Bariatric Surgery: Why Long-Term Follow-Up, Nutrition, and Lifestyle Matter More Than You Think
- Katrin Peo
- 15 minutes ago
- 6 min read
Two weeks ago, I attended a day seminar on the bariatric surgery patient journey — about surgeries, nutrition, supplements, and movement. The seminar was aimed at family doctors, nutrition therapists and nutrition counsellors.
Obesity is a chronic, progressive disease—not a personal failure. And like all chronic illnesses, it deserves skilled support, early intervention, and compassion.
The Health Risks Linked to Obesity
Obesity affects every organ system in the body. It increases the risk of:
Prediabetes and type 2 diabetes
Non-alcoholic fatty liver disease
Sleep apnoea
Osteoarthritis
Cardiovascular disease
Stroke
Infertility
Asthma
Certain cancers (breast, colon, liver, pancreatic, etc.)
Depression
Early mortality
These risks make it clear why some individuals eventually consider medical or surgical intervention.
1 in 8 people worldwide live with obesity
Adult obesity has more than doubled since 1990
Adolescent obesity has quadrupled
2.5 billion adults are overweight; 890 million live with obesity
35 million children under 5 are overweight
Over 390 million children aged 5–19 are overweight or obese
In Estonia:
All this information is deeply concerning.
For individuals with severe obesity, bariatric surgery can be a highly effective tool that improves metabolic health, supports weight loss, reduces medication needs, and enhances quality of life. But surgery is not a cure. It is a medical tool that requires lifelong cooperation between the patient, healthcare team, and daily lifestyle choices.
This article explains what is bariatric surgery, when it is recommended, why nutrition, yearly medical follow-up, appropriate supplementation, psychological support, and lifestyle habits are essential for long-term success after bariatric surgery.
When Is Bariatric Surgery Recommended?
Bariatric surgery is generally indicated when:
BMI ≥ 40, or
BMI ≥ 35 with obesity-related co-morbidities (e.g., diabetes, hypertension, sleep apnoea)
You can calculate your BMI here. In parallel it's also recommended to measure your waist and your hip. The recommended healthy waist circumference is less than 88 cm for women and less than 102 cm for men.
The two most common bariatric surgeries are:
1. Gastric Bypass
A small stomach pouch (20–30 ml) is created and connected directly to the small intestine, bypassing the rest of the stomach and duodenum. This reduces food intake and decreases nutrient absorption.
2. Gastric Sleeve
Around 85% of the stomach is permanently removed, leaving a narrow “banana-shaped” tube (100–150 ml). This reduces stomach volume and lowers hunger by reducing ghrelin production.
Why Bariatric Surgery Changes Everything in the Body
Bariatric procedures such as sleeve gastrectomy, gastric bypass, and mini-bypass work by reducing stomach size or rerouting food past parts of the stomach and small intestine. This leads to:
reduced stomach acid production
altered digestive enzyme activity
reduced absorption of several vitamins and minerals
changes in hunger and satiety hormones
faster alcohol absorption
higher sensitivity to certain medications
Because the digestive system is permanently changed, the body cannot process food the same way it used to. This is why patients need special dietary guidelines, lifelong supplementation, and regular biochemical monitoring.
Micronutrient Deficiencies: A Real and Common Risk
People living with obesity already have a higher risk of micronutrient deficiencies. Studies show that up to 66% of individuals have at least one deficiency before surgery—especially vitamin D, iron, B12, folate, and zinc.
After bariatric surgery, the risk becomes even higher due to reduced absorption:
Most common deficiencies after surgery
Iron
Vitamin D
Vitamin B12
Folate
Calcium
Fat-soluble vitamins (A, E, K)
Protein (if daily intake is insufficient)
Many of these deficiencies can lead to fatigue, hair loss, bone problems, anemia, weak immunity, and neurological symptoms.
This is why checking blood levels of the above micronutrients every year (or more often if problems arise) is critical for long-term health.
Why Pharmacy Multivitamins Are NOT Enough
After bariatric surgery, the body requires higher, therapeutic amounts of certain vitamins and minerals—something regular pharmacy multivitamins do not provide. For example:
Iron needs increase dramatically.
Vitamin B12 absorption drops sharply and may require high-dose tablets or injections.
Calcium citrate (not calcium carbonate) is needed due to low stomach acid.
Vitamin D must often be taken all year round.
Bariatric-formulated supplements are specifically designed for hese needs. They ensure correct forms, doses, and combinations that support proper absorption and prevent deficiencies.
The Problem: Many Patients Stop Follow-Up Too Early
It was stated at the bariatric seminar that 30–40% of patients stop attending follow-up appointments within two years after surgery.
This is concerning because:
deficiencies often appear years after surgery
weight regain can happen gradually
medication needs may change
mental well-being requires long-term support
physical symptoms may not be noticeable until complications arise
Not attending follow-up increases the risk of long-term health issues that could otherwise be prevented.
Essential Eating and Drinking Guidelines
Because the stomach is smaller and the digestive process is altered, the following guidelines are crucial:
1. Eat regularly and avoid long gaps
Irregular eating with long gaps leads to:
low energy
unstable blood sugar
hypoglycaemia
overeating later in the day
poor protein intake
slower metabolism
Small frequent meals work best.
2. Prioritise protein intake
Protein must be prioritised before surgery and lifelong after. The recommended intake of protein is 1.2-1.5g per kg of body weight. This supports:
muscle mass
metabolic rate
wound healing
satiety
weight maintenance
3. Hydration matters
Because the stomach is smaller, sipping water is often difficult. Techniques like small, frequent sips, room-temperature water, herbal teas can help maintain hydration.
Don't drink 30 minutes before meals
Don't drink during meals
Don't drink 30–45 minutes after meals
Sip slowly throughout the day
Avoid carbonated drinks (including carbonated water). Gas can expand in the stomach and cause discomfort or stretch the pouch.
4. Avoid carbonated drinks
Gas can expand in the stomach and cause discomfort or stretch the pouch.
5. Be careful with alcohol
After bariatric surgery:
alcohol reaches the bloodstream faster
blood alcohol levels rise higher
addiction risk increases (alcoholism is a known complication)
Alcohol should be consumed rarely or avoided altogether. Many bariatric clinics recommend avoiding alcohol for 6–12 months, sometimes longer.
Medication Adjustments: What You Need to Know
Some medications are absorbed differently after surgery.
Avoid NSAIDs such as:
ibuprofen
diclofenac
These irritate the stomach lining and increase the risk of ulcers.Safer alternatives should be discussed with a doctor.
Many patients also need to adjust blood pressure medications, diabetes medications, and sometimes antidepressants. It is important to review all medications with a doctor after surgery—and then regularly over time, as the body changes.
Pregnancy After Bariatric Surgery
Women should not take bariatric-specific supplements during pregnancy. Instead, they should switch to pregnancy-specific supplements under medical guidance.
Pregnancy is safest 12–24 months after surgery, depending on the individual’s nutrition status and weight stability.
Weight Regain: Why It Happens
About 20–30% of patients experience weight regain or inadequate weight loss in the long term. The main reasons include:
Stopping follow-up visits
Not taking supplements
Irregular eating
Emotional eating
Lack of physical activity
Alcohol use
Returning to old habits
Surgery is a powerful tool — but it must be combined with:
consistent healthy nutrition
regular physical movement
psychological support when needed
yearly medical monitoring
Can Bariatric Surgery Be Reversed?
Gastric bypass and mini-bypass may be reversible in certain cases (rare, and only when medically necessary).
Sleeve gastrectomy is not reversible, because most of the stomach is permanently removed.
This is why it is essential to seek thorough consultation from the doctors before deciding on surgery.
Professional Support Matters
Successful long-term outcomes are much more likely when individuals work closely with:
bariatric surgeons
nutrition therapists
psychologists or behavioural therapists
general practitioners
physiotherapists or personal trainers
Weight loss is deeply physiological, emotional, and behavioural. No one should go through it alone.
Final Message
Bariatric surgery is not a quick fix or a short-term solution. It is a life-changing medical intervention that requires commitment, knowledge, and ongoing support.
To protect your health and maintain the benefits of surgery:
Follow the nutrition and hydration guidelines provided to you
Take the correct supplements in the correct amounts
Have your blood checked every year
Adjust your medications with your doctor
Seek support for emotional or behavioural challenges
Stay physically active
Attend all follow-up appointments
With the right approach, bariatric surgery can help you achieve long-term health, improved quality of life, and a better relationship with your body.
If you’ve tried dieting for years, feel stuck, or don’t know where to start to get to a healthier weight with nutrition and lifestyle changes, do reach out to me for personalised nutrition counselling and health coaching at info@katrinpeo.com.
Comments