Medical & Metabolic Care After Weight Loss Surgery
Reminder and Checklist for Patients
- After the operation, you need medical follow up to minimize the risks of rapid weight reduction, including gallstones, malnutrition, dehydration, gout, vitamin deficiencies and electrolyte disturbances.
For example, if your gallbladder has not been removed, taking pills of ursodiol 300 mg twice daily helps prevent gallstones. Follow-up may also be needed for conditions caused by obesity such as diabetes, hypertension, hyperlipidemia, sleep apnea, reflux esophagitis, arthritis, heart disease.
As these problems improve with weight loss, their treatment may need to be adjusted. For example, medications to reduce blood glucose in a diabetic may need to be stopped to avoid low blood sugar.
- These operations alter your stomach and intestines. This can cause serious problems due to malnutrition with serious problems unless you take ongoing preventive measures throughout your life. For example:
- Vitamin and mineral deficiencies: Vitamins B1, B6, B12, D, A, K, folic acid, iron
- Protein malnutrition
- Weakening of your bones (osteoporosis and osteomalacia) raising the risk of fractures
- To prevent these problems you should, for the rest of your life:
- Attend monthly a follow-up support group led by a medical professional such as an R.D.
- Take a complete multivitamin and mineral pill twice a day. It should include iron, folic acid, fat-soluble vitamins (A, D, E, K), thiamine (B-1), pyridoxine (B-6), trace minerals.
- In addition, take 1000 mcg of vitamin B-12 either injected every month or taken under the tongue every week. (Not needed after lap band).
- Take calcium at least 1200-1500 mg per day and vitamin D at least 1000 IU/day (many people need more). Calcium citrate is the best absorbed type of calcium.
- Prioritize protein intake (at least 60 grams per day) with your meals. Eat three small, nutritious meals, slowly, and drink water liberally between (not with) meals.
- Have a nutritional/metabolic evaluation at least once every year, more often if your test results are not normal (see section V below)
- Watch out for hypoglycemia (low blood sugar), even if you do not take medication for diabetes. It can cause sweating, shakiness and/or confusion, relieved by sugar intake. If you have such symptoms after eating sugary meals, try to prevent them by limiting sugar intake.
If this does not prevent the problem, see a specialist (such as an endocrinologist) for more definitive evaluation.
- Regular, routine monitoring at least once a year for the rest of your life is necessary to detect and prevent serious problems due to malnutrition. These problems often develop silently, without symptoms at first, but they are treatable and can be detected with lab tests. Abnormal results indicate a need for prompt treatment and follow-up. For the first 2 years after your operation, you should have these check-ups at least every 6 months, and thereafter at least annually even if your results are normal.
- Blood count, albumin, ferritin, vitamin B12, folate, vitamin B1 (this is thiamine, and should also be checked and corrected immediately if you develop persistent vomiting), fasting calcium, parathyroid hormone, glucose, 25-hydroxy-vitamin D, and 24-hour urine for both calcium and creatinine. If you your operation was either gastric bypass or duodenal switch surgery, vitamin A should also be checked, realizing that levels <20 indicate deficiency.
- Once your weight has stabilized, you should have a bone mineral density test (DEXA scan), and thereafter at least every 4 years even if your bone density is still normal.