This is a great question and one that isn’t asked often enough.  Understandably, your initial focus is usually on researching the available surgical options.  After that, your next focus tends to be who will perform your surgery, where your surgery will be performed and how much it will cost.  Unfortunately, the focus doesn’t usually turn to one of the most important considerations – what you need to do to guarantee your results after weight loss surgery.

The reality is that everyone loses weight after weight  loss surgery (particularly with the gastric bypass and sleeve gastrectomy procedures).  It’s exciting!  It’s rewarding!  It’s awesome!  But…eventually…your weight loss slows down and you will plateau.  Don’t despair, with proper support and guidance, you can get through plateaus and the final plateau will ideally be somewhere just above your ideal body weight.

This occurs, especially if you use the time after surgery (particularly the first year) to not only lose weight, but learn how to modify your mindset and your lifestyle habits…for good!  If you do this, your potential for true long-term success is exponentially increased.  Remember, weight loss surgery is a tool to lose weight.  If you don’t fully understand how to properly use your tool, your results can be compromised.  Instead, why not optimize your results?  This is where your post-operative comprehensive program comes in.  Don’t skip this important aspect of your research process prior to surgery.

This may be disheartening to hear because you might think of weight loss surgery as a guarantee.  Don’t get me wrong, I see success each and every day and it is truly amazing!  However, weight loss surgery is not a magic bullet.  Long term success requires long-term changes.  Don’t worry though.  With proper comprehensive support, this process is not only rewarding and fulfilling, it is actually fun!

So…What should you do after weight loss surgery to guarantee your results?  This was reviewed somewhat in Chapter 10 but I am going to expand this explanation.  I will begin with identifying the most common things you should be doing and then I will take a slightly different approach and share with you the five most common culprits to poor/slower weight loss or eventual weight re-gain.

In addition to the actions described in Chapter 10, your post weight loss surgery steps to success should include:

1. Don’t miss your post-operative visits with your surgeon. It is important for him/her to monitor your recovery and progress.  Sometimes people avoid their visits because either they are feeling so great, they don’t think they need to be seen or they are struggling and too embarrassed to see their surgeon due to a perceived sense of failure.  Unfortunately, this is the time you REALLY need to come in for your visits.  If you feel great, you can confirm your progress and celebrate even more.  If you are doing well, your surgeon WANTS to see you and celebrate with you as well.  If you are struggling, your surgeon WANTS to see you to help you identify the reason(s) why you are struggling.  It is best if this occurs as early as possible so you can take necessary actions to get back on track as soon as possible. You are not alone and recommendations can usually be determined quickly.  You can leave with a plan in hand and the confidence you need to master the use of your new tool and get back on your path to success.
2. Don’t miss any scheduled visits with your primary care provider. This is particularly important if you are on any medications that need to be adjusted as you lose weight (i.e. hypertension and diabetes medications).
3. Don’t miss any scheduled visits with your team of weight loss coaches. Included in comprehensive programs such as the one offered at the Center for Weight Loss Success, you will also be coached by a dietician, weight loss coach and/or personal trainer.  These professionals help you navigate the specific barriers or situations that may impede your optimal progress.  They will also keep you on track and guide you through this life changing experience.  In addition, your team loves to help you celebrate your success and assist you to avoid pitfalls and create new habits that keep you headed in the right direction.
4. Make the most of the educational materials provided to you before and after surgery. At the Center for Weight Loss Success, you receive a comprehensive  pre-operative and post-operative learning series called Weight Management University for Weight Loss Surgery™.  This program is reviewed at your office visits guides you each step of the way for the first 12 months after surgery.  Each monthly module explains what to expect that month, what to expect the next month, success stories, recipes and educational materials explaining what you need to know.  They also include information regarding nutrition, metabolism, fitness and other topics that assist you to attain your optimal success.  The modules are supported videos in your membership site and homework assignments that help put it all together.  This comprehensive system is well received by patients.  By the end of your first year after surgery, you will feel as if you have earned a new degree in weight loss surgery!  No matter what learning method you prefer, all bases are covered so dive on in and enjoy!
5. Attend the support group provided by your experienced surgeon/center. These are generally offered in a group setting and often supplemented with online support as well.
6. Surround yourself with positive and supportive people who have healthy behaviors. Beware of saboteurs.  There will usually be someone at work or at home who intentionally or unintentionally attempts to sabotage your new way of life.  Sabotage comes in many forms.  Here are a few strategies for dealing with the most common types:
   • Self-Sabotage: Hard to admit, but sometimes we are our own worst enemies. Do you have an internal dialogue that sounds like a tug of war between something you want to do and a rationalization as to why you can’t possibly do that today (better known as excuses)? It all starts with a realistic goal, a realistic plan and realizing that you are in control of your own behavior.  Try replacing the word “can’t” with the word “won’t” the next time that happens and your “self-talk” will begin to change!
   • Family/Friends: You like to think they are all supportive but the reality is that those we count on the most for support are often the ones encouraging a “treat”, “celebration”, “one more bite” or those trigger foods that you can’t say no to. The truth is that you are vulnerable right now and they need to understand your dedication to your goal.  You may need to have a “heart-to-heart” asking for their support. Be assertive, keep your goals handy, put treats out of site or give them away, focus on activities rather than food events.  At parties, focus on conversation and go in with a plan of attack you know you can stick to.
   • Vacations: Time away should be a time to enjoy and relax. However, be careful about your sabotaging thoughts to “let loose”, “do nothing” or “blow it out for the week”.  You can have fun in moderation, incorporate a new sport or activity, enjoy new foods (focus on protein, new vegetables or fruit) and feel great by working in a long walk, run or visit to the fitness center at that great resort!
   • Office Life:  Why is it that your office has to celebrate every event with cakes, cookies & donuts?  Let your co-workers know you are trying to get healthier and welcome them to join you.  Start a new office healthy thinking initiative. Avoid trips to the snack-laden break room and take your break outside.  Make a point not to eat at your desk or if you have to, only bring things you know fit into your plan. Keep a stretch band or small weights at your desk to use.  You could use eight different muscle groups in an eight-hour day!
   • Holidays/Parties: We need to celebrate life!  It can be done though without all of the focus being on food and/or alcohol (which diminishes our sense of control).  Plan for the event ahead of time and don’t go hungry.  You will be less tempted. Plan on picking one or two special food items, giving yourself permission to sample what is there…you don’t want to feel deprived.  Keep your alcohol consumption absent or to a minimum and stay hydrated with water with a twist of lemon or lime.  Hold your drink in your dominant hand to avoid picking at food and talk to others…it’s harder to eat while you are talking.

You can overcome these problem areas!  Make sure you identify what is risky for you so you can have a game plan to combat the situation(s).  Don’t prevent yourself from enjoying life but sometimes (especially early on in your weight loss until new habits are developed) it is easiest to limit exposure, make small strides, build your confidence and then celebrate your success!

Another way to look at how to achieve long-term success is to know and understand the most common reasons you might not get the results you desire and what to do about them.  Below are the five most common culprits to poor/slower weight loss or eventual weight re-gain:

1. Depression – Emotional health is as important as physical health.  Although depression is not a problem for most after surgery, it can be a significant deterrent to optimal weight loss.  It is important to identify depression (admit that it is ok) and seek appropriate treatment so you can move on with your weight loss journey.
2. Not Exercising – We require each of you to complete a fitness evaluation with a personal trainer which is included with the program.  The reason for this is because we believe some form of consistent exercise is essential for optimal success.  You should determine what form of exercise is right for you and begin your exercise plan before surgery.  We cannot over-emphasize the importance of this factor.  Although most find it difficult to begin an exercise plan, those that take that plunge never regret it.  It can only enhance your weight loss experience and progress.
3. Drinking High Calorie Liquids – Many do not realize the excessive amount of sugar and calories contained in some liquids (i.e. Gatorade, Juice, Soda).  As a result, you may “waste” calories on such liquids.  This can significantly impede your weight loss.  It is better to choose water, water with lemon, Fruit₂O, Crystal Light or other low or no calorie drink options.
4. “Grazing” – After the first 2 months or so, you should have progressed to three meals per day with some higher protein snacks in between.  If not, you may develop the habit of “grazing” or eating throughout the day.  If this is the case, you tend to take in a significantly higher amount of calories throughout the day (more than what your body needs).  This will slow down your weight loss and can potentially cause weight re-gain.  Please guard yourself against such habits.
5. Eating and Drinking at the Same Time – When you eat and drink at the same time, the food is “washed through” the stomach quickly.  It is important to hydrate yourself by drinking a low/no calorie beverage approximately 30 minutes prior to eating.  In this way, your hunger will be decreased.  When you eat, you should not drink at the same time.  As a result, your “pouch” will remain fuller for a longer period of time.  Thus, you will remain satisfied for a longer period of time.  Be sure to stop eating before you truly feel “full”.  It is a slow communication from your stomach to your brain to indicate a feeling of fullness.  Thus, you may overeat and realize it too late.  This can be a very uncomfortable feeling.

So although you may be focusing on the surgery itself, you will be doing yourself a big favor by not neglecting your post-operative plan.  Use these tips and don’t forget to enjoy this journey of self-discovery.

Rhonda’s Opinion:  Make yourself a priority and it will work.