I haven't lost weight since gastric sleeve despite following the plan. What can I do?

There are different causes why a bariatric procedure can fail, not letting reach your weight goals. The main reasons are:TECHNICAL: The surgery was not executed optimally, this is very rare, but unfortunately occurs. MECHANICAL: This could be an alteration of the procedure due to the transit of the food o pressure from the body.ADAPTATIVE: The body has adapted to the modifications made by the surgery, in the case of gastric sleeve, increase elasticity making the gastric reservoir larger.
But whatever the cause, it might be pertinent to do and x-ray study (barium swallow) to assess the size and shape of your sleeve.You should seek a consult with a bariatric surgeon with experience in revision surgeries, to asses your case and look for the best option for you.

Hello,
Thank you for your question. Congratulations on your surgery, I am sorry you are not getting the results you expected. In my experience, patients tend to lose 20-30 pounds in the first month and average 10 a month thereafter. That said, it is not unheard of for patients to lose little weight the first month following gastric sleeve surgery. Factors that influence the rate and total weight loss include gender, age, starting BMI, and extent of lifestyle changes. 
The goal of the first month is to keep hydrated and focus on maintaining a healthy lifestyle. This includes following the regimented dietary guidelines that your doctor has most likely provided for you. I caution you to avoid puréed and soft foods and be careful you do not consume too many liquid calories. It is much easier for sleeve patients to consume too many calories through liquids than with solid food. This is because the liquids are digested more quickly than the solids, allowing the patient to more easily "overeat" if consuming high-calorie liquids. Excessive liquid calories can stall and even reverse weight loss. It’s also important not to consume liquids with solids since it can push the food more quickly through your stomach. 
I am happy to here you are committed to regular exercise. At this point the goal is 45 minutes of daily exercise. 
Follow up care with your surgeon and support team (ideally including a therapist and nutritionist) are essential to help you determine the underlying cause of your weight loss stalling; it's important not to feel discouraged during these times and to look to your care team and support network for guidance and encouragement.
Kind regards,
Dr. Moein

I understand your concern about not seeing the desired weight loss after having a gastric sleeve procedure. It's essential to address this issue and find the best course of action to help you achieve your weight loss goals. First and foremost, it's important to note that every patient's response to bariatric surgery can vary, and there are several factors that could influence your progress.
Given that you had a gastric sleeve procedure in November and have not experienced significant weight loss, there are a few potential reasons for this. One possibility is that there may be an issue with your gastric sleeve, such as stretching or complications, which could be assessed with an esophagogastroduodenoscopy (EGD) to determine its condition. However, based on the information you've provided, it's more likely that the issue lies with your diet and lifestyle habits.
While you're following the recommended post-operative plan and engaging in exercise, the quality and quantity of the food you're consuming may need closer examination. It's possible that you're not adhering to the recommended dietary guidelines for your specific surgery. Portion control, nutrient intake, and food choices are critical aspects of a successful recovery and weight loss journey after a gastric sleeve.
To address your concerns effectively, I would recommend scheduling an appointment with your bariatric surgeon or a registered dietitian who specializes in bariatric nutrition. They can review your dietary habits and provide guidance on making necessary adjustments. Additionally, they can determine if an EGD is warranted to assess the condition of your gastric sleeve.
Remember that each patient's journey is unique, and patience and persistence are key during this process. It's essential to work closely with your medical team to tailor your plan to your specific needs and address any obstacles that may be impeding your weight loss progress.

Hello,Thanks for your question.Your diet should be reviewed and organised.(should be 70% protein, you should exercise, drink a lot of water and solid-liquid seperation)Then it is necessary to check with Endoscopy.Have a healthy dayDr HE

1. Caloric intake2. Energy expenditure3. Surgical factorsCaloric intake and energy expenditure are relatively self-explanatory.Surgical factors in this situation mainly refers to how "tight" a sleeve is. Another way of looking at it is: how much stomach is left behind. A "loose" sleeve can mean reduced food portion restriction.

The first is to have a consultation with your bariatric surgeon so he can asses your current status regarding your sleeve size and procedure, also can be recommended to consult a nutritionist to guide you with the best foods you can consume to trigger your metabolism.Don't be discourage and continue to search the options to improve your health and weight loss process.My Best Wishes, 

It is important to understand what to expect after surgery. The sleeve is to help control your portions but you should not expect to feel "tight" with your meals. Stop eating when you are satisfied, not when you are uncomfortable. 
Separate your liquids and solids.  Wait 30 min after drinking water before your meal and you can resume drinking 45 minutes after.  This will prevent the food from being "pushed through" too fast.
Also, if you are exercising hard, you may be building more muscle and bone density which does weigh more than fat. In this situation, your weight may be unchanged but you will see your clothes getting too big for you.  If this is the case, you are doing well and keep up the good work, the pounds will come down eventually.
If your weight is unchanged and your clothes are still tight, that is not the case. Make sure to communicate with your surgeon and your dietician to optimize the tool you have.  Your surgeon may need to investigate your sleeve to check size, etc.

Failure to lose weight after the gastric sleeve procedure can be attributed to numerous causes. You should have an X-ray to evaluate the size and shape of your sleeve. You would feel no restriction and fail to enjoy any weight loss if your sleeve is too large. Regardless, you should have a heart to heart with your surgeon and try to understand what went wrong and if the large size of your sleeve is the reason you should consider to have either a "re-sleeve" or a plication of your sleeve, or a Lap-Band put over your sleeve, or a conversion of your sleeve to a bypass.

I would get a second opinion from another bariatric surgeon to perform an endoscopy to see if the original sleeve was performed correctly.  If they made your stomach too large this can lead to the poor weight loss.  You should have never even had a sleeve gastrectomy with a BMI of 32. The criteria for sleeve gastrectomy is a BMI of 40 or greater or a BMI fo 35 or greater with at least one medical problem related to obesity.

A lot of patients with central obesity (big belly with skinny legs)
complain of this.  I think you will
eventually be okay as long as you follow the instructions given by your
nutritionist.  Your meals should be 70%
protein, exercise, drink plenty of water.