Bariatric Surgery: Types, Risks & Expected Weight Loss

What Is Bariatric Surgery and How Does It Work?

Bariatric surgery is a group of surgical procedures that modify the digestive system to help people with severe obesity lose weight. These procedures work by restricting stomach size, reducing nutrient absorption, or both, leading to reduced calorie intake and metabolic changes that promote weight loss.

Bariatric surgery, also called weight loss surgery or metabolic surgery, represents one of the most effective treatments for severe obesity and its related health conditions. Unlike diets and medications that often produce temporary results, bariatric surgery creates permanent anatomical changes that can lead to sustained weight loss of 50-80% of excess body weight over several years.

The term "bariatric" comes from the Greek words "baros" (weight) and "iatrikos" (treatment). Modern bariatric surgery has evolved significantly since the first procedures in the 1950s, with today's operations performed almost exclusively through minimally invasive laparoscopic techniques. This means surgeons make several small incisions rather than one large opening, resulting in faster recovery, less pain, and fewer complications.

Bariatric procedures work through several mechanisms. Restrictive procedures reduce the stomach's capacity, limiting how much food can be consumed at one time. Malabsorptive procedures bypass portions of the small intestine, reducing how many calories and nutrients the body absorbs. Combined procedures like gastric bypass use both mechanisms. Additionally, all bariatric procedures cause significant hormonal changes, particularly affecting gut hormones that regulate hunger, satiety, and blood sugar control.

Research has demonstrated that the metabolic effects of bariatric surgery extend far beyond simple calorie restriction. The procedures alter the production of hormones like ghrelin (the "hunger hormone"), GLP-1, and peptide YY, leading to reduced appetite, increased feelings of fullness, and improved insulin sensitivity. These hormonal changes explain why bariatric surgery can resolve type 2 diabetes even before significant weight loss occurs.

The history and evolution of bariatric surgery

The field of bariatric surgery began in the 1950s and 1960s with intestinal bypass procedures that caused significant malabsorption but also serious complications. The modern era began in the 1990s with the development of laparoscopic techniques, which transformed bariatric surgery from a high-risk operation to a relatively safe procedure with outcomes comparable to common surgeries like gallbladder removal or hip replacement.

Today, over 250,000 bariatric procedures are performed annually in the United States alone, with gastric sleeve (sleeve gastrectomy) now surpassing gastric bypass as the most commonly performed procedure. Advances in surgical technique, anesthesia, and perioperative care have reduced mortality rates to approximately 0.1-0.5% at experienced centers, making bariatric surgery safer than many common operations.

What Are the Different Types of Bariatric Surgery?

The three main types of bariatric surgery are gastric bypass (Roux-en-Y), gastric sleeve (sleeve gastrectomy), and adjustable gastric band (lap-band). Gastric bypass creates a small stomach pouch and bypasses part of the intestine. Gastric sleeve removes about 80% of the stomach. Each procedure has different benefits, risks, and expected outcomes.

Gastric bypass (Roux-en-Y gastric bypass)

Gastric bypass, technically called Roux-en-Y gastric bypass (RYGB), has been performed since the 1960s and is considered the "gold standard" of bariatric surgery. During this procedure, the surgeon creates a small pouch from the upper part of the stomach (about the size of an egg or walnut) and connects it directly to the middle portion of the small intestine, bypassing the rest of the stomach and the first part of the intestine (duodenum).

This dual mechanism—restriction from the small pouch plus malabsorption from bypassing the duodenum—typically results in 70-80% excess weight loss over 18-24 months. Gastric bypass also produces significant hormonal changes that reduce hunger, increase satiety, and improve blood sugar control. Studies show that 60-80% of patients with type 2 diabetes experience complete remission after gastric bypass, often within days of surgery.

The advantages of gastric bypass include excellent long-term weight loss, high rates of diabetes remission, and decades of research supporting its effectiveness. However, it is a more complex procedure than gastric sleeve, carries slightly higher surgical risks, requires lifelong vitamin supplementation due to malabsorption, and can cause "dumping syndrome"—an unpleasant reaction to high-sugar foods that some patients find helpful for maintaining dietary compliance.

Gastric sleeve (sleeve gastrectomy)

Gastric sleeve, or sleeve gastrectomy, has become the most commonly performed bariatric procedure worldwide since 2014. During this operation, the surgeon removes approximately 75-80% of the stomach, leaving a narrow, tube-shaped "sleeve" about the size and shape of a banana. Unlike gastric bypass, the intestines are not rerouted.

The sleeve procedure works primarily through restriction—the smaller stomach holds much less food—and through hormonal changes. Removing the fundus (the curved part of the stomach) eliminates most of the cells that produce ghrelin, the hormone that stimulates hunger. Patients typically report dramatically reduced appetite and feel satisfied with much smaller portions.

Gastric sleeve results in 60-70% excess weight loss on average, slightly less than gastric bypass but with a simpler operation, shorter surgical time, and lower complication rates. The procedure is technically irreversible since part of the stomach is permanently removed, but it does not involve intestinal rerouting, meaning fewer nutritional deficiencies and no dumping syndrome. Diabetes remission rates are slightly lower than with gastric bypass but still substantial at 50-70%.

Adjustable gastric band (lap-band)

The adjustable gastric band, commonly known as lap-band, involves placing an inflatable silicone band around the upper portion of the stomach, creating a small pouch above the band. The band can be tightened or loosened by injecting or removing saline through a port placed under the skin, allowing adjustment of how much restriction the band provides.

Once the most popular bariatric procedure, gastric band has declined significantly in use due to lower weight loss results (40-50% excess weight loss) and high rates of complications requiring removal or revision surgery. However, it remains an option for some patients because it is the least invasive procedure, is completely reversible, requires no cutting or stapling of the stomach or intestines, and has the lowest short-term complication rate.

Other bariatric procedures

Several other bariatric procedures exist for specific situations. Duodenal switch (biliopancreatic diversion with duodenal switch) is a more aggressive procedure that results in the greatest weight loss (up to 90% excess weight) but also carries higher risks and requires extensive nutritional monitoring. Single anastomosis gastric bypass (mini gastric bypass) is a simpler variation of traditional gastric bypass. Revision surgery may be performed when a previous bariatric procedure has failed or caused complications.

Who Qualifies for Bariatric Surgery?

Candidates for bariatric surgery typically must have a BMI of 40 or higher, or BMI of 35-39.9 with serious obesity-related health conditions such as type 2 diabetes, sleep apnea, or hypertension. Patients must have tried other weight loss methods without sustained success and be willing to commit to lifelong lifestyle changes.

Eligibility criteria for bariatric surgery have been established by major medical organizations including the American Society for Metabolic and Bariatric Surgery (ASMBS), International Federation for the Surgery of Obesity (IFSO), and National Institutes of Health (NIH). These guidelines ensure that surgery is offered to patients who are most likely to benefit while minimizing risks to those who may not be appropriate candidates.

The primary eligibility criteria include Body Mass Index (BMI) requirements: BMI of 40 or higher (approximately 100 pounds or 45 kg overweight), or BMI of 35-39.9 with at least one serious obesity-related condition such as type 2 diabetes, obstructive sleep apnea, hypertension, fatty liver disease, or significant mobility limitations. In 2022, guidelines were updated to consider surgery for patients with BMI of 30-34.9 who have poorly controlled type 2 diabetes despite optimal medical therapy.

Candidates must also have documented history of unsuccessful weight loss attempts through non-surgical methods including diet, exercise, and behavioral modification. Most insurance policies and surgical centers require 3-6 months of medically supervised weight loss attempts before approving surgery. This requirement ensures patients understand that surgery is not a quick fix and helps identify those committed to the lifestyle changes necessary for success.

Medical and psychological requirements

Comprehensive medical evaluation is required before surgery to identify and optimize any health conditions that could increase surgical risk. This typically includes cardiac evaluation (especially for patients with heart disease or risk factors), sleep study if sleep apnea is suspected, blood work to assess nutritional status and metabolic health, and evaluation of any gastrointestinal conditions. Patients with certain conditions may require medical treatment before being cleared for surgery.

Psychological evaluation by a mental health professional experienced in bariatric surgery is mandatory at most centers. This assessment evaluates the patient's understanding of the surgery and its requirements, identifies any eating disorders, depression, or anxiety that should be addressed before surgery, assesses the patient's ability to make permanent lifestyle changes, and ensures the patient has realistic expectations about outcomes. Patients with active substance abuse, untreated severe mental illness, or those unable to comprehend or comply with post-surgical requirements may be deemed not ready for surgery.

How Should You Prepare for Bariatric Surgery?

Preparation for bariatric surgery involves completing comprehensive medical evaluations, attending nutritional counseling sessions, making lifestyle changes including smoking cessation, following a pre-operative diet to shrink the liver, and preparing mentally for the permanent dietary and lifestyle changes required after surgery.

The preparation period for bariatric surgery typically spans 3-6 months, though this varies based on insurance requirements, the patient's baseline health, and the surgical center's protocols. This time is not wasted waiting—it is an active period of education, optimization, and habit formation that significantly impacts surgical safety and long-term success.

During the preparation phase, patients undergo multiple evaluations and consultations. Medical clearances ensure the patient can safely undergo anesthesia and surgery, while also optimizing any existing health conditions. Patients with diabetes may need adjusted medications, those with heart conditions may need cardiac testing, and patients with sleep apnea may need to begin CPAP therapy if not already using it.

Nutritional preparation and counseling

Nutritional counseling with a registered dietitian experienced in bariatric surgery is a critical component of preparation. During these sessions, patients learn about post-surgery eating patterns, protein requirements, vitamin supplementation, food textures they will progress through during recovery, and long-term dietary guidelines. Many patients begin practicing these habits before surgery, making the transition easier.

Pre-operative weight loss is often required, typically 5-10% of body weight. This serves multiple purposes: it shrinks the liver (which becomes enlarged and fatty in obese patients), making laparoscopic surgery safer and easier; demonstrates the patient's commitment to dietary changes; may improve surgical outcomes; and helps patients begin the behavioral changes they will need to maintain long-term.

In the 1-2 weeks immediately before surgery, most programs require a liquid protein diet. This very low-calorie, high-protein diet further shrinks the liver and reduces abdominal fat, significantly improving surgical conditions and reducing operative time and complications. Common components include protein shakes, broth, sugar-free gelatin, and sometimes small amounts of lean protein.

Lifestyle modifications before surgery

Smoking cessation is mandatory, as nicotine significantly increases risks of blood clots, poor wound healing, ulcers at surgical connection sites, and long-term complications. Most centers require patients to be smoke-free for at least 6-8 weeks before surgery and test nicotine levels to verify compliance. This includes all nicotine products including cigarettes, vaping, patches, and gum.

Beginning an exercise routine, if medically cleared, helps patients prepare physically and mentally for post-operative activity requirements. Even modest exercise like walking improves surgical outcomes. Patients should also reduce or eliminate caffeine and carbonated beverages, which can cause discomfort after surgery and may contribute to ulcers or stretching of the stomach pouch.

What Happens During Bariatric Surgery?

Bariatric surgery is typically performed laparoscopically (keyhole surgery) under general anesthesia. The surgeon makes 4-6 small incisions in the abdomen, inserts a camera and specialized instruments, and performs the chosen procedure. Surgery takes 1-3 hours depending on the procedure type. Most patients stay in the hospital for 1-3 days.

Modern bariatric surgery is almost exclusively performed using minimally invasive laparoscopic techniques. This approach uses small incisions (typically 0.5-1.5 cm each) through which the surgeon inserts a camera and specialized instruments. The camera provides a magnified, high-definition view of the surgical field on monitors in the operating room, allowing precise work with minimal tissue trauma.

Patients arrive at the hospital on the morning of surgery having followed pre-operative fasting instructions. In the pre-operative area, an IV is placed for fluids and medications, and the anesthesia team reviews the patient's history and discusses the anesthetic plan. Sequential compression devices are placed on the legs to prevent blood clots, and antibiotics are given to prevent infection.

The surgical procedure

Under general anesthesia (completely asleep), the abdomen is inflated with carbon dioxide gas to create space for the surgeon to work. The surgeon then makes the small incisions and inserts the camera and instruments. For gastric bypass, the surgeon divides the stomach to create a small pouch, then divides and rearranges the small intestine to create the bypass configuration. For gastric sleeve, the surgeon removes approximately 75-80% of the stomach using surgical staplers, creating the narrow sleeve. The procedure takes 1-3 hours depending on the type and any complicating factors.

After surgery, patients are monitored in the recovery room until the anesthesia wears off, then transferred to a hospital room. Most laparoscopic bariatric patients stay 1-3 nights, though some centers have protocols for same-day discharge for gastric sleeve in select patients. During the hospital stay, patients are encouraged to walk frequently to prevent blood clots and promote recovery, and gradually progress from ice chips to clear liquids.

Before discharge, many programs perform an upper GI study—a test where the patient swallows contrast liquid while X-rays are taken—to verify there are no leaks at the surgical staple lines. Patients receive detailed instructions on diet progression, medications, activity restrictions, and warning signs that should prompt medical attention.

What Is Recovery Like After Bariatric Surgery?

Recovery after laparoscopic bariatric surgery typically involves 2-4 weeks off work, gradual diet progression from liquids to solid foods over 6-8 weeks, and return to normal activities within 4-6 weeks. Most patients report tolerable discomfort managed with medication, and complications requiring hospitalization occur in approximately 5-10% of patients.

The recovery period after bariatric surgery involves both physical healing from the operation and adjustment to the new digestive system. Most patients describe the first week as the most challenging, with discomfort from the incisions, fatigue from anesthesia and reduced calorie intake, and adjustment to the liquid diet phase.

Pain after laparoscopic surgery is typically managed with over-the-counter medications within a few days. Some patients experience referred shoulder pain from the carbon dioxide gas used during surgery—this resolves within a few days as the gas is absorbed. Walking is encouraged immediately and is one of the most important recovery activities, preventing blood clots and promoting healing.

Diet progression after surgery

The post-operative diet progresses through several phases designed to allow the stomach to heal while ensuring adequate nutrition. While specific protocols vary by program, a typical progression includes:

• Phase 1 (Days 1-7): Clear liquids only—water, broth, sugar-free gelatin, diluted sugar-free juice
• Phase 2 (Days 8-14): Full liquids including protein shakes, skim milk, thin cream soups
• Phase 3 (Weeks 3-4): Pureed foods with smooth, baby-food consistency
• Phase 4 (Weeks 5-6): Soft foods that can be easily mashed with a fork
• Phase 5 (Week 7+): Gradual introduction of regular solid foods

Throughout recovery and long-term, protein intake is prioritized. Most programs recommend 60-80 grams of protein daily, which can be challenging with the small stomach capacity. Patients learn to eat protein first at each meal, take small bites, chew thoroughly, and stop eating at the first sign of fullness. Eating too quickly, not chewing adequately, or overeating can cause discomfort, nausea, or vomiting.

Return to normal activities

Most patients return to sedentary or desk work within 2-4 weeks, though those with physically demanding jobs may need 4-6 weeks. Driving is typically permitted once the patient is off narcotic pain medications and can move comfortably and quickly—usually within 1-2 weeks. Heavy lifting (more than 10-15 pounds) is restricted for 4-6 weeks to allow abdominal wall healing.

Exercise is strongly encouraged and is a critical component of long-term success. Walking begins immediately and should increase progressively. Most patients can begin more vigorous exercise at 4-6 weeks, with the specific timeline determined by their surgeon based on healing progress. Regular exercise not only improves weight loss but also helps maintain muscle mass during rapid weight loss, improves mood, and reduces risk of weight regain.

How Much Weight Can You Lose After Bariatric Surgery?

Weight loss after bariatric surgery is typically measured as percentage of excess weight lost. Gastric bypass patients lose 70-80% of excess weight, gastric sleeve patients lose 60-70%, and gastric band patients lose 40-50%. Most weight loss occurs in the first 12-18 months, with some weight regain common but manageable.

Understanding weight loss expectations after bariatric surgery requires familiarity with how outcomes are measured. Excess weight is the amount of weight above "ideal body weight" for a person's height. If someone weighs 300 pounds and their ideal weight is 150 pounds, they have 150 pounds of excess weight. If they lose 105 pounds after gastric bypass (70% of 150), their new weight would be 195 pounds.

Weight loss typically follows a predictable pattern: rapid loss in the first 3-6 months as the body adjusts to drastically reduced calorie intake, continued significant loss through 12-18 months, and then gradual stabilization. Most patients reach their lowest weight (nadir) between 12-24 months after surgery. Some weight regain is normal and expected, typically 10-20% of the lost weight over the following years.

Factors affecting weight loss success

Several factors influence how much weight a patient will lose after bariatric surgery. Procedure type is the most significant factor, with more extensive procedures (gastric bypass, duodenal switch) producing greater weight loss than less extensive procedures (gastric band). Pre-operative BMI matters—patients with higher starting BMIs lose more absolute weight but may achieve lower percentage excess weight loss.

Compliance with post-operative guidelines is crucial for maximizing and maintaining weight loss. Patients who follow dietary guidelines, attend follow-up appointments, take recommended supplements, and exercise regularly achieve significantly better outcomes than those who do not. Studies show that patients who attend regular follow-up visits lose 18% more excess weight than those who miss appointments.

Age and gender influence outcomes, with younger patients and males typically losing more weight. However, older patients and females still achieve substantial, clinically meaningful weight loss that significantly improves health. The most important predictor of long-term success is consistent adherence to lifestyle modifications.

What Are the Health Benefits Beyond Weight Loss?

Bariatric surgery provides significant health benefits beyond weight loss, including 60-80% remission rates for type 2 diabetes, major improvements in sleep apnea, hypertension, and high cholesterol, reduced cancer risk, improved fertility, and increased life expectancy. Many patients reduce or eliminate medications for obesity-related conditions.

The health benefits of bariatric surgery extend far beyond the scale. For many patients, improvement or resolution of obesity-related health conditions is the primary motivation for surgery, and research consistently shows that bariatric surgery is more effective than medical management alone for treating these conditions.

Type 2 diabetes remission

Type 2 diabetes responds dramatically to bariatric surgery, particularly gastric bypass. Remission rates (normal blood sugar without diabetes medications) range from 60-80% for gastric bypass and 50-70% for gastric sleeve. Remarkably, diabetes often improves within days of surgery, before significant weight loss, due to hormonal changes from the procedure. Long-term studies show that even patients who do not achieve complete remission typically require fewer medications and have better glucose control.

Cardiovascular health improvements

Hypertension (high blood pressure) improves in approximately 75-85% of patients, with many able to reduce or discontinue blood pressure medications. Hyperlipidemia (high cholesterol) improves in 70-95% of patients, particularly triglycerides and HDL ("good") cholesterol. These improvements significantly reduce the risk of heart attack, stroke, and cardiovascular death. Studies show bariatric surgery patients have a 40-50% lower risk of cardiovascular events compared to similar patients who do not have surgery.

Sleep apnea and other conditions

Obstructive sleep apnea resolves or significantly improves in 80-95% of patients. Many patients who required CPAP machines before surgery can discontinue them after losing weight. Improved sleep quality contributes to better daytime energy, mood, and cognitive function. Non-alcoholic fatty liver disease (NAFLD), which can progress to cirrhosis, improves in 90% of patients, with resolution of inflammation (steatohepatitis) in 80%.

Other conditions that commonly improve include joint pain and osteoarthritis (reduced mechanical stress on joints), GERD (acid reflux) (especially with gastric bypass), urinary incontinence, polycystic ovary syndrome and related fertility issues, and depression (though this relationship is complex and requires ongoing mental health support).

Cancer risk and mortality

Bariatric surgery reduces the risk of obesity-related cancers by 30-50%, including cancers of the breast, colon, uterus, and esophagus. Perhaps most importantly, multiple large studies demonstrate that bariatric surgery increases life expectancy. Patients who have bariatric surgery have a 30-50% lower risk of death from any cause compared to similar patients who do not have surgery, primarily due to reduced cardiovascular deaths, cancer deaths, and diabetes complications.

What Are the Risks and Complications of Bariatric Surgery?

Bariatric surgery risks include short-term complications like infection (1-3%), bleeding (0.5-2%), blood clots (0.5-1%), and leaks from surgical connections (1-2%). Long-term complications include nutritional deficiencies (requiring lifelong supplements), dumping syndrome (gastric bypass), gallstones, hernias, and weight regain. Overall mortality risk is 0.1-0.5% at experienced centers.

Like any major surgery, bariatric procedures carry risks that patients must understand and weigh against potential benefits. The good news is that serious complications are uncommon, particularly when surgery is performed by experienced surgeons at accredited centers with comprehensive follow-up programs.

Short-term surgical complications

Anastomotic leak (leaking from surgical connections) is the most feared early complication, occurring in 1-2% of patients. This requires prompt recognition and often additional surgery. Warning signs include fever, rapid heart rate, severe abdominal pain, and feeling "unwell." Bleeding occurs in approximately 0.5-2% of cases and may require blood transfusion or rarely reoperation. Blood clots in the legs or lungs occur in 0.5-1% of patients despite preventive measures—early walking and compression devices significantly reduce this risk.

Infection at incision sites or within the abdomen occurs in 1-3% of patients. Minor wound infections are treated with antibiotics; deeper infections may require drainage. Bowel obstruction can occur if internal scar tissue (adhesions) causes kinking of the intestines, sometimes requiring surgery. Stricture (narrowing) at surgical connections can cause difficulty swallowing and vomiting, usually treated with endoscopic dilation.

Long-term complications

Nutritional deficiencies are the most common long-term issue, affecting virtually all patients who do not take recommended supplements. Deficiencies of vitamin B12, iron, calcium, vitamin D, and folate are particularly common after gastric bypass due to reduced absorption. These are preventable with consistent supplementation and regular blood tests but can cause serious problems including anemia, osteoporosis, and neurological issues if ignored.

Dumping syndrome occurs primarily after gastric bypass when high-sugar foods move too quickly into the intestines, causing nausea, cramping, diarrhea, sweating, and rapid heart rate. While unpleasant, many patients find this helps them avoid unhealthy foods. Gallstones develop in up to 30% of patients during rapid weight loss; some surgeons remove the gallbladder at the time of bariatric surgery for high-risk patients.

Weight regain affects most patients to some degree, typically 10-20% of lost weight over time. Significant regain (returning to pre-surgery weight or developing recurrent obesity-related health problems) occurs in 10-20% of patients and may require revision surgery or intensive medical management. Adherence to dietary guidelines and regular follow-up are the best prevention.

What Is Life Like After Bariatric Surgery?

Life after bariatric surgery involves permanent changes including eating small, protein-focused meals, taking daily vitamins and supplements, avoiding certain foods, exercising regularly, and attending lifelong follow-up appointments. Most patients report dramatically improved quality of life, but adjustment requires commitment and support.

Bariatric surgery is often described as a "tool" rather than a cure—its success depends on the patient's commitment to using that tool effectively through permanent lifestyle changes. Understanding what daily life looks like after surgery helps patients make informed decisions and prepares them for long-term success.

Eating after bariatric surgery

Meals after bariatric surgery are dramatically different from before. The stomach pouch holds only about 1/4 to 1/2 cup of food at a time (gradually stretching to 1 cup over the first year), so patients eat much smaller amounts at each meal. Most patients eat 4-6 small meals per day rather than three large ones. Meals must be eaten slowly (30 minutes minimum), with food chewed thoroughly to prevent discomfort.

Protein becomes the priority at every meal, as adequate protein intake is essential for maintaining muscle mass during weight loss and preventing nutritional deficiencies. Most programs recommend 60-80 grams of protein daily, which requires deliberate planning. Patients learn to eat protein first at each meal, before vegetables and other foods. Fluids must be consumed between meals, not with meals, as drinking while eating can cause discomfort and may reduce satiety. Most patients aim for 64 ounces of fluid daily.

Certain foods become problematic after surgery. High-sugar foods may cause dumping syndrome (especially after gastric bypass) and contribute to weight regain. Carbonated beverages can cause discomfort and may stretch the stomach pouch. Fibrous or tough foods like steak, bread, and raw vegetables may not be tolerated well, especially in the first months. Patients learn their individual tolerances through experience.

Supplements and medications

Daily vitamin and mineral supplementation is mandatory for life after bariatric surgery. The specific regimen varies by procedure and individual needs but typically includes a bariatric-specific multivitamin, calcium citrate (better absorbed than calcium carbonate), vitamin D, vitamin B12 (often as sublingual or injection for gastric bypass patients), and iron for menstruating women and others at risk of deficiency.

Regular blood tests monitor nutritional status and guide supplement adjustments. Testing is typically performed at 3 months, 6 months, and 12 months after surgery, then annually. Failure to take supplements consistently is one of the most common causes of preventable complications after bariatric surgery.

Psychological and emotional adjustment

The psychological journey after bariatric surgery is often underestimated. While most patients experience improved mood, self-esteem, and quality of life, the adjustment involves complex emotional terrain. Some patients struggle with the loss of food as a coping mechanism, changes in relationships as their body and social role change, or difficulty adjusting to their new appearance.

"Head hunger"—the desire to eat for emotional rather than physical reasons—persists even when physical hunger decreases. Patients must develop new coping strategies for stress, sadness, and boredom that do not involve food. Support groups, whether in-person or online, provide valuable connection with others who understand these challenges. Mental health support should remain available and be used whenever needed.