Lose Weight Regain After WLS

Four Steps To Lose Weight Regain After WLS

November 17, 2020

Lose Weight Regain After WLS

Many people seek out WLS (bariatric surgery) as a last resort; what they hope will be a final step toward lifelong health. They usually don't think about having to lose weight regain after WLS.

It takes tremendous courage to undergo bariatric surgery, the courage that is often bulwarked by before-and-after photos of success from others. What is not always shown is the real risk of partial or complete weight regain.

Weight regain is defined as the difference from the lowest post-surgical weight to present weight. In one study, the average weight regain at 7 years post-gastric bypass was 23.4% of total weight lost (1). While thoughts of failure, anger, and defeat understandably accompany this phenomenon, underneath lies a call to action.

Obesity is a lifelong disease that requires lifelong management. Weight regain to some degree is an expected occurrence to keep us paying attention. Fortunately, there are ways to lose weight regain after WLS.

Contributing Factors to Weight Regain

Just like there are numerous factors that contribute to weight gain, there are just as many factors that contribute to weight regain. Understanding these factors can help point to effective solutions. Below are some of the most common reasons for weight regain after bariatric surgery.

Biological

  • Pouch size increase or a lap-band is too loose leading to an increase in portion sizes.
  • Changes in hunger/satiety hormones leading to an increase in appetite or cravings
  • Menopause or pregnancy
  • Medical problems (e.g. Cushing’s syndrome, thyroid disease)
  • Weight-gaining medications
  • Disability which limits physical activity

Behavioral

  • Mindless eating or grazing on food
  • Skipping meals
  • Consuming high-calorie foods and beverages (which is often associated with a loss or lack of dumping syndrome)
  • Excessive alcohol intake
  • Sedentary lifestyle
  • Insufficient moderate- and vigorous-intensity exercise

Psychosocial

  • Emotional eating
  • Binge eating or lack of control around food urges
  • Nighttime eating
  • Lack of support
  • Stressful life event

Taking Action To Lose Weight Regain After WLS

It can be difficult to assess which factors may have contributed to your weight regain, therefore, it is important to have a discussion with your bariatric medical team to rule out any medical or biological contributors.

If you are unsure about what you should be eating or need nutrition guidance, make an appointment with your bariatric program’s dietitian to review a healthy bariatric meal plan. Below are four steps to help guide you to lose weight regain after WLS.

Four Steps To Lose Weight Regain After WLS

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HONESTY

Keep a food and exercise log. Whether you prefer using your phone or notebook, the first step is to be honest about what you are or are not doing. Be as detailed as possible including all nibbles, licks, sips, or steps.

At the end of each week, make two columns, one labeled assets, the other labeled liabilities. In the assets column, list anything you did that week that showed strength such as meeting your water goal or joining a walking group.

In the liabilities column, list anything you did that indicates room for improvement such as mindless snacking at work or forgetting breakfast. Being honest about your current diet and activity level is the first step to freedom.

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HOPE

Re-discover your motivations and successes. Writing down your current habits can be difficult, so it is important to also reinforce why you were motivated to lose weight in the first place and why you are motivated to get back on track. Whether your motivations are related to appearance or health or quality of life, include all of them.

Write down any successes you have achieved since surgery to see that you are not starting from square one. Maybe you are still off certain medications or are still able to climb up and down the stairs without being out of breath. Maybe you have more confidence in your ability to take control of your health than you did before surgery. 

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WILLINGNESS

Set both short-term and long-term goals. Now that you can clearly see where you are at, it is time to really act by setting goals. Start with a goal you would like to achieve in the next 6 months to a year. Then break that long-term goal into short-term goals.

For example, if you have a long-term goal to lose the 20 pounds you regained, break that goal into smaller goals such as losing 5 pounds in the next month. Look at your liabilities column and set goals to address those issues. Use your strengths to help you meet those goals.

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ACCEPTANCE

This may be the hardest step for some, as sometimes we do not want to accept ourselves the way we are. This does not mean being passive or never changing but establishing a lifestyle we can realistically adhere to.

Maybe getting back to your lowest weight would mean an unsustainable workout regimen or feel too deprived. Find a balance between your body weight and the type of lifestyle you can follow long-term.

What you resist, persists. What you accept, transforms. - Carl Jung

There will be constant challenges and changes that occur during the weight loss journey including weight regain and having to lose weight regain.

Instead of seeing weight regain as a failure, see it as a call to action.

Recognize that you are not alone in weight regain and that there are multiple biological, behavioral, and psychosocial factors that contribute to weight regain.

Ways to Handle Weight Regain

  • Be honest with where you are now;
  • Have hope that you can reclaim your health;
  • Be willing to make changes; and,
  • Accept the rest.

References

  1. Cooper TC, Simmons EB, Webb K, et al. Trends in weight regain following roux-en-y gastric bypass (RYBG) bariatric surgery. Obes Surg. 2015;25:1474-1481.
  2. Kushner RF, Webb K. Medical approach to a patient with postoperative weight regain. In: Still C, ed. The ASMBS Textbook of Bariatric Surgery Volume 2. New York NY: Springer; 2014:205-216.
  3. Stoklossa CJ, Atwal S. Nutrition care for patients with weight regain after bariatric surgery. Gastroenterol Res Pract. 2013;256145.
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Julie Wintersteiner

ABOUT THE AUTHOR

Julie Wintersteiner, MS, RDN, CDN is a Touchpoint bariatric dietitian for Lourdes Hospital in Binghamton, NY. Julie earned her BS in biology from the University of Michigan, her MS in human nutrition from Cornell University, and her dietetics degree from Russell Sage College. She earned a Certificate of Training in Obesity Interventions for Adults from the Academy of Nutrition & Dietetics. Julie is passionate about helping her clients achieve healthy bodies, minds, & spirits.