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10 Things Your Doctor Won’t Tell You About Weight Loss Surgery

If you’re considering weight-loss surgery, there’s a good chance you’re getting plenty of pre- and post-op guidance from a doctor you trust. But that’s not always the case, and for many people who have this type of procedure, life after surgery can be full of surprises — the good, the bad, and even the downright embarrassing. If you’re thinking about undergoing bariatric surgery, here are a few things you should know that the doctor may forget to mention.

1. You may get very depressed post-surgery.

There’s a proven link between obesity and depression, and while the majority of patients who undergo bariatric surgery do experience an overall improvement in their well-being after surgery, feelings of depression can worsen for some. Researchers from Yale University published a study in the Obesity Journal in which 13 percent of patients studied reported an increase in Beck Depression Inventory – a numerical rating that measures eating disorder behavior, self-esteem, and social functioning – six to 12 months after gastric bypass surgery, a time frame that the authors conclude is an important period to assess for depression and associated symptoms.

2. Excess skin can be an issue — and corrective surgery is costly.

Though the post-surgery weight loss may be gradual enough that your body and skin can adjust slowly, many people are left with such an excess that it requires cosmetic surgery to fix. And unless it’s deemed medically necessary (such as a surplus of droopy skin causing a rash or infection), your insurance company will not be footing the bill. According to the American Society of Plastic Surgeons, in 2013 member surgeons performed nearly 42,000 body contouring operations — reshaping of breasts, arms, thighs, and stomachs — for patients who lost substantial amounts of weight. Body contouring operations can cost anywhere from $4,000 to much, much higher.

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3. You’re going to poop more — a lot more.

About 85 percent of patients who undergo Roux-en-Y Gastric Bypass (RNYGB) surgery will experience extreme bouts of diarrhea known as dumping syndrome at some point post-surgery, according to The American Society for Metabolic and Bariatric Surgery (ASMBS). It’s usually the result of poor food choices (including refined sugars, fried foods, and some fats or dairy), and can have mild-to-severe symptoms that also include sweating, flushing, lightheadedness, desire to lie down, nausea, cramping, and active audible bowels sounds. Sound like a nightmare? Unfortunately, that’s not all: Loose stools, constipation, and embarrassing gas (or as experts refer to it, malodorus flatus) are other common bowel-related complaints after surgery.

4. It could boost your risk for alcohol use or abuse.

One study published in JAMA examined people who had gastric bypass surgery at one, three, six, and 24 months after surgery and found that patients’ risk for increased alcohol use after the procedure was significantly higher. This may be because patients have higher peak alcohol levels, and reach those levels more quickly, after bariatric surgery, although other theories do exist to explain the connection.

5. You’ll still need that gym membership.

Many doctors will counsel patients on a proper post-surgery diet to help promote weight-loss success after surgery, but that’s not the only lifestyle change patients have to make. The Obesity Action Coalition recommends that once a patient is cleared by his or her doctor to introduce physical activity into a daily routine, gradually working up to 60 minutes of exercise six days per week is ideal for promoting post-surgery weight loss success. In other words, don’t think you’re getting off easy; this surgery isn’t a  quick fix.

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6. You’ll have to say goodbye to soda.

That’s right: Carbonated beverages are a big no-no because they introduce air into your belly, creating gas that can put pressure on your stomach and cause it to expand unnecessarily, thereby undoing the surgery results. Instead of soda, drink lots and lots of water, as dehydration is the most common reason for a patient’s readmission to the hospital, according to the ASMBS.

7. It could put a strain on your marriage.

Drastic physical transformations can lead to a variety of emotional changes that can affect not just you but your relationships as well. At least one study has found an uptick in divorce rates among couples with a bariatric surgery partner, especially in the first year after surgery. So in addition to great post-operative medical care, you also may need to think about seeking emotional guidance for you and your spouse — either via counseling with a therapist or by joining a support group, which can help limit the negative effects on your relationships.

8. You could be a candidate for new hunger-controlling device that can treat obesity.

The FDA just approved a first-of-its-kind pacemaker-like weight loss device called the Maestro Rechargeable System, which helps suppress appetite by sending electronic pulses to the nerve of the body that communicates hunger to the brain. Though less invasive than bariatric surgery, the device does require an hour-long outpatient surgery to implant the device in the patient’s abdomen. Since it’s not yet widely available, and weight loss results aren’t nearly as impressive as bariatric surgery, it may not replace your need for bariatric surgery; still, it could be a good option for severely obese patients who need help getting to a weight where they can safely undergo bariatric surgery, or for those who need help with post-surgery weight control, so it’s worth discussing with your doctor.

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9. The risks of surgery are low compared with doing nothing at all.

Though weight-loss surgery has a reputation for being risky, the procedures have improved over the years and are a lot safer now; the ASMBS reports that the chances of having a major complication are only about 4.3 percent. The risks of staying obese — heart disease, diabetes, stroke, and even death – are far more dangerous.

10. Most people say they’d do it again in a heartbeat.

Though success is a long-term project for patients who undergo this serious procedure, most people say that if they could go back in time, they’d choose to have the surgery again. Many people report that after the surgery and subsequent weight loss they feel better, are more active, and take fewer medications to treat the complications of obesity — all of which can greatly improve a person’s quality of life.

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