Committing to bariatric surgery can be challenging yet exciting for those who are struggling with obesity and weight-related issues. Although many expect quick weight loss effortlessly, this can be far from the truth. Patients who go through a comprehensive assessment by the bariatric medical team will learn there are a lot of changes and material that needs to be reviewed prior to surgery. And, although tempting, gastric sleeve diet cheating should be avoided.

Vertical sleeve gastrectomy is a common choice for weight loss surgery as it only restricts the amount of food intake and does not alter the intestinal tract. Since approximately 80% of the stomach is removed, fast weight loss is expected post-surgery. To best assist with optimal results and minimal complications, patients are given specific details on the preparation for the pre-op and an extensive post-op diet.

A pre-op diet provides specific instructions to help prepare the body for the surgery. This diet will generally be a very low calorie diet to help reduce the liver and the fat mass around the abdomen to better assist the surgeon. It will entail the use of protein supplements, calorie-free liquids, and/or puree to soft consistency foods. While restricting calories during this time may be stressful, this will help set the right expectations and habits as to what the diet will be post-operatively.

I cheated on the pre-op diet. Can I still get the gastric sleeve?

The answer is not an obvious yes or no. There are some questions to be asked, such as:

• What did you eat?
• When did you eat it?
• How much did you have?

If you took one bite of the burger or ate a handful of French fries during the earlier part of the pre-op diet and got back on track immediately, then the surgery is probably still on. However, if you are cheating throughout the diet and constantly referring to “my last meal,” then the likelihood of getting the surgery is slim. Regardless of the extent of “cheating,” the medical team should be notified right away about your behavior and lack of compliance.

Gastric sleeve diet cheating before the surgery may be a reflection on the longevity of your long-term success after surgery. Therefore, patients need to take the time from their initial appointment and surgery date to change any behaviors and seek help that will sustain the weight loss. If you find yourself having a hard time conforming to your new lifestyle, you may want to reconsider getting any weight loss surgery until you are mentally ready.

What can I avoid to have successful long-term weight loss after the gastric sleeve?

It is pivotal to follow the detailed post-op diet to support a quick recovery and healthy weight loss. Any degree of noncompliance with food choices during this time usually will result with gastrointestinal problems such as nausea, vomiting, gas, and/or diarrhea and other complications. With regular follow-up appointments post-op, patients are guided to stay on track. Despite the persistent reinforcement, old dietary habits may resurface and slowly start to jeopardize the weight loss.

If you find your weight starting to plateau or notice weight gain, you need to ask yourself what, how, when, where, and why are you eating. Here are common pitfalls that will put your weight loss at risk.

Making poor choices

If you are experiencing slow weight loss or weight gain, document your intake and you may be surprised to see the choices and quantity of food consumed during the day. The daily grind of juggling between work, family, school, and/or pets can lead you to make poor choices that got you into trouble in the first place. Ask yourself these questions before taking the first bite.

• Are you eating adequate protein, fruit, and lower carbohydrate vegetables?
• Are you eating “bad” carbohydrates? For example, chips, pretzels, bread, bagels, crackers, French fries.
• Are you meal/snack planning?
• Are you grazing?
• Are you starving yourself?

Often times, patients will eat poorly or overeat due to “hunger.” While the hunger sensation should be lessened after the sleeve, others will feel hungry more frequently. However, what we eat can control the hunger and subdue the urge to eat throughout the day. Choosing foods high in protein such as eggs, grilled chicken strips, or protein supplements will handle the hunger better than grazing on sweets, chips, and other junk foods.

Some will do the opposite and purposely starve themselves with the assumption this will expedite weight loss. This is a myth that does not work. Restricting yourself even more than before can result in deficiencies and unhealthy weight fluctuation. Providing the body with adequate and proper nutrition post-surgery is significant to sustaining a healthy weight.

Making poor beverage choices

One of the quickest ways to gain weight is by drinking empty calories. Fruit juices, soda, milk shakes and alcohol are the common culprits. Even if you are monitoring your meals, drinking at least 200 calories from beverages will hinder your weight loss. With the gastric sleeve, every calorie consumed will be absorbed since the small intestine is intact. Therefore, you need to be extra careful where your calories come from.

Stick to non-carbonated liquids with zero calories or add flavor to water with fresh cut-up fruit, or use flavor-enhancing products such as Crystal Light® or Mio®. Adequate hydration is crucial as it helps flush out toxins and water weight. Otherwise, symptoms of dehydration may hinder your daily routine with constant headaches, nausea, and lack of focus.

Severe cases may result with hospital admission, which can be treated with fluid IV, or you can avoid the visit and have fluid available to you at all times.

Drinking with meals

From day one, patients will hear the words “DO NOT DRINK WITH MEALS” numerous times from the dietitian. With the new stomach pouch, you want to make sure the limited space you have is filled with high quality protein foods. Mixing food with fluid can push it out quicker and allow you to eat more frequent.

Often times, the mixture can cause an upset stomach, which may also lead to unhealthy eating habits. Despite practicing this new habit before the surgery, some will go back to their old ways and drink with meals. Coming from a dietitian, this rule does not change at any point after surgery.

Not taking supplements

Gastric sleeve patients will often show signs of deficiencies pre-operatively. Thus, the medical team tries their best to correct these deficiencies before surgery. So it is important to make sure a patient's lab work is monitored regularly to avoid any deficiencies such as calcium, vitamin D, B1, and B12 post-operatively.

The protocol for sleeve patients is a comprehensive multivitamin along with other micronutrient supplementation such as B complex. Noncompliance with supplements can continue to cause deficiencies with long-term effects such as fatigue, muscle weakness, and anemia.

Lack of exercise

Lack of exercise before surgery is very common with bariatric patients. It is possibly due to their weight, medical problems, lifestyle, and/or low self-esteem. Many will find ways to incorporate any kind of physical activity such as using the stairs, walking the long way to the parking lot, or joining a fitness class. All of these efforts count and should be continued post-surgery.

However, patients need to realize that with their new stomach and digestive system, the level of exercise needs to adjust along with the weight change. If you are going to walk, it needs to be more than “walking down every aisle at the supermarket.” New goals should be set once you achieve them one at a time.

Finding ways to boost your heart rate will help accelerate or jump start your weight loss. There are various ways to do this. A gym membership and personal trainers are not necessary. If you were once an athlete, return to the sport you loved and start slow.

Yoga is another form of exercise that will make you break a sweat. You will quickly discover muscles you’ve never thought were there. Best of all, you are using your own body weight as resistance and the calm nature allows you to self-reflect and meditate using positive energy.

Strength training in addition to cardiovascular activity has also shown to help promote weight loss. By targeting the major muscle groups and gaining more muscle mass, metabolism will improve and your body will start to look more toned while losing weight.

Finding the appropriate exercise routine will take some time to figure out, but you cannot give up. Your goal should be to work your way up to a comfortable level yet continue to challenge yourself.

Lack of personal accountability

Staying committed to this new lifestyle takes a lot of time and effort. You need to be responsible for every choice you make. Being perfect is nearly impossible, but it is recognizing and responding to your mistakes that counts. Personal accountability is often lost or ignored during this transition.

Many patients have expressed to me that having an accountability buddy or group helped them stay on track. Being called out on the excuses and unhealthy behaviors may be a tough reality check, but it is necessary. Find an individual or an organized group that will challenge you and help you succeed in this life-long journey.