Is weight loss surgery the ‘easy’ way out?

I often see people saying that weight loss (bariatric) surgery is an easy option. There is an idea that anyone can lose weight if they try hard enough. 

I think it’s fair to say that the initial weight loss could be ‘easy’. You could cut your calories and exercise daily and the weight will come off, but the real difficulty is keeping the weight off. Once you stop the diet and go back to your normal way of eating, the weight will come back on, and you’ll likely regain more than you lost initially.

With people that have tried lots of diets and have had their weight go up and down for years, they may reach a point where they need more help. This is where weight loss surgery comes in.

Types of bariatric surgery:

The most common types of weight loss surgery are the gastric sleeve and the gastric bypass.

They work by reducing the amount of food you can eat, reducing feelings of hunger so you eat less, and with the bypass, reducing the amount of energy you absorb from food. 

Here is everything you need to know about the lifestyle changes with bariatric surgery.

Bariatric surgery changes how you eat forever:

Bariatric surgery means you can’t eat as much as you did before, with most people eating what would be considered a child’s portion. It also means certain foods have to be prioritised over others. 

The key nutrient is protein. When people lose weight, they’ll lose fat but they can also lose muscle. To reduce muscle loss, getting enough protein is essential. As your stomach size is greatly reduced, you need to make sure you’re filling up on what’s most important. So protein becomes the priority at every meal and snack.

When eating, there lots of other things that have to change after weight loss surgery:

• Chewing food slowly: if you eat too quickly, you won’t be able to recognise when you’re full and can easily overeat. If you overeat you will likely vomit as there is nowhere for the food to go. Putting your cutlery down between each bite is a useful way to help slow down.
• Sipping drinks slowly: It’s important to sip fluids slowly too as you won’t have the stomach capacity to chug drinks down. If you were to drink too quickly, you can easily overdo it and bring things back up.
• Eating the protein part of the meal first: protein is needed to preserve muscle mass. You should eat this first to ensure that if you get too full to keep eating, you know you’ve filled up on what’s most important. After the protein you can eat the fibrous foods like vegetables. Lastly, if you have room, you can eat carbohydrates. These are the least important after surgery and a lot of people are not able to manage carbs afterwards as they’re too full or find them difficult to get down.
• Separating eating and drinking: leaving a 30 minute gap between eating and drinking is needed to prevent bringing things back up. This means if you eat something, you wait 30 minutes before you can have a drink.
• Snacking on protein foods: as protein is the key nutrient, any snacks someone has between meals should be working towards their protein target. Snacks like boiled eggs, low fat cheese, yoghurts, or ham slices are popular options.
• Limiting fizzy drinks and alcohol: carbonated drinks can be incredibly uncomfortable as the gas in the drink creates pressure in the stomach. This can cause bloating and nausea. Alcohol is a known toxin and stomach irritant. After surgery people will also get drunk quicker as the alcohol is absorbed faster, which can lead to more risky behaviours. Ideally both should be avoided for at least 6 months after surgery.

There is also the risk of nutrient deficiencies after surgery so people have to commit to taking supplements for the rest of their lives. The standard regimen for someone after surgery would look like:

• 1 or 2 multivitamin tablets a day
• A calcium and vitamin D tablet every day
• An iron tablet every day
• A vitamin B12 injection every 3 months

If any other nutrient deficiencies are found, then this will have to be supplemented too.

That’s all the food things that have to change, but there’s the mental side to think about too.

Bariatric surgery changes how you think about yourself: 

Emotional eating is very common in people with larger bodies. After surgery, it won’t be possible to use food as a coping mechanism, there won’t be the stomach capacity for it. People need to find something else to bring them the same satisfaction that they used to get from food. This is a difficult switch to make if it’s something someone is used to doing.

It can also be hard to get used to the new ‘you’. If you’ve been living in a larger body for some time it takes a while for your brain to adjust to your new size. 

People that have lost lots of weight tend to still see themselves as the 'fat one’. They may reflexively go for larger sizes when clothes shopping, may put lots of food on their plate out of habit, or may avoid mirrors as they don’t want to see themselves.

People can also find it challenging being in social situations as their identity has always been ‘the fat friend’ and they may be treated differently in their new size. It can be hard to handle the new attention or the change in friendship dynamics.

It can take a long time to adjust to all of this.

Finally, there’s the risks of the actual surgery itself.

Bariatric surgery comes with risks:

As with any surgery there is a risk of complications like blood loss, infection, blood clots, reaction to anaesthesia, the list goes on. But specifically to weight loss surgery, the new anatomy of your stomach can also go wrong.

People can have things like:

• Bowel obstructions - where there’s a blockage in their gut and food can’t pass through
• Strictures (narrowing) anywhere in the gut - leading to not being able to eat or drink as things can’t pass through
• Staple line leaks – where the formation of the new stomach is faulty and stomach contents leak out
• Malnutrition – it may sound silly to have malnutrition as a risk of weight loss surgery as the goal is to lose weight, but there is a still a risk of vitamin and mineral deficiencies. If these go untreated, it can lead to a host of other issues.
• Gallstones - when people lose weight quickly there is a risk of gallstones forming which can be severely painful and become infected. People may need further surgery to remove their gallbladder.

That’s a whistle stop tour of the lifestyle changes that come with bariatric surgery. This blog post isn’t meant to replace medical or dietetic advice but to give you a better idea of what signing up for weight loss surgery means. 

If you have any questions, feel free to comment below.

Bye for now 👋

References: 

https://bomss.org/wp-content/uploads/2021/06/BOMSS-guidelines-Final-version1Oct14.pdf 

https://pubmed.ncbi.nlm.nih.gov/22525731/ 

https://www.bmj.com/content/382/bmj.p1880 

https://www.nice.org.uk/guidance/ng246/chapter/Medicines-and-surgery#surgical-interventions