Before Surgery

Why is it recommended to lose weight before surgery?

To improve the safety and effectiveness of metabolic and bariatric surgery, surgeons ask you to lose some weight before surgery. This does three things.

1. Decreases the size of your liver. This makes it easier for the surgeon to operate.

2. Makes laparoscopic surgery safer. It also makes it less likely to be converted to an open procedure. This is because the gas pumped into your abdomen not only holds up your skin so the surgeon can see but also pushes down on major blood vessels, which can reduce blood pressure. If this happens, the surgeon can’t pump in more gas, which reduces visibility. The less visibility, the higher the risk of complications. Therefore, people with a higher BMI may be asked to lose more weight before surgery.

3. It can make it easier to lose weight after surgery. This varies for each person. In general, losing weight
leads to a lower resting metabolic rate (the rate at which you burn calories at rest) and your body will burn fewer calories. Therefore, it can actually be easier to lose weight before surgery and use the surgery as a tool to help you lose and maintain more weight loss long term.

Overall, research has shown that weight loss before surgery may reduce complications after surgery.

Source: Anderin, C. (2017). Response to “Weight Loss Before Bariatric Surgery and Postoperative Complications”. Annals of surgery, 265(4), e55.

Is there a standard diet right before surgery?

This will depend on your surgeon. Follow your surgeon’s guidance for what to eat in the days right before surgery.

Why do I need to quit smoking before surgery?

Smoking or chewing tobacco or using other nicotine products (vaping devices, e-cigarettes) harms every organ in the body and has been linked to ulcers, blood clots (the leading cause of death after metabolic and bariatric surgery), heart disease, stroke, lung disease, increased risk for hip fracture, cataracts, and certain cancers. It can also increase the risk for ulcers, wound infection, and leaks after surgery.

What are important considerations for women of child-bearing age when thinking about metabolic and bariatric surgery?

It’s recommended that you wait 18 to 24 months after surgery to get pregnant. This allows you to have maximum weight loss and reach a stable weight. You will also be able to build your nutrition back up to help make sure you have a safe pregnancy. Fertility improves with weight loss, and people often become more sexually active. Therefore, it’s important that women of child-bearing age (still menstruating) choose a birth control method before surgery.

Learn more about metabolic and bariatric surgery and family planning.

What if I decide not to have surgery right now?

At Kaiser Permanente Southern California, your referral to metabolic and bariatric surgery is good for 1 year after completing the Options pre-surgery workshops. After that, it is recommended that you retake the Options pre-surgery workshops to make sure you are prepared for a safe and effective surgery.

After Surgery

What are some alternative pain medications if NSAIDs are not recommended after surgery?

Surgery can change the way you absorb certain medications, and you may need to work with your doctors to make changes. Before surgery, it’s important to talk to your prescribing doctors about any medication you are on and have a plan for after surgery. After surgery, it will be important for you to be aware of how you feel and speak up to your health care team if anything changes.

Learn more about medications that are safe and medications to avoid after surgery on the Surgery Information page.

If I have type 2 diabetes, can I still have low blood sugar reactions after surgery? If so, how do I treat it without getting dumping syndrome?

Yes, you can still get low blood sugar reactions after surgery.

  • Mildly low blood sugar (less than 70 to 50 mg/dL) can be treated with a food that has 15g of carbohydrate (for example, an apple, grapes, banana, and string cheese).
  • More severe low blood sugar (less than 50 mg/dL) can be treated with 3 to 4 glucose tablets, 1 tube of glucose gel, hard candy, 1 tablespoon of honey, 2 tablespoons of raisins, ½ cup orange juice, or 1 tablespoon of sugar.

Dumping syndrome is usually caused by a larger sugar “load” such as ice cream and baked goods. Smaller doses like the examples above should not cause dumping.

Learn more about dumping syndrome and other possible side effects of surgery on the Complications and Side Effects page.

Can I use CBD oil or lotion for pain management after surgery?

For a successful surgery, it is recommended that you stop using any THC-containing products (marijuana, CBD oil that contains THC) at least 2 months before surgery and any time after surgery.

THC is an appetite stimulant and can interfere with the goal of surgery, which is to support weight loss by reducing desire for food and increasing satiety.

You can use CBD oil or lotion after surgery. Just make sure it does not contain any THC.

What happens if I don't take my vitamin and mineral supplements?

Surgery changes the way the body absorbs vitamins and minerals. This makes it important to take vitamin and mineral supplements for the rest of your life to stay healthy. Not getting enough vitamins and minerals can lead to:

  • Anemia
  • Bad breath
  • Bone loss
  • Brain damage
  • Depression
  • Dry skin
  • Fatigue
  • Hair loss
  • Headaches
  • Hearing loss
  • Heart disease
  • Insomnia
  • Lack of energy
  • Lack of sex drive
  • Muscle weakness
  • Skin changes
  • Tooth decay
  • Weight gain

Learn more about possible nutrition-related complications on the Complications and Side Effects page.

Will Kaiser Permanente pay for bariatric vitamin and mineral supplements after surgery?

In most cases, no. In some cases, vitamin and mineral supplements may be covered by pre-tax health spending accounts (HSA). Some patients who qualify for financial assistance can get generic vitamins covered when ordered by a physician. This does not apply to bariatric specialty vitamins.

Kaiser Permanente has contracts with bariatric specialty vitamins (Bariatric Advantage and Celebrate), which are available at a discounted rate for Kaiser Permanente members. Learn more about the vitamin and mineral supplements you need to take and the different options you have available on the Nutrition After Surgery page.

What should I do if I am struggling to get enough calories after surgery?

Connect with your bariatric health care team (care manager, registered dietitian, or bariatrician).

Are there any guidelines for wearing a corset or waist band ("waist training") after surgery?

Discuss this with your surgeon to make sure it does not interfere with wound healing. However, if the goal is to reduce excess skin, you should not use a waist band because excess skin is related to amount of weight loss, time interval of weight loss, and skin elasticity.

What is the probability of hair loss after surgery?

Hair loss is very common after surgery. It will occur within the first 6 months of surgery due to dramatic reduction in calorie intake. Regularly taking vitamins as well as meeting daily protein requirements is the best way make sure that the hair loss is only temporary. There are no proven supplements to reduce hair loss or to make hair return more rapidly. Biotin and zinc are supplements associated with healthier hair, but these are not proven remedies for this issue.

What is the likelihood of having dumping syndrome after surgery?

The likelihood of getting dumping syndrome after surgery varies by the type of surgery you have.

  • For gastric sleeve: 2 to 25% chance of getting dumping syndrome.
  • For gastric bypass: 15 to 70% chance of getting dumping syndrome.

Dumping syndrome is most commonly caused by drinking within 30 minutes of eating and/or eating fried foods, pasta, breads, and alcohol. Learn more about the types of dumping syndrome and ways to manage and prevent it on the Complications and Side Effects page.

Source: Ahmad, A., Kornrich, D. B., Krasner, H., Eckardt, S., Ahmad, Z., Braslow, A., & Broggelwirth, B. (2019). Prevalence of dumping syndrome after laparoscopic sleeve gastrectomy and comparison with laparoscopic Roux-en-Y gastric bypass. Obesity surgery, 29(5), 1506-1513.

Can I have another surgery if I regain weight?

No. Revisional surgeries (like converting a gastric sleeve to a gastric bypass) are 6 times more complicated with little or no long-term weight loss. Newer techniques like single anastomosis duodeno-ileal bypass are being studied for weight regain after sleeve, but this is not offered outside of research protocols. There are no revisional surgeries offered for regain after gastric bypass.

Can I really never drink alcohol after surgery?

Alcohol is not recommended after surgery. Surgery changes the way your body absorbs and processes alcohol. Alcohol contains calories that will work against your weight loss goal, and it may cause ulcers and dumping syndrome. Alcohol is also more addictive after surgery. One in five patients develops alcohol-use disorder within 7 years after surgery.

Learn more about alcohol and cross addiction after metabolic and bariatric surgery.

How can I get support after surgery?

The Options program is designed to support you long term.

  • Support group: Continue to attend or start attending a support group near you or online. This group offers a chance to ask questions, get support from peers and professionals, and practice ongoing skill-building. Check out the schedule of support groups:
  • Wellness Coaching by Phone: Wellness coaches are health educators with expertise in preventive health care and behavior change. Through one-on-one support, a wellness coach can help you identify goals that will work for you, create a personalized action plan, and improve your health. To schedule a phone appointment, call 1-866-862-4295 Monday through Friday, 7 a.m. to 7 p.m.
  • Connect with your bariatric team: Attend all your follow-up appointments and keep in touch with your bariatric health care team (care manager, registered dietitians, bariatricians, and surgeons).
  • Reference your Options materials: Use your Options Workshop Guide and Meal Plan as your main references. Be careful of misinformation on the internet. If you find conflicting information, always consult your Options materials or talk with your care team.

Why do patients gain weight again after bariatric surgery? Will this happen to me? When should I contact my health care team if I start to gain weight after surgery?

Weight regain can happen to anyone. Eating is often based on emotions or situations, and if either promote poor eating/drinking habits, you can regain weight.

Think about the effects of surgery like new car smell. It’s strongest when the surgery is new, and it’s likely to wane over time.  Surgery is just a tool. Tools are only as effective as you allow them to be. On average, you will see the greatest effects within the first 18 months after surgery. After that, the ability to maintain weight loss will depend on long-term lifestyle changes (sleep, physical activity, healthy eating, and mental health).

Most common patterns with weight regain are seen when patients are:

  • Drinking calories (including alcohol)
  • Grazing in between meals on “slider foods” (simple starches made with sugar, flour, or both, like pretzels, crackers, popcorn, chips, cookies, cakes, and candy)
  • Eating past fullness
  • Drinking within 30 minutes of eating

If you start to experience weight regain, get in touch with your health care team early. Many patients wait too long because they are worried their health care team will be upset. We only want to help, so get in touch sooner rather than later.

Learn more about average weight regain.

How much does metabolic and bariatric surgery cost?

Options is a covered benefit for Kaiser Permanente Southern California members. However, there are costs associated with hospitalization that will vary based on individual coverage. Please contact Member Services to discuss your individual coverage at 1-800-464-4000 24/7, except major holidays.

Can I eat cheat foods?

Many people worry whether life after surgery will mean that they’re restricted in everything they can eat. This isn’t true! Following the post-surgery meal plan will help make sure you can still enjoy many of your favorite foods. As you move through the stages of the post-surgery meal plan, you will learn which foods work for you. However, there are some key foods and drinks to be cautious of for the rest of your life. Learn more about these foods on the Nutrition After Surgery page.

If “cheat foods” are also trigger foods and it’s hard to moderate the amount you eat, then you should probably avoid them.

Will I still have cravings after surgery?

Most likely. Cravings come from a mental and emotional connection to food, drawn from past experiences. While surgery can reduce desire for food, surgery does not change the past or your relationship with food. Cravings can reduce and then reemerge over time. Learn more about how surgery may change your relationship with food on the Mental Health and Wellness page.

Do I qualify for excess skin removal surgery? When can I have it?

Excess skin is a very common side effect of surgery. Everyone reacts differently to having excess skin, but it’s important to be prepared for it and learn strategies to adjust, cope, or (possibly) remove it. Learn more on the Complications and Side Effects page.

Even if you follow all the recommendations, it’s realistic to expect that you will still have some excess skin after surgery. For some people, this is totally fine, but it may really bother others. If you do not have abnormal excess skin but wish to explore options that will reshape normal skin or remove fat to improve your appearance, cosmetic surgery (often called body contouring surgery) may be an option for you.

Excess skin removal surgery is not cosmetic surgery. The primary aim of reconstructive excess skin removal surgery is to remove abnormal skin. Cosmetic surgery goes a step further, enhancing normal appearance according to the patient’s preferences.

If you are eligible for excess skin removal surgery but also wish to further enhance your appearance, surgeons can perform cosmetic enhancements for an additional cost.

Check with your health plan to see what’s covered for you.

Important things to know:

  • Wait until your weight stabilizes. For the best results, you should wait until your weight stabilizes at your new size for several months (usually about 18 months after surgery). Otherwise, as you continue to lose weight, you are likely to develop more excess skin. Your weight should be stable for at least 6 months before you consider body contouring surgery.
  • Recovery can be painful. Many people who have had body contouring surgery say that the recovery is worse than from metabolic and bariatric surgery. In some cases, you may have to be off work for a month or more to recover fully.

How long should I take off work to recover from surgery?

This may vary from person to person, and your health care team will support you in finding what works for you. Two to three weeks off work is common after surgery.

How long after surgery until I can lift heavy objects (like my young child) or do a job that involves heavy lifting?

This may vary from person to person, but in general 3 to 4 weeks.

Can I use short-term disability and/or FMLA for time off work?

Yes, you can use short-term disability and/or FMLA for time off work.

Is the stomach removed during surgery?

This depends on which surgery you have.

Gastric sleeve (sleeve gastrectomy) surgery makes the stomach smaller by permanently removing most of it. Once you’re under anesthesia, the surgeon will place a small tube in your mouth and guide it down to your stomach. This tube is about the size and shape your stomach will be after surgery. The surgeon cuts the stomach around the tube’s outline. The part that’s left behind is closed with permanent staples. The tube is then carefully pulled back out. The portion of the stomach that was cut is then removed from the body.

With gastric bypass surgery, the stomach is separated into two parts. Each part is stapled shut. This leaves a small stomach pouch about the size of an egg. Like gastric sleeve, this small pouch limits (restricts) how much food you can comfortably eat. Next, the small intestine is cut and reattached to the stomach pouch. This is the “bypass.” The other part of the intestine is reattached to your new digestive system so digestive juices can flow easily. Food now moves from the new stomach pouch directly to the lower part of the small intestine. In gastric bypass surgery, nothing is removed.