After Bariatric Surgery: The First 6 Weeks

After surgery for weight loss, your body needs time to adjust. Once you're ready, you'll get programs to follow for your nutrition and physical activity. Follow them as directed. The success of the surgery depends on the choices you make. You'll need to make lifelong changes in your eating and exercise habits to maintain your weight loss.

At first you may have stomach or bowel cramping or upset stomach (nausea). Tell your doctor if pain or nausea is severe or doesn't improve with time. Take pain medicines as prescribed for 1 to 2 weeks. To ease back into your daily life, you may get guidelines like these.

• You may shower within 48 hours.
• You may start driving again after you no longer need pain medicines. This may be up to 3 weeks after surgery.
• You may start having sex again in 3 weeks.
• You may return to work in 4 weeks, or as instructed, depending on the type of work you do.
• Don't lift anything over 10 pounds for 3 weeks.
• Ask about birth control. Some bariatric procedures make birth control pills (oral contraceptives) less effective. It's advised to delay pregnancy for 12 to 24 months after bariatric surgery. This gives you time to lose the weight and reduce any problems that may be caused by loss of nutrition right after surgery.

Activity helps you lose weight after surgery. Start easy, but try to be a little more active each day. You might try walking each day. This not only helps with weight loss, it can also help you recover faster. Other choices include chair aerobics or using a stationary bike.

Each person's relationship with physical activity is different. Ask for help from your doctor if you aren't sure which type of activity is best for you. The long-term goal is to do an average of 30 minutes per day of moderate physical activity. It may seem overwhelming at first. But with support and guidance, you can get there.

Your care team members can help you adjust to changes after surgery.

• Your surgical team oversees follow-up care after surgery. Keep all your appointments and ask any questions you have.
• Your dietitian sets up your new nutrition plan. They can help you plan meals you'll enjoy. Talk with them if you're having trouble sticking to the required diet.
• Your psychiatrist or psychologist or other mental health provider can help you adjust to change. It may help to talk to someone about your body or other issues. Contact a bariatric surgery support group in your area, or join an online group, such as BariatricPal.

After surgery, a special diet will help your stomach heal. At first you'll just drink low-sugar liquids like tea or broth. During your first 4 weeks at home, you'll go from a full liquid diet to a diet of low-fat pureed or semisolid food, such as applesauce.

In your first week at home: You'll be on a full liquid diet. This includes about 60 to 100 grams (g) of protein and 64 ounces (oz) of fluid a day. Half of the fluids should be from clear liquids with no protein or added sugar. Half can be from liquid protein supplements. That would be 2 to 4 protein drinks a day depending on the brand you choose. Be sure to get enough protein. If you don't take in enough protein, you may have weakness and muscle loss. This can cause serious problems.

From your 2nd through your 4th week at home: You'll be on a pureed diet. You'll begin to eat a range of foods in small amounts. Here are some tips to get you started.

• Stay focused on getting your fluids and protein. You'll still need 64 oz of fluid and 60 to 100 g of protein a day.
• Try to get 5 or 6 small meals or snacks a day. At first they may be very small, only a couple of tablespoons.
• Try one texture of pureed food at a time.
• At meals and snacks, have the protein foods first.
• Don't eat and drink at the same time. Wait 30 minutes after eating before you drink liquids.

It's important to stay hydrated. This can be a challenge because you can't gulp fluids when you're thirsty. You'll have to slow down. Drinking too much too fast can cause pain and bloating. Here are some tips for reaching your fluid goals.

• Keep fluids handy at all times, wherever you go.
• Sip slowly and frequently throughout the day, at least every hour. Try to get 4 to 8 oz of fluid every hour when you get home from the hospital, to eventually 8 oz in 5 to 15 minutes after 4 weeks.
• Make a plan. Try 8 oz by 10 a.m., 16 oz by noon, 24 oz by 2 p.m., and so on until you reach 64 oz by 10 p.m.
• Set reminders to drink. Your physical cues for thirst and hunger will be different after surgery.
• Track your intake on paper or with a smartphone app. This will help keep you mindful of your progress through the day.
• Remember that your fluids should not have caffeine, sugar, alcohol, or carbonation.

After 4 to 6 weeks: You'll begin a stabilization diet. You'll start easing back into eating a wide variety of healthy foods.

These are general guidelines. Your doctor and dietitian will give you full details about what you'll need to eat and drink, how much, and when.

Certain problems may happen after surgery, depending on the type of surgery you have. They may include:

• Malnutrition. Your body may not be able to absorb all the vitamins it needs. Symptoms include severe tiredness (fatigue), feeling cold, swollen ankles, or excessive hair loss. Take vitamin supplements as prescribed, for life, to help prevent this.
• Dehydration. A smaller stomach means liquids must be consumed in smaller amounts. Not getting enough liquids can lead to dehydration. Symptoms include feeling “dried out” or having dark and decreased urine. You may also have nausea, dizziness, less energy, headaches, and dry skin.
• Dumping syndrome. This can happen after gastric bypass procedures. After eating high-sugar foods, you may have weakness, stomach cramps and pain, nausea, sweats, or, in some cases, fainting. Stay away from foods that cause any of these symptoms, such as soda or ice cream.
• Lactose intolerance. You may lose the ability to digest lactose. Lactose is a sugar found in dairy products. Symptoms include cramps, bloating, and diarrhea. Diarrhea may occur 60 to 90 minutes after a meal. Stay away from dairy foods, such as milk and cheese, if this happens.
• Gastrointestinal issues. These can include nausea, vomiting, diarrhea, and abdominal pain. The symptoms may be short-term or persistent.
• Psychological issues. Bariatric surgery can lead to emotional and psychological changes, including depression, anxiety, and body image issues.
• Stomal stenosis. This is a narrowing of the connection between the stomach pouch and small intestine. It can lead to vomiting and trouble eating.

Contact your doctor if:

• You have a fever of 100.4°F (38°C) or higher, or as directed by your doctor.
• You have chills.
• Your incision is red, bleeding, or draining fluid.
• You have nausea or vomiting that doesn't go away.
• You feel increased pain at an incision.
• You have pain or swelling in your legs.
• You have trouble breathing or chest pain.
• You have any symptoms that your doctor told you to report.
• You feel anxious or depressed.