Complete Guide to Bariatric Multivitamins

Bariatric providers require patients to take a bariatric multivitamin after weight surgery, along with other vitamins, to ensure optimal health. After bariatric surgery, the digestive tract will be altered, reducing the amount of vitamins and minerals absorbed by the body. Therefore, to avoid malnutrition, patients will be required to take vitamins for life after their weight loss surgery procedure. Yet, choosing a bariatric multivitamin can become overwhelming. In this blog, we break down what you need to look out for when selecting a complete bariatric multivitamin.

Bariatric Multivitamins 101

The most vital supplement to take after weight loss surgery is a complete bariatric multivitamin. Multivitamins are a great way to get all the essential nutrients you may need after weight loss surgery without having your pantry overtaken by supplements. Still, how should you go about choosing your bariatric multivitamin, and what is it even made of? Let’s dive in. 

Vitamin B12 (Cyanocobalamin and Methylcobalamin)

Recommended Dosage: 1000 mcg

B12 is one of the most common vitamin deficiencies after bariatric surgery. B12 is an essential nutrient for metabolic and nervous system health and helps break down fatty acids and amino acids to provide you with energy and strengthen your immune system.

Biotin (Vitamin B7)

Recommended Dosage: 600 mcg 

Also known as the beauty vitamin, biotin is an essential nutrient for better hair, skin, and nails and helps support metabolic processes, which is essential after weight loss surgery.

B Vitamins (Vitamins B1, B2, B5, B6)

Recommended Dosage: 12 to 20 mg

The bariatric patient’s favorite vitamins, B1, B2, B5, and B6, are critical for healthy skin, hair, muscles, nervous system, and brain function. But, better yet, the B vitamins are essential in the process of converting carbohydrates into energy. 

Vitamin A (from Beta Carotene & Vitamin A Acetate)

Recommended Dosage: 3,300 mcg

Vitamin A is used to form and maintain healthy teeth, bones, skin, and soft tissue.

Vitamin D (Calciferol)

Recommended Dosage: 75 mcg, 3,000 IU

The sunshine nutrient. A lack of vitamin D can cause bone deficiencies and other diseases. Vitamin D is required in high doses after bariatric surgery and is best absorbed with calcium, which is why there will also be vitamin D in most bariatric calcium supplements. 

Chromium (as Chromium Picolinate)

Recommended Dosage: 100 mcg

Chromium is the insulin nutrient that helps maintain healthy blood glucose levels and converts glucose into energy, essential for patients with diabetes.

Vitamin E (as D-alpha tocopheryl succinate)

Recommended Dosage: 40.2 mg

An essential nutrient in wound healing, vitamin E aids in the production of red blood cells and assists vitamin K in the healing of wounds and scars.

Iron (from Ferrous Fumarate)

Recommended Dosage: 45 mg

Another common vitamin deficiency after bariatric surgery and the most probable reason for post-bariatric anemia, iron is essential in producing red blood cells and making amino acids.

Niacin (Vitamin B3)

Recommended Dosage: 40 mg

Otherwise known as vitamin B3, this nutrient helps maintain healthy skin, nerves, and brain and plays a vital role in lowering cholesterol levels. 

Copper (from Copper Gluconate)

Recommended Dosage: 2 mg 

Copper aids in metabolizing iron and supporting your immunity. 

Folic Acid (L-Methylfolate Calcium)

Recommended Dosage: 800 mcg

Folic Acid is an essential nutrient in the production of DNA and vital for women of childbearing age as a lack of folate can result in birth defects. 

Selenium (Selenium Amino Acid Chelate)

Recommended Dosage: 100 mcg

Selenium helps fight oxidative stress that could result in chronic health conditions such as heart disease and cancer. Low selenium levels in post-bariatric patients could result in cardiomyopathy

Molybdenum (as Molybdenum Amino Acid Chelate)

Recommended Dosage: 75 mcg

Molybdenum is an essential mineral found in most grains and legumes. This nutrient helps break down unhealthy toxins in the body.

Zinc (Zinc Oxide and Zinc Amino Acid Chelate)

Recommended Dosage: 16 mg

Zinc is critical to the support of a healthy immune system and optimal metabolic control.

Vitamin C (L-ascorbic acid)

Recommended Dosage: 130 mg 

The immunity mineral, vitamin C bolsters the immune system and plays a vital role in wound healing and the regeneration of antioxidants. 

Vitamin K (Phytanadione)

Recommended Dosage: 120 mcg 

Vitamin K is an essential nutrient in the blood clotting process and assists wound healing after bariatric surgery.

Iodine (as Potassium Iodide)

Recommended Dosage: 150 mcg

Iodine is a mineral essential to thyroid control by regulating your metabolism for weight and energy control. Iodine also promotes skin repair and slows down the appearance of aging—a woman’s best friend.

Manganese (as Manganese Sulfate)

Recommended Dosage: 2 mg

Manganese is essential in the formation of bones and helps metabolize amino acids, cholesterol, and carbohydrates.

Magnesium (as Magnesium Oxide, Magnesium Amino Acid Chelate & Magnesium Citrate)

Recommended Dosage: 100 mg

Magnesium is an essential mineral that aids in absorbing and breaking down the other ingredients in the vitamin formulation. 

Bariatric Multivitamin Frequency 

When purchasing a bariatric multivitamin from a reputable retailer, almost all of them will contain the recommended dosage of each mineral listed above. But we still recommend you thoroughly review the nutrition label to ensure you are getting the appropriate doses after your bariatric procedure. Bariatric multivitamins must be taken up to two times daily, depending on the brand of vitamin you are taking. If you have the Live Healthy MD Complete Bariatric Multivitamin, you only need to take one vitamin a day. 

Additional Bariatric Vitamins Needed

Bariatric patients must also take a calcium citrate supplement. It is essential to remember to take calcium citrate, NOT the calcium carbonate supplements found at your local convenience store. Calcium carbonate is not absorbed as quickly as calcium citrate is. For patients who had the gastric bypass or the gastric sleeve, the recommended dosage is 1500 mg of calcium citrate per day. If you had the duodenal switch, you would be required to take 2000 mg per day. 

There are several options on the market for bariatric supplements. Yet, no matter which brand you choose to take, be sure to review the nutrition label thoroughly to ensure the product you are buying has the recommended dosage of each vitamin and mineral. It is necessary to understand that bariatric multivitamins are very different from other complete multivitamins. If you have any questions regarding what vitamins to take after weight loss surgery, we encourage you to reach out to your bariatric care team. 

Blood Clots after Bariatric Surgery

Like any major surgical procedure, there is a risk of blood clots after bariatric surgery that could lead to serious health concerns if not addressed early on. A blood clot is a clump of blood that forms in the arteries (which carry blood away from the heart) or the veins (which carry blood to the heart). Typically blood clots will dissolve on their own; however, they can become extremely dangerous if and when the clot breaks off and travels to the heart or lungs, restricting blood flow. 

Types of Blood Clots 

There are two types of blood clots, which vary in symptoms and severity based on where they occur. 

Arterial Blood Clots

Arterial blood clots form in an artery, which carries blood away from the heart to the rest of the body. Arterial blood clots, otherwise known as arterial thrombosis, create a sudden onset of symptoms that require emergency medical treatment. Arterial clots are most often a cause of fat deposit buildups on the walls of the arteries, which will harden and restrict the flow of blood. Overweight and obese individuals have a higher risk of developing arterial blood clots and will be screened of their risk before bariatric surgery. 

Venous Blood Clots

Blood clots in the veins, which carry blood to the heart, are known as venous thromboembolism or venous blood clots. Typically this type of blood clot forms more slowly over time in the deep veins of the legs, arms, or pelvis and can become dangerous if they break off and travel to the lungs or heart (known as an embolus). The most severe type of venous blood clot is deep venous thrombosis (DVT)

After bariatric surgery, there is a risk of pulmonary embolism, a medical condition in which a DVT breaks off and travels to the lungs. Signs and symptoms of deep venous thrombosis include swelling, pain, soreness, warmth, redness, or discoloration. Depending on the size of the clot, symptoms and severity may vary. If a blood clod forms in the lungs, pulmonary embolism, you may experience additional symptoms such as 

  • Chest pain 
  • Dizziness or fainting
  • Shortness of breath or trouble breathing
  • Fever
  • Blueish discoloration in the skin or lips
  • Coughing up blood
  • Increased heart rate
  • Low blood pressure 

If you suspect you might have a pulmonary embolism, contact your bariatric care team or your primary care physician immediately. Patients who are at an increased risk of developing blood clots or have had blood clots in the past need to speak with their bariatric surgeon about this medical condition to take steps to lower their risk of developing venous blood clots. If your bariatric surgeon determines you are at risk of developing blood clots, they may require you to have a DVT filter inserted before your bariatric procedure to catch any clots before they travel to the heart or lungs. 

Blood Clots after Bariatric Surgery 

After any surgical procedure, your body will go through a healing process that increases blood clotting. You are at rest for more extended periods during the healing process, which stops the blood from flowing throughout your veins and arteries, ultimately increasing your risk of blood clots. Furthermore, tissue, debris, fat, or collagen can potentially get released into the blood flow during any surgical procedure, thickening the blood and restricting flow. 

Thankfully, severe blood clotting only occurs in less than 1% of bariatric surgery patients. Your bariatric care team will place you on blood thinners before and after your procedure. They will also require you to walk around every few hours after your bariatric surgery to decrease your risk of developing a severe blood clot. Similarly, you will be required to stop smoking several weeks before and after your bariatric procedure to reduce your risk of blood clots and a pulmonary embolism. 

Reducing Your Risk of Blood Clots after Bariatric Surgery 

As mentioned above, your bariatric care team will take the necessary steps to lower your risk of developing a blood clot after bariatric surgery. However, there are also steps you can take to prevent clotting. 

1. Move Regularly

Sitting for long periods stops the blood from flowing and can increase your risk of clotting. Therefore, it is recommended you get up and walk every 2 to 3 hours to keep the blood flowing throughout your body. 

2. Stop Smoking

Studies have found that chemicals inside cigarettes change the viscosity and thickness of blood, thus increasing your risk of clotting. Therefore, your bariatric surgeon will require you to stop smoking before and after your bariatric procedure to lower your risk of complications. 

3. Lower Your Cholesterol

It is commonly understood that high cholesterol levels can lead to heart disease, and the reason is the buildup of cholesterol particles on the artery walls. Over time, this buildup will turn into plaque, and sometimes the plaque will break off to form a clot that could cause a heart attack or stroke. 

4. Lose Weight

Overweight and obese individuals are at an increased risk of developing blood clots due to the pressure the weight puts on their arteries and veins. Similarly, obesity is also linked to inflammation in the body, which makes blood more susceptible to clotting. Luckily, after bariatric surgery, you will lose weight and thus reduce your risk of blood clots. However, it is imperative to be screened for an increased risk of clotting before surgery to prevent serious health complications. 

5. Wear Loose Clothing

As wild as it may sound, tight clothing can restrict blood flow and could increase your risk of clotting. Therefore, it is recommended to avoid wearing restrictive clothing, especially around the legs, arms, and abdomen, where clotting is most common. 

Blood clots after bariatric surgery are a risk of the procedures, and if left untreated, can lead to severe medical conditions such as a pulmonary embolism. Although the risk of developing a severe blood clot that will travel to the heart or lungs occurs in less than 1% of bariatric patients, there are still precautionary steps the patients and care teams need to take to lower the risk of complications after weight loss surgery. 

4 Ways to Enhance Your Recovery After Weight Loss Surgery

If you are having weight loss surgery, you may be interested in how you can enhance your recovery after weight loss surgery so you can get back to normal activities and ensure optimal safety and success. This blog will address some of the things we tell our patients – the do’s and don’ts after weight loss surgery. 

The recommendations we make in this article apply to all of the weight loss surgery procedures, and largely apply to any surgical operation. We want to stress that what we recommend in this article is what we generally tell our patients; however, this may not be consistent with what your surgeon or program recommends. 

4 Tips to Improve Recovery after Weight Loss Surgery

1. Follow Your Doctor’s Instructions

The number one tip we can give our bariatric patients for success immediately after their surgery and in the years to come is to follow what your weight loss surgery program recommends. Over the years, I have seen some patients follow instructions that they like and disregard the ones they don’t like or feel apply to them. 

When you leave the hospital, you will be given a bunch of paperwork. Most patients will tend to ignore some, or all, of this paper. However, it will contain your doctors’ specific recommendations and follow-up instructions, so please pay attention to your nurse’s discharge instructions and the discharge paperwork you are sent home with. If you don’t understand why you are being told to do/not do something, please ask before disregarding the instructions.

2. Keep Your Follow-Up Appointments

Follow-up after weight loss surgery is essential for your success and recovery after weight loss surgery. In the short term, follow-up ensures that your recovery after weight loss surgery is healthy and you are advancing through your diet as expected. We worry about early complications, although rare, it is much better to pick up on early warning signs before a patient becomes ill. If you feel well and your incisions look good, an appointment may seem like a waste of time. But nothing could be further from the truth. At your initial post-op follow-up visit, we will ask you how you feel and look for other things that you may not think are important but could be early warning signs.  

Additionally, during the early postoperative period, we adjust our patient’s medications. Most of the time, we are discontinuing medications that our patients take (hypertensive and diabetic medications); however, at times, we need to add back some of these meds based on how the patient is doing, and this really can only be done during your follow-up visits. 

3. Pay Attention to Your Incisions

Even though we perform weight loss surgery using minimally invasive techniques, you will still have 5 to 7 small incisions. It’s uncommon but occasionally, wound infections will occur while in recovery after weight loss surgery. We tell our patients that they can shower the next day after surgery; however, recommendations might vary based on how the incision is closed. Early signs of wound infection are increasing pain at the site, redness, and swelling. Some drainage from the incision is to be expected (thin and usually transparent in color); however, drainage that is cloudy or has an odor is not normal and needs to be reported to your surgeon immediately.   

Aside from infections, other potential wound problems include hematomas (blood in the incision). When this occurs, the patient will usually experience more pain at this site than the other areas of the incision point, yet the skin around the incision will look normal. 

After your surgery, there will likely be some swelling, and after about a week, bruising will probably become noticeable. As the body starts to break down the clotted blood, there might be some dark, bloody drainage at the corner of the incisions, which may require your surgeon to aspirate or even open the incision to get all of the old blood out.

A common problem with wound care is some patients trying to get their incisions a bit too clean. Avoid scrubbing the incision or removing scabs that form. You don’t need to wash with alcohol or peroxide either. We recommend that you shower and wash as you usually would. Unless specifically instructed otherwise, a gentle wash with soap and water is more than adequate. We recommend not to submerge your incisions underwater or swim for about a week or two. Some surgeons will use glue over the incisions (dermabod) or adhesive strips (Steri-strips) to reinforce the closure. If this is the case, do not pick at or remove the glue or strips.

4. Know When To Go To the Emergency Room

True emergencies after weight loss surgery are uncommon, but they do happen, and you need to know what to do. What we tell our patients is that “if you are concerned that something is wrong, then don’t assume it will go away – call us for guidance.”  

We think of complications after surgery as either “early” (within a week or so of surgery – generally directly related to the surgery) or “late” (weeks, months, or years later – generally a consequence of the surgery but not necessarily a direct complication of the surgery). There are a handful of early complications that you need to know about and what to do if they occur while in recovery after weight loss surgery.

Anastomotic Leaks

The first major complication bariatric surgeons are worried about is a leak (less than 1% of cases). A leak will generally occur in the first seven days after surgery. A leak occurs when the cut portion of the stomach or intestine leaks bowel contents into the abdomen. 

The most common symptoms of a leak will be increasing abdominal pain over a short time (hours) and feeling ill (weak, nausea, fever, etc.). However, in the beginning, these symptoms may be a bit more subtle and may present themselves as feelings of anxiety, low urine output, rapid heart rate, shortness of breath, or shoulder pain. 

Blood Clots

Other early complications are related to blood clots (DVT-deep venous thrombosis). Any surgical operation is a risk factor for forming blood clots, and unfortunately, obesity increases this risk. When a clot forms, it usually starts in the legs. There is often swelling of one or both legs that might be associated with pain. However, sometimes blood clots can be asymptomatic. More worrisome is when a blood clot breaks off and travels to the lungs (pulmonary embolus). This causes sudden shortness of breath and even sudden death (fortunately, this is extremely rare). Any unexplained shortness of breath needs to be reported to your surgeon on the way to the emergency room. 

Post-Op Bleeding

Although uncommon, post-op bleeding can also occur. Most of the time, if this happens, it will occur before leaving the hospital; however, in rare cases, it can happen after going home. After surgery, the first bowel movement will most likely be dark and have a small amount of old, dark blood, which is considered normal. However, any vomiting of bright red blood or bloody bowel movements with clots is not normal and needs to be addressed immediately.

Nausea and Vomiting

Lastly, post-op nausea and vomiting is a fairly common complaint. One or two episodes of vomiting after starting your post-op liquid diet are expected. However, any persistent nausea (lasting hours) or vomiting should be reported to your surgeon for guidance, especially when the symptoms are not related to eating.

Wound Infections

Although less severe yet certainly needs attention, is any evidence of wound infections during your recovery after weight loss surgery. Increasing pain, redness, or drainage from the wound should be reported to your surgeon immediately. Generally, this should not necessitate a visit to the emergency room and can probably be addressed in your bariatric clinic’s office.

8 Reasons You are Constantly Hungry After Bariatric Surgery

Many patients have bariatric surgery with the intent to lose weight and feel full faster. Due to the restrictive nature of the gastric bypass, gastric sleeve, and duodenal switch resulting from the surgeon making the stomach smaller, most patients will achieve weight loss by limiting their caloric intake. There is also a decrease in the hunger hormone ghrelin (produced in the stomach), resulting in patients feeling less hungry. 

However, some patients, especially those who are 1+ years out from weight loss surgery, may begin to experience increased hunger after bariatric surgery. This can become alarming for post-bariatric patients as they fear they may be at risk of regaining their weight if they eat more than the recommended amount. 

What is Hunger

Hunger is a critical biological signal that tells our brains when we should eat. Our brains pick up messages from our stomachs via our parasympathetic nervous system (PNS) about every 2 hours. So if you are eating multiple small meals a day, as recommended by your bariatric care team, you shouldn’t feel extreme hunger all the time. However, if you are constantly feeling hungry, it could be due to one of the following reasons.

1. You are not eating enough. 

One of the most obvious reasons you may experience hunger after bariatric surgery is you are not eating enough calories and nutrients throughout the day. After weight loss surgery, your bariatric care team will recommend you eat anywhere between 1,000 to 1,200 calories per day to achieve your goal weight. However, if you are more than one year post-op, your caloric needs may have shifted due to hormones, your activity levels, and in general, your biological set-point. 

If you believe your hunger is coming from not eating enough, we recommend you begin tracking your daily food intake. You may be shocked to find you are eating less than 1,000 calories a day. Tracking your food intake will also be of assistance when talking with your bariatric care team to get your hunger cues more regulated. 

2. You are not getting enough protein.

Protein is a critical component of the post-bariatric patient’s diet. It is recommended that patients eat 80 to 100 grams of protein a day to “plug the pouch.” Many studies have found that high-protein foods keep patients full for more extended periods. Additionally, since protein only has four calories per gram (compared to 9 calories per gram for fat), eating a protein-dense diet will aid in weight loss.

3. You increased your physical activity. 

Once you have gotten in the rhythm of life after bariatric surgery, you may have started to increase your physical activity, which is especially common in patients more than a year post-op trying to overcome that weight plateau. And the more you exercise, the more calories you burn. So if you haven’t increased your calorie and macronutrient budgets with the increase in exercise, this may be a reason you are experiencing constant hunger. If you exert yourself pretty intensely in physical activity multiple times a week, we recommend you adjust your calorie and macro budgets to fit your new lifestyle. 

4. You are eating too quickly.

Many studies have shown that people who eat fast have a larger appetite and are more likely to overeat. This results from not spending enough time chewing your food, which creates awareness around eating and alleviates feelings of hunger. Similarly, the longer we chew our food, the more time our brains have to release signals that convey fullness. This is one of the reasons your bariatric surgeon and dietitian will recommend you thoroughly chew your food. Other reasons are to avoid food getting stuck in your smaller pouch and to maximize food breakdown and nutrient absorption. 

5. You are not drinking enough liquids. 

After bariatric surgery, your surgeon and dietitian will recommend you drink at least 64 ounces of sugar-free liquids a day. Proper hydration not only will keep you feeling full but also has the potential benefit of reducing your appetite. It is not uncommon for patients to confuse thirst for hunger, so if you feel unusually hungry, we recommend drinking a glass of water before indulging in a snack or a meal. 

6. You are drinking your calories. 

If you are more than six months post-op, you should have begun incorporating solid foods into your post-bariatric diet. Eating solid foods promotes a different response in the body compared to drinking liquids and is more effective in suppressing hunger. It is common for bariatric patients to supplement their diets with protein shakes. Similarly, some patients may try the pouch reset diet (which consists of only drinking protein shakes) to get back on track after weight regain. So, if you are experiencing constant hunger after bariatric surgery, it may be beneficial to begin incorporating more high-protein, solid foods into your diet. 

7. You are not getting enough sleep. 

There are two types of hormones that affect our feelings of hunger and satiety; leptin and ghrelin. Sleep impacts these hormonal levels, therefore influencing our desire to eat and the ability to stop eating. Sleep-deprived individuals will have increased ghrelin levels, resulting in them feeling hungrier and decreased leptin levels, resulting in them feeling a lack of satiety. To best keep your hunger hormones in check, we recommend sleeping 7 to 8 hours a night.  

8. Your hormones are off-balance. 

Whether you are not getting enough sleep, are constantly stressed, have begun taking medications, or have some underlying medical condition, our hormones play a significant role in hunger and our desire to eat. Some medical conditions that impact hunger cues and the sense of satiety are diabetes, hyperthyroidism, hypoglycemia, premenstrual syndrome, depression, and anxiety disorder. If you believe you have any of these conditions, we recommend you schedule a consultation with your medical provider to receive a proper diagnosis and treatment options. 


Constant hunger is a method of your body telling you something is off. It is almost always a result of unbalanced hormones, whether from a poor diet, bad lifestyle habits, or underlying conditions.

If you are experiencing constant and extreme hunger after bariatric surgery, it may be beneficial to take the advice provided in this article. However, if you are still unable to curb the hunger, we recommend you reach out to your bariatric care team or primary care provider so they can provide the appropriate diagnosis and treatment options. 

5 Reasons You Are Experiencing Constipation after Weight Loss Surgery

After bariatric surgery, many patients will complain of constipation. Aside from discomfort, constipation can become worrisome, especially if you were previously used to having regular bowel movements. 

Constipation is defined as having fewer than three bowel movements in a week, feeling the need to strain during bowel movements, or having hard stools. This can result in feelings of bloat, abdominal pain, and the sense that you cannot completely empty your bowels, leaving you feeling pretty crappy (pun intended). 

After bariatric surgery, the frequency of bowel movements will change, partially due to reduced food intake. But, some other factors can affect regular bowel movements after surgery too. 

Causes of Constipation after Weight Loss Surgery

1. Change in Diet

After bariatric surgery, patients will be eating a smaller volume of food. Similarly, your dietitian will place you on a liquid and soft food diet in the first few weeks after surgery. Therefore, the change in the quantity and the consistency of the food you consume can significantly impact your bowel movements. 

If you are experiencing constipation several months, or even years, after bariatric surgery, this may be because you are not eating enough nutrient-dense foods that contain fiber. Our daily fiber goal is 25 to 40 grams a day, but your new and smaller pouch will prohibit you from consuming large amounts of fiber at any given time after surgery. 

Therefore, we recommend you actively try adding more high-fiber foods into your diet or begin supplementing with fiber.

2. Vitamins and Supplements

Certain supplements can cause constipation after weight loss surgery to include iron, calcium, and protein drinks. Most notably, whey protein causes constipation due to the lactose, and other sugar substitutes added. Similarly, high protein intake can cause constipation if you are not getting enough fiber intake. Try to look for a high-fiber protein powder.  

3. Pain Medications

If you are taking pain medications post-operatively, you may experience constipation as a result. Opioid pain medications cause constipation because they are known to slow down the ability of your body to digest food. 

If you are taking pain medications and experiencing GI issues, it should resolve itself once you stop taking the opioids. If the discomfort and constipation persists, we recommend you try a laxative or stool softener.  

4. Lack of Exercise

Regular exercise creates a stronger blood flow throughout the body and digestive tract that helps food get passed through the intestines more easily. Also, an increased heart rate and breathing rate will stimulate muscles in the lining of the intestines that will result in a more efficient and timely passing of waste through the body. 

The best exercises to aid in digestion and feelings of discomfort are cardio, yoga, and pelvic floor exercises. 

5. Dehydration

If you are not adequately hydrated, your body will absorb water from your food waste to help digest the food. This will leave your stool dried out and hard, making it more difficult and uncomfortable to have a bowel movement. 

After surgery, you should be drinking a minimum of 64 ounces of sugar-free liquids a day. If you are experiencing constipation, I recommend increasing your fluid intake to help soften the stool and make it easier to pass. 

The Dangers of Constipation

If you are experiencing constipation and not treating it properly, it could result in the development of hemorrhoids (bleeding and thrombosed), diverticulum that could lead to diverticulitis, or other complications. It may also lead to the development of chronic abdominal pain, discomfort, and increased gas. 

The best way to avoid experiencing constipation after weight loss surgery is to drink enough fluids to prevent dehydration and get an adequate amount of fiber intake. You can also try stool softeners or laxatives if necessary. But it is imperative to treat constipation early before it results in severe pain and discomfort, or worse, medical complications. 

4 Practical Tips to Avoid Weight Regain after Bariatric Surgery

A common misconception surrounding weight loss surgery is that it is a permanent fix. Although surgery can help patients lose weight at an otherwise faster rate than they would with diet and exercise, it will not keep the weight off forever—patients must maintain a healthy lifestyle. 

As a bariatric surgeon, I have seen many patients who are confused about why they have regained their weight after bariatric surgery. In most cases, patients are partaking in unhealthy lifestyle habits that they are entirely unaware of. In last week’s blog, we talked about the steps you can take to avoid regain from a wellness perspective, and this week we will dive into the more practical tips to help you achieve long-term weight loss success. 

1. Follow Up with your Bariatric Care Team.

Some of the most successful bariatric patients are the ones who frequently attend their follow-up visits after weight loss surgery and maintain regular contact with their weight loss provider. Patients who attend their post-op visits have the chance to meet one-on-one with their surgeon and dietitian to evaluate their eating and exercise habits. 

By attending follow-up visits with your physician, you are likely to mitigate the bad behavior and avoid weight regain. Similarly, your physician will be able to identify any possible medications that are preventing successful weight loss. 

The most common reason an individual fails to get help after weight loss surgery is feelings of embarrassment and a sense of failure if and when they have regained the weight. We want our patients to know that weight regain is not a sign of failure. Most of the time, the patient’s overall health is still significantly better after surgery, which is one great accomplishment in and of itself. It has been proven that when patients are held accountable, they are more likely to succeed. So be sure you are scheduling your visits to stay on track and avoid significant weight regain. 

2. Stick to the Program

Following your weight loss program’s recommendations may seem obvious. Still, we know from experience that patients tend to follow their own dietary guidelines soon after surgery (within the first 6 to 12 months). It’s human nature to fall back into the old habits that contributed to obesity in the first place.

At Bariatric Centers of America, we teach bariatric patients the “food test rule” to make regular healthy food choices. The “food test rule” focuses on filling your plate with high-protein foods, aka anything that walks, swims, crawls, or moves in any form. Next, fill up on non-starchy vegetables – preferably green vegetables because they are low in carbs and have lots of vitamins and minerals. If you are looking to lose weight, you can still eat carbohydrates (in moderation) but focus on complex carbs such as whole grains, brown rice, beans, etc.

The consistent application of our “food test rule,” along with thinking of food differently, helps our patients apply these weight loss principles to their everyday life to make healthy food choices that will help them maintain the weight they lost.

3. Find Support

Many studies have proven that physical and emotional support will ultimately help patients become more successful with their weight loss. Support can come in all forms, but regardless of the type or the degree of involvement you would like your “mentor” to have, you must find encouragement to meet your goals.

A healthy support system consists of people who celebrate your successes and love reminding you when your stated desire to live a healthy lifestyle does not match your actions. Find someone or a group of people you can lean on that will walk this weight loss journey with you. 

For patients seeking to lose weight, we encourage them to find a workout/accountability partner, lean on family and friends for times of encouragement, or to get involved in online communities such as a bariatric support group. Regular support group attendance has been shown, in many studies, to improve patients’ long-term outcomes after weight loss surgery. A properly run support group provides an informal way to maintain contact with the patient’s weight loss provider while at the same time providing ongoing education about proper nutrition and lifestyle changes.

4. Recognize Obesity is More than a Food Addiction

As the prevalence of obesity continues to rise, doctors and society alike have begun to look at obesity as more of a metabolic problem than a social problem. In many cases, obesity is not a sole result of overeating food but is also a result of hormonal imbalances. 

With that being said, you may need to look outside your bariatric office to seek treatment. This may include following up with your GYN (ladies) or even visiting an endocrinologist to get your thyroid tested. If you are experiencing weight regain and you have been adhering to a healthy diet and exercise regimen, we suggest you schedule an appointment with your bariatric surgeon so they can help you get to the root of the problem. 

At Live Healthy, we are on a mission to help patients live healthy, not just one-year post-op, but for the rest of their lives. We emphasize the importance of having a bariatric care team that will walk with you through your post-op journey. So, even if you had surgery elsewhere, we encourage you to fill out a form on our website and get connected with a provider in your area that can support you on your post-op journey to success.

Wellness Based Tips to Avoid Regain after Weight Loss Surgery

The journey to weight loss surgery is long and requires a lot of effort, possibly even a lot of money, so regaining weight after surgery can feel entirely defeating. According to the American Society for Metabolic and Bariatric Surgery, more than 50 percent of patients will end up regaining a small percentage of their excess body weight within two years of their procedure. Unfortunately, other patients will end up regaining most, if not all, of their weight back after bariatric surgery. 

This is most often a result of resorting back to old eating habits while not incorporating physical activity into their everyday life. Within the first year after surgery, patients are diligent about their portion sizes and the quality of food they are consuming, yet they may begin to slack off over time.

At Live Healthy MD, we are on a mission to help patients live healthy, not just one-year post-op, but for the rest of their lives. In this blog, we give you our six wellness-based tips to avoid regain after weight loss surgery, that if followed, will help you reach your goal weight and maintain weight loss long term. 

Tips to Avoid Weight Regain after Bariatric Surgery

1.  Drink Lots of Water

Our bodies are made up of about 70% water, and therefore it is an essential substance we must consume for optimal bodily function. When you do not drink enough water and are dehydrated, you will experience adverse effects within your body, including your organ function, mental clarity, and overall health.

Drinking water is a great defense mechanism against fighting diseases and viruses. We all have mucus membranes in our eyes, nose, and mouth that catch germs before they enter our body. Yet, the mucus membranes are essentially ineffective if they are dried out. Similarly, water is essential in flushing out toxins from our bodies.

Water is also effective in helping you maintain a healthy weight as it acts as an appetite suppressant and helps your body metabolize fat. To experience all these benefits, you want to drink at least 64 ounces of water a day. Try adding a slice of lemon or mint to your water to add variety to your hydration schedule.

2. Get Enough Sleep Each Night

Getting a good night’s rest is an essential aspect of achieving overall wellness and functions as a time for your body to heal and repair itself. Sleep impacts many of your bodily functions, including your mood, mental clarity, immune system, weight, and overall health. Over time, sleep deprivation will negatively impact your physical health. When we talk about being sleep deprived, we refer to not going through enough REM and non-REM sleep cycles, which ultimately affects your ability to function at your optimal point throughout the day.

When you do not get enough sleep each night, your risk of developing diabetes, heart disease, high blood pressure, cancer, arthritis, an overactive thyroid, and obesity increases significantly. Many studies have found that sleep deprivation increases a patient’s risk of developing heart disease by nearly 50 percent and triples the risk of having type 2 diabetes.

3. Increase Daily Activity

Exercise is a key component of a healthy living plan. Exercise makes us feel better, reduces depression, and improves heart and lung function. Exercise increases our lean body mass (muscle mass), which increases our resting metabolic rate, the rate at which our body consumes glucose (carbohydrates). While exercise is a foundation for a healthy, happy life, it plays a relatively minor role in weight loss compared to focusing on your diet. However, it is beneficial in weight maintenance and helping patients avoid regain after weight loss surgery. The key to starting any exercise program and making a habit out of movement is to start slow.

Tips to creating an exercise regimen that you stick to are:

  1. Find something you enjoy doing and makes you feel comfortable
  2. Get a workout/accountability partner
  3. Know your “why” – understanding your primary motivator is key to your long-term success
  4. Set attainable goals that will keep you motivated along the way

4. Make a Grocery List

Grocery shopping can seem like a chore, especially if you are buying for a family or even trying to eat healthier in a world of uncrustables and cookies. If you have recently had Bariatric Surgery or are on a weight loss journey, navigating the grocery store can be overwhelming. Therefore, we always encourage our patients to make a grocery list before heading into the store.

Benefits of Making a Grocery List: 

  1. Saves Time: A grocery list saves you from wandering up and down the aisles, wondering what you will eat for the next few days.
  2. Saves Money: Grocery lists give you guidelines for what to buy based on the meals you plan to eat that week, eliminating your spending on unnecessary food items.
  3. Healthier Choices: Most unhealthy decisions are made impassively. Therefore, a shopping list keeps you from making last-minute, unhealthy food choices and ultimately avoid regain after weight loss surgery.
  4. Planned Meals: Prior to going to the grocery store, you can review all of your meals and add ingredients to your shopping list based on what you plan to cook for the week.
  5. Minimize Waste: A grocery list ensures you only buy what you intend to use, therefore saving you from buying too much food that will end up going bad and being thrown out.

5. Focus on Food Quality and Quantity

Two behaviors that are almost always the culprit for weight regain are frequent snacking and the overconsumption of carbohydrates. Snacking between meals can lead to significant weight gain after weight loss surgery due to the quality and quantity of food consumed. Most often, snack foods are full of carbohydrates and sugar. They are considered “low density” food items due to the lack of nutrition. 

When you don’t sit down for planned meals, it is easy to overeat or eat foods that are not on your nutrition plan. Although we suggest bariatric patients eat five small meals a day, we also suggest they plan accordingly. Patients who recently had their bariatric surgery will notice they do not need more than the recommended 1 cup serving size to feel satisfied. However, as the years go by and you begin to eat more, your stomach will expand, allowing you to consume larger amounts of food. Therefore, patients must be highly aware of how much food they are putting on their plate at each meal. 

The second reason you may start seeing the number on the scale go up is due to the overconsumption of carbohydrates. Although the body needs a certain amount of carbohydrates to fuel itself, if you are not burning more than you consume, you will gain weight. Therefore, we recommend bariatric patients stay away from high-carb foods such as fruit, starchy vegetables, and grains (including pasta and bread). Your body will receive enough carbs from the other foods on your nutrition plan to function correctly and still help you lose weight. 

6. Keep a Food and Exercise Journal.

When patients start to regain weight and even hit a plateau, it is most often a result of consuming more calories than they are burning. When you aren’t keeping a close look at your food intake, it is easy to consume too many calories and experience regain after weight loss surgery. Therefore, we recommend bariatric patients track their food intake and energy expenditure for a week to see where you may be slipping up. 

Similarly, you want to be sure you measure out your food. Start using diligent portion control methods and scales to accurately measure and report on everything you are consuming. This will give you an idea of how much and how frequently you are eating and give you a look into your macronutrient breakdown between carbs, fats, and protein. When you schedule a follow-up visit with your surgeon, be sure to bring the food diary with you so you both can go over it together. 

Calorie and Macronutrient Breakdown After Bariatric Surgery

We have all heard of calories, but do you know what they actually do? Calories are what make our bodies run; they are the gas to our tank. Calories are needed for our organs to function and for our brains to work; they are what allow us to live. Remember, from last week’s blog, A Guide to Reading a Nutrition Label, fat has nine calories per gram while protein and carbs have four calories per gram. If you want pure weight change, counting calories is enough and will yield results. However, if you track and control your individual macronutrient levels, results will be far more favorable to weight loss.

What are Calories?

Calories are a unit of energy. On nutrition labels, calories let us know how much energy we are getting from that food source. Thus, if you eat 600 calories, you’re getting 600 units of energy.  

Calories are measured through a process of burning the food item—sounds interesting, right? Let’s take a piece of white bread; scientists will place the bread in a sealed container surrounded by water. They will then proceed to heat the food until it is completely burned. The rise in water temperate determines the amount of calories that are in the piece of bread. 

How Many Calories Should I Consume?

Every individual requires a different amount of calories per day depending on their age, height, sex, and activity level. The amount of calorie consumption has to do with metabolism, hormone levels, and how much energy you burn throughout the day. In general, men who are taller, younger, and more active need to consume more calories. Whereas women, people who are shorter, older, and live a more sedentary life, need to consume less.

Individuals who consume an excess of calories, especially bad calories (i.e., processed foods), are more susceptible to weight gain because calories in excess will be stored as fat. 

Tracking food after Bariatric Surgery to avoid regain

When trying to determine how many calories you should be consuming in a day, we first recommend talking with your bariatric surgeon’s office as the amount will vary based on how far out you are from surgery. 

There are calorie calculators out there that take into account your height, weight, age, and sex to calculate your resting metabolic rate, which is the number of calories your body burns when you are at rest. However, they are not always completely accurate, especially if you are trying to lose weight or maintain your weight loss post-surgery. 

In general, we recommend bariatric patients consume anywhere from 1,000 to 1,200 calories a day, which will vary based on the factors mentioned above. 

Macronutrients for Bariatric Patients

Macronutrients (“macros” for short) are the components of food that we consume in large quantities that provide energy in the form of calories—fat, protein, and carbohydrates. Macros provide the bulk of our body’s energy, and all of the food we consume contains some relative percent of each. 

Many people who are looking to lose weight or build muscle count their “macros,” typically on a ratio. For example, a person looking to build muscle and lose fat will have a 50% protein, 35% fat, and 15% carbohydrate ratio.

For a bariatric patient, though, I typically recommend 40% protein, 40% fat, and 20% carbohydrates. So if you’re one-year post-op and eating 1,000 calories, you will eat 100 grams of protein, 44 grams of fat and, 50 grams of carbs.

There are four calories per gram of protein, four calories per gram of carbohydrates, and nine calories per gram of fat. 

Counting Calories

Why You Should Count Your Macros?

An advantage to counting macros is that you are more in control of the types of foods you are eating, and it helps hold you accountable to eat the right amount of food. Some people overeat while some under-eat – I see that a lot with bariatric patients less than six months post-op. By counting macros, you will ensure you’re meeting your caloric and percentage needs.

Another advantage is that it provides mindfulness to any imbalance you may have with your current intake. Some people may realize they are eating way too many carbohydrates while not eating enough protein or overeating protein but not enough fat. Once you start tracking your intake, which I HIGHLY encourage, you may notice the macros you are over sufficient or insufficient in.

Counting macros can also be suitable for anyone who feels deprived of certain foods. I do not advise bariatric patients to have carbs within the first six months and to focus mainly on protein. As I have seen, the most common carb missed is fruit. Once you hit six months post-op and are allowed to eat a few carbs, counting macros allows you to moderate your choices a bit more than a rigorous denial of certain foods.

One big con for counting macros though is that it does not take into account food quality – only quantity. I have seen people eat pop tarts as a meal because they have not had any carbs for the day and decide to use their carb % on simple carbs. Our bodies react differently to 100 calories of oatmeal vs. 100 calories of potato chips. You will be far more hungry earlier on eating potato chips than you would oatmeal.

Being aware of calories and macronutrient levels can help you make informed, healthy food choices while also focusing on your weight loss goals. We recommend you reach out to your bariatric clinic to gain more insight into how many calories and macros you should be consuming at the stage you are in post-weight loss surgery.

A Guide to Reading a Nutrition Label After Bariatric Surgery

Nutrition facts are on any packaged food item and even pertain to produce and meat products. Nutrition labels are essential to providing valuable information on the quality of food you are eating and making informed, healthy food choices—which is especially important after bariatric surgery.

The Food and Drug Administration (FDA) created the nutrition label to compare food items on a standardized scale. If you are unfamiliar with reading a nutrition label, it can become overwhelming due to all the numbers and percentages. In this blog, we are going to walk through how to read and understand a food label. We will also break down the nutrition facts so that you can use them as a guide as you incorporate nutrient-dense, high protein, and low carbohydrate foods into your weight loss diet plan. 

After bariatric surgery, you will need to make changes to your eating habits and the type of food you consume—not only in quantity but also in quality. When you have a thorough understanding of nutrition facts, the nutrition label on packaged food items will serve as a cheat sheet to help you make healthy food choices. 

The nutrition label will also ensure you are eating enough nutrient-dense foods after surgery since malnutrition is a potential side effect of bariatric surgery. 


Percent Daily Value

First, it is important to point out that almost all nutrition labels are based on a 2,000 calorie diet, which the FDA deems the “average” daily caloric intake. We know that after bariatric surgery, most patients will consume around 1,000 calories a day, so when reviewing “% Daily Value” on the nutrition label, you will want to double the value. 

For example, if the label says that the “% Daily Value” of Total Fat is 12% (8g) based on a 2,000 calorie diet, your “% Daily Value” will actually be 24% (but still 8g) when based on a 1,000 calorie diet. 

In general, if the percentage is greater than 20%, that indicates a high quantity, whereas if it is less than 5%, that means a low quantity. You want to apply your understanding of macronutrients (carbs, proteins, and fats) to find the right “% Daily Value” based on your nutrition needs. 

We will also encourage you to refer to your diet advancement sheets provided by your bariatric surgeon’s office for recommended calories and macros.

Foods Hindering Weight Loss after Bariatric Surgery

Despite what you may think, all “healthy” foods are not created equal. The food industry has spent billions of dollars on marketing certain foods that they claim to be “healthy”. And unless you are doing your own research on food nutrition and food science, you are likely falling prey to this form of information dissemination. 

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My Journey From 600 to 230 Pounds: Josh Bounce

I had a Duodenal Switch on October 10, 2018. From the time I can remember, I have always been a heavier-set person. Growing up in Las Vegas with a lower-class family, eating healthy wasn’t a priority, and a lot of the time, the cheapest choice was all we could afford. So early on in life, I developed some pretty bad eating habits. Combined with the fact that I had hypothyroidism, maintaining a healthy weight was not easy. 

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How Stevia Helps with Weight Loss After Bariatric Surgery

The bottom line is that the only way to lose weight is to create a calorie deficit by eating fewer calories than your body burns for energy. There are many ways to accomplish this, and targeting added sugars and replacing them with stevia is an easy and tasty fix.

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How to Support Your Partner after Bariatric Surgery

True story: A friend of mine had bariatric surgery. Her husband came to her hospital room the morning after her surgery with a box of donuts. They weren’t for her, of course, but he wanted something to munch on while she was recuperating.

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Misleading Hunger Signals after Bariatric Surgery

Is this feeling really hunger? It may sound a bit odd, but many people genuinely cannot tell if they’re physically hungry or if what they’re experiencing is a misleading hunger signal. what? Misleading… Hunger… Signal. Sometimes you think you’re hungry, and you may even experience physiological signs that feel like genuine physical hunger. Still, you ate an adequate meal a short time ago, and your body is not actually physically hungry.

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My Weight Loss Story: Crystal Hilton

Growing up, I was always overweight. I don’t remember a time in my life when I wasn’t always the “fat one.” It was so hard to watch my two siblings and cousins play sports and enjoy “normal” childhood activities. I wanted to do those things so very badly, but because of my weight, I was an introvert and always opted out of everything. I am a huge sports fan, but never played anything. I love to be outside, but never took part in activities. I love being with friends and family, but never did anything.

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Tips to Keep the Weight off after Bariatric Surgery

One of the common concerns for patients months after weight loss surgery is “will I be able to maintain this weight loss?” and “what if I gain all my weight back?”. If you are considering having bariatric surgery or have previously had the surgery, these question themes may have crossed your mind, and you may even be milling over these questions in your weight loss phase today. Continue reading “Tips to Keep the Weight off after Bariatric Surgery”

The Pros and Cons of Excess Skin Removal Surgery

There are many benefits to bariatric surgery, including improved health and extreme weight loss, of course. However, with extreme weight loss does come excess skin, or loose skin that has lost its elasticity. Loose skin can make everyday life harder and more painful. The body areas that seem to be the most problematic are around the abdomen (pannus), back, breast, arms (bat wings), and legs. Occasionally patients will develop redundant skin around the neck. Fortunately, there is surgery to remove this extra tissue and improve cosmesis and functionality.

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My Weight Loss Story: Priscilla Post

My weight loss story began 7 years ago and I am still on it today. Since my surgery in April of 2012, I have struggled to lose the weight and keep it off. Many people will say that weight loss surgery is the easy way out, but I (along with the rest of the weight loss surgery community) know that having the surgery is not at all easy. Every day is a challenge to make the right food choices and to not end up where I began.

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My Weight Loss Story: Paris McCrary

All my life I have been on the heavier side. From the time I was a young girl, I would turn to food to deal with my emotions. I would turn to food when I was happy or sad or angry. Food was my comfort and quickly turned into my demon. Over the years, I knew my weight was getting out of control, but I was terrified to face the scale—so I didn’t. Until one night when my curiosity set in. I stepped on the scale, and the number I saw had me in disbelief—500 pounds!

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My Weight Loss Story: Tres Taylor

The first time I remember struggling with my weight, I was probably around nine years old. I remember as I sat in my third-grade classroom, my teacher started to ask for my classmates’ weights for a math problem. As they called out their weights, all averaging about 75 to 80 pounds, my heart pounded. I began to dread the thought of my teacher asking for my weight, to which I would have sheepishly answered with a whispered “One-hundred and fifteen.” As I sat there, I met shame for the first time. And it was horrible. That night, at nine years old, I decided to go on my first diet.

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My Weight Loss Story: Tamie Bartlett

I began struggling with my weight at the age of 19, shortly after my first pregnancy. Over the next 13 years, I would lose weight only to gain it back again. I tried everything to lose the weight and keep it off—fad diets, weight loss groups, prescription weight loss pills. And nothing ever stuck.

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My Weight Loss Story: Karen White

My weight loss story began when I was a young adult. At just 21 years old, I weighed 174 pounds. Then I got married and had three kids which resulted in a lot of weight gain over the next several years. I gained about 100 pounds over a period of 20 years.

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How to Find Support on Social Media after Weight Loss Surgery

Social media can be a great tool, however it can also be a means of self-deprecating behavior depending on your interaction with it. We have discussed the fact that if you compare yourself in a negative light to others who post online, you are not doing yourself, or your self-esteem, any favors. Focus on what you are doing well and ask for help in improving what you can do better. 

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Weight Loss Expectations

Many patients come to see us at Live Healthy MD because they have failed at pretty much every attempt to lose weight. As the prevalence of obesity continues to rise, more and more physicians and professionals in this field of study begin to recognize it as a disease. For many who have tried and failed to lose weight on their own or who feel as though their weight is out of control, weight loss surgery is the best solution for maximal and sustained weight loss. However, like any treatment, surgery is not fool-proof and results will vary based on each individual.

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The Post-Op Diet: All You Need to Know

It is a common misconception that weight loss surgery is the easy way out. However, this is not true at all! Weight loss surgery requires making many changes and change is not easy. In addition to mental changes, the diet changes necessary are usually the most challenging for most patients.

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Celebrating the Non-Scale Victories after Bariatric Surgery

Weight loss patients often obsess over the number on the scale. As an RD (registered dietitian), I can’t tell you the number of times I’ve heard from patients how they just want to weigh a certain weight or lose that last 10 pounds. Too often, patients lose sight of what they have already accomplished and focus on only the end goal. 

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How to Lose Weight and Keep It Off After Bariatric Surgery

Staying on top of your goals following weight loss surgery can be difficult. It may feel like the temptations around you are unbearable, especially as Halloween just passed and the holidays begin to roll in. As a physician who has practiced bariatric surgery and medicine for 23 years, I have seen many patients succeed and equally as many fail at their weight loss. So, what are those patients doing to successfully lose weight and keep it off?

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What You Didn’t Know About Post Weight Loss Surgery

After any extreme weight loss, including that which results from surgery or even natural methods, weird things can begin happening to the body. You may notice these signs and symptoms immediately following surgery or they may appear several weeks after surgery. Most of the symptoms that follow surgery are temporary and are a result of your body reacting to a change in nutrition, fat content, and eating habits. Continue reading “What You Didn’t Know About Post Weight Loss Surgery”