Frequently Asked Questions

Obesity is caused by consuming more calories than the body uses over a sustained period of time; this excess is stored in the body as fat. 

It is a complex, chronic long-term condition that can be difficult to treat. There are many causes of obesity including metabolic, environmental, genetic, hormonal and a disordered relationship with food.

Those who suffer with obesity are also more likely to develop a range of other diseases including diabetes, coronary heart disease, high blood pressure, sleep apnoea and early arthritis; which can only be managed by losing weight.

The support group is a place to meet Dr Evren and the patients who have had or are considering weight loss surgery. The group meetings are held online. If you would like to attend please email your full name and date of birth to [email protected] confirming your consent for email correspondence with our team.  

The group takes place on the third Friday of every quarter, from 6pm until 7.30pm. Virtual sessions are held via Microsoft Teams. We have limited spaces available, and these will be given out on a first come, first serve basis. 

We will post updates about future planned dates for 2022 nearer the time.

Immediately after surgery, for at least six to eight weeks, you will be required to follow a special eating plan. This will be planned and discussed with you by our specialist bariatric dietitian and specialist bariatric nurse.

If you experience any problems after surgery it is important that you contact us directly as soon as possible. You will be given contact details for us on your discharge from hospital. There are a number of other things that you will also need to consider:

Lifelong commitment:
As in all treatments for obesity, successful results will depend on your motivation and the actions you take. The surgery is a tool which enables you to make the necessary changes to your diet and physical activity levels.

Our specialists will support you along the way and you will be required to attend regular follow-up appointments for the rest of your life to ensure that your weight loss is maintained and to monitor your general health and wellbeing, as well as to pick up any potential problems early.

Monitor your diet:
All treatments for obesity require a lifestyle change. Our staff will provide you with after-surgery guidance to ensure you maintain your diet and nutrition plans, this will reduce the risk of any problems occurring after surgery and will maximise your weight loss.

It is important that you follow our recommendations to manage your diet and stick to the recommended food portions, so that you do not experience any unpleasant side effects. Our dietitian will advise you on how to manage your eating habits, dependent on which type of surgery you have.

Increase your physical activity levels:
In order to ensure you experience the best possible weight loss after surgery you will be required to increase physical activity levels.

Many patients who experience excess weight can suffer from long standing health conditions and are unsure which activity is right for them. You may then be invited to attend an appointment with the Bariatric Specialist Physiotherapist who will discuss appropriate activities, explore local services and create individual exercise plans.

Take regular supplements

If you have had obesity surgery you will be required to follow a well-balanced diet and take nutritional supplements and medications for the rest of your life. Some bypass surgery patients develop nutritional deficiencies such as anaemia, osteoporosis and metabolic bone disease – although these can be avoided if a balanced diet and daily vitamin and mineral supplements are taken. 

Our specialists will closely monitor you to ensure that any potential problems are picked up early.  Our specialists will discuss with you the impacts of surgery with you before a decision about whether to operate is made.

Weight loss following bariatric surgery varies greatly.  A weight loss of 70%-80% excess weight can be expected 18 months after surgery, but it can vary a lot depending on surgery type, physical activity and dietary habits. 

The term ‘excess weight’ refers to how much extra weight a person has over a healthy BMI (25 kg/m2).  Achieving a BMI of 25kg/m2 and below is not a realistic goal for every patient who undergo bariatric surgery, but they can still achieve clinically significant benefit to their health.

An example of excess weight and weight loss is shown here:

Weight at surgery: 127kg, height: 1.66m, BMI: 46kg/m2
Weight at BMI 25kg/m2: 69kg
Excess weight: 127-69= 58kg
Weight today: 90kg, BMI 32.7kg/m2
Weight lost: 127-90 = 37kg
% excess weight loss: 37÷58 x100 = 63.8%

18-24 months after surgery weight loss is expected to slow and stabilise. Sometimes some weight will be re-gained (6-12kg) and then plateau, for others a gradual increase can continue. If weight regain continues, please feel free to contact us for additional support.

To continue to maintain weight loss and avoid weight regain following weight loss surgery, certain behaviours and adjustments should be followed lifelong.  These include:

Eating Habits:

• Eating small portions by using small plates or bowls for meals to avoid over-eating.
• Taking 60-80g protein per day for satiety and to meet the nutritional requirement.
• Chewing food well and eating slowly (20-30 minutes for a meal) to minimise symptoms of nausea or pain on eating and to increase fullness.
• Leaving a 30-minute gap between eating and drinking to increase fullness and reduce dumping syndrome.
• Avoidance of fizzy drinks.
• Limiting alcohol.

For more information on eating after weight loss surgery, please speak to our team.

Physical Activity:

It is essential that patients continue with regular physical activity for life to help maintain weight loss and reduce the risk of developing co-morbidities associated with weight gain along with post-op risks such as osteoporosis and muscle loss.

Recommended physical activity guidelines for adults, Department of Health, UK:

1. Adults should aim to be active daily. Over a week this should add up to 150 minutes (or 30 minutes on at least 5 days a week) of moderate intensity activity in bouts of 10 minutes or more.
2. Adults should also undertake physical activity to improve muscle strength on at least two days per week.
3. Moderate intensity physical activity will cause adults to get warmer, breathe harder and their hearts to beat faster. Examples include walking or cycling.

Psychology:

Weight loss tends to significantly slow down around 12-18 months post-surgery, and for some, this is when it becomes clearer that surgery is only a tool and that keeping weight off in the long term will require lifelong changes in diet and physical activity.

Common difficulties include:

• Slower weight loss than anticipated, weight plateau or weight regain, ability to manage more food over time, stressful life events and disappointment that surgery does not solve particular life difficulties. These may result in a feeling of loss of control over eating, difficulties with motivation and mood, or getting back on track after lapses.
• Challenges in dealing with changes in relationships or unwanted sexual attention.
• Intense fear of weight regain, which may lead to unhelpful rules about food and eating which are difficult to follow, or coping with changes in body image from the point of view of weight and/or excess skin.
• Worry about surgical complications. For example, difficulty swallowing due to strictures post-op can lead to a fear of swallowing foods of a certain type or texture even when the stricture has been dilated and there is no physical blockage remaining. Others may experience worries about what has happened to the pouch, or in rare cases, develop signs of trauma following surgery.

While some worry and fears are a normal part of adjusting to the surgery, it is important to discuss any concerns if they persist or if they are impacting negatively on weight loss or quality of life. Consider whether a referral to a psychological service may be helpful, or whether it would be useful to get back in touch with our team.

You will need to follow a modified diet for a few weeks after surgery. Your stomach will be much smaller after surgery, meaning you will only be able to eat small amounts. It will also be sore and swollen and if you have a sleeve gastrectomy or gastric bypass operation then the staple lines need time to heal after surgery. 

You will start off on a liquid-only diet after your operation for 2-3 weeks, you will then progress to a puree/blended diet for 2 weeks and then on to a chopped/mashed diet for 2 weeks. After this time you will gradually be able to re-introduce harder and crunchier textures.

Everyone is different after surgery in terms of the foods they can and cannot manage. However, there are a few common foods that people tend to struggle with:

1. Roast meats- any fibrous, dry meat e.g. a chicken breast, a chop, a steak, bacon, sausages and any breaded/battered meat or fish
2. Bread- doughy textures absorb liquid and can swell. This can lead to pain and discomfort after surgery
3. Stringy vegetables- e.g. beans, celery, peas and sweet corn. These may not digest well and may get stuck or feel uncomfortable
4. Fizzy drinks- gas expands and can leave people feeling bloated and uncomfortable after surgery. We recommend fizzy drinks are avoided long term
5. Alcohol- particularly after a gastric bypass, it will enter the blood stream quickly and cause unwanted effects. We recommend avoiding alcohol completely for the first few months after surgery and then only drinking in small amounts, keeping to recommended limits.

Eating will be different after surgery because your new stomach is smaller, and this may take a while to adjust to. There are a few things you can do to make this easier and minimise complications:

1. Increase your water intake to prevent constipation
2. Use a small plate or bowl to serve your meals, this will help you get used to eating smaller portions
3. Stop eating as soon as you feel full, this will minimise feelings of discomfort and sickness
4. Chew well; this will help reduce feelings of discomfort, sickness and foods getting stuck. We recommend you chew each mouthful 30 times
5. Eat slowly; this will give your brain time to realise when is it full, it will also help minimise discomfort after eating. We recommend taking 30 minutes to eat a tea plate sized meal
6. Separate eating and drinking; we recommend you leave 15 minutes before and 30 minutes after a meal before having a drink.  Eating and drinking at the same time could cause you to be sick after surgery.

Yes. You are asked to lose 5-10% of your weight, as recorded at your assessment appointment. We would encourage you to start losing weight when you receive confirmation that you have been approved for surgery with Dr Evren. 

Losing weight before surgery will make your operation and anaesthetic safer and easier, lowering the risk of complications following surgery. By losing weight before surgery, it means you will have less to lose afterwards and it helps show motivation and commitment to making changes to your lifestyle to ensure success in the long term. Weight loss also helps with liver shrinkage.

Your liver is an organ in the body that sits over the top part of your stomach. In order for the surgeons to be able to carry out your operation they need to lift your liver up. 

We know that when people are overweight they can sometimes have an enlarged, fatty liver. This can make the surgery difficult and also more dangerous as an enlarged liver may be more likely to bleed. If a person’s liver is too large the surgeons may have to cancel their surgery.

The size of the liver can be shrunk by following a special diet before surgery. By shrinking the size of the liver, it will make the surgery safer. The diet is a low calorie diet (1000kcal a day) and low in carbohydrate and it is followed for between 2-4 weeks before surgery. You can choose which diet you follow and you will be given the information about the diets at your pre-admission appointment, usually 4 weeks before surgery.    

You may develop some loose (excess) skin following weight loss after surgery. Diet and exercise can help with the skin, but it will not get rid of it completely. We would encourage you to do exercises that may help tone your muscles and to make sure you are eating plenty of protein foods (e.g. meat, chicken, fish, eggs, beans and pulse, tofu, dairy foods) to help with your skin. It has also been suggested that regularly exfoliating and moisturising your skin and help improve its condition after surgery.

You must wait 18 months after surgery before getting pregnant. This is because it would be unsafe for both the mother and baby due to the fast weight loss people experience after surgery.

Weight loss can increase fertility and certain types of contraception (e.g. the pill) may be less effective after surgery, especially the gastric bypass. Pregnancy can also limit the amount of weight loss you can experience with the surgery. 

We recommend you speak to your GP of family planning clinic to discuss the most suitable form of contraception for you. 

As the surgeries are performed laparoscopically, patients typically spend five nights in hospital. It takes most patients about 2 weeks to go back out to work and about four to six weeks to resume exercising.

If you have a gastric balloon procedure then you might have a shorter stay in hospital (typically one night). We recommend for you not to travel straight away (wait 3-4 days before travelling/planning your journey back) due to possible nausea or vomiting. 

Recovery is seen as the number of days before patients can resume common activities such as shopping, house chores, work and driving, once one is able to do so they are on the road to recovery.

After surgery all medication will be reviewed by the doctors and you will be advised to take all prescribed medications.

Diabetes medication may be stopped or reduced depending on your blood sugar readings after surgery; your blood pressure tablets may be stopped if you loose sufficient weight to reduce your blood pressure.

You are advised to get your blood pressure and blood sugar monitored regularly after surgery by your GP. We recommend all medication should be in liquid, crushable or dissolvable form however, you would be able to take any required tablets once you move onto the 'puree stage' of your diet . 

You may be advised to avoid taking aspirin and other non-steroidal anti-inflammatory pain relievers because they may irritate the stomach.

Wound healing can vary from person to person; usually takes 2 to 6 weeks to heal completely. Closing your wound surgically (with stitches, clips and staples) encourages your wound to heal faster.

Evidence suggests that bariatric surgery puts type II (late onset) diabetes into remission in a high percentage of cases, (defined by a normalisation of Hb A1c and coming off medications for diabetes) after the surgery. A high percentage of those who stayed on medication or insulin after surgery found their dose reduced.

For those that have had type II diabetes for longer than ten years – you are less likely to have any remission.

Check with your car insurance provider when they will provide cover and inform them of the procedure you have had.

• Overall Mortality – 0.1%
• Gastric Bypass – 0.2%
• Overall Complications – 2.6%

(The National Bariatric Surgery Registry UK, First Registry Report to March 2010)