I had Gastric bypass surgery a year ago, and I am now gaining the weight back. How can I restart my weight loss?
Weight Gain After Bariatric Surgery
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Doctor Answers 11
Really, I Can Gain It Back?
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!
Weight Regain after Gastric Bypass
For reference, my usual length of intestine bypassed is 100cm for non-diabetics and 150cm for those who suffer from diabetes. In the circumstance where your bypassed intestinal limb, also called the bilio-pancreatic limb, is short (less than 50cm), weight loss can get re-started by performing a revisional surgery to increase the length of intestine that is bypassed. It is a major revisional surgery and carries more risk than the initial gastric bypass surgery, but can help patients who have regained a significant amount of weight early after their surgery take that weight back off and maintain a lower weight with healthy eating and regular exercise. Hope that helps.
Start with determining the cause of weight gain
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!
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Weight Regain After Gastric Bypass Surgery
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.
Weight gain after bariatric surgery
Weight loss surgery is an incredible tool for morbid obesity. Healthy diet, exercise, behavior modification, journaling and support groups are all tools for weight loss. They are all used in conjunction to provide you with the best possible results.
The number one cause for weight gain after surgery is due to reversting to former bad habits. It is important to develop the necessary skills required to maintain a healthy lifestyle after surgery. If bad habits have returned it is best to follow up with your bariatric surgeon, as well as a nutritionist and psychologist.
The second reason why people regain weight post-operatively is due to pouch expansion, which can occur in all bariactric procedures. If pouch expansion occurs, it is important to follow up with your bariatric surgeon, as well as a nutritionist and psychologist. Your bariatric surgeon will probably ask you to obtain an upper G.I. series and an endoscopy.
There are many surgical options to correct pouch expansion after gastric bypass surgery. The least invasive procedure would be an endoscopic plication of the pouch, either by the Stomaphyx procedure or the Rose procedure. In addition, another method of pouch correction is to place the band around the pouch laparoscopically which increases restriction. Another technique would be to revise the pouch and the connection to the small bowel by laparoscopically reducing the size of the pouch. Another technique would be to change the gastric bypass to a more malabsorptive procedure by making it a distal gastric bypass or changing it to a duodenal switch. If this is your problem it would be best to consult with a bariatric surgeon who is proficient in revisional surgery.
Weight Gain after Gastric Bypass
Gastric Bypass is a powerful tool that can help you achieve near ideal body weight BUT in order to achieve that goal one must eat well. A patient that gains weight over time after surgery is related to the same nurtionally bad habits that originally led to significant weight gain. Therefore it is important in the inmediate post -operative period to develop a good game plan and establish healthy eating habits that will carry you for the rest of your life. It is uncommon for weight gain to be realted to anatomic reason (ie surgery), although one should consult with your bariatric surgeon.
Weight Loss after Gastric Bypass Surgery: Plastic Surgery after Gastric Bypass
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.
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.
If you are gaining weight then you probably need to go back to your bariatric surgeon.
These answers are for educational purposes and should not be relied upon as a substitute for medical advice you may receive from your physician. If you have a medical emergency, please call 911. These answers do not constitute or initiate a patient/doctor relationship.