I am at a loss, I have gained 20lbs since I have had my total weight loss and skin removal. I am so devestated and I havent changed a thing I exercise and eat the same as I have since I had the surgery. Please someone give me some clue, it is depressing me to the point I dont want to go in public and I am embarrassed. I am currently at 168

What are you doing currently?  Like what do you eat, how many calories, how much protein?  How much exercise do you get?

 After the surgery you have a tiny pouch and your have intestines that have been rerouted so that not much of what you eat is not absorbed.  The combination of the surgery, healthy diet and exercise results in rapid weight loss.   For most people that results in a loss of about 100 pounds and the lowest BMI is generally reached at month 24.

I tell people to think of their old stomach as being the size of a 2-liter bottle of soda and their new pouch being the size of the bottlecap on that soda bottle.  By the end of the first year after surgery, the pouch has expanded to its full size and can then hold between eight and twelve ounces.

The bigger pouch holds more and we can eat more variety.  But there is often no weight gain even with eating more during the second year after surgery. The malabsorption of food continues but becomes less and less.  By the middle of the third year, most of the malabsorption has ended.  We can be eating the same food, but more of it is actually being absorbed so it is like we have been eating more food.  This is when about 10 pounds is typically gained.

Weight gain means that we no longer can maintain our goal weight with our current diet and exercise.    This is the point when people decide to go back to basics and eat like they did right after surgery.  But eating that way does not work because our pouch is bigger and needs more food than after surgery.  As we have healed from surgery we have enjoyed a much greater variety of foods.  Going back to trying to live on a few protein shakes and some soft foods would be boring and something that we quickly quit.

For people who don't accept that their diet and exercise needs have changed, the weight gain continues. Ten becomes twenty, thirty, forty, fifty and sixty pounds of overweight.  About 50% of post-ops have had a 50 pound regain by the end of year five.  When my personal regain exceeded ten pounds, I went back to Weigh****chers.  I tracked foods and increased exercise.  I eventually got back to my goal weight, but it took a lot of effort.  I found that weight was harder to lose than even before surgery.

You are still at a point where it will be doable to get the weight off and get back to your goal weight.  If you don't take action now, the weight gain will continue and losing will become harder with each added pound.  My biggest motivator is my scale.  I weigh every morning and adjust my diet and exercise according to what the scale says.  I am not silly enough to get devastated over a few pounds of water gain, but I am realistic enough to know when I am eating more, exercising less and seeing a regain as a result of that.

Once I got back to goal and understood what I need to do it is quite easy to maintain.  I still have the advantage of the surgery so cannot eat big meals.  I get full quickly, I have lots of energy, I make sure that I move my body.  I stick to healthy food choices and feel the best when I avoid starchy foods.  This will always be a journey for me and making wise choices is my job.  I look and feel my best when I take responsibility and make those good choices.

Great and helpful response! Thanks.

I've reached the end of my malabsorption, and am having to struggle with taking in less as well as continuing my exercising at a pretty intense level.

I also use my scale to keep me honest and accountable.

I have a sense that this is going to be a forever battle for me. I miss my honeymoon period.

If the gain has been very gradual, it may be attributable to the additional loss of the caloric malabsorption (but that has been happening slowly since the day you had surgery, so it would not be a situation where it would cause sudden weight gain, and you did not say over what period of time you have gained the 20 pounds).  

It is also very easy, however, to let the portion sizes creep up, so even if you are eating the same things, are you sure that you are eating the same amount of them?  Are you still adhering to the "no drinking with meals" rule?  If not, that can contribute to eating larger portions (and therefore weigt gain) as well.

Lora