Before and after bariatric surgery

Before

1. Get the full metabolic assessment done first Sugar, liver, lipids, thyroid, vitamin D, B12, iron, and a screen for sleep apnoea. Deficiencies present before surgery get much worse afterwards, and untreated sleep apnoea materially raises the anaesthetic risk.
2. Have the eating pattern properly assessed Surgery restricts how much you can eat at once. It does not treat a binge pattern, grazing, or eating driven by mood, and where those are present and unaddressed they are among the commonest reasons weight returns. The checklist is here, and it is worth being honest on it.
3. Understand what you are choosing between Sleeve gastrectomy and gastric bypass differ in weight loss, in effect on reflux, in diabetes remission and in how much nutritional supplementation you will need for life. Ask your surgeon to explain the trade-off for you specifically rather than in general. If you were referred from Caspian, that surgeon is Dr. Aslam Baba at Renova Century Hospital, Banjara Hills.
4. Sort out the insurance before the date Bariatric surgery is covered by Indian health policies under an IRDAI direction, generally at a BMI of 40, or 35 with a qualifying condition, with waiting periods of two to three years on most policies. The clinical threshold and the reimbursement threshold are different numbers. Read the policy first.

The first year afterwards

Supplements, for life

This is the part that gets abandoned once people feel well, and it is the part that causes the harm. Which you need and at what dose depends on which operation you had, so this is a checklist for the conversation rather than a prescription.

• Vitamin B12. Absorption is reduced permanently. Deficiency causes nerve damage that does not always reverse.
• Iron. Especially in women who still menstruate. Deficiency here is very common and is frequently mistaken for ordinary post-surgical tiredness.
• Calcium and vitamin D. Bone loss after bariatric surgery is real and it is silent.
• Thiamine. The one that matters acutely. Persistent vomiting after bariatric surgery plus low thiamine can cause permanent neurological damage within weeks. Vomiting for more than a few days after surgery is an emergency, not an inconvenience.
• A multivitamin, plus whatever the specific tests show. Annual blood tests are how this is managed. Guessing is not.

If the weight comes back

Some weight recurrence after bariatric surgery is normal and expected, usually starting somewhere between year two and year five. Substantial recurrence happens to a meaningful minority and it is not a moral failure, a sign the operation was wasted, or something to hide from.

What is worth knowing is that it is treatable. Medical treatment after surgery, either for inadequate initial loss or for weight that has returned, is now common practice and is supported by evidence. Surgery and medicine are not rival camps; using one does not disqualify you from the other, and the sequence is a clinical question rather than an identity.

What we would do is look for the treatable reasons first: an eating pattern that was never addressed, a returning sleep apnoea, a medicine causing weight gain, an untreated mood problem, a nutritional deficiency sapping the energy for activity. Often one of those is the whole story.

Things to tell any doctor, forever

• Which operation you had, and when. Carry it in writing.
• Avoid non-steroidal painkillers such as ibuprofen and diclofenac after bypass surgery unless a doctor who knows your anatomy has said otherwise. Ulcer risk is raised.
• Some tablets are absorbed differently, and some extended-release preparations should be swapped.
• Pregnancy is generally advised to wait 12 to 18 months after surgery, until weight is stable, and needs nutritional monitoring throughout.
• Sudden severe abdominal pain after bypass surgery needs assessment the same day. Internal hernia can present late and is a surgical emergency.

General guidance in this page follows established bariatric aftercare practice. The specific supplement regimen depends on your operation and your blood results and should come from your surgical team or from us with your reports in hand. Comparative outcomes: ASMBS analyses and the network meta-analysis in Obesity 2026. Insurance position: IRDAI circular, 2019.