Should I lose weight before surgery?
Yes, our team, including our consultant surgeons are keen that you lose some weight before your operation. 

You are asked to lose 5-10% of your weight, as recorded at your assessment appointment. We would encourage you to start losing weight when you receive confirmation that you have been approved for surgery at Homerton Hospital. 

Failure to lose weight could result in your surgery being delayed or cancelled. If you are finding weight loss difficult please contact one of the bariatric dietitians on 020 8510 7496 (option 5).

Why do I need to lose weight before surgery?
Losing weight before surgery will make your operation and anaesthetic safer and easier, lowering the risk of complications following surgery. 

By losing weight before surgery, it means you will have less to lose afterwards and it helps show motivation and commitment to making changes to your lifestyle to ensure success in the long term. Weight loss also helps with liver shrinkage.

What is liver shrinkage and why is it important?
Your liver is an organ in the body that sits over the top part of your stomach. In order for the surgeons to be able to carry out your operation they need to lift your liver up. 

We know that when people are overweight they can sometimes have an enlarged, fatty liver. This can make the surgery difficult and also more dangerous as an enlarged liver may be more likely to bleed. If a person’s liver is too large the surgeons may have to cancel their surgery.

The size of the liver can be shrunk by following a special diet before surgery. By shrinking the size of the liver, it will make the surgery safer. The diet is a low calorie diet (1000kcal a day) and low in carbohydrate and it is followed for between 2-4 weeks before surgery. You can choose which diet you follow and you will be given the information about the diets at your pre-admission appointment, usually 4 weeks before surgery.     

Will I develop excess skin after surgery and what can be done to correct it?
You may develop some loose (excess) skin following weight loss after surgery. Diet and exercise can help with the skin, but it will not get rid of it completely. We would encourage you to do exercises that may help tone your muscles and to make sure you are eating plenty of protein foods (e.g. meat, chicken, fish, eggs, beans and pulse, tofu, dairy foods) to help with your skin. It has also been suggested that regularly exfoliating and moisturising your skin and help improve its condition after surgery.

Plastic surgery for excess skin removal is not included as part of this operation and may not be available on the NHS.  Plastic surgery has to be agreed and funded by your primary care trust, through your GP. If plastic surgery is something you are considering you may have to fund it privately.

Can I get pregnant after surgery?
You must wait 18 months after surgery before getting pregnant. This is because it would be unsafe for both the mother and baby due to the fast weight loss people experience after surgery. 

Weight loss can increase fertility and certain types of contraception (e.g. the pill) may be less effective after surgery, especially the gastric bypass. Pregnancy can also limit the amount of weight loss you can experience with the surgery. 

We recommend you speak to your GP of family planning clinic to discuss the most suitable form of contraception for you. 

What will eating be like after surgery?
You will need to follow a modified diet for a few weeks after surgery. Your stomach will be much smaller after surgery, meaning you will only be able to eat small amounts. It will also be sore and swollen and if you have a sleeve gastrectomy or gastric bypass operation then the staple lines need time to heal after surgery. 

You will start off on a liquid-only diet after your operation for 2-3 weeks, you will then progress to a puree/blended diet for 2 weeks and then on to a chopped/mashed diet for 2 weeks. After this time you will gradually be able to re-introduce harder and crunchier textures.

Everyone is different after surgery in terms of the foods they can and cannot manage. However, there are a few common foods that people tend to struggle with:

  1. Roast meats- any fibrous, dry meat e.g. a chicken breast, a chop, a steak, bacon, sausages and any breaded/battered meat or fish
  2. Bread- doughy textures absorb liquid and can swell. This can lead to pain and discomfort after surgery
  3. Stringy vegetables- e.g. beans, celery, peas and sweet corn. These may not digest well and may get stuck or feel uncomfortable
  4. Fizzy drinks- gas expands and can leave people feeling bloated and uncomfortable after surgery. We recommend fizzy drinks are avoided long term
  5. Alcohol- particularly after a gastric bypass, it will enter the blood stream quickly and cause unwanted effects. We recommend avoiding alcohol completely for the first few months after surgery and then only drinking in small amounts, keeping to recommended limits.

Will I have to make any changes to my eating habits?
Eating will be different after surgery because your new stomach is smaller, and this may take a while to adjust to.  There are a few things you can do to make this easier and minimize complications:

  1. Use a small plate or bowl to serve your meals, this will help you get used to eating smaller portions
  2. Stop eating as soon as you feel full, this will minimise feelings of discomfort and sickness
  3. Chew well; this will help reduce feelings of discomfort, sickness and foods getting stuck. We recommend you chew each mouthful 30 times
  4. Eat slowly; this will give your brain time to realise when is it full, it will also help minimise discomfort after eating.  We recommend taking 30 minutes to eat a tea plate sized meal
  5. Separate eating and drinking; we recommend you leave 30 minutes before and after a meal before having a drink.  Eating and drinking at the same time could cause you to be sick after surgery.

Funding for surgery?
Bariatric surgery is a specialist procedure and the Hospital has to apply for funding before the surgery can be performed.

The funding application can take a while and the time it takes often depends on where you live. To help us to obtain the information please give as much detail as possible on your previous dietary history and your response to weight loss medication given by your general practitioner.

How long will it take me to recovery fully?
If surgery is performed laparoscopically, patients typically spend three days two nights in hospital. It takes most patients about 2 weeks to go back out to work and about four to six weeks to resume exercising.

Recovery is seen as the number of days before patients can resume common activities such as shopping, house chores, work and driving, once one is able to do so they are on the road to recovery. If you have open surgery or complications, recovery time may take longer.

Will I be able to continue taking regular medication?
After surgery all medication will be reviewed by the doctors and you will be advised to take all prescribed medications.

Diabetes medication may be stopped or reduced depending on your blood sugar readings after surgery; your blood pressure tablets may be stopped if you loose sufficient weight to reduce your blood pressure.

You are advised to get your blood pressure and blood sugar monitored regularly after surgery by your GP. No whole tablets to be taken for four weeks after surgery all medication should be in liquid, crushable or dissolvable form. 

You may be advised to avoid taking aspirin and other non-steroidal anti-inflammatory pain relievers because they may irritate the stomach.

Will I suffer from constipation?
You may suffer from constipation after surgery due to the reduction in fluid and fibre intake. You would be prescribed laxatives on discharge from hospital to help with this.

How long will my wounds take to heal?
Wound healing can vary from person to person; usually take 2 to 6 weeks to heal completely. Closing your wound surgically (with stitches, clips and staples) encourages your wound to heal faster.

Will my diabetes be cured after surgery?
Evidence suggests that Bariatric surgery puts type II (late onset) diabetes into remission in a high percentage of cases, (defined by a normalisation of Hb A1c and coming off medications for diabetes) after the surgery. A high percentage of those who stayed on medication or insulin after surgery found their dose reduced.

For those that have had type II diabetes for longer than ten years – you are less likely to have any remission.

When will I be able to drive?
Check with your car insurance provider when they will provide cover and inform them of the procedure you have had. 
Ensure you have no abdominal discomfort and if you drive a manual car, ensure you can effectively perform an emergency stop.

What is the complication and mortality rate of bariatric surgery?

  • Overall Mortality – 0.1%
  • Gastric Bypass – 0.2%
  • Overall Complications – 2.6%

(The National Bariatric Surgery Registry First Registry Report to March 2010)

Why am I having difficulties opening my bowels (constipation) after my bariatric surgery?

  • Constipation can be caused by not getting enough fluids during the day (dehydration).
  • Symptoms of dehydration include hard stools or straining to open your bowels, feeling of nausea, fullness, or loss of appetite.
  • It is important that you do not strain when opening your bowel.
  • It is important that you drink 2 litres of fluids a day and have vegetables, fruits, and fibre in your diet.
  • For more information see the NHS website on constipation and how to amend your diet.

Will I get dumping syndrome following my bariatric surgery?

  • Yes, you could however only 20 to 50% of patients get it.
  • Dumping syndrome, also known as rapid gastric emptying, occurs when sugary or starchy food moves too quickly from the stomach into the first section of the small intestine. This causes a rise in blood sugar levels as the carbohydrate is absorbed into your bloodstream.
  • Avoiding sugary and oily foods – such as cakes, chocolate, sweets and deep-fried food could  help
  • The symptoms range from mild to severe and often reduced or improved with time, as your bowel adapts.
  • Dumping syndrome is not life threatening although alarming at first and you can help to control it by making changes to what and how you eat, and by following our post-surgery dietary advice.  

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.
  • Ensure that you have requested a sickness note from your surgeon/GP if you require one.

Can I exercise/go to gym after surgery?

  • Yes, you may start on gentle exercises such as walking and increase slowly as you can tolerate.
  • Regular exercise following your weight loss surgery is just as important as eating healthily to help you lose weight safely. It is always advisable to avoid strenuous exercises and heavy lifting in the first six weeks. Do follow our bariatric physiotherapist’s post-surgery advice.

Will I have excess skin after a successful weight loss?

  • Yes, loose excess skin is common after weight loss surgery.
  • You may be left with excess folds and rolls of skin, particularly around your breasts, tummy, hips, and limbs.
  • There are factors that determine how much loose skin a person could have after huge amount of weight loss.
  • A person’s age is one of them. Skin naturally becomes less elastic as it ages.
  • The older you are when you lose weight, the less likely your skin will return to its original shape.
  • Another reason is the amount of weight loss. For example, a person who loses 250 lbs is likely to have more excess skin than someone who loses 80 lbs.

Will I get skin removal surgery under the NHS?

  • Bariatric surgeons do not perform surgery for removal of excess loose skin.
  • It is considered cosmetic surgery which means it is not always available on the NHS.
  • Surgery such as tummy tuck (abdominoplasty), are commonly performed to improve the shape of the tummy area (abdomen).
  • Many patients are not concerned by loose skin but if it becomes a future concern, you should discuss with your GP.
  • To qualify for surgery, you need to have a stable Body Mass Index (BMI) of less than 27 kg/m2 for at least 24 months, unless you are experiencing significant psychological or physical complications from the excess skin.
  • The waitlists could be very long under the NHS therefore the quickest way would be to self-fund and pay privately. It is important to remember that the NHS may not get involved when you have private treatment of this type, if your procedure goes wrong unless if it is a life-threatening condition where you need emergency treatment following a serious complication.   

What are some late complications of bariatric surgery?

  • Bowel obstruction could develop later but not initially. Due to a rapid weight loss, the patient has an increased risk of gallstones developing. Most patients at some time will experience dumping syndrome. www.ncbi.nlm.nih.gov/pmc/articles/PMC4843041/

Will weight loss surgery stop me from becoming pregnant in future?

  • No, losing weight can result in increased fertility in women within childbearing age instead.
  • It is recommended that you avoid pregnancy for at least 18 months after bariatric surgery by using two forms of contraception.
  • Discuss this with your local family planning team or your GP
  • Oral contraception may not provide enough protection after surgery, particularly in malabsorptive surgery such as gastric bypass as absorption rate is suspected to be lower.
  • It is a critical stage where most patients will be experiencing rapid weight loss therefore, they are most at risk of nutritional deficiencies which may lead to both maternal and fatal complications

Can I still smoke?

  • No, smoking is a serious health risk, and you must stop smoking if you wish to have weight loss surgery.
  • Smoking increases overall risk of complications and the specific risk of ulcer formation in the stomach.
  • This can lead to long-term pain, vomiting and even internal leaks. Smoking cessation services are available through your GP www.nhs.uk/smokefree/help-and-advice/local-support-services-helplines

Will I get low blood sugar (hypoglycaemia) after bariatric surgery as I will be eating small?

  • Not necessarily however it can happen if you do not eat when you need to or as much as you need, or if you skip a meal, drink alcohol, or exercise more than usual.
  • People with diabetes should make sure blood sugar is monitored and in target range.
  • Stay in touch with your community diabetes team and GP

When can I start exercising after bariatric surgery?

  • It is important after your surgery to start physical activity to help you to recover more quickly, it is common to be sore and uncomfortable immediately after surgery however a little movement is recommended. To start with you should take short walks of 5 to 10 minutes several times a day, use the stairs at home and move around the house.
  • Increasing your physical activity will help improve your circulation, reduce the risk of blood clots, promote wound healing, and improve your bowel function.
  • Walking is recommended as an ideal way to increase physical activity levels. You should aim to increase the distance and intensity of your walk as you feel able and aim to increase steps to 10,000 each day.
  • Aerobic activities such as brisk walking and cycling are also helpful however they will be limited by the degree of discomfort these activities cause.

How much exercise should I do?

  • Adults should do some type of physically activity daily. It is recommended that over a week, physical activity should add up to 150 minutes or 30 minutes on at least five days a week of moderate intensity activity, which can be done in bouts of 10 minutes. Alternatively, this can also be achieved through 75 minutes of vigorous intensity activity spread across the week.
  • When being physically active you should feel your heartbeat faster than normal, your breathing rate should increase, and you may feel warmer.

What exercise can I do after weight loss surgery?

A variety of endurance, flexibility and strengthening exercises are recommended six weeks after bariatric surgery.  

  • Aerobic - can give you more energy, burn calories, boost your metabolism, and strengthen your heart and lungs
  • Strength – to maintain lean muscle and keep bones strong, can help with toning
  • Flexibility – stretching to prevent injuries 
  • Swimming, cycling, and walking. Yoga, dancing, aerobics, Tai chi, and resistance training are examples of the types of activity that are recommended
  • Please do allow six weeks before doing any strength training or swimming to allow time for your incisions to heal.

What are the benefits of physical activity?

  • Maintains weight loss
  • Improves fitness, boosting your metabolism
  • Helps to develop muscle strength and preserve lean muscle mass
  • Improves mobility and balance which can aid your ability to complete activities of daily living
  • Increases your confidence and self esteem
  • Manages stress, raises mood, and reduces anxiety

Will exercise get rid of my excess skin?

After weight loss surgery loose skin can cause physical and emotional challenges. Excess skin may be uncomfortable and can interfere with normal activity. It can cause chafing and rashes when it rubs against other folds or if it stays moist. It can usually be found around the abdomen, arms, breasts, and legs. Exercise can help to build muscle which can tighten and firm up saggy skin, but it will not remove it, you may consider cosmetic surgery to remove loose skin.

How can I develop an exercise plan

  • Find a partner to exercise with
  • Use the stairs instead of a lift
  • Park your car as far from your destination as possible and walk
  • Walk as often as you can
  • Listen to motivational music while you exercise
  • Wear comfortable shoes and clothes to work out in

Take on a weekly plan of how you are going to be physically active every day