weight regain

5 Steps to Take If Weight Regain Occurs After Weight Loss Surgery

June 19, 2019

A very common question asked by metabolic surgery patients is how to lose weight regain after weight loss surgery. Before we tackle this complex issue, let’s visit a few principles about weight loss, weight gain, and general weight management.

Weight management is a complicated and complex issue; it’s influenced by social, psychological, physical and emotional factors.

We ALL, pretty much everyone on this planet, struggles with his or her weight. This is the reason most surgeons discuss in great length the importance of other compounding factors in weight loss maintenance with patients. These include dietary, social and physical activity habits.

While weight loss surgery (WLS) plays a pivotal in the initial phase of weight loss, the other factors play an equally important role in the maintenance of weight loss. The so-called ‘honeymoon’ period of weight loss allows the patient to reset the way our gut interacts with our brain and vice-versa, leading to major hormonal and metabolic changes.

Most patients enjoy the initial weight loss, which can be resistant to bad habits, so one can cheat with calorie restriction initially, and still enjoy excellent weight loss results. However, that phase eventually passes over 12-18 months after surgery. This usually translates into WLS patients slowly regaining weight 3-4 years after their initial surgery.

The biggest challenge to a weight loss specialist is the late presentation of most patients. The vast majority of patients present after they have regained most of their excess weight back. This makes the challenge very steep for the patient and treating physician.

5 Steps to Take for Weight Regain After WLS

Step 1 - Acknowledge the Weight Regain

The first step is always to acknowledge your weight regain. Often patients resume bad eating and activity routines which leads to slow weight regain.

As pre-operative comorbidities resolve, in fact, the vast majority of pre-operative comorbidities resolve or significantly improve 10-12 months post-surgery. This leads some patients to slowly lose focus, return to bad eating habits and slowly decrease their activity levels, while slowly regaining weight. Patients feel depressed and a sense of disappointment creeps on them. This leads many patients to feel helpless and think they are a failure. Therefore, the most important first step is to acknowledge weight recidivism and seek help as soon as possible.

Step 2 - Start an Activity and Food Journal

A very important tool in identifying relapsed habits is to keep a detailed food and activity journal.

Your physician wants to identify the triggering impulses, eating habits, and activity level. Some important triggering impulses to be mindful of are from stress, mindless eating (for example, eating while working, doing homework, watching television, or any distracting activity while eating usually leads to unnecessary increased calorie sugars which dissolve very rapidly.

Combining mindless eating with these food leads to fairly rapid weight regain.

By documenting and deliberately recording every action we can then start targeting these habits and slowly changing them. Remember, changing a habit takes at least 4 to 6 weeks but the relapse of bad habits is much shorter. You have to be patient, your actions must be deliberate and persistent to have lasting change. Have reasonable short, intermediate and long term goals to keep you focused.

Step 3 - Consult With an Experienced Bariatric Surgeon

Do not delay seeing an experienced bariatric surgeon if you feel your plans aren’t going well and you aren’t meeting your weight loss goals or, the weight is slowly creeping back on.

An experienced bariatric surgeon with his team of dieticians and psychologists can guide you with the appropriate workup and treatment plan. This will be different for each individual depending on their comorbidities, the type of WLS, activity abilities, age, and overall functional status.

Unfortunately, most patients wait too long before seeking professional help. Your bariatric surgeon will rule out any anatomical abnormalities. For example, if you have had a gastric bypass, they will need to rule out a connection between your gastric pouch and the separated part of the stomach. This is called gastrogastric fistula, this leads to increased capacity to eat food and it may lead to increased appetite, lack of satiety (feeling full) and increase caloric intake.

Your surgeon will also look at your daily activity and food log to elucidate the potential reasons for the weight regain. This may be due to bad eating habits such as multiple small, calorie-rich meals or, it may be due to large meals at inappropriate times. For example, you may not have breakfast and lunch but, consume a large number of calories later during the day and before going to bed.

Your metabolism usually slows down at night so your body is more likely to store the calories than consume them. Not all calories are made the same. Your body handles 100 calories of protein very differently than 100 calories of saturated fat and refined sugars.

The type of calories, as well as the timing that they are consumed, will result in different outcomes. Manipulating both the timing, type and the number of calories consumed may stimulate weight loss again.

Step 4 - Explore Medical Treatment Options

Medical therapy continues to evolve and there are several medical treatment options currently on the market. Unfortunately, many of these are only effective in the short run and do not result in significant weight loss. Having said that, they remain a viable option in well-selected patients who have had weight loss surgery and are seeking to reverse their weight recidivism.

There are two general classes of medications; stimulants which increase metabolism and appetite suppression. After reviewing your activity and food log, your bariatric surgeon can initiate a trial of these medications.

Some of the new formularies are a combination of both stimulants and appetite suppressants. These medications can be very effective if started appropriately along with a calorie restrictive dietary regime and exercise program.

Step 5 - Explore Surgical Revision Options

Should all treatments fail despite having a calorie restrictive diet, intensive exercise regimen, and a very dedicated patient, surgical treatment could be considered.

A potential surgical revision of the initial procedure may be pursued. This always requires a very experienced bariatric surgeon and the revision will depend on the initial procedure. Revisional surgery is very complicated and is beyond the scope of this article.

Empower Yourself!

In summary, acknowledge the problem of weight regain early and seek professional help. There are many options out there so you don’t have to feel helpless. In fact, empower yourself with seeking appropriate medical attention from experienced professionals. Luckily there are many of us out there!

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ABOUT THE AUTHOR

Dr. Husain Abbas of Memorial Advanced Surgery, is a Board Certified surgeon trained in Minimally Invasive Surgery. After his surgical residency at St. Mary's, a Yale University affiliated hospital, Dr. Abbas completed a fellowship in Minimally Invasive Gastroesophageal & Bariatric Surgery at the University of Florida, Gainesville. Dr. Abbas' expertise extends to a wide array of gastroesophageal disorders, anti-reflux surgery, complex hernia repairs, endocrine, oncology and bariatric procedures.

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