The first thing I need to say is that there are absolutely NO stupid questions after weight loss surgery. There are only unasked questions that can lead to problems!

Here are five questions folks tend to preface with “This may be a stupid question but…” But here’s the deal. I don’t want the conversation to end here! If you have a question you’ve been shy to ask, either leave it in the comments (if you feel comfortable) or email me directly at nikki@bariatricfoodie.com. Knowledge is power!

How do you take communion after weight loss surgery?

This is a question I see a lot. Many post-ops are Christians who participate in the practice of communion, which involves ingesting a small bit of bread and wine during a church service. The process of taking communion is usually very streamlined in churches. That is to say, there’s usually not an opportunity “in the moment” to ask for a substitution or change. You just have to go with the flow.

But many post-ops, especially newbies, wonder how they can participate in this practice. After all, wine has sugar and alcohol, two things new post-ops are generally warned not to consume. While many post-ops are eventually cleared for bread, it is usually restricted in the beginning and can cause problems. So what do you do? Here are some tips:

• Talk to your clergy! And preferrably before you have surgery. When you talk to them, you can tell them what your limitations are and then you can make a plan together.
• Be open to alternatives. I know one post-op who discussed her surgery with her pastor and he suggested that she get a special blessing in lieu of communion the first few months. After that they made a plan to use low-sugar fruit juice in place of wine or regular fruit juice. These were things that could happen because she kept an open mind.

This advice, of course, depends on your church and how comfortable you feel sharing your process. But bottom line: ask for what you need! Many times people are more than willing to help you in any situation if you just reach out and ask.

If I eat too much, will I stretch my stomach out?

To address this question I had to enlist help because I’m not so great with the anatomy stuff. But I will say this.

I too was warned of the perils of stretching my anatomy by overeating, consuming certain beverages, etc. And I think it’s a pretty common worry since restriction after weight loss surgery is one of the most powerful long-term tools we have to control our eating. So here’s what I found out.

Yes, it is possible to stretch out your stomach/pouch/sleeve. It can be done.

However.

It’s not necessarily an easy thing to do. With RNY, the pouch is made of a part of the stomach called the fundus, which is a fairly tough portion of the stomach. Stretching it isn’t easy! (Which is probably why this is the portion used to make the pouch.) But it is possible. My sources tell me, however, that it would take habitual (read: over and over), prolonged (read: over a long period of time) and gross (read: super extreme) overeating to truly stretch out your anatomy.

There are, however, other ways you can inadvertently alter your anatomy to make it possible for you to eat too much. For RNY patients, one thing that can happen is that your stoma can become stretched. When I say stoma, I am referring to the opening between your stomach and your intestines. When you RNY gastric bypass, your stoma is made very small so that only small bits of food can pass through at a time, causing you to feel full on very little food since your pouch cannot hold much. But it is possible to stretch out that stoma so that food passes through more quickly, leaving you feeling hungry more frequently and from less food. A very common way to stretch the stoma is by eating and drinking together. Not eating and drinking together is an almost universal rule after RNY surgery and this is just one of the reasons.

With the vertical sleevel gastrectomy (VSG or “the sleeve”) there is no re-routing of the intestines and thus the original stoma between the stomach and intestines remains in tact. While many websites warn of potential sleeve stretching, there currently aren’t any reputable studies to suggest that stretching a sleeve is easy, although I’m quite sure that like RNY, it is possible.

So here is the most important point I’d like to make on the subject of stomach stretching. If, by chance,you have truly  stretched something, that is an issue that requires medical intervention! I’m very serious here. If you feel like you can eat way too much and you suspect either your stomach or stoma is stretched, you need to see your surgeon about it. There are tests that can be performed to see if there is truly something wrong with your anatomy. True stomach stretching cannot be addressed by altering the diet.

Does eating soup count as eating/drinking together? How about cereal/milk?

While we are on the subject of eating and drinking together, this is another question that comes up a lot. With many foods, determining whether you are eating/drinking together is fairly clear cut. Sometimes not so much though. Two commonly confusing foods are soup and cereal with milk.

Soup

First let’s acknowledge how wonderful a hot bowl of soup can be on a cold day, especially for a newly altered stomach. Warm liquids can sometimes work much better. But when there are things in the soup (veggies, meat, etc.), and you eat them, does that mean you are eating and drinking together?

In a word: Yes.

So what do you do about that? Well my advice is to talk to your surgeon or registered dietician because advice tends to vary. I can tell you that when I was a newer post-op, I tended to do soup a lot simply because proteins cooked in soup were very tender. I would eat as much of the soup “fillings” as I wanted (I called them the “soup guts”) and then leave the broth. You may have another method (if so, post in the comments, please!).

Cereal/Milk

I’m going to cut straight to the chase and say yes, this too constitutes eating and drinking together. By eating cereal with milk you are taking in both a liquid and a solid. Again, my advice is to first and foremost talk to your surgeon or dietician about how to handle that. For me, I tend to stay away from cereal and milk for one simple reason. No matter how much protein the cereal says it has, it usually doesn’t have enough to keep me from having a blood sugar crash after eating it. Even the protein in milk doesn’t help that much. Instead, I tend to sprinkle a little cereal over my Greek yogurt or cottage cheese when I want some crunch. And I tend to stick to very low-sugar/high-fiber cereals like Fiber One.

How will my body know when to stop losing weight?

At some point in our first year post-op, many of us have this feeling that we are losing too much weight or losing too quickly. It can be scary on a number of levels, especially when you have concerned family members and friends telling you that you’re losing too much or they fear you are unhealthy.

Science is still studying many aspects of how the body regulates weight (check out this good podcast for a good general primer), but the main take-away for you should be this. Your body has a way to regulate body weight and it has a way to stop you from fading away into nothing. Since I know that’s not very comforting by itself I’ll also say that your surgeon will monitor you very closely during your first two years post-op to observe the rate at which you are losing weight. If your weight loss concerns your surgeon, they will intervene. There are a number of things that can be done (alteration of diet and exercise schedules, changing the composition of food you eat, etc.).

The bottom line is this. It’s important to stay up to date on your post-surgical follow-up. If you are losing too much weight your surgeon will intervene. If you are concerned but your surgeon hasn’t mentioned it, ask! Your bariatric practice doesn’t mind when you ask questions and very often they will talk through these things with you.

Has anyone had this surgery and not lost any weight?

This is a fear I think we all have. What if surgery doesn’t work? Like…what if it doesn’t work at all?

Within the bariatric professional community, standards on bariatric surgery success vary but the most common measure I’ve heard is that a patient is successful if they lose at least 50% of their excess body weight. Your surgeon may have a different measure. It might be a good idea to ask them!

Monitoring your progress in this aspect is one of many reasons your surgical practice wants to see you many times throughout your first two years after surgery. When they see you every few months they can note trends, identify problems and intervene when needed.

Here’s the important message though. If you aren’t losing weight after surgery, it isn’t always a behavioral issue. There are anatomical and medical factors that can interfere with weight loss, even after weight loss surgery. I point that out because we, in our hyper-motivated states, can tend to be hard on ourselves and our behavior, thinking we caused ourselves to stall. This behavior can further make us not want to go to our bariatric professionals for fear of being lectured or admonished.

But I’ve heard of quite a few instances where insufficient weight loss was in fact a medical issue and not simply behavioral. The patients involved were able to find that out by working with their bariatric team. And even if your issue is behavioral (as it sometimes is), you should still seek the help of your bariatric team because they can help you to correct whatever issues you are having or can refer you to someone who can.

There are no stupid questions!

I hope that’s your main take-away from this article. Ask as many questions as you need to ask in order to understand what’s going on with your body. Knowledge is power! If you hear or read something you don’t understand, ask your bariatric professionals! If their information contradicts what you’ve read, it’s ok to point that out and get their feedback on that too.

That brings me to the last point I want to make. Use reliable sources of information! When researching this article alone I came across many misleading and straight-out false facts about some of the questions asked. Just in case you need it, here are two good sources of information to research different aspects of bariatric surgery:

• The American Society of Metabolic and Bariatric Surgery (ASMBS): This body established the “Bariatric Centers of Excellence” distinction and conducts research and provides recommendations for things like nutritional intake and vitamin consumption.
• The Obesity Action Coalition (OAC): The OAC promotes information, education and advocacy for people living with obesity. Their website provides a wealth of information about post-bariatric life, and their magazine (sent to members) features articles by leading professionals in the bariatric and weight loss fields.