Optimising your health for good outcomes

Before you undergo bariatric surgery, your healthcare team will carry out a series of assessments and tests to evaluate your physical and mental readiness for the procedure. These tests are essential to identify any health risks and to tailor a safe and individualised surgical plan.

Your preoperative workup may include blood tests, an electrocardiogram (ECG), a sleep study, and an endoscopy if needed. You’ll also meet with various members of the bariatric team including surgeon, nurses, dietitians, psychologists, physiotherapists, anaesthetist and physicians, who will support and guide you through each step of the preparation process.

What about my weight prior to surgery?
The team at Homerton understands that obesity is a complex health condition and many patients have spent years trying to lose weight through various methods, feeling frustrated when weight loss hasn’t been sustained.

Weight loss prior to bariatric surgery reduces the risks of surgical complications and improves post operative healing. The guidelines on our website are designed to help patients build lifelong healthy and sustainable habits. For some patients, following these will result in weight loss, but this won’t be the case for all patients. The team asks that you work with us to make every effort to follow the advice we provide as this will set you up with the greatest chance of success. If your surgeon requires you to lose a certain amount of weight prior to your surgery due to concerns about surgical risks, they will discuss this with you.

Will I have to quit smoking before surgery?
Yes, it is important to have stopped smoking (including the use of any kind of vapes/e-cigarettes including those that do not contain nicotine and other tobacco products) three months prior to your surgery. If you require support to quit smoking, please visit the Quit smoking - NHS.If you are still smoking, you will not be offered bariatric surgery. 

The importance of good adherence to treatment for any other health conditions
In order to optimise your health ahead of undergoing bariatric surgery, and to minimise surgical risks, it is important that other health conditions are managed well. We ask you to work with your GP and adhere to any medication or treatment you require. This includes full adherence with CPAP if you have sleep apnoea. If your other health conditions are not well managed, it is possible that surgery may not be offered. 

Nutrition information from our dietitians

At your bariatric assessment appointment, the team will ask some questions about your current eating habits. This is to help us establish what level of support you will need from our dietitians to optimise your diet ahead of surgery. You may be referred for support from the dietitians at any point during your journey towards surgery. Some patients will be invited to attend group sessions and others may meet with the dietitian 1 to 1. We encourage all patients to read and refer back to the nutrition information on our website to support healthy nutrition habits throughout their journey with us.

Nutrition Before Bariatric Surgery - why make dietary changes before surgery?
To help maximise success from bariatric surgery and reduce the risk of experiencing post-op symptoms, certain eating behaviours should be followed lifelong.  It is important to start making these changes now to establish good habits and make it easier for you to follow them after surgery.

Bariatric Eating Principles: 

  • Follow a regular meal pattern of 3 balanced, high protein meals over the day. These should include:
    • Protein   - meat, eggs, chicken, fish, pulses, dairy products, tofu should make up a quarter of your plate
    • Fruit and vegetables   – aim to fill half your plate with veggies and salad as these are low in calories but high in fibre, vitamins and minerals
    • Slow-release carbohydrates   - whole grains such as whole meal bread, brown rice, potatoes with skin, bulgur wheat, barley, yam, plantain, cassava, couscous, quinoa, fufu etc should fill the last quarter of the plate
    • Note  : This plate balance changes after your surgery because your portion sizes will reduce a lot but it is important you manage enough protein each day – see the section on eating well after surgery for more information

  • Aim for a minimum of 60g protein per day  – you might like to track your protein intake using an app or by checking food labels for a few days to get used to the protein content in your day to day foods. You will also find a guide to the protein content of various foods in the patient resources page.
  • Aim for 2-3 portions of calcium-rich foods  daily (dairy foods, fortified plant alternatives, green leafy veg, fish with small bones, calcium-set tofu)
  • Include 2L (or more) sugar free fluids daily  e.g. water, sugar free drinks, low fat milk
  • Avoid fizzy drinks
  • Reduce intake of ‘slider foods’   like biscuits, crisps, ice cream, chocolate – these foods are high in calories, fat and/or sugar, but don’t fill us up
  • Separate eating and drinking by 30mins
  • Practice the 20:20:20:20 ruleMouthfuls are no bigger than a 20  pence coin
    • Chew 20  times per mouthful
    • Leave 20  seconds between bites
    • Spend no more than 20  minutes eating each meal
    • start taking A-Z multivitamin and mineral x1 daily

  • Limit alcohol intake

Visit the patient resource page for more information on eating well before bariatric surgery

Movement and exercise for improved outcomes

Physical activity and exercise play a vital role in every patient’s journey towards bariatric surgery. The bariatric physiotherapy team can provide expert support to help you to optimise your physical health, support surgery recovery and promote long-term health and wellbeing throughout this journey. 

Following referral into the service, you will have an appointment with a clinician where you will be asked about many aspects of your current lifestyle. This will include questions about your general physical activity levels, any targeted exercise if this is applicable to you, and any barriers to movement or activity. There are many reasons why you may have difficulties with movement or exercise, for example persistent pain, reduced energy levels, lack of time or confidence with exercise.

Following this assessment, you may be referred to the bariatric physiotherapy team, if there are support needs identified. If you have not been referred but feel you would benefit from support with physical activity or exercise, please speak with any member of the team during your pre-operative appointments about whether you would benefit from a referral to the physiotherapy team.

If you are referred to the physiotherapy team, the type of support that would best suit your individual needs will be identified. This may include: 

  • an individualised assessment with personalised advice, education, and an exercise prescription or plan.
  • a seated group exercise class alongside other patients in the bariatric pathway. 
  • a gym-based group physical activity and education programme alongside other patients in the bariatric pathway. 

We understand that many people in our pathway have experienced challenges with physical activity in the past. Our role is to support you in finding ways to move that feel manageable and meaningful to you, to help you become more active, build strength and feel more confident with movement. All support is tailored to your current level of activity and personal goals. 

Being physically active before surgery has significant benefits, including:  

  • improved cardiovascular fitness and respiratory function: Enhances heart and lung function, reducing the risk of complications during and after surgery.
  • weight management: supports pre-operative weight loss, which can lower surgical risks and improve recovery time.
  • enhanced metabolic health: Improves blood sugar control and insulin sensitivity, reducing the risk of diabetes-related complications. 
  • increased muscle strength and mobility: Supports better physical function and independence, facilitating early post-operative mobilization which reduces risks of post-surgical complications. 
  • improved general wellbeing: Research supports positive effects of exercise on mood and stress. 
  • fosters long-term habits: Establishing an exercise routine pre-surgery supports sustained lifestyle changes critical for long-term weight management. 

 To support your health outcomes, we recommend that you try to work towards or continue to achieve at least 150 minutes of moderate intensity activity per week. At least two days per week you should incorporate a resistance-based type of activity (for example using weights, household items or resistance bands), to help build or maintain muscle mass. For further essential information and support to achieve this, please refer to the patient resources tab of our website. 

Emotional wellbeing and behavioural change

Bariatric surgery is not just a physical procedure; it also brings major emotional and behavioural changes. That is why psychological input may be a key part and recommendation for your journey before surgery. Here at Homerton Bariatric Service, the psychology team offer pre-operative patient support via a variety of mediums to help them prepare for a sustainable, life-changing journey.

Psychological Benefits of Bariatric Surgery
Bariatric surgery not only improves physical health but can also have positive effects on emotional well-being. Everyone’s bariatric surgery journey is unique, so the following benefits may or may not apply to you. 

Bariatric surgery can lead to significant weight loss and improvements in overall health, such as better control of diabetes, high blood pressure, sleep problems, and joint pain. Many individuals also report feeling more energetic and able to take part in everyday activities more easily.

Psychologically, research shows that bariatric surgery can lead to significant improvements in anxiety, depression, and eating behaviours, leading to better overall well-being. Additionally, bariatric surgery may improve body image, boosting self-esteem and confidence.

Psychological Risks of Bariatric Surgery
While bariatric surgery offers many benefits, there are psychological risks that should be considered. It is important to be aware of these potential risks, monitor your mental health, and maintain open communication with your healthcare team(s). Everyone’s bariatric surgery journey is unique, so the following risks 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 patients 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.

Bariatric surgery is just one part of your journey. We strongly recommend accessing psychological support before 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 before 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. 

What We Offer Pre-Operatively

Self-Guided Online Resources
Please refer to the patient resources tab on 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.

Psychology Assessment
Pre-operatively, the psychology team plays a crucial role in assessing a patient’s psychological readiness for bariatric surgery and determining whether the timing is appropriate. This involves assessing whether the patient is currently free from disordered eating, emotionally and mentally stable, and has realistic expectations regarding bariatric surgery, along with effective coping mechanisms for any post-operative challenges that may arise. Additionally, they help set realistic expectations about the surgery’s outcomes and potential post-operative challenges, ensuring the patient is fully informed. These appointments are either in-person or online. 

Alternative one to one therapy
Due to limited capacity, we are unfortunately unable to offer one to one therapy for patients considering bariatric surgery. Bariatric surgery can be a challenging and long-term journey, with many ups and downs. Therefore, if you need support with your emotional wellbeing in relation to bariatric surgery and making long-term lifestyle changes, we strongly encourage patients to self-refer to NHS Talking Therapies. 

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 (9am – 9pm) – 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 include:

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

Preparing for surgery when you have a date

The pre-op liver shrinkage diet
In the weeks leading up to your surgery you will be asked to follow a very low calorie (around 1000kcals) diet that is also low in starchy foods and sugar (carbohydrates). The main aim of this diet is to reduce the size of your liver ahead of attempting laparoscopic (keyhole) bariatric surgery. Keyhole surgery carries less risk and has faster recovery times when compared with open abdominal surgery and is the only type of bariatric surgery performed at Homerton. Without undertaking a strict liver shrinkage diet, your surgeon may not be able to access the parts of your stomach they need to operate on using the keyhole technique and may have to cancel or abandon your procedure.

The liver shrinkage diet will also help you to lose weight ahead of surgery which can reduce surgical and anaesthetic risks.

Your surgeon will advise you how long you need to follow this diet and when you need to start it. You will have a choice of a few different diets which are all designed to achieve liver shrinkage. The bariatric dietitians will support you to follow your chosen diet carefully. You will be invited to an education session as part of the pre-admissions process to learn more and ask any questions you may have. You will be sent supporting written information and are also able to access the presentation from the education session and our information leaflet under the patient resources section of our website.

It is crucial that you follow your liver shrinkage diet as prescribed, as if your liver remains too large, your surgeon may have to cancel or abandon your surgery. Following this diet for prolonged periods of time can be challenging and can risk nutritional deficiencies. Please do not start this diet unless and until you have been instructed by your surgeon.

Some medications may need adjusting or stopped, for example blood thinners or diabetes treatments. If you have any medical conditions that may be impacted by a significant change in your dietary intake, please discuss this with your healthcare professional during your appointments.

You may use the links below to remind yourself of the liver shrinkage advice and what you need to do in the early stages after surgery. These videos are designed for bariatric patients. If you have been advised to watch these videos in preparation for a different type of surgery, please note that not all the information will be relevant to you and seek clarification from your surgical team if any questions arise.

 Link to Surgery Preparation Group Videos and handouts