Living with Bariatric Surgery: Managing your mind and your weight

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Confirm date and type of procedure, pre-surgical weight, lowest post-surgery weight, and current weight sleeve gastrectomy – some of your stomach is removed, so you cannot eat as much as you could before and you'll feel full sooner

Sweating, dizziness, or fainting after eating or drinking – this may be from post-prandial reactive hypoglycaemia especially if provoked by high-glycaemic index foods or drinks. The symptoms may include flushing, weakness and loss of consciousness and can be severe, and may impair driving, and have implications for the DVLA. Specialist referral to an endocrinologist is recommended for confirmation of the diagnosis, which can be complex as symptoms may overlap with dumping syndrome, and a dietetic referral in the interim can be helpful if there is likely to be a long wait.

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Rothmore J. Medications after bariatric surgery. In: DATIS frequently asked questions February 2019. Adelaide: Drug and Therapeutics Information Service; 2019 Gastric bypass and other weight-loss surgeries don't always work as well as you might have hoped. If a weight-loss procedure doesn't work well or stops working, you may not lose weight and you may develop serious health problems.

Difficulties were described in developing new coping strategies to replace food, which had previously been a ‘comfort blanket’: ‘…all your insides are different but your brain…no different whatsoever…that for me was the hardest thing to adjust to, because my brain was still telling my stomach I was hungry but obviously I couldn’t [eat]…’ (P03). One patient described developing an alcohol dependency postsurgery (which they had eventually overcome), and two participants mentioned the need for more psychological input to help with their adjustment following surgery: ‘There was no formal counselling…and that might be a good idea to find out why we eat so much, why are we addicted to food…’ (P04). Confusion, eye problems, hair loss, pins and needles and a wide variety of other neurological disturbances. These can occur with vitamin and mineral deficiencies. This should be investigated and referral made if concerned. Serious neurological problems are associated with thiamine (B vitamin) deficiency and require urgent treatment (as per BNF) and referral. Biliopancreatic diversion with duodenal switch (BPD/DS). This is a two-part surgery usually performed in one setting. The first step involves performing a sleeve gastrectomy. Developed by the working group: Dr Carly Hughes, Mary O’Kane RD and Dr Helen Parretti with input from Ken Clare, Dr Esther Waterhouse and Dr Emma Shuttlewood.Standardization of HRQL measures used in future bariatric surgery studies is needed to overcome the current issue of heterogeneity of measures leading to difficulties synthesizing HRQL results of individual studies. To improve outcome selection and reporting in future bariatric surgery effectiveness trials, the UK-based BARIACT study developed a core outcome set for bariatric surgery, using a Delphi process with health professionals and patients [ 60]. HRQL was one of the nine items prioritised for inclusion in the final core outcome set. Building upon the BARIACT study, work is underway to standardize measures of HRQL through the Standardizing Quality of life measures in Obesity Treatment (SQOT) initiative, an international collaboration of healthcare professionals and people living with obesity aiming to achieve global consensus on the key components of HRQL and preferred measures [ 61, 62]. This may include a recommendation to include both a generic and an obesity-specific HRQL measure. This would allow information about specific issues relevant to people with obesity to be compared with generic HRQL issues which could also be considered in relation to population norms [ 25••, 28]. More well-designed RCTs with long-term follow-up are needed to provide good quality evidence comparing the impact of different bariatric surgery operations on HRQL [ 25••]. The By-Band-Sleeve study ( n=1351) and the BEST study ( n=2100), both ongoing, will be the largest randomised datasets [ 55••, 57••]. you've tried all other weight loss methods, such as dieting and exercise, but have struggled to lose weight or keep it off Diarrhoea, or abdominal pain after eating or drinking. This may indicate dumping syndrome which is caused by the release of gut hormones and the rapid entry of water into the gut. It is classified as early or late dumping. Early dumping is most common type (40% after RYGB and SG), late dumping is experienced by around 25% of patients ( Bettini et al). Early symptoms are predominantly vasomotor (palpitation, flushing, faintness) and gastrointestinal (abdominal pain, diarrhoea, bloating and nausea) and occur within 15 min after meal. Late symptoms (tremor, perspiration, aggression, fatigue, weakness, confusion, hunger and syncope) occur in 1–3 hr after eating when the blood sugar drops to lower level. These patients should be referred to a bariatric dietitian. Some participants described an improved or more ‘normal’ relationship with food after surgery, whereby they had retrained their mind to focus on ‘eating more sensibly’ rather than thinking they were ‘on a diet’ (P11). Others experienced no real change to their relationship with food, feeling as though they still had to be ‘on a permanent diet’ (P19), or continued to use food as way of coping with difficult emotions which remained: ‘I still have an awkward relationship with food…still have the same demons…I probably rely on food to deal with certain emotions’ (P14). Moreover, she stressed that it is important that patients think about actively managing mood issues, such as depression and anxiety, either before or alongside surgery. These are not necessarily factors which should prevent people from having surgery, she added, but it is vital that patients are aware so they are able to anticipate, recognise and manage themselves after surgery. By identifying these issues and how they are linking to eating, healthcare professionals can then help patients develop strategies and coping mechanisms, so patients can manage their issues in a different way rather than defaulting to their usual patterns. Managing expectations

More long-term risks are associated with the changes made to your stomach. According to the Endocrine Society, these may include: Furthermore, Groven found that many of the women reported having a negative relationship with food after the procedure. gastric band – a band is placed around your stomach, so you do not need to eat as much to feel full Rebecchi F, Ugliono E, Palagi S, Genzone A, Toppino M, Morino M. Robotic "Double Loop" Roux-en-Y gastric bypass reduces the risk of postoperative internal hernias: a prospective observational study. Surg Endosc. 2020;35:4200-4205. doi:10.1007/s00464-020-07901-0

After gastric bypass, avoid products (including over-the-counter products) that contain a large amount of sucrose, corn syrup, lactose, maltose, fructose, honey or mannitol, as they can result in dumping syndrome. Keep a coded register of all patients who have had a bariatric surgery procedure, using a major active problem code.

Meet with your surgeon: This will happen a few weeks before the surgery and is a good time for you to ask questions. The first few days of recovery right after bariatric surgery typically consist of resting and slowly easing into physical activity. It can lead to significant weight loss and help improve many obesity-related conditions, such as type 2 diabetes or high blood pressure. SF-36 Short Form-36 questionnaire, IWQOL-Lite Impact of Weight on Quality of Life-Lite questionnaireyou have a body mass index (BMI) of 40 or more, or a BMI between 35 and 40 and an obesity-related condition that might improve if you lost weight (such as type 2 diabetes or high blood pressure)