Weight Gain After Bariatric Surgery

Question

I had Gastric bypass surgery a year ago, and I am now gaining the weight back. How can I restart my weight loss?

Thomas McNemar, MD, FACS · Answer

I think it's important to determine the cause of your weight gain when deciding the best approach to weight loss. Are you taking in too many calories? Not exercising enough? Is there a problem with the gastric pouch? I suggest you consult with your bariatric surgeon first to rule out any complications from surgery. If the gastric pouch has expanded, a second surgery may be needed to make the pouch smaller and decrease nutritional absorption. If this is not the case, perhaps consult with a nutritionist or behavioral therapist to modify your eating habits and exercise routine. Best of luck!

Gabriela Rodriguez, MD, FACS · Answer

Weight regain after bariatric surgery could be a sign of fail procedure and is both disappointing and a major health issue. Fail procedure is a challenge not only for assessing the patient correctly and deciding the best surgical therapy but the technical difficulty of performing a revision procedure. For a number of reasons, a weight loss procedure can fail to allow the patient to reach his or her goals. 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.A complete evaluation is necessary, a food log, imaging studies, to assess your case. You should seek a consult with a bariatric surgeon with experience in revision surgeries, to assess your case and give you the options for your case specifically.

Babak Moeinolmolki, MD, FACS · Answer

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, reaching a stable weight at 12-18 months. Factors that influence the rate and total weight loss include gender, age, starting BMI, and extent of lifestyle changes. 
Generally, to be successful, patients need the support of a multidisciplinary team, including their surgeon, a nutritionist, and psychologist. It is essential to maintain the health lifestyle changes expected after surgery. I also 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. 
Regular exercise is also essential. At this point the goal is 45 minutes of daily exercise. 
It is also possible there are mechanical issues with your pouch that are leading to your weight gain. In rare cases, revisional surgery may be necessary to maintain weight loss. It is essential you follow up with your surgeon to help you determine the underlying cause of your weight gain; 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

Raffy Karamanoukian, MD, FACS · Answer

Patients who have undergone gastric bypass surgery are able to metabolize calories in a manner similar to individuals who have not undergone the surgery.  The difference is the size of the neo-stomach and the feeling of early satiety, or feeling of fullness after surgery.
Patients who have undergone gastric bypass may continue to gain weight if they consume foods with a  high calorie to volume ratio.  Examples include protein shakes, milkshakes, or other foods with high calories without a lot of bulk or fiber.
If you are continuing to gain weight without feeling full, you may alter your foods with increased amounts of bulk or fiber in order to consume less calories before feeling full. 
If you are considering plastic surgery, most surgeons will delay surgery until you have reached a plateau weight for 6 months to one year.

Steven H. Williams, MD · Answer

You need to see your bariatric surgeon and explain your weight trend.  Bariatric surgery does not make it impossible to gain weight but if you are gaining weight and have not met your goal a discussion with the bariatric team may get you back on track.
 
Good luck.

Ali Solmaz, MD · Answer

Weight regain after gastric bypass is more common than many people realize, and it can feel discouraging, but it does not mean you have failed or that the surgery is no longer effective. At one year after surgery, some patients experience plateaus or even regain if old habits return, if portion sizes gradually increase, or if “slider” foods high in carbohydrates and fats are consumed more often. In some cases, anatomical changes such as stretching of the gastric pouch or enlargement of the connection to the intestine may also contribute.
The first step is to return to the fundamentals: tracking protein intake, limiting simple carbohydrates, avoiding grazing, staying well hydrated, and committing to regular exercise. Working closely with your bariatric team&mdash;including your surgeon, dietitian, and possibly a psychologist&mdash;can help you identify where changes can be made. Sometimes structured “reset” programs or very focused dietary plans can help get weight loss moving again.
If behavioral and dietary adjustments do not help, medical options such as weight-loss medications can be considered, and in selected cases, revision procedures may be appropriate. The key is not to give up, but to treat this as part of the long-term journey that bariatric surgery requires.

Sashidhar V. Ganta, MD · Answer

It's not uncommon to gain some weight back with any weight loss surgery. It's important to get back with your surgical team to jump start your weight loss. In our practice we use a combination of methods including appetite suppressants, metabolic enhancers, diet plans and supplements

Hasan Erdem, MD · Answer

Hello,
Thank you for your question.
All bariatric surgeries require a diet period. The surgery essentially facilitates the diet for patients; however, they shouldn’t be regarded as a sole means of losing weight. If the patient reverts to their former eating habits, the risk of weight-gain will persist in the long run.
Make sure you follow your dietary plan provided by your nutritionist. 
I hope this answer helps you
Dr HE

Shawn Garber, MD, FACS, FASMBS · Answer

Weight regain after gastric bypass surgery occurs in 20 - 30 % of patients. The first step is to seek out an experienced team of bariatric surgeon, nutritionist, psychologist to try to get you back on track. The best revision surgery if your gastric pouch has stretched or the connection between the stomach and small intestine has stretched in band over bypass. Avoid surgeons suggesting StomaphyX because it is a scam that doesn't work and you will waste your money. Alway seek out and experienced Center of Excellence for Bariatric Surgery with extensive revision surgery experience.

Lloyd Stegemann, MD, FASMBS · Answer

After a gastric bypass, most patients will lose weight for about 12 months and will then "settle out".  This second phase which I refer to as the "maintenance phase" is really challenging because the excitement of the "weight loss phase" (often referred to as the Honeymoon Phase) is over and we get back to real life!  

	It is important for every patient to understand that there is NO magic to weight loss surgery.  By changing your anatomy we are able to better control your hunger and your portion sizes, but that's it!  By controlling these two areas we open up a window of opportunity to start working on the REAL reasons that people gain weight:  they take in more calories than they burn.  This involves changing eating behaviors, cleaning up the diet, and increasing activity levels, what I refer to as "the real work".  The surgey does the work for the most part in year one, but starting in year 2 it is the new, healthy habits patients have worked on that keep the weight off!

	Weight gain after weight loss surgery really falls into 2 broad categories:

	1)  The surgery is failing the patient (aka anatomic failure).  There are a number of anatomic and physiologic conditions that can occur that cause the patient to no longer have adequate hunger or volume control.  If present, these will very likely lead to weight regain.  Luckily these are pretty unusual and account for only about 5% of patients who regain weight after gastric bypass.  The downside is that if this IS the cause of the weight regain, it almost always requires a second operation to address the problem.

	  2)  The patient is failing the surgery (aka behavioral).  This is the cause of weight regain in about 95% of gastric bypass patients.  The good news is that this is MUCH easier to fix and it doesn't require an operation!  

	The first step is to get in to see your surgeon so he/she can figure out which category you fall into.  Once they have that figured out they can direct you on how best to get on track again!

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