So what’s the big deal about having  a cocktail after WLS?    WLS has been shown to drastically lower alcohol tolerance – to the point that some post-surgery patients have a blood alcohol content above the legal driving limit after just one drink.  Alcohol is absorbed more rapidly into the blood and small intestines due to the reduction of hydrochloric acid in addition to the alteration of shape & size of the stomach.  Bariatric patients will be more sensitive to the affects due to their low caloric intake, metabolic changes and hypoglycemia is more likely to occur.

As far as cooking with alcohol, people believe once heat is added all the alcohol burns off and only the flavor is left.  This is a myth.  The US Dept of Agriculture shares that if alcohol is added to boiling water and quickly removed from a flame, 85% of the alcohol is retained in that dish.  Simmering a meal with alcohol can take as long as 2 hours or more to burn off.

The American Society of Metabolic and Bariatric Surgery recommends high-risk groups (those with any history of psychiatric illness, substance abuse or addiction) who have had gastric bypass should completely eliminate alcohol consumption due to impaired alcohol metabolism and risk of alcohol abuse post-operatively.

Remember you’ve had a surgery that puts you at risk for malnutrition.  Alcohol inhibits the absorption of thiamin which is a vitamin that can already be deficient in many bariatric patients due to malabsorption. B1 depletes quickly with chronic vomiting or increased alcohol intake because B1 is essential for glucose metabolism.  Regular alcohol consumption is strongly correlated with thiamine deficiency.  Symptoms of thiamine deficiency may include headaches, brain fog, nausea, muscle aches and pains.  It can progress to worse symptoms such as depression, amnesia, unstable gait, motor weakness, peripheral edema, hallucinations and even congestive heart failure.  If anyone is experiencing these symptoms, please check that your multivitamin includes at least 1.2 mg of thiamine.  Share your symptoms with your doctor immediately.  Early diagnosis is extremely important.

If you still choose to consume alcohol after WLS, wait until after the first year during the most rapid weight loss period.  Find a designated driver. It is apparent that alcohol affects people very quickly after their procedure. Be cautious and keep your low sugar drinks to a minimum as you learn how alcohol will affect you and to prevent dumping syndrome. If you are drinking to cope with emotions and feel it may be an issue, seek professional support to address the underlying issues.  The Chrysalis Center offers a Bariatric Recovery Group if you are struggling with alcohol addiction or dependency.

How much weight should I be losing?
Am I losing weight fast enough?
Questions similar to these are asked everyday in my office.
Let’s dive into some research for realistic expectations and mathematics to answer this question for each of you.

So here’s the research:
RNYGB patients are predicted to lose 70-80% of their excess weight by 18 months post-op.  By 15 years post-op, maintaining the loss of 60-65% of excess weight is considered successful.  Most people do not maintain the lowest weight they achieve; it’s normal to gain a small amount of weight typically between 3-5 yrs post-op.

SG patients are predicted to lose 55-60% of their excess weight by 5 years post-op.

Another marker of success is to stabilize in an overweight BMI category.  Most of you want to get to your dream weight and be in a normal BMI category but WLS does not get rid of 100% of your excess weight.  Unrealistic expectations can lead to feeling like a failure or sabotaging your success.  Remember to also measure your success by how much better you feel physically and how you’re able to move more comfortably in your body.

You’ll need a few numbers to answer “how much weight will I lose after bariatric surgery” including your pre-op weight, ideal weight and excess weight.

Pre-Op Weight – Ideal Weight = Excess Weight
Excess Weight x 65% = Expected Weight Loss
Pre-Op Weight – Expected Wt Loss = Expected Goal Weight

Example:
Patient is 5’8″ with pre-op wt of  375 lbs.
On a BMI chart, his ideal wt at a 24 would be 158 lbs.  Subtracting 158 lbs from 375 lbs determines he’s carrying 220 lbs of excess weight.
Multiple 220 by 65% and this patient can expect to loose a total of 143 lbs.
Subtract 143 lbs from starting weight of 375 lbs gives patient a goal weight of 232 lbs.

Check out this resource via Obesity Help; it calculates expected weight loss for you: http://www.obesityhelp.com/morbidobesity/information/planner+results.php

Keep in mind, these calculations are averages, not guarantees.  Lifestyle habits such as meal planning, reading labels, food tracking, staying hydrated, vitamin compliance and moving your body are all significant factors in improving your health and maximizing your weight loss.  Use your bariatric dietitian for education, support and accountability!