Adjusting to your new normal

We recognise that adjusting to the ‘new normal’ can be challenging. This initial adjustment often involves learning to cope with multiple challenges such as adhering to strict dietary guidelines, managing changes in appetite and digestion, maintaining regular physical activity, navigating emotional and psychological adjustments, and developing new social habits. 

Listed below are some psychological challenges that people may struggle with post-operatively. Everyone’s bariatric surgery journey is unique, so the following challenges may or may not apply to you. Please note, this list is not exhaustive.

Losing a lot of weight can change how you feel, both in your body and your mind. Many people expect to feel better about how they look and to have more confidence, but sometimes the changes don’t match what they hoped for. Things like excess skin can make it harder to get used to your new body (Note. Reconstructive surgery is currently not commissioned by the NHS). This can make you feel worried, sad, or even upset. These feelings might cause mood swings or make mental health problems worse, especially if you already find them hard to manage.

The stress from the surgery, recovery, and changes after the operation can sometimes lead to feelings of depression, mania, or even psychosis in some people. This is more likely in those who already have a complex mental health condition(s).

After bariatric surgery, some people might develop unhealthy eating habits or find it hard to manage their relationship with food, especially if they have had problems with food before or have a mental health condition(s) that make it difficult to regulate emotions.

Research shows that bariatric surgery can increase the risk of suicide and self-harm. This can happen because of changes in how they feel about themselves, emotional stress, or adjusting to life after surgery. While anyone can be affected, those who have struggled with these thoughts or behaviours before are at a higher risk.

Research also shows that some people might start having problems with alcohol after bariatric surgery. This can happen because they feel different about themselves, feel stressed, or find it hard to get used to life after the operation. Sometimes, people replace one addiction with another, which is called addiction transference. While this can happen to anyone, people who have had problems with alcohol before are at higher risk.

Following surgery, losing weight can change how your body processes medications, including those for your mental health. If relevant, you may need adjustments to your medications, so it is important to contact the service that prescribes them. It is also essential to closely monitor any changes in your mood or emotional well-being during this time.

Crisis Support Services

Please note, we are not a crisis support service. If you don’t feel you can keep yourself safe right now, seek immediate help by calling NHS 111, text SHOUT to 85258 or go to any hospital A&E department. Call 999 and ask for an ambulance if you can’t get to A&E.

The Samaritans
Offers 24/7 telephone and email emotional support and befriending in complete confidence at any time of day or night. They will accept reverse charge calls, or they will call you back.
Telephone: 116 123 (National Free Phone Number)
Website: www.samaritans.org
Email: jo@samaritans.org
Face-to-Face: Central London Branch – 46 Marshall Street, London, W1F 9BF (9:00am – 9:00pm) – Behind Carnaby Street. Nearest tube stations Piccadilly Circus & Oxford Circus)

Saneline
Offers telephone and email information and emotional support for those experiencing mental health difficulties, their families and carers.
Telephone: 0300 304 7000 (available 4:30pm – 10:30pm, every day)
Website: www.sane.org.uk

Shout Crisis Text Line
Free, 24/7 mental health text support in the UK. You can text us any time, day or night. Your messages with us are confidential and anonymous.
Textline: Text ‘SHOUT’ to 85258
Website: www.giveusashout.org

National Suicide Prevention Helpline UK
Offers a supportive listening service to anyone with thoughts of suicide.
Telephone: 0800 689 5652 (available 24 hours, every day)

Drug and Alcohol Services
Explore the impact drugs and/or alcohol has on life, set goals to reduce/abstain from alcohol, develop support network, improve health and wellbeing, learn skills to manage cravings, increase self-esteem.

Examples of services
Change Grow Live (CGL)
Telephone: 0800 014 7440
Email: thealcoholservice.info@cgl.org.uk
Website: www.changegrowlive.org

Turning Point
Website: https://www.turning-point.co.uk/support-we-offer/drugs-and-alcohol

We Are With You
Website: https://www.wearewithyou.org.uk/

To find your local drug and alcohol service, please use the following link: https://www.nhs.uk/nhs-services/find-alcohol-addiction-support-services/

What We Offer Post-Operatively

Here at Homerton Bariatric Service, the psychology team offer post-operative patients support via a variety of mediums to help them adjust to their ‘new normal’.

Self-Guided Online Resources
Please refer to the patient resources tab of this website.

Exploring Your Emotions Group
This group is an online, five-session Acceptance and Commitment Therapy-informed group-based treatment designed to help patients understand emotional eating and equip them with practical coping strategies to effectively manage it. You may be recommended to attend this group by your healthcare team, alternatively, if you feel that you would benefit from attending, please contact us on the relevant number in our contact section. 

Please refer to our short video in the patient resources section for an introduction on this topic on this website.

Building Body Acceptance Group
This group is an online, four-session Acceptance and Commitment Therapy-informed group-based treatment designed to foster greater body acceptance and empower patients with practical strategies to manage challenges effectively. You may be recommended to attend this group by your healthcare team, alternatively, if you feel that you would benefit from attending, please contact us on the relevant number in our contact section.

Please refer to our short video in the patient resources section for an introduction on this topic on this website.

Psychology Assessment
Post-operatively, the psychology team plays a vital role in supporting patients in maintaining both physical and psychological well-being after surgery. These appointments are typically online. 

One to one therapy
Bariatric surgery is just one part of your journey. We strongly recommend accessing psychological support after surgery to help manage the emotional changes that can arise throughout this difficult journey. Seeking this support is a normal and important part of achieving overall wellness and adjusting to the many challenges along the way.

If you notice any changes or challenges in your mental health after bariatric surgery, please remember that support is available, and we encourage you to stay in touch with us, your GP, and/or mental health team to ensure both your physical and emotional well-being are maintained.

Most patients do not require psychological intervention. However, our psychology team is available to provide one-to-one, short-term psychological therapy to assist patients to manage a variety of post-operative challenges. Depending on staff’s relevant training and experience, this may include support with emotional eating, body image concerns, coping with change, weight regain, binge eating or disordered eating, and trauma relating to the surgery. Please note that, due to high demand, there may be some waiting time before support can begin, but we are committed to ensuring you receive the care you need. 

Alternative one to one therapy
It is common to experience low mood or anxiety that is not related to surgery but can make it difficult to follow your recovery plan. If you need support with your emotional wellbeing, we strongly encourage patients to self-refer to NHS Talking Therapies. Please refer to the following website: https://www.nhs.uk/mental-health/talking-therapies-medicine-treatments/talking-therapies-and-counselling/nhs-talking-therapies/

What you can do and when

Can I still smoke/vape? 

  • No. Smoking before or after bariatric surgery can seriously increase your risk of complications and reduce the long-term benefits of the procedure. Most bariatric teams strongly advise quitting at least 3 months before surgery  and staying smoke-free afterward.
  • Smoking increases overall risk of complications and the specific risk of ulcer formation in the stomach, blood clots (deep vein thrombosis and pulmonary embolisms) and higher chance of breathing problems and pneumonia.
  • Smoking cessation services are available through your GP. https://www.nhs.uk/service-search/other-health-services/stop-smoking-support-services 

  
When is it safe to have sex again? 

  • You may resume sexual activity once you are pain-free and feel physically ready.
  • It is normal to feel a mix of emotions after surgery. Communicate openly with your partner and take things at your own pace.
  • Fertility may increase soon after surgery—even before periods return—so use contraception.


When is it safe to get pregnant?  

Bariatric surgery often improves fertility, especially in people with conditions like PCOS or irregular periods. But because your body goes through rapid weight loss and nutritional changes, it's important to wait before trying to conceive.

It is recommended that women wait 18-24 months after bariatric surgery before considering pregnancy. This gives your body time to recover and stabilise from the weight loss which helps reduce increased risk of miscarriage, malnutrition, high blood pressure in pregnancy and need for caesarean delivery. Oral contraceptive pill is not absorbed the same way after bariatric surgery, so it is recommended that non-oral forms of contraception are used, or two methods of contraception concurrently. We recommend you speak to your GP of family planning clinic to discuss the most suitable form of contraception for you.


How quickly can I return to work after bariatric surgery? 

  • You should expect to return to work after two to four weeks depending on what you do for a job and how you are feeling within yourself. Physically demanding jobs may require 4-6 weeks of recovery time.
  • Ensure that you have requested a sickness/fit note from your surgeon/GP if you require one.
    Even after returning, you might experience low energy and need time to adjust to full workdays. If your job involves lifting or strenuous activity, you may require returning to modified duties temporarily if your work allows. You will need to discuss this with your work manager.
     

Tips 

  • Ease back in with part-time hours if possible.
  • Plan meals and hydration around your new dietary needs.
  • Avoid heavy lifting for at least 6 weeks.
  • Stay in touch with the bariatric team for guidance.
  • Everyone heals differently, so it’s best to follow the post-surgery advice and listen to your body.
     

When will I be able to drive?
You should wait at least 1 to 2 weeks before driving after bariatric surgery and only do so when you are pain-free, no longer taking sedating painkillers, and can safely perform key driving tasks—like wearing a seatbelt comfortably, checking blind spots, and making an emergency stop.  It’s also important to contact your car insurance provider to ensure you're covered and to inform them of the procedure you’ve had.  

When you should seek help

Recognising when to seek medical help after bariatric surgery is essential for a safe recovery. If you experience any of the symptoms listed below, seek urgent medical attention.

You can do this by attending the Emergency Department at Homerton Hospital (Homerton Row, London E9 6SR) or by calling 999 for an ambulance if you are too unwell to travel safely.

Homerton’s bariatric team advises patients to contact them for post-operative concerns, within working hours. Monday-Friday 9am-5pm, and you will have been given contact details upon discharge.

  • Persistent high fever or chills
  • Vomiting blood or black, tarry stools
  • Severe chest or abdominal pain
  • Rapid heart rate or breathing
  • Unable to eat or drink due to vomiting/dehydration

 

Early Complications (Days to Weeks After Surgery) 

These are surgical emergencies and requires immediate attention.  

  • Anastomotic leak - Symptoms: Fever, rapid heartbeat, abdominal pain, breathing difficulty
  • Internal bleeding - Symptoms: Light-headedness, low blood pressure, bloody vomit or stool
  • Blood clots (DVT or pulmonary embolism) - Symptoms: Leg pain/swelling, chest pain, shortness of breath
  • Stomach or bowel leak - Symptoms: Severe abdominal pain, nausea, fever
  • Wound infection - Symptoms: Redness, warmth, swelling, pus, or fever around incision site. Contact your GP

 

Short-Term Complications (Weeks to Months After Surgery) 

Contact the Bariatric team

  • Stricture or stenosis (narrowing at surgical site) - Symptoms: Vomiting, trouble swallowing, food intolerance
  • Gallstones (from rapid weight loss) - Symptoms: Sharp upper abdominal pain, nausea, pain after eating fatty foods
  • Bowel obstruction - Symptoms: Abdominal bloating, pain, vomiting, constipation