Bariatric Surgery Stomach Reset 2

Does A Bariatric Surgery Stomach Reset Work To Lose Regain?

June 8, 2018

Bariatric and metabolic surgery have gained widespread acceptance mainly due to the long-term reduction in mortality and significant improvement in co-morbid conditions such as diabetes type II and high blood pressure. Beyond the health benefits, there is a drastic improvement in the quality of life.

Over time, we find that, depending on the procedure, as many as 20% of people who have had procedures experience significant weight regain by about 10 years after the procedure.

A large number of people that struggle with weight regain admit they have allowed carbohydrates and large amounts of artificial sweeteners and caffeine back into their diets. I always try to educate my patients that allowing those things back into your diet will have a slow but significant effect on your metabolism. The result of that effect is weight gain.

It is an insidious process which is why most patients who regain weight do so after several years of initial success. It is also why I stress even before surgery that those things should NEVER become a regular staple in one's diet after surgery.

That knowledge is unhelpful for those who have already regained weight. Many of these patients fall back into the same pattern they were in prior to surgery with short-term diet and exercise programs. Their results after surgery are often similar to the results they had prior to surgery; many lose weight but gain it back again quickly once the diet ends. From the frustration caused by this phenomenon, the idea that one can reset their pouch has grown.

Does a Bariatric Surgery Stomach Reset Lose Regain?

The theory of a pouch reset is that it causes the stomach pouch to shrink back to its post-surgery size resulting in weight loss.  Instructions to patients who attempt a pouch reset are to follow the dietary guidelines that we give to our patients immediately after surgery.

  • In a nutshell, three 4 ounce meals a day starting with a clear liquid diet and a slow advancement to a full liquid, pureed, and soft diet spending 2 to 3 days at each step.
  • Finally, patients are to resume a regular high protein, low-carb diet maintaining the 4-6 ounce serving size.
  • In our practice, we recommend that each meal should consist of about 70% protein and 30% vegetables.

I have some issues with this theory because it reflects several incorrect notions as to why metabolic surgery works. First, the idea that weight loss occurs due to restriction exclusively and is completely dependent on pouch size is a false one. Several studies have clearly shown that weight regain is not related to pouch enlargement.

That’s not to say weight loss or regain has nothing to do with pouch size. There are clearly some post-ops that have much larger pouches than others, but that is likely a result of their initial surgery and not stretching over time.

There is a theory that by making a short-term change in diet somehow restarts the metabolic change that is ultimately responsible for much of the initial weight loss, but more importantly maintenance of that weight loss after surgery. The idea that one can eat a high-carb diet, go through the pouch reset steps, and go back to the same diet but still experience significant weight loss is unrealistic. Only a permanent change can have the long-term effect of maintaining weight loss. This is true both before and after surgery.

There are those who could see significant weight loss by going through this process, specifically, those who have abandoned the post-operative high-protein, low-carb diet. Going through the pouch reset process helps to eliminate regular ingestion of large amounts of carbs, artificial sweeteners, and caffeine and replacing them with healthier high-protein, low-carb habits.

If one continues to follow those habits indefinitely then that could result in significant and sustainable weight loss. If the pouch reset is a temporary diet lasting several weeks only, then it ends up being similar to several cleanse type diets that are out there and have been proven to be ineffective in the long-term.

Bariatric Surgery Stomach Reset Summary

When it comes down to it, there is no silver bullet that will help people lose weight regardless of whether or not they have had surgery. Bariatric surgery is a tool that generally produces significant weight loss with an accompanying metabolic change that helps to maintain that weight loss.

Once people have passed through the bariatric surgery weight loss stage (12-24 months), weight loss will likely become as difficult as it was prior to surgery. Just as before surgery, the only way to effect a long-term weight loss is to undergo a permanent lifestyle change.

If a pouch reset is a means to eliminate carbs, artificial sweeteners, and caffeine long term, then I fully endorse it.  On the other hand, if it is undertaken with the idea that significant weight loss will result from a few weeks of following guidelines then a return to bad eating habits, I’m afraid there will be some disappointed folks out there.



Nicholas Paulk, MD, FACS specializes in bariatric surgery for the treatment of obesity and weight-related conditions at Rocky Mountain Associated Physicians in Salt Lake City, Utah. As a board certified general surgeon and Fellow of American College of Surgery, Dr. Paulk offers patients lifesaving operations to live a better, more healthy and active life. It is a privilege to be part of such a positively life altering endeavor that is bariatric surgery.

Read more articles by Nicholas Paulk, MD, FACS