The 10 Most Common Mistakes Weight Loss Surgery Patients Make


While weight loss surgery (WLS) is considered the most successful treatment for morbid obesity, it is just the first step toward a fresh start. Weight regain is a common phenomenon, as is illness when weight loss surgery patients do not follow recommended guidelines.

Breaking old patterns, establishing an effective post-WLS lifestyle, and addressing the emotional issues that often complicate obesity takes more than commitment; it takes support, information, and resources.

The National Association for Weight Loss Surgery (NAWLS) helps WLS patients shape new lives. We teach people what they need to know and help them makes the changes they need to make to achieve long-term WLS success — physically, mentally, and spiritually.

In a November 2005 poll conducted by NAWLS, the following were identified as the top 10 mistakes WLS patients make:

1st Mistake: Not Taking Vitamins, Supplements, or Minerals

Every WLS patient has specific nutritional needs depending on the type of surgery you have had. Not only is it a good idea to ask your surgeon for guidelines, but also consult with an experienced WLS nutritionist. Understand there is not a standard practice that all surgeons and nutritionists follow in guiding WLS patients. So, it is important to do your own research, get your lab tests done regularly, and learn how to read the results.

Some conditions and symptoms that can occur when you are deficient in vitamins, supplements, or minerals include:

Osteoporosis; pernicious anemia; muscle spasms; high blood pressure; burning tongue; fatigue; loss of appetite; weakness; constipation and diarrhea; numbness and tingling in the hands and feet; being tired, lethargic, or dizzy; forgetfulness, and lowered immune functioning.

Keep in mind, too, that some conditions caused by not taking your vitamins, supplements, or minerals are irreversible. For example, a vitamin B-1 deficiency can result in permanent neurological deficits, including the loss of the ability to walk.

2nd Mistake: Assuming You Have Been Cured of Your Obesity

A “pink cloud” or honeymoon experience is common following WLS. When you are feeling better than you have in years, and the weight is coming off easily, it’s hard to imagine you will ever struggle again. But unfortunately, it is very common for WLS patients to not lose to their goal weight or to regain some of their weight back.

A small weight regain may be normal, but huge gains usually can be avoided with support, education, effort, and careful attention to living a healthy WLS lifestyle. For most WLSers, if you don’t change what you’ve always done, you’re going to keep getting what you’ve always gotten — even after weight loss surgery.

3rd Mistake: Drinking with Meals

Yes, it’s hard for some people to avoid drinking with meals, but the tool of not drinking with meals is a critical key to long-term success. If you drink while you eat, your food washes out of your stomach much more quickly, you can eat more, you get hungry sooner, and you are at more risk for snacking. Being too hungry is much more likely to lead to poor food choices and/or overeating.

4th Mistake: Not Eating Right

Of course everyone should eat right, but in this society eating right is a challenge. You have to make it as easy on yourself as possible. Eat all your meals–don’t skip. Don’t keep unhealthy food in sight where it will call to you all the time. Try to feed yourself at regular intervals so that you aren’t as tempted to make a poor choice.

And consider having a couple of absolutes: for example, avoid fried foods completely, avoid sugary foods, always use low-fat options, or only eat in a restaurant once a week. Choose your “absolutes” based on your trigger foods and your self knowledge about what foods and/or situations are problematic for you.

5th Mistake: Not Drinking Enough Water

Most WLS patients are at risk for dehydration. Drinking a minimum of 64 oz. of water per day will help you avoid this risk. Adequate water intake will also help you flush out your system as you lose weight and avoid kidney stones. Drinking enough water helps with your weight loss, too.

6th Mistake: Grazing

Many people who have had WLS regret that they ever started grazing, which is nibbling small amounts here and there over the course of the day. It’s one thing to eat the three to five small meals you and your doctor agree you need. It’s something else altogether when you start to graze, eating any number of unplanned snacks. Grazing can easily make your weight creep up. Eating enough at meal time, and eating planned snacks when necessary, will help you resist grazing.

Make a plan for what you will do when you crave food, but are not truly hungry. For example, take up a hobby to keep your hands busy or call on someone in your support group for encouragement.

7th Mistake: Not Exercising Regularly

Exercise is one of the best weapons a WLS patient has to fight weight regain. Not only does exercise boost your spirits, it is a great way to keep your metabolism running strong. When you exercise, you build muscle. The more muscle you have, the more calories your body will burn, even at rest!

8th Mistake: Eating the Wrong Carbs (or Eating Too Much)

Let’s face it, refined carbohydrates are addictive. If you eat refined carbohydrates they will make you crave more refined carbohydrates. There are plenty of complex carbohydrates to choose from, which have beneficial vitamins. For example, if you can handle pastas, try whole grain Kamut pasta–in moderation, of course. (Kamut pasta doesn’t have the flavor some people find unpleasant in the whole wheat pastas.) Try using your complex carbohydrates as “condiments,” rather than as the center point of your meal. Try sprinkling a tablespoon of brown rice on your stir-fried meat and veggies.

9th Mistake: Going Back to Drinking Soda

Drinking soda is controversial in WLS circles. Some people claim soda stretches your stomach or pouch. What we know it does is keep you from getting the hydration your body requires after WLS–because when you’re drinking soda, you’re not drinking water! In addition, diet soda has been connected to weight gain in the general population. The best thing you can do is find other, healthier drinks to fall in love with. They are out there.

10th Mistake: Drinking Alcohol

If you drank alcohol before surgery, you are likely to want to resume drinking alcohol following surgery. Most surgeons recommend waiting one year after surgery. And it is in your best interest to understand the consequences of drinking alcohol before you do it.

Alcohol is connected with weight regain, because alcohol has 7 calories per gram, while protein and vegetables have 4 calories per gram. Also, some people develop an addiction to alcohol after WLS, so be very cautious. Depending on your type of WLS, you may get drunker, quicker after surgery, which can cause health problems and put you in dangerous situations.

If you think you have a drinking problem, get help right away. Putting off stopping drinking doesn’t make it any easier, and could make you a lot sicker.

Are you taking your Super B Complex?

Cause if you’re not, here’s another GREAT reason to do so!

Can B Vitamins Lower Risk of Blindness?
Taking a Combination of Vitamins B6, B12, and Folic Acid May Lower Risk of Age-Related Macular Degeneration

By Jennifer WarnerWebMD Health News

Reviewed by Louise Chang, MD

Feb. 23, 2009 — Taking a combination of B vitamins may offer a rare and inexpensive opportunity to help prevent the most common cause of blindness in older Americans, age-related macular degeneration (AMD).

A new study shows that women who took vitamins B6 and B12 along with folic acid had a 34% lower risk of any AMD and a 41% lower risk of AMD with significant vision loss.

Researchers say treatments for AMD are limited to people in the later stages of the disease.
“For the large population with early or no AMD, there is no method of disease prevention other than avoidance of cigarette smoking,” write researcher William Christen, ScD of Harvard Medical School and colleagues in the Archives of Internal Medicine. “From a public health perspective, this is particularly important because persons with early AMD are at increased risk of developing advanced AMD, the leading cause of severe, irreversible vision loss in older Americans.”

Vitamin Combo Curbs Macular Degeneration

In the study, researchers randomly assigned more than 5,000 women over 40 without signs of age-related macular degeneration to take a combination of 2.5 milligrams of folic acid, 50 milligrams of vitamin B6, and one milligram of vitamin B12 or a placebo every day. The women were part of a trial looking at the use of these vitamins and cardiovascular disease. The women had heart disease or at least three risk factors for heart disease at the start of the study.

During about seven years of follow-up, 137 new cases of age-related macular degeneration were diagnosed, including 70 that resulted in significant vision loss.

The results showed that women taking the B vitamin supplements had a 34% lower risk of any AMD and a 41% lower risk of AMD with vision loss than the placebo group.

Researchers say the benefits of the vitamin combination in preventing AMD appeared to emerge about two years after treatment began.

“The trial findings … are the strongest evidence to date in support of a possible beneficial effect of folic acid and B vitamin supplements in AMD prevention,” the researchers write. They note that further research is necessary in other groups of people to confirm their findings.

View Article Sources

There are SO MANY reasons to stay on top of your B Vitamins – but if this one isn’t way up there, I don’t know what is!

Interesting! Very, very interesting!

For years now I’ve heard DS’ers remark to me: “It’s so strange – I just haven’t gotten sick since my DS! For like years now! I can’t figure out why!”

Maybe we know why now:

Low Vitamin D Levels Linked to Colds
Study Shows Vitamin D May Have a Role to Play in Preventing Colds and Flu

Also in my inbox today, from the Vitamin D Council:

The Vitamin D Newsletter
February 24, 2009

As readers from 3 years ago remember, this newsletter first published
evidence vitamin D would prevent influenza and many varieties of the
common cold in 2005:

I then published the theory in:

Cannell JJ, et al. Epidemic influenza and vitamin D. Epidemiology and Infection. 2006 Dec;134(6):1129-40.

As Science News reported, I realized this after observing an influenza epidemic at Atascadero State Hospital.

The antibiotic vitamin: deficiency in vitamin D may predispose people to infection. Science News, November 11, 2006

Last year, we used vitamin D to explain virtually all of the many unsolved mysteries of influenza.

Cannell JJ, et al. On the epidemiology of influenza. Virology Journal. 2008 Feb 25;5:29.

Our second influenza paper is by far the most accessed paper in the journal this year.

Top 20 most accessed articles for last year in Virology Journal

Today, researchers from Harvard and the University of Colorado, writing in the Archives of Internal Medicine, published convincing evidence my observations at Atascadero State Hospital were correct.

Vitamin D deficiency linked to more colds and flu. Scientific American, Feb 23, 2009

Adit A, et al. Association Between Serum 25-Hydroxyvitamin D Level and Upper Respiratory Tract Infection in the Third National Health and Nutrition Examination Survey. Arch Intern Med. 2009;169(4):384-390.

Influenza kill around 35,000 Americans every year and similar viruses cause additional mortality and untold morbidity. As I have said, It appears Linus Pauling was right about everything he said about vitamin C, but he was off by one letter. The Vitamin D Council, the nearly broke non-profit educational organization, now believes most influenza deaths and many other respiratory infections, like the common cold, could be prevented if Americans, and their doctors, understood some simple facts:

  • Vitamin D is not a vitamin, but a steroid hormone precursor, which has profound effects on innate immunity.
  • The amount of vitamin D in most food and nearly all multivitamins is literally inconsequential.
  • The correct daily dose of vitamin D for adults is approximately 5,000 IU/day, not the 200-600 IU recommended by the Institute of Medicine, the National Institutes of Medicine and the FDA.
  • The only blood test to determine vitamin D adequacy is a 25-hydroxy-vitamin D, not the 1,25-di-hydroxy-vitamin D test many physicians now order.
  • Healthy vitamin D blood levels are between 50-80 ng/ml, levels obtained by fewer than 5% of Americans.
  • Medicare’s new proposed rule change, which forbids Medicare carriers for paying for virtually all vitamin D blood tests (Draft LCD for Vitamin D Assay Testing (DL29510), will kill tens of thousands of Americans yearly.
  • The mechanism of action of vitamin D in infection, dramatically increasing the body’s production of broad-spectrum natural antibiotics (anti-microbial peptides or AMP) suggests pharmaceutical doses of vitamin D (1,000 IU per pound of body weight per day for several days) will effectively treat not only influenza and the common cold, but help treat a host of other seasonal infections, including meningitis, septicemia, and pneumonia, in both children and adults.
  • In 1997, when the Food and Nutrition Board (FNB) set the current guidelines for vitamin D intake, they forgot to correct for the widespread sun avoidance that began in the late 1980’s when the AMA’s Council of Scientific Affairs warned against sun-exposure, and recommended that all Americans should make every effort to never let a photon of sunlight strike their skin. The failure of the 1997 FNB to compensate for sun-avoidance, has led to millions of deaths around the world.
  • Physicians who ignore vitamin D deficiency will eventually suffer medical-legal consequences.
  • While many think the influenza virus causes influenza, Cannell notes it was George Bernard Shaw who first understood: “The characteristic microbe of a disease might be a symptom instead of a cause.” George Bernard Shaw, (Preface on Doctors, The Doctor’s Dilemma, 1911).

If you want professional newsletter services, you will need to help find a foundation that will fund us.

John Cannell, MD
The Vitamin D Council
9100 San Gregorio Road
Atascadero, CA 93422


It’s so interesting…. my statement made at the beginning of this blog entry – I’ve made it myself. In fact, my kids have mentioned many times since my DS – “You never get sick. We get everything – but you never get a thing!” It’s been true… until this winter, shortly after my revision. At which time I went off of my Vitamin D supplements for a time while I was healing up after surgery. Then it took me a while to ease into my full vitamin regime. During that time I got sick THREE times – one stomach flu, and two killer colds. I’ve only been sick ONCE before this since July 2, 2002.

Interesting, huh?

Tree Huggers!

I’ve lived in Oregon since I was 4 years old. When I was a kid I tried to laugh and understand when people would joke, “Oregonians don’t tan – they rust!” I mean, huh? Doesn’t everyone get rain? Lots and lots of rain?

I can admit that as I’ve grown older that the rain has begun to – well, wear on me a bit. Usually some time around February John and I look at each other and say, “We live here because????” I’m sure his memories of living in Arizona right at the forefront of his thoughts! Me – just *longing* for sunshine and warmth! We vowed several years ago – should we ever manage to scrape up enough money – we really ought to travel someplace warm come every February!

A relatively new friend asked me – after having relocated here from the Rocky Mountain region of the country, “So when does it rain?” You see, we met when it was sunny and warm and beautiful out. Without half a thought I said, “From October to July 5th.” She looked at me and laughed and said, “No really!” To which I said, “Seriously.”

This February I’ve been amazingly content. I haven’t felt that squirmy feeling like I gotta get out of Dodge! I haven’t been spending time looking vainly at travel bargains to the tropics.

I found out why last night. On the news they said, “And as you know,” obviously I didn’t! “we’re 2.5 inches behind on rainfall for the month of February – so th rain we’ll be getting this week will be really helpful!”

They’re saying we’re gonna get 1/2 an inch of rain today, tomorrow, and the next day.

Now I’m feeling squirmy! LOL!

BUT – we must ask the girls how they feel about the rain – cause it’s been raining buckets this morning.

Apparently they aren’t much amused, either! See them down there? Hugging that big old Willow tree? Trying to get out of the rain?

I wish I could get a picture of what it looks like when they don’t know that I’m there – all 14 of them are ringed around that tree – pretty much kissing it! – trying to stay out of the rain.
They’re so goofy!

You’d think they didn’t know there was a nice, dry, full of brand new sweet-smelling pine shavings, coop – just a few feet away. BUT NO – they might miss out of something, so they stay out in the rain.
Thanks girls! I needed the laugh!


I’m almost 15 weeks post-op.

During the course of my life as Patient Support Coordinator to Baltasar patients I can count on some things that happen like clockwork. Notably:

1. The panic expressed by early post-ops (usually at about the 1 month post-op mark) when they say things like, “He made my stomach too small!” “I’ll never be able to eat enough!” “I’m going to die of malnutrition!” I know these statements will come, as surely as I know the sun will rise. I always tell patients – “You’re not alone. Everyone feels this way.”

*I* felt this way. Not my first surgery – but definitely with my revision. I knew I would. But I wasn’t prepared for what a whiney butt I would be!


2. The panic expressed by just about every post-op (at about 3 months post-op) when they say things like, “He made my stomach too large!” “I can eat too much!” “I’ll never lose all of my weight!”

Yes, these are the same folks that made the previous statements.

I’ve always jokingly said I’d love to have just one buck for every time I heard these statements – ’cause they we could certainly be debt free and maybe even buy a house some day! LOL!

And just this week – I found myself thinking: “OH MY WORD! I can eat too much!”


*I* said that!

I know better!

I’ve longed for the day when I would eventually be able to eat a little more – cause, well, I like eating easily.

Lord! I’m such a wuss.

So there’s my first confession.

Next: I’m addicted to orange juice.

I love orange juice.

A lot.

Too much.

Not just any orange juice – but the GOOD (aka expensive) orange juice.

I’ve consumed far too much of it in the past weeks. But, I reasoned, I had to get my fluids in… and orange juice was HELPING…

It didn’t help that I couldn’t bring myself to drink iced tea. I still think it’s absolutely BIZARRE that straight green tea still makes me want to hurl. Which has meant that getting my fluids in daily has been a HUGE challenge.

BUT I’m happy to report – I’ve finally found a beverage I actually like, is non-sweetened, and makes it a breeze to get my fluids in! Woo Hoo! It is:

Half-green, half-black, iced tea.

Here’s how I order it at Starbucks: Venti Iced Tea – half green, half black, no classic, with extra ice please!

How’s that for a frou-frou drink?!

But you know what? I’m just so stinking relieved that I’ve finally found something to drink that I actually enjoy (almost as much as I enjoy orange juice!), I’m willing to live with it! I make it at home with the Stash Fusion Breakfast Green & Black Tea – it’s every bit as good (and quite a bit cheaper than) the Starbucks version.

I will also confess that I invested some time this week trying on clothing. You’ll note that I didn’t say that I invested some time this week buying clothing. I just couldn’t do it. I tried on bras… I’m just going to have to go and get a professional fitting. What a pain. But I just couldn’t find a bra that was the right size in the cup – and still worked with all of the excess skin that cascades everywhere else! UGH!

And I tried several pairs of jeans on… All size 12. A couple were – well, a little roomy. Wierd. But I couldn’t bring myself to buy any of them, either. Why? I don’t know, exactly… part of me wished heartily that Jessica (my daughter) had accompanied me and was there to give me her honest opinion. Well, then there was also the fact that I’ve been in a cast on my left leg since June – and the legs of two of the pairs that I tried on wouldn’t fit over the cast.

I finally decided that it was smartest to NOT buy jeans yet because I’m having surgery on my left ankle on the 4th of March – and will be non-weight-bearing for a month after that. And after that – will I only want to wear shorts or capris? If so – why buy jeans? I might not be in a size that I buy NOW for long, you know?

How’s that for justification? 🙂

So, life as an almost 15 week post-op has been good. Eating is easier. Getting hydrated is WAY easier. Getting my vitamins in daily is going WAY better. And life is good.

Spring Cleaning!

Today John mucked out the coop. We do the deep litter method of chicken keeping. That means that – typically – once or twice a year it will be mucked out and started all over again with fresh pine shavings. Throughout the course of the year additional fresh pine shavings are added to the top, when things need “freshened up” so to speak.

Aside from finding a WHOLE BUNCH of chicken poo, John also found 10 – yes, I said TEN – eggs – all of varying age. Elijah, my inquisitive nephew, decided to squeeze one of the eggs to see what would happen! Yeah – rotten egg is not such a pleasant experience when you end up wearing it.

See that white egg there behind John?

This Welsummer was pretty put out with John as he worked. She’d come in – squak at him – supervise his work for a while, leave for a while, then come back and repeat!

BB – along with all of the other girls – was trying to figure out what the heck we were doing in her coop!

You see – we do have a plan! (Of course!) John reattached the door that was taken off last fall – so that we can divide the coop once again. The big girls will sleep on the side that the nest boxes are on…

and the chicks that we’ll be getting this spring will hang out on the other side of the coop!
We are looking at adding chicks from the following breeds this year:
Cuckoo Maran

I don’t know which of these we’ll actually be able to get our hands on – but I’ve started the process of seeking them out.

Tonight, the big girls were a little confused about all that was going on tonight when they were going to bed at first – but eventually settled down for the night just as they always do.

On a sad note. Angel, our California White with the prolapsed vent, has not responded to therapy. Even worse, her prolapsed vent seems to have gone necrotic – I believe she’s been pecking HERSELF. We had her in isolation – away from the other girls – so that they would not harm her – but apparently that wasn’t good enough. So we’ve decided to cull her from the flock. It seems the only humane thing to do.

What a Day!

This morning, as I was making William’s breakfast I happened to catch a flash of movement out of the corner of my eye – and lo and behold! What did I see? An escape artist!
Every morning, for the last several mornings, one of the California White’s has been managing to get out of the chicken yard and have at it without competition with the cat’s food. I can understand the motivation – but honestly, it can be a bit of a pain in the butt. Well, and then there’s the fact that solo chicken running around the yard seems – well – more vulnerable.

So – I made oatmeal for the girls, and the minute I took it in to them – escapee wanted back in. Go figure! Yeah, I wasn’t surprised, either.

So guess what! We had a GORGEOUS day today. It got up to nearly 60 degrees! Woo Hoo! SPRING WILL COME AGAIN! HALLELUJAH!

This is what Spring should look like:

And this…
and this…

and of course, this…
By the time the early afternoon rolled around, I decided it was time to let the girls out. Boy oh boy, where they happy to be out and about!

Caleb, hanging with the girls.

Pepper, running with her ball on a rope. She loves that toy!

And here’s Angel. Looks fine – but well, seemed a little more skittish than normal today.
I’d been keeping an eye on the California Whites because for the last three mornings there have been some VERY large white eggs in the nest boxes – and they’ve had quite a bit of blood on them. Hmmm… I decided I had to get to the bottom of this!
As it happened, I noticed that Angel had a BLACK butt. Yes, my chicken pictured above – like she looked like someone had held her over an open flame and singed her fanny. So I determined that I needed to catch her and get a closer look.
Yeah. Right. Not so much.

Thankfully, not much time went by and Jessica arrived home from school. Have I mentioned that my daughter is chicken wrangle extraordinaire? If not – let me just say it here and now: the girl has a gift!
So Jess and I set out to corner and catch the not so interested in being handled AT ALL chicken. Amusing.
So – we finally did it! We caught Angel and I did a little exam. Once I got a closer look it seemed as if her butt were just CAKED – like seriously – with poo, mud, dust, and some blood. Yuck. I realized that this was going to take a concerted effort, so Jess and I worked as a team. She held Angel, I found a large bucket and filled it with nice warm water, and then we set to… yep, bathing the chicken.
It took about 20 minutes, but once I had her butt all cleaned up – it didn’t take long for us to ascertain that something was more than just passingly not okay.
Warning: the pictures below are graphic! Like gross and ickey. Okay?

This, unfortunately, is a prolapsed vent. Darn it!

Poor Angel!

Anyway, eventually got her inito a second bath to make certain she was VERY clean (don’t want any infection to set in!), I went ahead and attempted to gently push the vent back into it’s appointed place! It stayed for about 10 minues, but then re-prolapsed. Darn it. I did get the Preparation H applied – and I’m hoping it helps her!

So – armed with excellent advice from older/wiser cihcken keepers, we’re keeping Angel separated from the rest of the flock, we have her in a location where she can’t hear the rest of life going on around her. It should be restful for her.

And we’ve also draped the crate she’s in with blankets – to help keep her warm.

I think we’ve done all we can for her just now.

I’ll keep you updated on Angel’s progress.

Very, very interesting!

New Study of Splenda Reveals Shocking Information About Potential Harmful Effects

James Turner, the chairman of the national consumer education group Citizens for Health, has expressed shock and outrage after reading a new report from scientists outlining the dangers of the artificial sweetener Splenda (sucralose).
In animals examined for the study, Splenda reduced the amount of good bacteria in the intestines by 50 percent, increased the pH level in the intestines, contributed to increases in body weight and affected P-glycoprotein (P-gp) levels in such a way that crucial health-related drugs could be rejected.
The P-gp effect could result in medications used in chemotherapy, AIDS treatment and treatments for heart conditions being shunted back into the intestines, rather than being absorbed by the body.
According to Turner, “The report makes it clear that the artificial sweetener Splenda and its key component sucralose pose a threat to the people who consume the product. Hundreds of consumers have complained to us about side effects from using Splenda and this study … confirms that the chemicals in the little yellow package should carry a big red warning label.”

Globe Newswire September 28, 2008
Journal of Toxicology and Environmental Health Part A 2008;71(21):1415-29