in which all but 30 cm (12 in) to 45 cm (18 in) of the small bowel was detached and set to the side. post-procedure follow-up in many institutions, patients are followed closely both before and after a procedure. the care team may also include people in a variety of disciplines, including social work, dietitians and medical weight management specialists. follow up post-op is typically focused on helping avoid complications and tracking patients' progress toward their weight goals. dietary recommendations diet restrictions after recovery from surgery depend in part on the type of surgery. in general, immediately after bariatric surgery, the patient is restricted to a clear liquid diet, which includes foods such as clear broth, diluted fruit juices or sugar-free drinks and gelatin desserts. this diet is continued until the gastrointestinal tract begins to recover. the next stage provides a blended or pureed sugar-free diet for at least two weeks. this may consist of high protein, liquid or soft foods such as protein shakes, soft meats and dairy products. foods high in carbohydrates are usually avoided when possible during the initial weight loss period. post-surgery, overeating is curbed because exceeding the capacity of the stomach causes nausea and vomiting. in the long term, many patients will need to take a daily multivitamin pill for life to compensate for reduced absorption of essential nutrients. because patients cannot eat a large quantity of food, physicians typically recommend a diet that is relatively high in protein and low in fats and alcohol. fluid recommendations it is very common, within the first month post-surgery, for a patient to undergo volume depletion and dehydration. some patients have difficulty drinking the appropriate amount of fluids as they adapt to their new gastric volume. additionally, limitations on oral fluid intake, reduced calorie intake and a higher incidence of vomiting and diarrhea all contribute to dehydration. family planning in general, patients are advised to avoid pregnancy for 12–24 months after a bariatric surgery. this waiting period is intended to reduce the possibility of intrauterine growth restriction or nutrient deficiency, since the bariatric surgery patient will likely undergo significant weight loss and changes in metabolism. in the long run, however, the rates of many adverse maternal and fetal outcomes are reduced for obese mothers following bariatric surgery. cosmetic body contouring after a person successfully loses weight following bariatric surgery, they are usually left with excess skin. these can be addressed in a series of plastic surgery procedures sometimes called body contouring in which the skin flaps are removed. targeted areas include the arms, buttocks and thighs, abdomen, and breasts. these procedures are taken slowly, step by step, and from beginning to end often takes three years. economic implications the cost of healthcare in the united states is increasing, and obesity rates are likely to be playing a role. per the cdc, approximately 41.9% of us adults are obese (as measured from 2017-2020), a rate that has increased significantly from a level of 30.5% in 1999-2000. obesity-related illnesses account for 14.3% of us healthcare spending, and also result in significant losses to the economy through decreased productivity. bariatric surgery is expensive, with average cost estimates ranging from $11,500 to $26,000, however, this cost is estimated to be recovered within 2–4 years due to decreased healthcare spending, gains in quality-adjusted life-years (qalys) and increased productivity. cohort modeling has found that bariatric surgery results in a net qaly gain of 4.2, and is cost-saving from a societal perspective. even by the previous bmi criteria, a study had found that more than 32 million people may have been eligible for bariatric surgery in 2016—nearly triple the 1993 amount. importantly, only ~1% of eligible patients receives bariatric surgery. considerations in adolescent patients