The Bariatric Surgery Journey: Long Term Issues

Issues-everyone has them! In our life’s journey, there are always issues. Actually, I prefer the word “challenges.” That is life, if you are growing and changing. What matters is how we respond to the challenges in which we are presented. It’s important to recognize that there is no personal growth during the easy times. It is only during the times when life gets hard that there is the potential for personal growth. Your surgical journey is full of opportunities for personal growth.

One such opportunity is the challenge of maintaining your new lifestyle so that your weight-loss success is lasting. Success in this area starts with achieving small victories on a daily basis. Win these small battles each day, and the war will not seem insurmountable. The difficulties encountered differ from person-to-person, however, in my opinion, the pathway to maneuvering through the minefield is consistent from person-to-person. It starts with “changing your mind” as we discussed previously. We must change how we choose to see ourselves and how we choose to respond to situations in which we find ourselves. In order to maintain the lifestyle and keep your hard won “New Life” you don’t have to be perfect or lead a life that denies you of pleasure. You just have to make good decisions day-by-day regarding your activity and nutrition.

Remember, life is messy! Things we don’t like are going to happen. How we respond to this will decide how healthy we remain in the long run. If we turn to our tried and true way of using food to soothe us or to celebrate, we will regain weight. I believe that weight regain after bariatric surgery is one of the most devastating things that can happen to my patients. I instruct them to return for an evaluation if they gain 10 pounds. It is a slippery slope and cannot be left unmanaged. We must also develop new coping strategies. Activity is a great way to deal with stress! It raises our own natural endorphins (opiate like substances), you have heard of the “runners high” and our self-esteem.

“I had always experienced relief from mental torment in bodily exercise.” – Victor Frankenstein.

Excess Skin
Another issue (challenge) that consistently comes up is what to do about areas of sagging skin that some patients have after massive weight-loss. This turns out to be one of those areas where patience is a virtue. Skin is a tissue that is very biologically active and does remodel itself to a great extent. Its capacity to do that does however diminish with age. We obviously cannot do anything about that, but we should do all that we can to promote healthy skin. This generally means that you must get your nutrition right so that the skin has a chance to rebound as much as possible. Hydration is important. Follow your surgeon and dietitian’s advice in this area. Eat a healthy high protein, low carbohydrate, low-fat diet. Follow the American Association of Clinical Endocrinologist, The Obesity Society and The American Society for Metabolic and Bariatric Surgery (AACE, TOS and the ASMBS) combined clinical practice guidelines regarding vitamin and mineral supplementation after bariatric surgery.

Additionally, smoking and ultraviolet radiation from the sun is damaging to the skin and must be avoided. Following these simple rules will give your skin the best chance to rebound as much as possible. After living with your new body for 18-24 months, you can decide if there are areas that are problematic and seek help with those. There are surgical procedures, and there are exciting non-surgical (laser, freezing) procedures as well that you may want to consider down the road!

Hair Loss
Finally, concern about post-operative hair loss is almost always brought up. Hair loss is usually a temporary phenomenon that occurs between three to six months after surgery. After that, the rapid weight-loss starts to slow down for most patients, and the hair starts coming back in. I have never seen anyone go bald, but if your hair is thin to start with the, loss is more noticeable. This initial hair loss appears to be a stress response to the dramatic physical and hormonal changes that the body is going through. Long-term hair loss is probably related to poor nutrition, so once again it goes back to the basics. That is, follow the high protein, low carbohydrate, low-fat diet recommended by your surgeon and dietitian and follow the vitamin and mineral supplementation recommended for your surgical procedure by the combined research of the AACE, TOS and ASMBS.

Conclusion
I cannot stress enough the importance of preparing for surgery as recommended, changing your mind set, following-up with your multidisciplinary team, surrounding yourself with positive, supportive people and most importantly, implementing regular exercise and eating a high protein low carbohydrate diet with appropriate vitamin and mineral supplementation. In the end, achieving weight-loss success with bariatric surgery is about continually pursuing a healthy lifestyle which will free yourself to enjoy all the things you want to do that the obesity was preventing you from doing. Embrace and enjoy your healthy New Life!

About the Author
Dr. Stephen Boyce obtained his Bachelor of Science and Masters of Science from Texas A&M University, College Station, before beginning medical school in Dallas, Texas at the University of Texas Southwestern Medical School where he received his medical degree. Surgical Residency was performed at Parkland Memorial Hospital in Dallas where he completed his general surgery training and was introduced to weight loss surgery under the tutelage of Dr. Otto Wilbanks, a pioneering father of weight-loss surgical procedures. With more than 24 years of experience performing bariatric surgeries, Dr. Boyce has completed more than 4,000 weight-loss surgical procedures, has special training in advanced laparoscopic surgery and has also completed a Masters Certification in Bariatric Surgery. He started his own practice the New Life Center for Bariatric Surgery in Knoxville, Tennessee in 2002, which shortly after became one of the Nation’s first Centers of Excellence (7th in the Nation) in 2005.  He is the Medical Director of the Tennova Center for Surgical Weight Loss in Knoxville, TN.  His special interest in bariatric nutrition led him to develop Bari Life Bariatric Supplements, specializing in custom multivitamin formulas for the weight loss surgery patient. Additionally, he is an active educator for Ethicon-Endo Surgery and he was the first physician to be awarded by the Obesity Action Coalition (OAC), “Outstanding Membership Recruitment by a Physician Award.”

Disclaimer: This blog post does not reflect the views of the OAC, the National Board of Directors or staff. Information contained in this blog post is not based on scientific research and has not been validated. The OAC does not endorse any merchandise mentioned in this blog post.



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