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After Bariatric Surgery: Weight Regain Resolution

March 29, 2017

In the beginning of our weight loss surgery journey, our paranoia and need to follow the rules keep us on track. During the honeymoon period, we have defined goals that we are working towards, which contributes to our advanced weight loss. This weight loss ends and can reverse when we lose sight of these goals. It is after the honeymoon period when the real work begins.

As post-ops, we will never be in the same category as non-ops again. We need to learn how to adapt to the changes in our bodies and our lives after WLS.

What Causes Weight Regain?

As former habits sneak back into our lives, our former weight can begin to creep back on. Complacency can lead to weight regain. In addition, many post-ops start to experience an increase in appetite as ghrelin levels return to normal. Ghrelin is nicknamed the “hunger hormone” due to its effects on appetite. Nutritional indiscretion can also lead to regain; this entails when we learn to “eat around” our tools, and perhaps even begin to rely on non-nutritive sources of calories, such as alcohol. An important part of weight loss surgery is not just the operation on our stomachs but also adapting how our mind processes internal and external stressors.

Sometimes, however, despite our best efforts, we continue to struggle to lose weight after surgery. If you feel that this is you, the best avenue would be to discuss your concerns with your surgeon. On very rare occasions, failure to lose weight after surgery can be due to anatomic surgical failure, and the only recourse for such an issue would be a surgical revision.

What Can I Do About Weight Regain?

In a previous article, I discussed the pros and cons of commercial weight loss programs. These programs may or may not be what you need to address your regain, so here are some of my own thoughts on how to approach weight regain after surgery.

While I have used the phrase “back on track” in the past, and probably will use it the future, I am not a big fan of this saying. “Back on track” suggests returning to the exact lifestyle prescribed after surgery; however, we all know that it is impossible to go back in time. While we might be able to recreate the habits we had originally implemented, we cannot return to the exact mental, emotional, physical, and metabolic states we had immediately after WLS.

What we can do is to evaluate our emotions, eating, and exercise, and do our best to re-align them with the long-term post-op recommendations provided from our surgeons. In addition, “back on track” implies that there is only one way to go about it. We have all had different weight struggles, different amounts of weight loss, different challenges, different successes and even different surgery types. And while there are generalized recommendations for us to follow as post-ops, the most important factor is regular checkups to ensure you are at your optimal health.

Now some of you may be reading this article thinking, “Ok, where are the answers? What will she tell me to do that I haven’t thought to try before?” And unfortunately, I don’t have all the answers and I probably couldn’t think of something that you haven’t already tried to lose weight. What I can do is highlight the need for change.

What Do I Need To Change?

Weight loss is a journey and not a destination, so while the work never ends, it can become easier as we learn how our post-op bodies work and come to understand what works best for us.

Treat every day, every meal like an experiment. What worked before may not work again, and what hasn’t worked before might work now! It is up to you to experiment and try different avenues for battling regain to see what will help you the most.

Take a step back and analyze what you are currently doing. You need to be able to assess your habits and hang-ups in order to address them. Only once you know what your intake is can you focus on increasing your protein and fiber intake or decreasing your carbohydrate intake. Perhaps you need to focus more on your beverages and incorporate more non-caloric fluids into your day. For others, it could be something simple such as switching out a sweet treat for something with less sugar that’s still satisfying. I am not an advocate for depriving yourself of enjoying food, but if you could be satisfied with a healthier choice, why wouldn’t you want to deviate towards that option?

Check your energy output. For others, the problem is not with their intake, but rather with their energy output: exercise. While you can’t outrun your fork, that doesn’t mean you shouldn’t try adding exercise into your healthy lifestyle. It is not reasonable to expect significant weight loss without combining physical activity with improved nutrition. However, we shouldn’t go overboard on exercise, as there is a physiological limit as to how many calories your body can burn in a finite amount of time, and we often overestimate our caloric burn. This can be damaging when we eat to make up for burned calories, rather than eat to refuel.

Who Can I Turn To For Support?

Family, Friends, and Accountability Partner.  I fully believe that support is one of the biggest determining factors for maintaining weight loss. If you don’t have one already, find an accountability partner, someone who will both encourage you and hold you to a higher standard. Seek support from your family, friends, community and fellow patients to help maintain your personal motivation. Surround yourself with those who love and support you in every way! Unfortunately, for some of us, that will mean addressing toxic people, including food pushers and well-meaning yet ignorant family and friends.

Bariatric Team and Medical Professionals.  In addition to friend and family support, you always have the support of your bariatric team. Sometimes, rather than turn to a team that is established to help us, we feel ashamed of our regain so we turn away and hide. For some, it is difficult to get to a visit with their bariatric team, but perhaps they have the support of their primary care doctor. Wherever it comes from, it is important to discuss all of your options with your doctor: pharmacotherapy, nutrition counseling, therapy, bariatric revision, and more.

Other WLS Patients.  One of your biggest tools for support is at your fingertips: your fellow WLS patients. We are here to support each other, encourage each other, and empower each other to become healthier, happy individuals.

Just as our weight loss journeys before surgery were not simple, neither are our journeys afterward. We need to truly learn how to adapt to our post-op lifestyle, to turn to others for support, and to try the various evidence-supported methods for weight loss. This does not include the restrict-relapse-repeat cycle of yo-yo dieting but rather supports making lasting habits that support a healthy lifestyle. Once these habits become ingrained, it actually becomes more difficult to return to the habits that once lead us to bariatric surgery in the first place.

bec

ABOUT THE AUTHOR

Bec McDorman, MS, RDN discovered her passion for health and wellness after undergoing Roux-en-Y Gastric Bypass surgery in 2010 to lose more than 100lbs. Bec has received her masters from Cal Poly Pomona and completed her dietetic internship at Johns Hopkins Bayview Medical Center. She has reached her goal of being a registered dietitian so she can help pre- and post-op bariatric patients with their journey.

Read more articles by Bec!