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Life After Bariatric Surgery: Managing the Side Effects and Loose Skin (video)

Weight-loss surgeon discusses nutrition, exercise, appearance

Weight-loss surgeon discusses nutrition, exercise, appearance

Bariatric surgery includes several types of surgical procedures that alter your digestive system to promote weight loss, including gastric bypass and gastric sleeve. Losing weight is an obvious result, but it’s important for patients to understand what else to expect after bariatric surgery, especially in terms of nutrition, exercise and appearance. In this video, San Diego Health host Susan Taylor talks about the side effects of weight loss surgery with Mark Takata, MD, a general surgeon at Scripps Clinic who specializes in minimally invasive bariatric surgery.

Managing weight loss after bariatric surgery

Patients often have concerns about what they can eat after bariatric surgery. While the procedure can cause significant weight loss, it’s up to the patient to maintain their new weight through long-term lifestyle habits, including a diet high in fiber and protein and low in sugar and carbohydrates. Build meals around lean proteins and whole foods, including plenty of vegetables, while minimizing processed foods and “empty” calories with little nutritional value, such as sodas and sweets.


Most patients can have alcohol after bariatric surgery if there is no medical reason to avoid them. However, beer, wine and other alcoholic drinks can be high in calories and carbohydrates without providing much in the way of nutrition, so it’s better to minimize or skip them altogether.


What about your morning coffee? Generally, surgeons recommend you avoid coffee or other caffeinated beverages after bariatric surgery for about a month. Dehydration is a serious risk for these patients, and drinking enough water is a must. As a natural diuretic, caffeine can make staying hydrated even more challenging. Moreover, caffeine can affect digestion, increasing gut motility and interfering with the absorption of important nutrients as your body works to adapt to your altered digestive system. 


Dr. Takata also strongly recommends that patients take vitamins after bariatric surgery as directed by their care team.


“If some of the vitamin levels drop too low or possibly go too high, there can be some clinical side effects, so we monitor patients’ vitamin levels with regular blood work to make sure they’re staying in a relatively normal range,” he says. “With careful monitoring, there are very minimal risks as far as long-term side effects after bariatric surgery.”


Regular exercise is also a strong component to lasting weight maintenance. Dr. Takata encourages patients to begin walking for exercise right after surgery, steadily increasing the time and distance they walk over the first four to six weeks. At that point, most patients can start any type of exercise they enjoy.


“After about six weeks, there are really no restrictions to physical activity and we encourage that as part of their weight maintenance program,” says Dr. Takata. “We have patients who do kettlebell competitions, races, surfing, swimming and weight-lifting.”

Removing loose skin after weight loss surgery

Depending on their age and how much weight they lose, some patients may have excess loose skin after bariatric surgery. Patients who lose more than 150 pounds, for example, will have more excess skin after weight loss surgery than those who lose 70 or 80 pounds. While some patients aren’t concerned about loose skin, others want it removed. In some cases, excess skin needs to be removed for medical reasons; it may be rubbing against the body and causing irritation or rash. Or, the appearance of the saggy skin may be bothersome.


Exercise can help improve skin elasticity to some extent, but cosmetic surgery is also an option for some patients. Usually, this is an outpatient procedure performed under general anesthesia.


“In general, we want patients to wait a year or even two before we start exploring surgery to remove excess skin, mainly to show some stabilization of their weight and make sure from a health standpoint they’re doing well,” says Dr. Takata. “And plastic surgeons will generally want to see weight stabilization for about six months or a year before they start pursuing excess skin removal. It’s a discussion each patient needs to have with their surgeon.”