If you’ve recently had bariatric surgery or are considering bariatric surgery as a way to lose weight, today we are going to explain the three distinct phases of weight loss following surgery. Each phase requires different advice to ensure that patients are not only going to recover well from their surgery, but also achieve optimal weight loss and health throughout every stage of their journey.
While every person is different, after surgery we want the focus to be on healthy and sustainable eating and exercise habits. Maintaining weight loss is only possible by the proper management of nutrition by eating healthy food and taking vitamin supplements. Having regular follow-ups with the team helps us meet your health needs more effectively.
Early Postoperative Phase (first 6-8 weeks)
Typically patients lose 50% of the weight they will likely lose during the first 3 months after surgery. During this early postoperative phase, regardless of the procedure, the aim is not only to maximise the speed of your recovery from surgery but also to help establish good habits for the next stage of sustained weight loss.
Until you have healed internally (typically approximately a month after surgery), eating solid food will be uncomfortable and can potentially cause injury. Therefore nutrition in order of importance is fluid intake, protein, fibre and vitamins. Firstly liquids, then purees, then soft food.
It is important to keep hydrated so you should be aiming for over 1 – 1.5 litres of fluids per day, including any fluid-like foods (e.g. soup). If you’re consuming any less than this you risk dehydration which will cause nausea, and you will not be discharged from the hospital until you have shown you can drink this much.
A minimum of 25 grams of protein is needed for health, but aiming for 50 + grams is the aim once you can manage it. Protein supplements can help if you are falling behind. Liquid fibre supplements or gentle stool softeners will prevent constipation and we also start you on chewable multivitamins at this point. But fluid and protein are more important for how you recover at this very early stage.
Around the 3 – 4 week mark you will be able to start consuming soft foods, but before then you will rely on liquid foods like yoghurt (available with added protein), soups, protein drinks and purees for main meals.
Weight Loss Phase (2 – 18 months)
As you have now recovered from your weight loss surgery and will have initially lost a significant amount of weight due to the restrictions in your eating and dietary changes, this next phase is typically when patients lose the remaining weight. There are very few patients that continue to lose weight beyond 18 months, so it is important to focus on your diet and, later on, exercise during this crucial phase.
The habits that you establish during the weight loss phase post-bariatric surgery will assist you in creating the lifelong changes that are needed for long-term weight maintenance in the next phase.
Key areas contributing to weight loss during this phase:
Regular meals – sticking to three meals a day (usually two simple and one complex meal). It’s important to establish a meal eating routine that works for you and stick to it, this will help you avoid grazing and snacking which will hinder your weight loss or lead to weight regain in the future. For example if you go to bed late, don’t have your evening meal early, as you are more likely to eat again (snack) before you go to bed. Sticking to regular meals and eliminating snacks leads to significant weight loss.
Avoiding liquid calories – although liquid calories are important in the weeks immediately after your surgery, once you can consume solid foods again the only liquid foods should be soups or meal replacement drinks. Fizzy drinks, milkshakes, and milky/sugary coffees are all high in calories and low in nutritional value and should be avoided, as they will hinder weight loss.
What You Should Be Eating During This Phase.
Protein – aiming for 50+g of protein a day (minimum 30g). Protein is an excellent appetite suppressant and a better option as a base for a meal than carbohydrate items such as pasta or bread.
Fruit & Vegetables – in addition to protein, including low-starch vegetables, salads and fruits in your mealtimes are excellent inclusions, as they are high in nutritional value and low in calories. But that doesn’t mean that you can use fruit as an excuse to snack between meals; snacks contain pointless calories (usually as sugars) that could have been avoided and usually increase your overall hunger.
Vitamin & Mineral Supplements – you don’t want to miss out on important nutrients while losing weight and you need to support your body during this time. Patients benefit greatly from daily multivitamins, some examples: vitamin D, iron, calcium, vitamin B12 or other minerals such as zinc, magnesium etc.
Regular exercise patterns – Complex exercise is mostly pointless in the immediate and early post-op period, but daily exercise “activities” such as walking are essential. From 2 weeks post-op it’s ok for most people to do simple treadmill/stationary cycle exercise and light (1-2kg) weights in addition to walking. Aqua aerobics is also ok to start after this time as well. Gradually increasing intensity of exercise and the amount of “resistance” in exercise is appropriate but we generally tell people to stay away from “endurance” or “bulking” regimens until at least 6 months after surgery, otherwise there are risks of injury, excessive loss of body protein and immune function, or risks of interfering with your weight loss trajectory.
Weight Maintenance Phase (18 months and beyond)
By this phase of weight loss following bariatric surgery, you have hopefully formed some positive habits that will enable you to maintain your new lower weight, long-term. Remembering that if the habits that lead you to become overweight in the first place return, then your weight problem will also return.
What you should be considering during this phase:
Avoiding snacks – by now you should be eating three regular meals a day, so shouldn’t require snacks, aside from the odd special occasion. Most patients will regain their weight as a result of snacking, so avoiding snacks will help you to maintain your weight long-term.
Multivitamins – weight loss surgery alters the way that your body absorbs and processes vitamins and minerals, sometimes permanently, so it is important to ensure that you are taking your daily multivitamins and have blood tests every 6 – 12 months to determine if you need to adjust your supplements.
Controlling dietary intake – there are certain ‘problem’ foods such as cheese, carbohydrates, alcohol and milky drinks that can be part of a diet and can cause weight gain. Where possible try to avoid or at least limit your intake of these types of problem foods.
Exercise is crucial!
Weight loss will have created a host of exercise opportunities that were not previously available to you. If you are not undertaking a minimum of 2 hours, and preferably around 4 hours every week of exercise activity, above your normal weekly routine then you can expect problems with your weight and health to occur at some stage. We recommend a mixture of aerobic and resistance work. While aerobic exercise such as brisk walks, cycling and swimming are easily available to most people, resistance exercise such as light weights, aerobics/aqua aerobics, yoga and pilates takes more planning so this needs to be an intentional part of your schedule.
After around three years post-surgery the majority of patients will find that they experience some sort of weight gain – this is completely normal. That’s why it’s critical that if you have gained weight, to seek help from the team who will be able to support you with the right tools to get you back on track. Losing weight following bariatric surgery is challenging, but the biggest challenge is creating new lifestyle habits and sticking to them long-term.
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