Guide to Bariatric Surgery

Welcome

If you are reading this guide, you or someone you love may be thinking about bariatric surgery. This is an important step, and we are here to help you understand your options.

The most important thing to know is this: struggling with your weight is not your fault. Obesity is a medical condition, not a choice. Your body has powerful systems that control hunger, cravings, and how it stores fat. These systems can make managing weight very hard, no matter how hard you try.

This guide will give you the knowledge you need to make an informed decision. Understanding the science of obesity and how surgery works is the first step toward long-term success.

About the Network

About the Western Zone Obesity Network

The Western Zone Obesity Network (WZON) was created to improve obesity care in Nova Scotia. We bring together patients, doctors, nurses, dietitians, and other healthcare providers to give you the best possible care.

We believe the best care happens close to home. Your family doctor will be your main point of contact throughout your journey.

How It Works

Understanding bariatric surgery

More than just a smaller stomach

Many people think bariatric surgery just makes your stomach smaller so you eat less. But it does much more than that. Bariatric surgery is really a “metabolic” treatment – it changes how your body and brain communicate about hunger, fullness, and energy.

How it works

1. Hunger hormones decrease. The part of your stomach that makes the “hunger hormone” (ghrelin) is removed or bypassed. This means you feel less hungry overall.
2. Fullness hormones increase. Surgery changes how food moves through your digestive system. This leads to higher levels of hormones that tell your brain you are full and satisfied.
3. Your brain’s “set point” changes. Your brain has a “thermostat” for body weight. Surgery helps reset this thermostat to a lower level, making it easier for your body to stay at a lower weight.
4. Blood sugar improves. Changes in gut hormones help your body use insulin better. This is why many people with type 2 diabetes see major improvements – sometimes even going into remission.

Types of Surgery

Types of bariatric surgery

The Western Zone offers two types of bariatric surgery. Both are done using “laparoscopic” (keyhole) surgery through small incisions.

1. Vertical Sleeve Gastrectomy (VSG)

“Gastric sleeve” or just “the sleeve”

The procedure: the surgeon removes about 80% of the stomach, leaving behind a thin, banana-shaped stomach.

How it helps you lose weight

• Smaller stomach – you feel full after eating much smaller amounts
• Less hunger hormone – the removed part makes most of your ghrelin, so you feel less hungry
• Hormonal changes – other gut hormones shift to help your brain recognize fullness

2. Roux-en-Y Gastric Bypass (RYGB)

“Gastric bypass”

The procedure: the surgeon creates a small pouch (about the size of an egg) from the top of your stomach. Then the small intestine is cut and reconnected in a “Y” shape, so food bypasses most of your stomach and the first part of your intestine.

How it helps you lose weight

• Very small stomach pouch – you can only eat small amounts at a time
• Less calorie absorption – your body absorbs fewer calories from food
• Major hormonal changes – powerful changes to gut hormones that control hunger and blood sugar

Bypass surgery may be recommended if you have:

• Severe acid reflux (GERD) that has not responded to other treatments
• Type 2 diabetes that needs better control
• Had a sleeve gastrectomy before but regained weight

Comparing the two surgeries

Comparing the two surgeries: late complications

Your surgeon will recommend the best option for you based on your health conditions, not just which one has more weight loss.

Eligibility

Who can have bariatric surgery?

To be considered for bariatric surgery in Nova Scotia, you must meet certain requirements:

Weight requirements (at least one)

• BMI of 40 or higher, OR
• BMI of 35 or higher WITH a serious health condition related to weight (such as type 2 diabetes, sleep apnea, or heart disease), OR
• BMI of 30–35 WITH type 2 diabetes that is hard to control despite your best efforts

Other requirements

• No strict age limit – your team will assess your individual situation, but mortality is higher for patients of advanced age
• No strict upper weight limit, but special assessment is needed for BMI over 60

Surgery may not be right for you if:

• You are currently smoking or using cannabis
• You have current problems with alcohol or drug use
• You have an untreated eating disorder (like binge eating or bulimia)
• You have severe mental health problems that are not stable
• You have medical conditions that make surgery too risky

Benefits & Risks

Benefits and risks of surgery

Potential benefits

Major health improvements

• Type 2 diabetes – many patients see major improvement or complete remission
• High blood pressure – often improves or goes away completely
• Sleep apnea – improvement or resolution of OSA
• High cholesterol – usually improves significantly
• Joint pain – less pain due to less weight on joints

Quality-of-life improvements

• More energy for daily activities
• Better mobility and ability to exercise
• Improved mood and mental health
• Better sleep
• Longer life expectancy

Potential risks

Like any major surgery, bariatric surgery has risks. It is important to understand short-term risks (within 30 days of surgery):

The overall chance of having ANY complication is about 10%. Most complications can be treated successfully.

Long-term considerations

• Gallstones – rapid weight loss can cause gallstones to form and become symptomatic.
• Nutritional deficiencies – you will need to take vitamins and minerals for life.
• Marginal ulcers – a sore that forms where the stomach pouch meets the small intestine after a RYGB; the main cause is smoking, NSAID use, or tension during surgery.
• Internal hernia – happens when the intestines shift into gaps created during surgery, occurring in about 1% to 5% of cases and often triggered by significant weight loss. If you have abdominal pain after a RYGB, seek medical attention.
• Increased risk of alcoholism and addiction in some.
• Dumping syndrome (diarrhea, flushing, fast heart rate) occurs in 50% or more cases at some point after a RYGB, and in 10 to 15% of patients after a VSG.
• Low blood sugars can occur in up to 20% of people after meals with RYGB, and less frequently in VSG. Severe symptoms requiring hospitalization are rare.

What to Expect

What results can you expect?

Realistic weight-loss expectations

Here is what studies show about weight loss after surgery:

Sleeve gastrectomy

• Average: 20–25% of total body weight lost
• 300 lb person → expect to reach about 225–240 lbs
• 250 lb person → expect to reach about 187–200 lbs

Gastric bypass

• Average: 25–30% of total body weight lost
• 300 lb person → expect to reach about 210–225 lbs
• 250 lb person → expect to reach about 175–187 lbs

The true goal: better health

The goal of bariatric surgery is to improve your health – not to reach a specific number on the scale. Many patients will still be in the “obese” category by BMI after surgery. But they often have improvements in their health, mobility, function, energy, quality of life, and work productivity.

This is success! Health improvements matter more than any number on a scale.

Getting Ready

Getting ready for surgery

Preparing for bariatric surgery takes time and effort. This preparation is important for two reasons:

• It makes the surgery safer
• It builds the skills you need for long-term success

How to get a referral

1. Learn about the program: read this guide and visit valleymetabolichealth.com
2. Talk to your doctor: your family doctor, nurse practitioner, or specialist can send a referral to our surgeons
3. Work with your team: you will work with dietitians, counsellors, and others to get ready

Surgery readiness checklist

Knowledge and understanding

• Understand obesity as a medical condition
• Understand the risks and benefits of surgery
• Have realistic expectations for weight loss
• Know what life will be like after surgery

Nutrition

• Work with a dietitian
• Understand the post-surgery diet stages
• Know how to get enough protein
• Reduce ultra-processed foods
• Take recommended supplements
• Read the companion Nutrition Guide for Bariatric Surgery

Lifestyle

• Smoke-free and cannabis-free for at least 6 months
• Regular physical activity in your routine
• Work on behaviour change with a counsellor if needed

Medical

• Have an established primary care clinician
• Blood work completed
• Sleep apnea test completed (and using CPAP if needed)
• Mental health stable and supported
• Cancer screening up to date
• Other medical conditions assessed
• Consider the impact of surgery on your medications
• Avoid NSAIDs (Motrin, ibuprofen, Advil)

Support

• Have a support person to help during recovery
• Plan for follow-up appointments

After Surgery

After surgery: the first few weeks

In the hospital (1–2 days)

Most patients stay in the hospital for 1–2 nights. During this time:

• You will start sipping clear fluids
• You will be encouraged to walk the same day as surgery
• Pain will be managed with medication
• You will be monitored for any early complications

At home: what to expect

The first 4–6 weeks at home are for healing. Here is what is normal:

Energy

• Feeling tired and weak is normal
• You may need frequent rest and naps
• Simple tasks may feel hard at first – this gets better over time

Activity

• Walk as much as you can – this helps prevent blood clots
• Do NOT lift anything heavier than 10–15 pounds for 6 weeks
• Do NOT drive while taking prescription pain medication

Incision care

• You can shower 48 hours after surgery
• Pat incisions dry gently
• Leave white strips (Steri-Strips) in place – they fall off on their own or can be removed at post-operative day 7–10
• No baths or swimming until incisions are fully healed (2–3 weeks)

Pain medication

• Take medications as prescribed
• For sleeves: take naproxen every 2 hours for 3 days
• For RYGB: take acetaminophen (Tylenol) for pain every 6 hours for 3 days, NO NSAIDs (aspirin, ibuprofen (Advil), and naproxen (Aleve))

Stomach pill

• You will be prescribed a proton pump inhibitor (PPI; rabeprazole or equivalent) to protect your stomach post-operatively
• Sleeve: 1 year
• RYGB: 6 months
• Take this as prescribed

Managing common problems after surgery

For Life

Life after surgery

Your lifelong commitments

Bariatric surgery is a powerful tool, but it is not a cure. Long-term success requires your active participation.

1. Take your vitamins every day

Because your body absorbs fewer nutrients after surgery, you must take vitamin and mineral supplements for the rest of your life.

2. Follow nutrition guidelines

• Eat protein first at every meal
• Eat slowly and chew thoroughly
• Stop eating when you feel full
• Do not drink while eating (wait 30 minutes after meals)
• Avoid sugary and high-fat foods
• Stay hydrated – sip fluids throughout the day

3. Stay physically active

• Aim for 150–300 minutes of activity per week (like brisk walking)
• Include strength training to maintain muscle
• Any activity is better than none – start where you are

4. Attend all follow-up appointments

• Surgeon visit: 4–6 weeks after surgery
• Dietitian: 4 weeks, 8 weeks, 12 weeks, and 6 months post
• Initial lab work: 3 months and 6 months after surgery
• Annual blood work: for the rest of your life

About weight regain

Some weight regain over time is normal and does not mean you have failed. Reasons for regain can include:

• Your unique genetics and brain biology
• The brain defending against weight loss
• Stomach stretching slightly over years
• Return to old eating habits
• Life stresses, weight-promoting medications, health conditions

If you notice weight regain, do not give up. Talk to your healthcare team. There are options to help:

• Review your eating habits with a dietitian
• Consider adding weight-management medication
• Get support for emotional eating
• In some cases, revision surgery may be an option

Resources & Contacts

Resources and contact information

Western Zone Obesity Network · Website: valleymetabolichealth.com. Here you will find educational resources, support materials, and information about our programs.

Getting a referral

Talk to your family doctor, nurse practitioner, or specialist about getting a referral for bariatric surgery.

You Are Not Alone

You are not alone

Your bariatric surgery journey is about more than weight loss. It is about improving your health, increasing your energy, and enhancing your quality of life.

Success comes from the daily choices you make and the support you accept along the way. Your healthcare team, your family, and your community are here to help you succeed.

This guide is for educational purposes only and does not replace advice from your healthcare provider. It is based on guidelines from Obesity Canada. Procedure illustrations credited to le Roux et al., “Bariatric Surgery: A Best Practice Article.” Last updated: April 2026.