I am now 9 months out from my gastric sleeve surgery in May 2016. Since I try to be open about the procedure and how I lost all the weight, I get a lot of questions about it. As a part of my series of posts on Weight Loss Surgery (WLS), I thought I would do a frequently asked questions post.
Who “qualifies” for weight loss surgery?
There are obviously a lot of factors that go into deciding who is a good candidate for WLS. The basic standard for most insurance coverage is a 35 BMI with at least one comorbidity (i.e., diabetes) or a 40 BMI or higher with no comorbidity required. At my highest weight, my BMI was 43, so I met the minimum requirements.
That being said, each insurance company has its own internal requirements for covering surgery. My insurer required that I had a documented history of unsuccessful weight loss through dieting, that I show successful weight loss in the months prior to surgery, and that I have assessments by a doctor, psychologist and nutritionist all recommending surgery.
The third layer of qualification was the meeting the requirements of my particular weight loss program. I had to attend multiple appointments with my team doctors and nutritionist, I had to attend many classes to learn about how to eat before, during and after my surgery, and I had to go through preoperative tests to make sure I was healthy enough for the procedure itself. I started the program in November 2015 and got approved for surgery in March 2016.
Is the surgery painful?
I think that probably depends on whether you tolerate pain well. I did not find the surgery to be particularly painful, but I have a very high pain tolerance, so that might not be true for everyone. My stomach area was pretty sore for a few days after the procedure, but they had me well medicated so I didn’t really feel it.
How much can you eat after surgery?
This is the big question from everyone. Your stomach is very swollen from surgery and needs time to heal. At first, you can only take liquids. Every program is different, but for me, I was allowed decaf tea or coffee, sugar free popsicles, jello, chicken broth and greek yogurt for the first two weeks after surgery. I also had to drink protein shakes three times a day. I had a schedule for eating and taking my vitamins to help me keep track.
After two weeks, I could eat pretty much any soft or pureed foods. For a few weeks, I still drank protein shakes because at first I could eat very little. I remember that only 3 or 4 spoonfuls of yogurt would fill me up. I used to feel very awkward in restaurants because I ate so little that the waitress would notice it.
Once I graduated to regular foods, I could eat anything but I had to be careful to chew it fully. By six months out of surgery, I could eat a whole serving of most foods. I still probably eat less than most people, but not so little that you would notice it. The difference for me now is that I only eat until I feel full, and it’s easier for me to tell when I’m full.
One thing that is new since surgery is that I don’t drink for 30 minutes after eating. That gives my stomach enough time to digest my food.
Are you on a special diet?
Every medical weight loss program differs. In my program, we are taught healthy eating guidelines instead of being placed on a specific diet. I don’t weigh my food or eat specific amounts of carbs or protein. I don’t restrict any foods unless I want to (like my potato chip ban, and not eating scrambled eggs because they make me feel sick). Instead, I follow general guidelines that help me make healthier choices.
For example, I try to eat all of my meals between 7 am and 7 pm. That means I try not to eat after dinner. I also try to eat my meals at about the same time every day. I eat breakfast at 7am, lunch at 1pm and dinner at 7pm. If I’m hungry in between meals, I have snacks at around 10 and 4pm. We learned that eating at about the same time each day trains your body to be hungry at those times. It also gives me a good structure so that I don’t fall into my old pattern of skipping meals.
I also try to eat mindfully. I don’t eat while watching TV or while distracting myself by doing something else. I chew slowly and I put my fork down in between bites. I try to stop eating when I feel full and satisfied. It’s often a lot less than I would think!
With regard to my food choices, I try to stick to unprocessed foods as much as possible. My family has made a real effort to cook most of our meals at home. I’m careful when shopping to avoid products with a lot of additives or heavily processed ingredients. All that really means is we eat a lot of fresh vegetables and protein. I shop twice weekly so that we don’t have to worry about spoilage. I avoid caffeine and processed sugar as much as possible. When I make myself a plate of food, I portion it so half of the plate is vegetables (or fruit at breakfast), 1/4 is a protein and if I feel hungry enough the other 1/4 is a whole grain or a starch. It’s actually pretty simple to eat this way.
I stick to healthy choices 80% of the time, and indulge myself 20% of the time. That means I can have a piece of birthday cake, or eat a slice of pizza or a piece of candy as long as I’m not doing it every single day. Knowing I can still occasionally have food that is not necessarily the healthiest choice really helps me stick to making healthy choices most of the time.
Do you get sick from certain foods?
They say that the gastric sleeve procedure is less likely to cause “dumping” syndrome (where certain foods make you physically ill, like sugary foods). Some doctors actually say you don’t have dumping at all with the gastric sleeve, but based on my experience, they are wrong. In my case, scrambled eggs made me very sick. Everything else was fine, but scrambled eggs made me want to die. It’s possible that I’ve outgrown that problem but the eggs made me so sick I’m afraid to try them again. The weird thing is that hard boiled eggs and scrambled egg whites don’t bother me at all. It’s just whole soft eggs.
Sugary foods do not seem to bother me, but I don’t eat a lot of sugar so I’m not sure what would happen if I did. I have eaten a cookie, a small piece of pie and a small piece of birthday cake without a problem so far (not all at once, but on different occasions). Sugar tastes so hyper sweet to me now that I don’t really want more than a small portion of sugary food.
Fried foods make me feel unwell, but that’s mostly because they taste bad to me ever since surgery. All I can taste is the oil they were fried in and it tastes awful (almost like it is rancid). French fries are the worst offenders. They smell so good to me, but they just taste disgusting. The other thing that tastes bad is diet soda. I used to love an ice cold diet coke, but now it tastes awful. I also can’t really tolerate more than a few sips of any carbonated beverage because the carbonation bothers my stomach.
Do you just lose weight automatically after surgery?
You do at first because you can’t eat very much, so your body burns the excess fat you are carrying. Once you are able to eat more food, however, you have to start exercising and eating healthy foods to continue losing weight. The surgery resets your metabolism so it is easier to lose the weight, but you have to work on diet and exercise to really maximize the loss.
How much weight will you lose?
The average person who undergoes a gastric sleeve is expected to lose about 60% of their excess weight. For example, I was approximately 120lbs overweight, so I was expected to lose around 70 lbs. Some people will lose less and some will lose more. It has a lot to do with genetics. Basically, the surgery resets your metabolism so you can get to the weight your body naturally wants to be. How well you stick to the program and make the lifestyle changes you need to make will also play a role, especially in maintaining the weight loss after surgery.
I think this is where much of the stigma of WLS comes in. So many people think the surgery is the “easy” way to lose weight. It is definitely easier to lose weight after surgery because your metabolism is not actively fighting you, but you still have to make the recommended lifestyle changes to be successful in the long term. You won’t lose weight without making lifestyle changes, and you risk regaining the weight you lost if you don’t learn how to change your habits.
Aren’t you afraid you will gain all of the weight back?
Honestly, yes. I am working really hard to try and learn (and stick to) better eating and exercise habits so that I won’t gain everything back. Based on what I’ve read, it’s unlikely I would gain all of the weight back, but you can definitely start trending upwards again if you don’t make lifestyle changes. Fortunately, my program offers a lifetime of free monthly support groups and nutrition refresher classes so that I can stay in touch with all of the skills they taught me. I will also continue to see my nutritionist, psychologist and doctor at regular intervals for a few years.