Weight regain (or limited weight loss) after surgery, and what to do! -
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initial weight loss, followed by weight gain after surgery

The holidays will soon pass and our thoughts will turn to New Year resolutions. Many of us commit to making resolutions that will suit healthier lifestyles. We will take the opportunity to forgive overindulgence and commit to living healthier lives – the right decision! With 65% of Americans overweight or obese, weight loss resolutions are extremely common. Many of us may try to commit to simply eating healthier or take steps to increase our physical activity. Intentions are important, but committing to incorporating these resolutions into our daily lives will make us all healthier.

Intentions aside, it is often hard to commit to living healthier. Maintaining a healthy caloric intake by eating a varied and healthy amount of food, while exercising regularly will naturally lead to sustainable weight loss. But, not everyone will find success losing weight through diet and exercise alone. Others may consider weight loss surgery, which is a good alternative.

What is Weight Loss Surgery?

Weight loss surgeries (meaning the gastric bypass or gastric sleeve) remain the most effective long-term solutions for losing significant amounts of weight and resolving or improving obesity related illnesses. Metabolic and bariatric surgery have proved to have positive outcomes when it comes to quality of life years after surgery. Surgery itself is not a solution, but surgical weight loss has proved effective to maintain a healthy weight for many people. There are many types of bariatric surgery. Not all weight loss procedures will result in weight loss, building muscle mass, or the resolution of comorbidities like type 2 diabetes or cushing syndrome.

Though there are many people who have had surgery with successful outcomes, there is a small portion of patients run into issues.
had surgery, experienced good initial weight loss, but have now regained some weight. There is another small group of bariatric surgery patients who had weight loss, but stalled before reaching their weight loss goals. There are reasons for these two groups of poor weight loss, and most importantly there are solutions for it as well.

What causes weight regain a weight loss plateau?

The underlying causes of weight regain can either be be “mechanical” or “behavioral”. Mechanical causes for weight regain after the gastric bypass involve a large pouch which gives little restriction. It is quite literally, a mechanical problem. This may mean that your doctor did not adequately perform surgery. But more often, it may mean that the surgeon did not have a positive outcome to surgery. A mechanical problem post surgery may mean that a patient had positive outcomes immediately following surgery, followed weight regain.

weight gain weight loss surgery

Occasionally a patient that initially had good weight loss could see their weight loss journey slowing down several months out from surgery. The patient may complain of being able to eat large amounts of food at one time, while feeling no restriction.

Another mechanical malfunction is when the connection from the pouch to the small intestine is too large. If that happens food may pass directly into the small intestine with no restriction. The presentation is poor overall weight loss, or even substantial weight gain. A sleeve gastrectomy that is failing due to a mechanical cause will present with the same weight regain patterns. It the sleeve is too large, it gives poor restriction.

What should you do if you have experienced weight regain after surgery?

THE GOOD NEWS IS: If it is a mechanical problem, it can be evaluated very quickly with a simple upper GI x-ray study. This is where you drink some contrast liquid and images are taken. If you are concerned that your weight loss journey has been hindered by a mechanical problem, please reach out to us. As frustrating as it can be to have a mechanical problem, it is a very simple problem to diagnose. If you are not suffering from a mechanical problem, we will be able to decipher where we can spend more time to get you to a sustainable position of weight loss.

Weight regain after gastric bypass surgery

The behavioral causes for weight regain are more common. Over time, people slip off their diet and make food choices that lead to weight regain, even if they have had weight loss surgery. As an example, a “treat” becomes an everyday occurrence. We may not even realize that these daily habits have become treats. That “treat” might just be a cup of coffee from Starbucks each day, which could lead to a 1 lb gain per week, which is 50 lbs gain in a year! It’s hard to think of a cup of coffee as a the culprit to weight gain, but a latte or similar from somewhere like Starbucks can easily be 400-600 calories.

There is always a way to continue your journey.

A thorough questioning of diet history can make this diagnosis rapidly. Regardless of the outcome. Once we can all decipher where behavioral modification might be successful, we have an opportunity to transform unhealthy habits into healthy ones. The good news is that once the cause for the weight gain is diagnosed, a treatment plan can be developed. If the cause of weight gain is a mechanical problem, then surgery is the solution and it will get you back on the weight loss track.

If the weight gain is more dietary in nature, then medical weight loss is by far the most effective treatment. This may entail prescription medication, food supplements, dietary counseling, and physical activity. As of January 2020 we are rolling out a comprehensive medical weight loss clinic. At the clinic we can help create the perfect weight loss plan for you. Peak Medical Weight Loss Clinic was established to address behavioral modification. If you think you may benefit from behavioral modification, please give us a call. We want to help you achieve your weight loss goals.

If you have had surgery and now are experiencing weight gain or inadequate weight loss, make an appointment with us. We will help you to get evaluated and get back on track to reach your desired weight loss goals. 2020 is just the year to get started! So call 303-861-4505 to schedule an appointment.

Cheers to the New Year!

Tom Brown, MD

Colorado Bariatric Surgery Institute

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