Life After Weight Loss Surgery

Though weight loss surgery has tremendous benefits, dealing with the aftereffects can also be very challenging

By Denise Mann
WebMD Weight Loss Clinic - Feature

Reviewed By Michael Smith, MD

Unlike past cruises, this summer as Susan Kochman, 57, and her husband, Ed, sail the Western Caribbean, she plans to spend significantly less time grazing the round-the-clock buffets and much more time touring Cozumel, Grand Cayman Island, and other ports.

The reason?

Like growing numbers of Americans (including such famous folk as weatherman Al Roker and singer Carnie Wilson), Kochman, who lives outside Philadelphia, underwent weight loss surgery on Dec. 3, 2004, and has since lost 54 pounds.

"I have so much more energy," she says. "Before I had the surgery I needed to nap every day. I almost never nap anymore." What's more, she is off all of her heart failure medications and almost completely weaned off of her blood pressure medications.

"The surgery met my expectations, and I had high expectations," she tells WebMD. In fact, she says this past New Year's Eve was the first ever that she did not shed a tear for auld lang syne. "I was so happy and so looking forward to the next year."

But weight loss surgery isn't a quick fix or a free ride. It is a major surgery that involves shrinking the stomach size by sealing off most of the stomach and creating a small, thumb-sized pouch that greatly restricts food intake. The pouch also bypasses part of the small intestine to reduce the amount of calories and nutrients absorbed from food. And the surgery is often only the beginning.

What follows can include additional surgeries and severe lifestyle restrictions, and sometimes disillusionment.

Weight Loss Surgery a Last Resort

That's why for Kochman and many others, weight loss surgery is often a last resort. "After years and years of dieting and losing a little weight and then gaining more, I knew that I had reached a point where it was do this or concede that I was going to die early," Kochman says.

In 2004, about 140,600 people underwent weight loss surgery; a 36% increase from 2003. Preliminary estimates from 2005 suggest the number will increase even further, according to statistics from the American Society for Bariatric Surgery (ASBS).

This especially holds as more and more people are deemed acceptable candidates. For example, elderly patients can safely undergo weight loss surgery and can be expected to experience similar benefits from the operation as currently experienced by younger patients, according to a recent study in the Archives of Surgery.

Buoyed by the increasing popularity, surgeons are also honing their skills and refining their techniques. Today, the procedure can be performed minimally invasively via small incisions, and in some centers, such as Cedars-Sinai Medical Center in Los Angeles, it can even be done on an outpatient basis.

Not Risk-Free

Like all major surgeries, weight loss surgery can have complications.

As many as 20% of patients need additional surgery to mend complications such as abdominal hernias. Because of malabsorption in the shortened digestive tract, roughly 30% of patients develop conditions due to malnutrition, such as anemia and osteoporosis, according to the National Institute of Diabetes and Digestive and Kidney Diseases. Some obese patients who have had weight loss surgery will also develop gallstones.

It's also not all that glamorous. The new stomach requires several tiny, nutrient-rich meals a day supplemented with additional vitamins and minerals. Eating too much or indulging in rich, sugary or fried foods can overload the pouch and cause dumping -- a term used to describe the sweats, chills, and nausea that result from food filling the pouch and overflowing straight into the small intestine.

"Initially after the operation, it's recommended that a person eat pureed foods to give the operation a chance to heal, but after that, behavioral modifications are key," says Harvey Sugerman, MD, emeritus professor of surgery at Virginia Commonwealth University in Richmond, Va., and president of the ASBS.

"You can't eat large volumes of food, and you get full more quickly," he says. But not indefinitely.

Regained Weight May Be an Issue

And that's why as time goes on, not all former weight loss surgery patients remain as pleased with the surgery as Kochman does right now, says Jacqueline Odom, PhD, the psychological director of the Beaumont Weight Control Center in Royal Oak, Mich.

"Surgery is not a cure for obesity, it's only a tool."

"A year or two years out, patients are reporting struggling with weight regain because they are struggling with their old eating habits and may have not incorporated portion control and exercise," she says.