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Studies show that about 90% of bariatric surgery patients lose 50% or more of their excess body weight and are able to maintain a long term weight loss1. Along with the weight loss often comes improvements or resolution of co-morbidities like hypertension, high cholesterol, sleep apnea, and diabetes.  In recent years, however, published research has also shown maintaining the weight loss can be difficult for some bariatric surgery patients, including those who had initial success.1
 
Most patients reach their maximum weight loss between 1-3 years after surgery.1  It is important to remember the surgery in and of itself is only a tool to help you lose weight.  You are the driver in your weight loss and weight maintenance success! That is why making lifestyle changes before and adhering to them after surgery, is extremely important so that they will facilitate healthy weight maintenance for the rest of your life.  

Weight regain is due to a number of factors including:

  • Over time the pouch can expand allowing you to eat more food without feeling as full as you did in the beginning, which can lead to over eating especially if choosing high calorie foods with little nutritional value
  • Muscle mass can be lost with rapid weight loss if proper amounts of protein are not consumed on a regular basis. Muscle tissue is metabolically active (AKA it burns more calories than other tissues) and a loss of muscle tissue = less calories burned
  • Physical activity is not incorporated regularly or the type of exercise is not vigorous enough. Over time your body gets used to doing the same types of exercise, so only walking may not be enough to maintain the loss or prevent regain. 
  • Changes in dietary intake. Maintaining a high protein healthy diet is extremely important to maintain the initial weight loss from the surgery. Occasional indulgences are fine, but consuming high calorie foods on a regular basis (i.e. chips, candy, and sausage) can lead to weight regain. 

It is often a long road to get to surgery day for many, requiring time and sometimes money, depending on insurance coverage. No one wants to go through the process of having bariatric surgery just to regain weight after investing so much, but knowing the realities and that it is possible to regain are important things to keep in the back of your mind. This is why the surgery is not a “quick fix” for weight loss and requires many lifestyle changes to truly be successful and keep the weight off. 

How best to maintain a healthy weight:

  • Talk with a therapist:  If you were an emotional eater prior to surgery and turned to food to cope with your emotions, the surgery is not going to “fix” that issue. This is something that needs to be addressed for long term success, and talking with a therapist is a great way to work through any underlying issues that may be holding you back.
  • Find healthy ways to deal with stress like meditating, yoga, exercise, reading, crafting, etc. All of these can be helpful to incorporate to remove food from the equation and break the cycle.
  • If you have regained weight and strayed from the healthy, high protein diet you were following in the initial period after surgery, take out the bariatric post-op diet and re-read it. This can help you remember exactly how you were eating after surgery that assisted with weight loss. Begin incorporating high protein foods, vegetables, and fruits and cut back on any snack/junk foods, sugary drinks, or high fat foods.  
  • Use an App to track your protein intake to see if you are still meeting the 60-80 grams of protein recommended. We love the app Baritastic designed for surgery patients (if you didn’t utilize this after surgery, give it a try as it has many helpful tools in it!) Incorporating protein shakes again as a meal replacement can also be very helpful.
  • Make sure you are incorporating physical activity doing both cardio and weight bearing types of exercise several times a week. After age 30 muscle mass begins to decline every year if you are not actively doing something to maintain it. This is part of the reason for weight gain as we get older. Only doing cardio activities will burn calories and is good for heart health, but it doesn’t build muscle mass.  Weight bearing exercise is not only important for muscle growth but also to maintain bone strength as we age. Check out previous blog articles regarding physical activity for more detailed information and suggestions!
  • Attending support groups has also shown to help maintain weight loss in the long run after bariatric surgery. It is not a requirement post-op, but strongly encouraged to keep you in the right mind-set. It is also a great place to ask questions and interact with others who have gone through exactly what you have and can relate. You never know, you may learn a thing or two!  

If you feel you need guidance regarding ways to improve your dietary intake after surgery to combat weight regain, don’t be embarrassed or afraid to give us a call to set up an appointment with a dietitian! We are here to give you support whenever you need it. We want our patients to be successful and happy with their results and never afraid to ask for some help to get you back on track!


Reference:
1.    https://www.uclahealth.org/comet/endoscopic-suturing-for-weight-gain-after-bariatric-surgery

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Carley Baulick MS, RDN, CDN
By Carley Baulick MS, RDN, CDN
Bariatric Dietitian Educator

Carley Baulick, MS, RDN, CDN is Garnet Health Medical Center’s Bariatric Dietitian Educator. She received her Bachelor’s and Master of Science Degrees in Nutrition and Dietetics from the State University of New York College at Oneonta. She is a Certified Dietitian-Nutritionist, holds an Academy of Nutrition and Dietetics Certificate of Training in Adult Weight Management, and is a member of the Academy of Nutrition and Dietetics (AND). Carley is passionate about nutrition and helping others reach their health and wellness goals through individualized counseling and nutrition education. Carley can be reached at (845) 333-2830 or cbaulick@garnethealth.org.

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