The Bariatric Stages

Have you ever been lost before? Most times, being "lost" is not a feeling we enjoy. We like to know where we are to plot our course forward. 

There are no medically recognized stages of bariatric life beyond the "pre-op" and "post-operative" statuses. In the medical world, you are either working towards surgery or learning to live life as a bariatric patient after surgery. 

As patients, we know that feelings, emotions, and changes happen rapidly, and we can experience different emotions and feelings along the way. It is important that we can identify where we are along our journey to onboard the support, resources, and education best suited for the particular stage we find ourselves in. We could have difficulty moving forward if we don't know where we are

🎉 So, let's fix that! 

Before we dive into the stages, it is essential to note that

  • Everyone's bariatric journey is different. Not everyone will simultaneously enter or exit a stage and experience the same emotions, feelings, or "things" in each stage. These stages are general and function as a guide.  
  • Our time estimates are just that, estimates. Our goal with "state education" is to prepare you for what could lie ahead for you along your journey 💗
  • Some stages are fluid, meaning you could move in and out of some stages often. 
  • There could be some lag time between exiting a stage and entering another. That's normal.
  • You don't have to be experiencing everything in a specific stage to be in it. You could experience some things, all of the things, or just one. Stages are more about feelings and emotions than physical experiences.
If you experience post-op complications, you might not experience these stages or experience them when you think you would have experienced them. Our goal is to help you prepare for anything that lies ahead, even some tough things.

Check out this video from our Founder, April Williams, talking about the different bariatric stages you will move through as a patient.

  • Pre-op Stages

    Pre-op stages describe actions, emotions, and feelings you could move through before your bariatric surgery. 

    We believe there are three pre-op stages:

    • Non-Starter
    • Contemplation
    • Pre-Op
  • Post-op Stages

    Post-op stages describe actions, emotions, and feelings you could move through after your bariatric surgery. 

    We believe there are five pre-op stages:

    • Bari Beginner
    • The Honeymoon
    • The Commitment
    • Life in Maintenance
    • Automation

Pre-op Stages

Non-Starter = "I would never have bariatric surgery."

  • Surgery is "off the table" in this stage for you or a loved one.
  • In this stage, you or your loved one might not understand that obesity is a disease and is not treating it as such. 
  • You might know surgery exists, but you think it is too dangerous, too risky, or you think you or your loved one would not qualify.
  • Usually, in this stage, potential patients will "double down" on a diet, workout plan, or other medical option.

Contemplation = "I think surgery might be something I need."

  • In this stage, you or your loved one is starting to be open to the idea of having surgery.
  • You or your loved one might start listening to podcasts or watching TV shows that focus on bariatric medicine, and you might start to have conversations with your PCP or friends who have had the procedure. 
  • You or your loved one might attend a free surgical consultation or workshop introducing you to bariatric surgery and what is involved.

Pre-Op = "I am committed to having bariatric surgery. I have a consultation with a surgeon / I am working through my pre-op requirements."

  • In this stage, you or your loved one has committed to undergoing bariatric surgery.
  • You have met with or have an appointment to meet with a surgeon, started the consultation process, and/or started your pre-operative "checklist."
  • You are working with a medical team to meet all insurance or pre-operative requirements. 
  • You or your loved one is feeling excited and anxious, all at the same time.
  • You are considered a pre-operative patient until you are wheeled into the operating room.

Post-op Stages

Bari Beginner = "OMG, what have I done?"

  • General stage timeframe: Day of surgery-3 months post-op
  • During this stage, you will experience BIG swings in your mood, emotions, and feelings. You could be in a higher-than-average pain level, and daily actions (using the restroom, bending over, doing the dishes) can be challenging. 
  • Your surgeon might restrict how you can move and how much you can lift. They might also recommend you take time off work and onboard someone to help you with your daily tasks. 
  • You will follow a very prescribed diet that includes only drinking liquids, then pureed and soft foods, before returning to eating "regular" food. You can only eat and sip minimal amounts at once- like an ounce!
  • Most patients experience the complete absence of hunger, and their desire to eat disappears. You might find that you have to set alarms to remind yourself to eat and drink. Some patients' hunger levels remain unchanged.
  • Some patients experience their first weight loss "stall" soon after surgery. This could be a reaction to the physical changes you are experiencing; it could be your body catching up to rapid nutritional changes, it could also be an equalization of your water weight after surgery. 
  • In this stage, you could experience emotions like anger, sadness, grief, loss, and frustration. You could also experience higher levels of joy, happiness, and contentment. You might question your decision to undergo surgery because of your physical and emotional pain. You could start to understand your relationship with food and how that relationship has shaped your life. 
  • Like all stages, this stage can be filled with big "aha" moments, essential realizations, and understandings that help you make sense of your past and better understand your future. 
  • In this stage, you are figuring out how to live as a bariatric patient! Everything is new, including your body's physical responses to eating and drinking.

The Honeymoon = "This is AMAZING!"

  • General stage timeframe 2-12 months post-op
  • Notice how the stages can overlap!

In this stage, things are going WELL. The weight is falling off, you have found a daily bariatric rhythm and routine, and people are noticing physical changes in size, shape, and weight.

Hormones are released when you lose weight, and many patients continue to experience their emotions and feelings in ways they have not experienced before. 

You might not feel like you are doing a ton of "work" because you think you are "just eating less."

You are doing a TON of work, but you are so overjoyed at your weight loss that you tend to brush over everything you do. 

Do not discount the work you are doing in this stage!

  • Hitting your surgeon's macro, hydration, and vitamin goals can be challenging because it can be difficult to monitor and manage.  
  • Many patients experience increased energy, capacity, and focus. 
  • Many patients experience their first or many stalls during this stage.

The Commitment = "I don't want to Bari anymore."

  • General stage timeframe: 8-24 months post-op.
  • This is when you feel like you have hit a wall when the Honeymoon has ended, and everything feels difficult. 
  • Many patients see the return of old, familiar habits, actions, and thoughts. Cravings can return stronger than ever, and you notice that you are falling back into your old ways. 
  • Regain is common here. You realize that you reached a low weight, and now your weight is creeping back up. Your clothes might start to feel tighter and your body's size and shape can shift again. 
  • You could feel a strong desire to isolate and "ghost" the community and your journey. You just don't want to "bariatric" anymore. You don't want to do the work of weight loss surgery; you want things to be and feel "normal," but you don't know what normal is because things that used to bring you comfort no longer do. 
  • You may feel lost, adrift, disconnected, angry, mad, sad. 
  • This is your "fork in the road" moment; are you going to commit to living and being a bariatric patient for the rest of your life or are you committing to your old life? 
  • Both decisions are valid and allowed. There is not a "bad" decision here. One choice will take your life in a new direction, an unknown direction, and one will allow you to return to what was known.  

You cannot live in both worlds. You must make a decision. Trying to live in both worlds will only lead you in circles; you will be doing a ton of work but going nowhere.

Life in Maintenance = "I am a patient for life; this is how I live my life now."

  • General stage timeframe: After you have committed to bariatric life!
  • In this stage, patients have embraced and committed to their bariatric life. Your goal in this stage is to make your bariatric lifestyle your normal, everyday lifestyle. 
  • You have shifted your mindset from compartmentalizing your bariatric experience to one where your bariatric life IS your regular, normal life. They have mashed into one beautiful experience! 
  • Many patients in this stage get back to basics. They start tracking data again, refine and dial in their vitamin routines, return to meal prepping and planning, onboard a calendar system and find ways to make movement and bariatric support a daily or weekly occurrence.
  • In this stage, patients will reconnect with the community and with the support they need to learn how to maintain their bariatric habits, routines, and systems. 
  • In this stage, patients can make substantial mindset shifts that allow them to address some of the things holding them back. Patients in this stage have a type of "ora"- they are committed to figuring it out and acknowledge that it will take time and experimentation to dial it all in! 
  • Patients in this stage can feel empowered, enlightened, positive, hopeful, and prideful. There can also be moments of setback, sadness, frustration, and anger. Change is HARD. 

Automation = "My bari habits, thoughts, and actions are automatic and normal."

  • General stage timeframe: The rest of your life :) 
  • In this stage, the habits, skills, mindsets, and tools you refined in Maintenance have become automatic, things you no longer think about. You do them because they have become you! 
  • In this stage, as the disease presents in new ways, you onboard new tools, skills, and resources to help you move through the moments. 
  • Patients who have automated their bariatric life tend not to panic when curve balls are thrown their way. Then lean into education, resources, support, and community to onboard what they need and support others going through the earlier stages.

Understanding the stages helps us connect with patients living through similar things and know that we are not alone in our struggles. 

After learning about the stages, we encourage you to join the stage space that best fits you and your needs. And it's ok to join multiple stage spaces- you might be in the middle of two stages or want to prepare for what is coming. Or maybe you want to help support members living through a stage you just exited! You are always in control of your experience here in BariNation. Find and access the support you need! 

You are the expert in your own patient experience.