals, even though it is more difficult.
Weight may be regained if too many calories
are consumed, exercise is discontinued or old habits
such as grazing, snacking or poor food choices,
especially from sugary foods like soda, ice cream, etc., occur.

Water Everywhere, So Make Sure You Drink

One of the most important tasks that you can do following bariatric surgery is to
drink a sufficient amount of liquids, mainly water and sugar-free drinks. You should try
to drink 64 to 80 fluid ounces in small amounts throughout the day. A simple way to
accomplish this is by buying a 32-ounce water bottle and consuming at least two bottles
per day via small sips. Note that it may take several weeks to build up to this amount.
Getting enough water immediately after surgery may be difficult. Take a sip, then
after several minutes sip again. You need to keep drinking water and shouldnt wait until
you are thirsty to do so. Increase water consumption when weather is hot and humid to
avoid dehydration. Pay attention to your urine especially during the first few weeks. If it
looks darker than normal, you are not getting enough liquid.

Diet Progression
Before your release from the hospital, your surgeon and the nutritionist will give
you a detailed bariatric diet plan to follow for the first weeks and months after surgery.
The purpose of this is proper healing, engaging in a healthy lifestyle and maximizing
your chances of losing weight.

For the first several weeks after surgery your diet will consist completely of
liquids. The length of this phase depends on the type of surgery you selected. Following
the liquid phase it is important to avoid damage to your new stomach and to avoid
complications and setbacks such as hospital readmission and repair surgery. The
consistency of your liquid diet will be watery at first and gradually thicken as you add
items such as protein powder for shakes, cream soups and yogurt for smoothies. At first
you may only be able to sip an ounce or two of your liquid meals every hour or so.
As the weeks progress, you will slowly be able to eat more, typically taking four
or five small meals per day. When you resume solid foods, eat three times per day at
usual meal times. There is no hard and fast rule as to how many times per day you should
eat as some individuals may need to eat five to six small meals per day to obtain adequate
nutrients and calories. Make sure that you are not grazing, however, as this habit can
sabotage weight loss. You will feel full quickly, so do what is best for you. Reintroduce
solid foods one at a time to determine which your digestive system can or cannot tolerate.
Cook everything well and chew it thoroughly before swallowing.

Diet Components
Protein should be your primary source of nutrition, with 70 to 75% of calories
coming from foods such as fish, eggs, soy, dairy products, legumes, lean meat and
protein shakes. Carbohydrates should make up 10 to 20%, while you should limit fats to
5 to 15% of total calories.
When selecting protein, be mindful of fat content as many sources contain ample
percentages. A diet of 600 to 800 calories is a good goal for the first six months. Caloric
intake will increase as your stomach stretches. Your body will do everything it needs to
get enough protein and will begin to break down muscle. Inadequate protein can result in
swollen ankles, fatigue, hair loss, cracked nails, impaired immunity and slow wound
healing.
Avoid simple carbohydrates such as white bread, potatoes, white rice, corn peas
and anything full of excessive sugar such as candy, ice cream and donuts. Even orange
vegetables like carrots and sweet potatoes can hamper weight loss as they are high in
sugar. Select good carbohydrates in small portions, including vegetables, low sugar fruits
and quality foods like brown rice, quinoa and whole-grain breads as these foods are often
high in fiber.

Overall Focus
Eat protein first so you can get enough of it and avoid the problems that come
with inadequate amounts. By eating protein first, youll have little room left for
carbohydrates and simple sugars. Try protein shakes if you have difficulty getting
sufficient protein. Sugars and carbohydrates may slow weight loss because they are easily
digested and absorbed. Sugars, artificial sweeteners and sugar alcohols lead to gas,
bloating, diarrhea and a mad dash to the bathroom. Starches like mashed potatoes and
cereals can also slow weight loss. Learn to recognize feeling full and avoid stuffing

yourself. By six months, most patients are eating a regular, healthy diet in smaller
portions.

Vitamins and Supplements

Even though you have committed to a lifetime of eating properly, your diet may
not have enough vitamins and minerals. Ask your surgeon or nutritionist for
recommended supplements. A multi-vitamin and mineral supplement, extra vitamin B12,
calcium and vitamin D may be recommended for most patients. Iron is recommended for
menstruating women and individuals with anemia.

Post-Surgery Diet Phases

ollowing bariatric surgery, patients go through as many as four stages of diet

progression. Dont worry as its not as difficult as you may think. The length of each
phase depends on the type of surgery you have, how your digestive system reacts to
reintroduction of food and your surgeons recommendation. These stages involve clear
liquids/pureed foods, soft foods and
finally solid or regular foods. By one
year post-surgery, you should be able to
consume a regular diet, albeit with much
smaller portions than previously.
Diet progression varies from
patient to patient. Proceed with caution
to minimize vomiting and the disruption
of staples or stitches. You can progress
to the next stage as per your doctors
guidelines and when feeling completely
comfortable with the current stage,
meaning no nausea or vomiting. If you
progress to the next stage and
experience problems, return to the
previous stage for at least 48 hours
before trying again.

Stage One: Clear Liquids

The goal here is to try to drink 64 ounces of liquid per day, although this may be
difficult in the first days after surgery because your stomach may be swollen from the
procedure. Sugar-free gelatin, ice pops; diluted sugar free juice and sugarless powdered
drinks like Crystal Light also count toward your liquid intake.
Your liquid diet may also include whey protein bullets, vitamin water zero and
similar commercial drinks, ice chips, chicken or beef broth, consomm and mild teas (no
cinnamon). Drink a minimum of two quarts of water every day at your own pace. Always
sip, never gulp or drink quickly.

Stage Two: Full Liquids

This transition stage helps keep your body hydrated and readies it for soft, solid
foods. Continue to sip water all day. At this point, youll add a protein supplement to
your diet. These supplements are plant-based or whey-based. Some people tolerate one
type better than the other. Note which works for you, and look for supplements with at
least 15g of protein and up to 30g, less than 5g of carbohydrates and under 130 calories

per serving. You can also purchase commercial protein shakes, but sample before buying
large quantities.
Skim milk 1% or 2% will also become part of your diet (Lactose free in gastric
bypass and duodenal switch, due to malabsorption). Individuals who are lactose
intolerant can substitute non-GMO soy, unsweetened coconut, almond or rice milk. Lowsugar fruit juices without pulp, and blended cream soups without chunks may also be
added. Initially avoid tomato soup because of its acidity.
Other foods that may become part of your diet include:
Strained creamy soups
Chunky vegetable soups, thoroughly blended and thinned with water
Cooked hot cereals (oats, cream of wheat or grits) blended and thinned with skim
milk
Low fat and low sugar drinkable yogurt
Blended fruit smoothies
Thin egg custard
Fresh vegetable juice (Prepared in a juicer not a blender) or V-8 juice
Applesauce

Stage Three: Pureed Foods

You will attempt to eat more foods in this transition stage as your digestive
system begins to acclimate to its new way of eating. You may puree some foods at first to
make them easier to digest. Introduce one new food each day or every other day to allow
you to identify which may cause digestive problems. The most common food
intolerances are red meat, chicken and bread. Meats are better tolerated when moistened
with broth. You may not be able to tolerate beef for several months.
Eat only until you feel full and then stop. Dont force yourself to finish what is on
the plate. Measure out half-cup portions to place on your plate, dont guesstimate. Try
small amounts, sometimes as little as a tablespoonful at a time to see how your stomach
handles it.
Foods in this step require minimal chewing
Creamy vegetable soup (carrot, zucchini, asparagus, spinach, peas prepared with skim
milk instead or water) *Avoid broccoli, Brussels sprouts, cauliflower, as they might
cause gas.
Fruits and vegetables (cooked-peeled- pureed).
Unsweetened applesauce with non-fat dry milk powder or peeled and cooked apples,
pear, peaches with yogurt.
Greek yogurt (<7g sugar).
Cottage cheese (fat-free/low-fat).
Eggs scrambled, soft boiled or poached.
If you are having trouble tolerating pured food, try slowing the speed of your eating.

Stage Four: Soft Diet

At this point, you are consuming 600 to 800 calories per day. Learn how to read food
labels to see how many calories a serving of each food contains and what is the percent of
protein, carbohydrates and fat. Keep carbohydrate intake to less than 30g per day. Add
non-fat powdered milk or unflavored protein powder to foods to obtain extra protein.
Always remember never to eat and drink at the same time.
Examples of food to add in this stage include:
Egg salad
Canned tuna or salmon, well-moistened with low-fat mayonnaise
Plain chicken salad
Mashed, pureed, canned or cooked fruit or vegetables
Fat-free refried beans
Soft, fresh bananas
Occasional sweet potatoes or mashed potatoes

Stage Five: Regular Solid Foods

Getting to this stage signifies that you now have a healthy diet that you can eat for the
rest of your life. You have learned to eat slowly, savor your meals and listen to your body
to understand how it handles certain foods. Its important to continue protein intake to
maintain muscle mass and to avoid malnutrition. Consume 800 to 1,000 calories per day
and dont exceed 1,200. Get at least 65g of protein per day, some people need up to 90100g a day. Use food scales or small plates to help guide portions. Never put more than 4
ounces of food on a plate at one time.
In addition to avoiding grazing, emotional eating and other unhealthy habits, you
need to avoid certain foods in order for your diet to have long-term success. White
starches (low fiber) and sugars are easy to overeat so managing carbohydrate intake is
essential. Being aware of hidden carbohydrate and fat sources and extra calories is also
important.
Starches include: breads, cereals, grains, noodles, baked goods, snack foods and
crackers. Many starchy foods are low-fat or fat-free but contain hidden sugars. If you
must eat starches, opt for whole grains. Learn to read labels to look for additives like fats
that increase caloric content. If an item states that it is fat-free, it may be loaded with
carbs. If the item is sugar-free, it is likely loaded with fat. When in doubt, simply look at
the calorie count as foods with few calories will be okay.
Foods you should avoid are:
Ice cream, unless sugar-free and fat-free
Sodas
Chocolate milk or other flavored milk products
Regular lemonade
Highly sweetened iced tea
Dried fruits

Canned or frozen fruits with high sugar content

Table sugar
Candy
Pastries, pies and cakes
Sugar-coated cereals
High-fat meats such as sausages and lunchmeat
Breaded and fried foods
Creamy dressings
Cheese with high fat content (Monterey Jack, Cheddar, Brie)

The Importance of Protein

for Bariatric Patients

s you have already read, protein is an essential part of your diet following bariatric
surgery, but you may wonder why it is so important. Protein is the second most
abundant substance in the human body, following water. Amino acids that make up
proteins are not stored in the body, therefore we need to consume sufficient protein daily
to meet requirements. Proteins play important roles
in metabolism, digestion and DNA replication and
help speed healing of wounds, minimize hair loss,
increase body metabolism and repair and rebuild
damaged cells.
Weight loss surgery stresses the physical and
psychological condition of patients, making the
inclusion of protein in the diet vital for accelerated
recovery and the healing of surgical wounds. Its not
easy to consume sufficient protein following
surgery, therefore most bariatric patients incorporate
liquid protein supplements in their diets to fulfill
recommended amounts.

The Benefits of Protein

A high protein diet at the beginning is essential for maximum weight loss and surgical
recovery. Here are some of its most important benefits:
Assists in early wound healing
Enhanced growth of nails, bone and hair
Forms hormones, antibodies and enzymes
Helps burn fat instead of muscle
Results in sense of fullness after meals
Promotes recovery of tissues and helps build lean muscle
Powerful source of energy
Strengthens the immune system
Helps regulate functioning of the bodys systems
Protein deficiency can make you prone to infection and may cause muscle or hair
loss. Because your stomach is smaller following bariatric surgery, you simply cant eat
everything that comes your way as you are only able to have small portions at one time.
Thus, it is important that everything you consume is filled with health and nutrition.
Choose food wisely for the sake of your health.

Surgery can be traumatic if you are obese because, most likely, you suffer from one
or more health conditions including diabetes, hypertension, high blood pressure and
cardiovascular disease.

How Much Protein Do Bariatric Patients Need?

Because protein is present in all major parts of your body, it is important to have
sufficient intake for proper functioning of your body. The best way to know your
nutritional needs after surgery is to consult a qualified nutritionist or dietician. They will
be your best source of advice to establish your diet plan according to your type of surgery
and health conditions. Your nutritionist will also help point you to foods that are highest
in protein and best for your health.
Protein comes primarily from animals and plants. Animal proteins are considered
complete as they have all essential amino acids. Plant proteins generally lack one or more
amino acids, except for soy proteins. Animal proteins are higher in fat and calories.
Approximate protein requirements after surgery is about 60 to 100 grams per day
(60-80g for women and 80-100g for men for the first year). This number drops
gradually as you recover and lose weight. The exact amount also depends on the type of
surgery you have, so working with your surgeon and nutritionist to develop a healthy
plan is in your best interest.

The Best Protein Sources

Proteins should be the primary foods for bariatric surgery patients and should be
consumed first before carbohydrates and fats, although you may consume the latter two
in small amounts. Healthy carbohydrates like vegetables, fruits and whole grains can be
included. Acceptable healthy fats include oils, fish oils, olives, nuts, seeds and avocado.
Select proteins that are rich in nutrients and low in calories and fats like soy, meats,
beans, seafood and low-fat milk. Whatever protein sources you choose, make sure you
are getting enough nutrients and are able to consume the recommend amount of proteins
daily.

Protein Supplements
Protein shakes and other supplements used to help maintain proper protein intake
levels are usually derived from whey, casein, egg white, soy and milk. Whey protein is
relatively inexpensive as it is a byproduct of cheese making. It is easily digested and is
available in concentrate and isolates. Patients who are lactose-intolerant should take
whey protein isolate as it contains only trace elements of milk solids.
Supplements derived from casein take longer to digest and do not dissolve as
easily in milk and water when compared with whey supplements. Egg protein
supplements come from egg whites and take between one and three hours to digest. They
are ideal for lactose intolerant individuals. Soy protein supplements contain several
essential amino acids and are good for lactose-intolerant vegetarians, but may lead to
digestion problems in some individuals.

Animal Protein Foods

Amount

Grams of
Protein

Beef, lean

1 ounce

7 grams

Cheese (American, cheddar, provolone, Swiss)

1 ounce

7 grams

Cheese, cottage

1/4 cup

7 grams

Cheese, ricotta

1/4 cup

7 grams

Chicken

1 ounce

7 grams

Egg or egg substitute

1 egg

7 grams

Fish: catfish, cod, flounder, haddock, herring, orange roughy,

trout, salmon, tuna (fresh or canned, in water only)

1 ounce

7 grams

Shellfish: clams, lobster, oysters, scallops, shrimp

1 ounce

7 grams

Milk, skim (recommended)

8 ounces

12 grams

Pork

1 ounce

7 grams

Turkey

1 ounce

7 grams

Yogurt, plain nonfat or low-fat fruit flavored

3/4 cup

12 grams

Plant Protein Foods

Amount

Grams of
Protein

Beans and peas (black-eyed, garbanzo, kidney, pinto, split,

white)

1/2 cup

7 grams

Cereal, ready to eat

3/4 cup

3 grams

Lentils

1/2 cup

7 grams

Lima beans

2/3 cup

7 grams

Non-starchy vegetables (tomatoes, green beans, cucumbers)

1/2 cup
cooked

2 grams

Oats

1/2 cup

3 grams

Soy burger, veggie burger

1 ounce

3 grams

Soy milk

8 ounces

7 grams

Nuts and seeds (After the third month)

cup

7 grams

Tofu

4 ounces

7 grams

What Medical Studies Say

Participants in a study published by the Journal of Nutrition showed that a highprotein diet after bariatric surgery, along with exercise, helped patients lose weight
without causing any deficiencies while also reducing blood fat levels. A high-protein diet
also allows better control of appetite and caloric intake.
Patients who undergo bariatric surgery have, over time, an increased risk of
developing kidney stones. Limiting protein consumption can be helpful. Following
weight loss surgery, protein is emphasized as a high priority food, but that doesnt mean
you are on a high protein diet. Most patients who have undergone weight loss surgery
cannot eat large portions of animal protein. Therefore, exploring more plant-based
protein like legumes (beans) isnt a bad idea as they tend to be tolerated well after
bariatric surgery.
See more at http://www.drbrianstork.com/blog/tips-kidney-stones-weight-losssurgery/#sthasg.Znsc4GbY.dpuf

Exercise, the Key to Becoming

a Successful Bariatric Patient
ouve breezed through surgery and progressed through the clear liquid diet and have
now gone on to full liquids. You may have even noticed that your pants are even
starting to get a bit loose, so whats next?
The answer is a good exercise
program. Adhering to the diet program
prescribed by your surgeon is the easier
portion of the program, especially in the
beginning. If you dont follow it, youll get
sick, which can range from digestion problems
to vitamin deficiency, and seriously who
wants to be sick? Yet if you dont start and
maintain an exercise program, your chances of
successfully losing weight and maintaining
that weight loss will diminish significantly.
Despite what has just been stated,
regular exercise is the component of a
successful weight loss program that most
often slips. Why? Lets face it, as an
overweight person, exercise was more than a
chore, it was almost impossible. Your mind
harkens back to these realities and says no. In
your new life, you have to throw out such
thinking and tell yourself, Yes, I CAN do it.

Why Exercise?
Recent analysis shows that consistent exercise for bariatric surgery patients leads
to a 4.2% lower BMI. Another study compared weight loss of gastric bypass surgery
patients who partook in 2.5 hours of physical activity per week compared with those who
did not. Those who were active showed 5.5% greater weight loss six months after surgery
and 5.7% greater weight loss 12 months after surgery.
Obviously, exercise burns calories, but a more important reason is it also boosts
your metabolism. This means your body will burn calories more efficiently, which
becomes even more important as you lose weight because your metabolism tends to shut
down as you drop pounds. By establishing a higher base metabolic rate through exercise,
your body will automatically burn calories faster even while you are resting, leading to
additional weight loss.

Start Slowly
One of the biggest reasons that people fail at exercise is that they try to do too
much too soon. Lets face it, youre probably not going to be an elite marathoner, and
thats quite okay. Most people in the world are not and never will be. The idea is simple.
Get up, get moving and burn more calories than you have in the past because that is what
you need to do to lose weight. Do you think you cant do it? Sure you can. Exercise is as
simple as walking, which is also one of the most underrated exercises you can do.
For maximum success, begin your program within a month following surgery.
Dont overdo it, but remain consistent. One week after surgery try to walk for 15 to 20
minutes each day. If you are able to do so, avoid dehydration by walking inside on a
treadmill in a climate-controlled environment where you are out of the sun. A week later,
start increasing your daily exercise time to reach 40 to 60 minutes of activity.
For your exercise program to be successful, it must be progressive. This simply
means as the weeks and months go on you need to add elements to your exercise
program, along with increasing the time and/or the intensity. In other words, exercise
needs to become a way of life.

Find Something You Enjoy

You wont stick to your program if you dont enjoy what youre doing. There is
also no single right way to exercise. Although walking is an excellent way to begin to
increase physical activity, you could become bored with it. You may prefer walking
outdoors to be in tune with nature, or may prefer the social aspect brought about by
walking on a track inside a facility. For others, cycling is a great way to burn calories, or
maybe you would rather get into a pool where you can get an aerobic workout along with
strengthening your muscles in a non weight-bearing environment.
As you lose weight and become stronger, you can try activities such as interval
classes, weight training, kickboxing or similar classes. Again, dont try to do everything
at once and think you have to work as hard as the instructor or the other class
participants. A good instructor will recognize your fitness level and will work with you
and encourage you to work to the best of your ability. If you feel self-conscious about
exercising in a group situation, find a personal trainer who can help design a program that
you can do on your own at home or at an exercise facility.
Whatever you choose, be aware that you will have days where you dont feel well
or simply dont want to exercise. Although everyone needs a restful day here and there,
dont make it a habit as talking yourself into not exercising as this is one way you will
start to regain weight.

Tips to Stay On Track

Find an exercise partner. You are more likely to work out if someone is
depending on you to go with them to work out.
Join an exercise gym or class. Park district facilities are a good place to start as
these often have a variety of classes suited to all fitness levels.
Develop a weekly routine. Take a look at your schedule at the beginning of the
week and find ways to include exercise. If you have appointments or events that
will prevent you from exercising on one of the days, look at substitute times or
activities that will suffice.
Buy good, supportive shoes. Theres nothing worse than working out with achy
feet. Comfortable and stylish athletic clothes also make working out more fun.
Do little things like taking the stairs instead of the elevator or parking your car far
away instead of finding the nearest parking space. Actions like these add up.
Listen to music on your iPod or MP3 player for motivation.
Reward yourself when you reach a weight-loss goal.

Common Complaints, Risks and Complications

Associated With Bariatric Surgery

ll medical procedures have some risks and potential complications, with bariatric
surgery being no exception. The best advice is to follow your doctors orders as
closely as possible, but even when doing so, you will most likely have some discomfort
along the way. Heres what you may experience.

Wound Care
Similar to other surgeries, you need to be careful with your incision. Generally,
youll be able to shower 24 hours after surgery with your back to the showerhead. Baths
are permissible two weeks post-op if all incisions heal.
Bruising around the incisions is common and
disappears slowly. Any increase in redness, warmth or
pain is cause for concern as you may have an infection. A
small amount of redness is normal at the beginning and
disappears with healing. Some patients may experience
minor drainage, which is also normal unless it begins to
increase and become foul smellinganother indicator of
infection. If this occurs, visit your doctor and inform your
bariatric follow up physician if required.
Tugging, pulling, pinching or burning sensations
may accompany larger incisions. This is also normal and
will resolve itself when swelling reduces and the sutures
disappear.

Leaking
Leaks from the stomach or intestine that go into the abdominal cavity usually
appear within two weeks after surgery. When leaks occur they must be treated
immediately with surgery and another hospital stay. Following your liquid diet is
important because liquids cause less tension or stress on your stomach, minimizing the
chances of a leak. Signs of a leak include:
Abdominal pain
Fever
Sweating
Difficulty breathing
Rapid heartbeat
Chills

If you have already been discharged, notify your surgeon as soon as possible.
Diagnosis is via an X-ray test with contrast material or a CT scan.

Gas Pain and Discomfort

Two types of gas pain can appear following surgery. The first is the result of
carbon dioxide that is pumped into your abdominal cavity that helps the surgeon
distinguish between organs during laparoscopic surgery. Usually this gas is released right
after surgery, but sometimes it can hide between organs and rise up to the diaphragm
where it irritates a nerve, causing pain in your upper left shoulder.
The new size of your stomach causes the second type of pain. Because its
smaller, your stomach can only hold smaller amounts of gas or air. Everyone has air in
their stomach. Normally, you burp this out, but for the first few days, you may have
trouble doing so, just like a newborn baby. In a similar way, you ingest air with liquids,
so drinking from a straw is not recommended. Sipping from a glass or sports bottle will
minimize the amount of air you ingest. While someone can pat you on the back to burp
you to help the air escape, the best remedy is walking because it will either move the air
down into your intestines or move it upward, causing you to burp.

Nausea and Vomiting

Mild nausea is common in the first few months following surgery. Try
decaffeinated green tea to ease it. If its more than just mild, contact your doctor for
prescription medication. If severe nausea persists, contact your doctor and your bariatric
follow up physician if required.
Nausea and vomiting may also occur when drinking while eating, not chewing
enough or eating too much. Trying new foods can also trigger nausea. When this occurs,
consume only liquids for 12-24 hours after nausea subsides. Wait a few days before
trying a particular food again. Repetitive vomiting to the point where nothing can be kept
down is dangerous. Contact your doctor and inform your bariatric follow up care
physician.

Heartburn
Acid reflux may initially worsen after surgery because of delayed emptying.
Eating or drinking too quickly can also cause heartburn; stomach spasms or a stricture are
other causes. If you are having this problem, dont wait more than a day or two to call
your bariatric doctor so you are advised about over-the-counter medication or visit your
local doctor to get a prescription that will help this problem to subside.

Stool Frequency and Diarrhea

You may have loose, frequent stools in the weeks or months following surgery.
Remember that at first, you will only consume liquids, resulting in loose stools. This will
slowly improve as your diet changes. Avoid foods that seem to cause diarrhea. However,

there is a wide spectrum of bowel regularity after surgery, with some patients
experiencing constipation and others having soft or even loose stools. Symptoms also
vary with the type of surgery you have. Occasional OTC medications for constipation or
diarrhea are okay. If you have constipation, drink more liquids and consider adding more
fiber to your diet. You may need stool softeners once or twice daily. If you get diarrhea
while on protein drinks, switch to a different kind. Remember to give your bowel time to
compensate and adapt.

Dysphagia
More commonly known as difficulty swallowing, this is a subtle side effect of
any procedure that causes restriction. It may be caused by eating too fast, too much or not
chewing well enough. Food backs into the esophagus and causes chest pressure or even
tightness in the throat. Stop eating and drinking if this occurs as vomiting or regurgitation
may follow. Avoid this symptom by chewing food at least 15 times, putting your fork
down between swallowing bites and avoiding foods such as doughy bread, overcooked
steak or dry chicken breast.

Hair Loss
It is common in people with rapid weight loss to experience hair loss, hair may
come out in clumps while brushing. Hair loss diminishes as you approach your weight
goal and weight loss slows. Most of the time hair loss occurs from hormonal changes in
fat cells. Some people find commercial hair and nail supplements to be helpful as well as
supplements such as biotin, co-enzyme Q, flax seed oil and zinc.

Bariatric Surgery FAQs

atients considering bariatric surgery have many concerns about what surgery will be
like and what will happen after the procedure. Here are some of the most commonly
asked questions and answers.

How much weight will I lose and will I regain

any weight?
The amount of weight you lose, and how fast you lose it,
depends on which weight loss surgery you have. Patients
who have the lap-band surgery usually lose weight more
slowly during the first year than those who have the sleeve,
gastric bypass or duodenal switch surgery. The amount of
weight loss also depends on your age, gender, starting BMI
and your ability to adhere to lifestyle changes necessary to
make surgery a success. In most cases, you will lose 90%
of excess fat. The more you weigh, the more weight you
will lose. With any bariatric procedure, however, there is
always the chance that you will regain weight, particularly
if you do not follow your surgeons program.

What is BMI?
BMI is the abbreviation for body mass index, a key index that relates weight to height.
BMI is determined by taking a persons weight and dividing it by his or her height
squared. The National Institutes of Health (NIH) defines normal weight, overweight, and
obesity according to BMI rather than the traditional height/weight charts. Overweight is a
BMI of 27.3 or more for women and 27.8 or more for men. Obesity is a BMI of 30 or
more for either sex (about 30 pounds overweight). A very muscular person might have a
high BMI without health risks.

Will I need to have plastic surgery to get rid of loose skin?

Most patients experience loose or sagging skin at some point after surgery, but often this
condition is temporary. Your individual appearance will depend upon several factors,
including how much weight you lose, your age, genetics and whether or not you exercise
or smoke. Weight training and strengthening exercises can help avoid loose skin. Yet
some patients may opt to have plastic surgery to get rid of loose skin and fix certain areas

particularly on the abdomen, legs, arms and breasts... even a facelift. If you want to do so,
wait at least six months after you have reached your ideal weight.

How long after bariatric surgery will I have to be out from work?
Most patients return to work within two weeks. You may have low energy for a while
and may need to work some partial days, but this is normal. Your surgeon and nutritionist
will advise on what you can and cannot do after weight loss surgery.

Do I have to do anything special

immediately prior to surgery?
Patients only need to fast for eight hours before
the procedure. There is no need for colon
cleansing or laxatives related to the sleeve and
banding procedure but it is highly recommended
on bypasses and DS.

How long will I be in surgery?

Length depends on several factors like what
type of surgery you have, your medical
condition and what your BMI is. Patients with
a lower BMI have less visceral fat allowing
the procedure to go more quickly. Generally a
banding procedure takes about 45 minutes
and with a sleeve procedure you will spend
45 minutes to just over an hour in surgery. Bypasses require around one and a half
hours and sometimes a little longer.

Will I be in the ICU?

No, unless, you have pre-existing conditions that require the support of an ICU, you
will go to a regular room to recover.

Do I have to stay in the hospital until I have a bowel movement?

Due to the diet before surgery and as you follow a liquid diet afterward; your
intestines will have nothing solid. Thus, a bowel movement may take a few days and
will normally occur during your stay at the hospital or after you are released.

What could prevent or delay my surgery? What if I have heart disease?

Abnormal findings in blood work that could make surgery risky or unsafe can prevent
surgery, along with severe respiratory infections that produce mucus and secretions that
can make intubation and maintaining an open airway difficult during the procedure.
If you have heart disease, you will need medical clearance from your cardiologist.
Bariatric surgery often leads to improvement in many problems related to heart disease
including:
High blood pressure
Cholesterol
Lipid problems
Heart enlargement
Vascular disease
Even patients with atrial fibrillation, heart valve replacement, stents or heart bypasses
usually do very well. If you are on blood thinners, expect special instructs just before and
after surgery.

Does Type II Diabetes Make Surgery Riskier?

It can. Be sure to follow instructions from your surgeon about managing your diabetes
prior to surgery. Almost everyone with Type II Diabetes sees a big improvement or even
complete remission following the procedure. Some studies have even reported
improvement of Type I Diabetes after bariatric procedures.

Will I need to stop taking medication before surgery?

You can continue to take most medications, except for NSAIDs such as Ibuprofen, Advil,
Motrin, Naproxen, Aspirin and Plavix. Check with your doctor if you should stop or
replace specific medications before surgery such as Warfarin. NSAIDs are not
recommended after surgery as these can irritate the stomach lining.

Will I be able to eliminate some medications following surgery?

As you lose weight, you may be able to reduce or eliminate the need for many of the
medications you take for high blood pressure, heart disease, arthritis, cholesterol and
diabetes as these conditions will improve.

When Can I Get Pregnant After Bariatric Surgery

and Will the Baby Be Healthy?
Many OB/GYN refer patients who cant get pregnant due to
severe obesity or polycystic ovarian syndrome (PCOS), which is
reversed with bariatric surgery in most patients. Wait at least 12
to 18 months, or until you have reached your goal weight before
getting pregnant. After surgery, you will have a lesser risk of
experiencing problems during pregnancy, such as gestational
diabetes eclampsia, etc., and during childbirth. You will also
have less risk of having a C-section. Children born following
bariatric surgery have less risk of being affected by obesity later
in in life due to activation of certain genes during fetal growth.

Will my hair fall out?

Hair falling out is more likely to occur if your post-surgery diet consists mainly of foods
with little to no nutritional value. Because you will have a smaller stomach, if you
initially eat non-nutritious foods instead of protein, you wont have any room left for
what your body really needs. If hair does start to fall out, take supplements to help this
from occurring and to start regrowth.

Will I have to diet forever following surgery?

The word diet not necessarily means you will deprive yourself from all type of food.
Every person is different, therefore through trial and error you will see what foods suits
you the best but remember, try to make healthy choices as your portions of food will be
smaller. Your commitment is to make smart choices but you can still enjoy pretty much
any type of food..

Will I be able to drink alcohol?

Drinking alcohol is not recommended following bariatric surgery as alcohol will take
longer to metabolize and you will become drunk more quickly. If you do drink alcohol,
take small amounts and be aware that you may take longer to become sober. Socially
speaking it is fine to have a glass of wine or maybe two but not right after your bariatric
procedure, remember to follow your post-op guidelines and be in communication with
your dietician and follow up care physician for questions and concerns.

You can enjoy your weight loss journey and love the person you will become; bariatric
surgery can be the key to your health and happiness!

Are you ready to have Bariatric Mexico Surgery help you take control of your life as you
discover the new you? Your decision to take control of your weight and your health right
now will not only increase your life expectancy, but will also enhance the quality and
happiness of your life.
Experience what thousands of bariatric patients have already enjoyed since making the
positive choice to have life-changing laparoscopic bariatric surgery under the expert care
of Dr. Fernando Garcia and Bariatric Mexico Surgery.
Bariatric Mexico Surgery in Tijuana, Mexico provides a customized approach to your
specific weight loss needs including gastric sleeve, single incision, and lap band
surgeries.
Visit our website for more information at http://bariatricmexicosurgery.com.
Send us an email from our contact form or call us directly at 1 (800) 316-8234 to speak to
one of our customer service consultants about your specific needs and to learn more
about bariatric surgery.
We look forward to hearing from you.