Weight Regain After Bariatric Surgery

One of the most common concerns for patients following bariatric surgery is weight regain. Many people fear they’ve done something wrong when they notice the number on the scale beginning to tick up. They are worried that they’ve stretched the size of their stomach or that they lack motivation or time to stay on track. However, it’s important to recognize that regain is a very normal and even expected part of the weight loss surgery process. If you have experienced regain, you are not alone. The causes for it are complex. Read on to learn about some of the most likely reasons for regain and how Iowa Weight Loss Specialists can help get you on track to meeting your health goals.

Many weight loss surgery patients go through a “honeymoon phase” during which the weight seems to come off almost effortlessly over the course of the first several months post-op. Patients are able to experience a sense of fullness at meals without the nagging hunger pangs associated with chronic dieting. They often feel increased energy levels while eating small amounts of food, and may find it easier to turn down foods that used to trigger overeating. The struggles with appetite and cravings they had before surgery may feel more manageable.

While this initial honeymoon period can be a great motivator for making permanent healthy lifestyle changes, the reality of surgery as a tool (and not a magic fix) eventually sets in. The newness of the experience begins to wear off, life stressors creep in and affect your day-to-day habits, and most alarmingly, your hunger and portion sizes may start increasing. This is where the importance of continuous follow-up care and your bariatric support team come in.

Obesity is a chronic disease, and like all chronic conditions, it requires regular treatment and attention over time. Humans used to live in a leptogenic environment, meaning an environment that is more likely to produce thinness by default. We ate more home-prepared and less processed meals, worked more physical jobs, and lived in walkable communities. Today we live a more obesogenic lifestyle, or one that is more likely to result in our bodies carrying extra weight. We eat energy-dense convenience foods that are purposely formulated to make us overeat them, work sedentary jobs, and live in communities that require cars to get around. As a result of this shift along with other factors like genetics, the majority of American adults now meet the criteria for either overweight or obesity. In other words, we must take a proactive role in making lifestyle changes that support our personal weight and health goals.

While our obesogenic environment can be tricky to navigate after bariatric surgery, there are behaviors to make it easier. First, let’s look at some of the most common reasons for weight regain:

• Unstructured eating patterns: We are more likely to “graze” on easily accessible junk food if we don’t have some kind of plan for meals and snacks. We may also experience loss of control of eating if we go long periods without food, skip meals, or wait until later in the day to eat.
• Non-hunger-related eating: This includes things like eating due to stress, anxiety, emotional eating, boredom or mindless snacking (like unknowingly finishing a bag of potato chips or pint of ice cream while watching TV). Not having a dependable support system or coping strategy in place can make behaviors like emotional eating or bingeing episodes more likely.
• Lack of self-monitoring or tracking: It is common for old food habits to sneak in further out from surgery. These might include eating more energy-dense “slider foods” like chips and sweets, drinking calories (ex. soda, juice, sugary coffee drinks, alcohol), or not prioritizing lean protein, fruits, vegetables, and other nutrient-dense foods in the diet.
• Increased appetite and portions: It’s normal for hunger levels and therefore portions and total calorie intake to increase after surgery. One common pitfall is not recognizing how energy-dense some favorite “protein foods” are (like cheese, peanut butter, trail mix, and energy bites).
• Inadequate physical activity: A sedentary lifestyle is more likely to lead to an overall energy imbalance that favors weight gain. Muscle and bone loss is also an increased risk after surgery which exercise helps to mitigate.

Although there are many barriers to sustained weight loss following surgery, there are also valuable tools available to you through Iowa Weight Loss Specialists to help on your journey:

• Follow-up appointments: Plan to meet with your bariatric provider several times during the first year post-op, and then every few months afterwards. These visits are vital for monitoring your progress and developing new healthy habits and skills. The provider can work with you to identify the behaviors (and other factors such as weight-promoting medications or hormonal changes) that may be contributing to regain. Your provider can also review realistic weight loss expectations to ensure you are on the right track.
• Nutrition: Your dietary goals one month after surgery will look very different than those one year after surgery. Meeting with a dietitian can help to ensure you are getting the most out of your food choices and alert you to any potential blind spots in your nutrition plan. Sometimes patients measure their overall compliance based on the quantity and portion size of food, and therefore try to eat less overall. However, in the long run diet quality, not quantity, is the most important factor. Remember to focus on solid proteins and plant-based foods (fruits, vegetables, legumes, whole grains) to fill you up at mealtimes. Planning and prepping more meals at home gives you more control over the quality of your diet.
• Behavioral health and community support: Bariatric surgery can be a challenging experience for both an individual and their relationships. Regularly meeting with a mental health specialist can help to shed light on these experiences and life stressors. Iowa Weight Loss Specialists’ therapists can also recommend appropriate coping strategies for conditions like anxiety and depression if you are likely to self-soothe with food, or have had a poor relationship with food historically. Bariatric surgery patients are also more likely to be successful with weight loss efforts if they belong to a support group of their peers.
• Self-monitoring and planning ahead: One of the most effective tools for weight management is self-monitoring, or keeping a food journal. This ensures you are regularly meeting your protein and water goals, and staying at an appropriate calorie level based on how far you are out from surgery. Planning meals and snacks in advance can help to prevent habits like grazing and skipping meals from creeping in. Talk to your dietitian about strategies for successful meal planning and tracking.
• Physical activity: Regular exercise after surgery is key. This should include both cardiovascular exercise (ex. walking, elliptical, cycling) and strength training or muscle-building activities (ex. resistance bands, weight machines, body weight exercises). Strength training is highly recommended for maintaining or growing muscle mass as well as improving your body’s metabolism.
• Weight loss medication: Medications may be appropriate to incorporate long-term after surgery. Talk to your provider to discuss if one may be right for you.
• Metabolic testing: Your calorie needs can shift dramatically based on the amount of weight you lose after surgery. As you lose weight, your body will naturally require fewer calories. Talk to your provider about scheduling a “met test” to determine if your metabolic rate is considered normal, or if you want to know what your calorie target should be for weight loss or maintenance. A met test is most appropriate for patients who are further out from surgery whose weight loss has stalled or are experiencing regain.