There are a lot of things you can expect from bariatric surgery, and there are a lot of things you cannot expect from a procedure. So let us go through a few of the myths that are popularized in the general press and find the facts.

MYTH: You can eat anything you want after weight loss surgery

FACT: Diet is a four-letter word and you will always be on one

Obesity is a life-long disease that requires life long treatment, and having weight loss surgery means that you will have to eat differently for the rest of your life. In fact, weight loss surgery means you will have to change your life entirely, and eat a certain way. Let me make this clear for you: If you don’t eat properly after a procedure, you can die. Weight loss surgery does not mean that you can eat whatever you want, whenever you want. This means you will be on a diet. There are a couple of simple reasons for this.

First, you cannot eat as much. All weight loss surgeries reduce the capacity of the stomach. The average stomach is between 40 and 50 ounces, or about a liter and a half. This means you can have a 16-ounce steak, a 12-ounce glass of water, the large basket of French fries, the nice spinach salad, and still have room for a glass or three of wine along with dessert. So this nice dinner at Morton’s not only supplies you with enough calories for a few days, it also contains enough protein, fat, carbohydrate, and almost enough essential vitamins and nutrients to last through the first part of the week. By the way, I love Morton’s. They even have a great chicken dish (Chicken Christopher). When your stomach is smaller, you cannot eat all of that. Practically, this is one reason we suggest that weight loss surgery patients take vitamins. Since you don’t have enough room to eat all the food required to keep you healthy, you must be careful that what you eat is going to sustain you. You need a certain amount of protein, carbohydrates, fats, calories, vitamins and minerals—if you do not get those you will become ill, very ill.

There is not one overweight healthy person who will trade places with a skinny sick person. So, you must learn about proper nutrition or at least develop a diet and menu plan that will allow you to sustain yourself. Fortunately, it is not that difficult to eat well, and if you normally eat well but just eat too much, then this is a good choice to treat obesity. However, if you eat poorly, you cannot expect that your body can sustain itself with smaller quantities of food that has little nutritional value. In fact, you can expect that if you eat poorly, even if it is smaller quantities of food, you will suffer.

There is a condition where people crave certain things, and this causes bizarre eating habits. One wonderful weight loss surgery patient of mine was embarrassed when he told me that at nights he would go outside and eat dirt from his garden. When we checked his laboratory work, we found that he had a deficiency in iron—his body was craving dirt because, as every Native Arizona person knows, we have a lot of iron in our soil. Once we replaced What happens if you do not follow through and eat well? You could die.his iron, he lost the craving for dirt and his garden didn’t get as much attention. Some weight loss surgery patients do not receive enough nutrition through their diet. Even though they consume a lot of calories, they do not receive enough vitamins and minerals from their diet. You can super- size any meal, but if it doesn’t contain the right stuff, you will feel full, but your body will still starve. Obesity is a disease that involves a lot of factors including genetic and environmental—one of the theories as to why some people consume so much more than others is their body is not receiving the essential nutrients they need, hence they crave more food. Just because you consume a lot of calories does not mean that you are nourished.

What happens if you do not follow through and eat well? You could die. You could experience simple, straightforward death, but it won’t be a fun death—it will be slow and agonizing. You will have multiple organ failures, including failure of your liver and your kidneys. Before you die, you may become demented, you may become constantly tired, and you may have wasting of muscles and be unable to get out of bed.

MYTH: If you eat a good diet, you won’t have to take vitamins

FACT: Your body may not be able to absorb enough nutrients to keep you healthy. Taking vitamins and supplements is easier than getting sick.

Prevention of vitamin deficiencies is easy and simple. You take a pill, or chew a pill, or swallow a liquid. Sometimes patients with weight loss surgery are required to take vitamin shots (I hate needles) and sometimes they have to take a lot of shots. In spite of that, not taking vitamins or calcium is foolish.

Taking vitamin C is simple

Here is a simple one: You need Vitamin C to help with healing. Taking vitamin C is simple, and it is absorbed well and isn’t toxic if you overdo it. Deficiency of vitamin C is a deadly problem, called scurvy. What happens is that old wounds open up. So imagine this: your abdominal wound starts to open up, as well as any other old wounds you have—not a pretty sight. It sure is easier to take the vitamin C. To cure scurvy you have to take vitamin C, but you also have to get all of those wounds healed again, and that is not fun.

I choose vitamin C, not because it is something that people become deficient in, but it has such a great history. In the old days of the British Navy, the sailors went to sea for months at a time. If they were lost in the new world—and at sea, they had plenty of fish, which are pretty nutritious. What they didn’t have was a source of vitamin C, so these sailors became ill. Their teeth fell out, old war wounds opened up, and a number of them died. Then they discovered those sailors who had citrus fruits on board didn’t get sick, so all British Navy vessels carried limes, and all sailors were required to eat a certain number of limes per week—hence, British sailors, to this day, are called “limies.” And you thought you are here just to learn about how to lose some pounds.

It is amazing that such a simple thing could prevent such a horrible and painful illness. The same is true of bariatric surgery. You can prevent a problem a lot easier than treating a problem so please, take your vitamins. Perhaps we should call weight loss surgery patients “Vitaminees.”

MYTH: Your weight loss surgery is done and so are your doctor visits

FACT: You have to follow up with your weight loss surgeon (we like seeing you)

So you are doing what you should—eating well (which really isn’t that difficult), taking your vitamins, even going for walks. You are feeling good and loving life after having bariatric surgery. Do you need to see the weight loss doctor? Yes, it is very important, and you will need to have your blood drawn too.

I had this great patient, a very athletic guy who was over 500 pounds. He had weight loss surgery, did well, and didn’t come in to see me. He felt a bit winded, and had lost over 200 pounds when he decided to finally reply to my mail and make an appointment. This fellow was white. I mean, he was anemic as he could be. His blood count was about a third of what it should be because he was iron deficient. We put him into the hospital and gave him six pints of blood before his blood count became just low, instead of deadly. He had to have some painful iron shots after that. It took a while, but finally he started to feel better.

You must see your weight loss doctor regularly

Even if you have your weight loss surgery in another county, or state, or continent you need to see your doctor regularly. It does not have to be the bariatric surgeon; it can be your primary care doctor. At the end of this book is a list of blood tests, which they should perform on you, yearly. It is easier to prevent a problem than it is to treat one.

You should keep in contact with your weight loss surgeon. If they live far away, it might be difficult for you to see them, but have your family doctor send them test results, your weight, and let them know of any complications that you might have. Many weight loss surgeons participate in registries of patients, and for us to have accurate statistics, and long-term follow up, we need to know what is happening. Besides, we want to hear the good news and the bad. Finally, if we discover some new pill that works great with weight loss surgery, or a better way to take a vitamin, or—God forbid, we find that the procedure needs to be reversed (as was the case in the jejunal-ileal gastric bypass surgery), we need to contact you.