Dealing with Weight Regain after Bariatric Surgery
JK Champion MD
2009
Questions about Dealing with Weight Regain after Bariatric Surgery
1.What are the keys to patients succeeding after Bariatric Weight Loss Surgery?
2.What are the causes of patients failing Bariatric Weight Loss surgery?
3.What can patients do to deal with post-op weight regain?
Keys to success After Bariatric Weight Loss Surgery and NOT Regaining Weight
1. Healthy food choices (reduce carbohydrates in diet to 50% or less with 35-40% protein and 10-15% fat, concentrate on meats, colored veggies and fruit, limit simple carbs such as bread, potatoes, rice and pasta to 2 days a week and never twice on the same day, no high calorie liquids such as soda, fruit juices, smoothies or protein supplements, no ice cream, no cream soups, no sugar free snacks, no junk food such as chips and nuts or candy, limit alcohol consumption to 2 drinks per week
2. Increased activity and exercise ( 45 minutes of aerobic activity three times a week: that means patients sweat and increase their hear rate) take the stairs, park in the back of the parking lot, get a pedometer and walk 6 miles per day
3. Behavioral changes (eat every 4 hours by the clock, no snacking between meals, don’t skip meals, don’t drink with meals and for 30 minutes afterwards, Slow down eating and chew food well, stop eating when full, eat protein first and then veggies or fruit, practice portion control with small plates, don’t utilize food to deal with emotions: anger, boredom, sadness, stress)
4. Stay connected with your Bariatric Weight Loss Surgery Support groups! Being active and connected with a Bariatric Support group also you to connect with others like you and with that in in various stages of Weight Loss surgery connected, informed and accountable is a key for many peoples successes. Bariatric Weight Loss Surgery is not only a tool for weight loss but it is a life style. People may slip but those that reconnect and have support are faster at getting back up and staying on the right path.
note: Dr. Champion has Bariatric Weight Loss Surgery Support groups in Atlanta, Georgia satellite Bariatric Support groups in Valdosta, Macon, Winder, Savannah, North Carolina and online. Please check our page dedicated to our Bariatric Support Group to find the most convenient one for you.
Causes of failure after bariatric surgery
A. Behavioral Noncompliance with recommendations
Maladaptive eating or eating around the operation, (snacking, drinking high calorie liquids, eating sweets, high carbohydrate diets), lack of exercise, unresolved emotional issues
The surgery requires significant changes in a patients’ behavior towards food and eating and physical activity; it is not a magical procedure that changes their metabolism and allows them to eat whatever they want and still lose weight. Their metabolism only requires around 1200 calories per day and if they eat 1600 calories they will regain 6 pounds per year. The changes they adopt the first 12 months after surgery must continue the rest of their life. Some patients think they only have to comply with the guidelines the first 12-15 months until their reach their target weight and then they can go back to eating their old way and the result is they regain weight.
In normal weight people it takes 30 minutes for the hunger control switch to be activated after beginning a meal. By slowing down, everyone will eat less by allowing the body’s natural control process to “catch up”. This is particularly important in patients attempting to lose weight from diets or surgery. Patients must choose coarse dense foods high in protein and low in carbohydrate which will stay in their pouch for 30 minutes after meals (meats and colored veggies) to control their appetite for the next 4 hours. The small gastric pouch controls hunger by filling with dense food and staying in the pouch for 30 minutes to stimulate the Vagus nerve to produce satiety, replacing Leptin (a hormone produced in fat cells) as the hunger control. If patients drink with a meal it washes the pouch out and hunger will return in about 45 minutes. If the meal is high in carbs the blood sugar will raise causing insulin to be released and again hunger will return quickly. A high protein diet causes the blood sugar to be level and not get the wide swings which cause increased hunger. Patients must eat by the clock every 4 hours and not skip meals or go too long between meals. Eating every 4 hours and not skipping meals keeps the body’s metabolism level; otherwise the body will slow the metabolism and make it harder to lose weight, or regain weight eating the same amount of calories. Skipping meals will result in overeating at the next meal and extra calories get stored as fat, or it results in snacking due to hunger. A healthy afternoon snack is scheduled to break up the interval between lunch and supper if it is going to be more than 4 hours between meals.
B. Mechanical or physical problems with the surgery
(see also Bariatric Weight Loss Surgery Revisions)
Gastro-gastric fistula, staple line breakdown, tubing or balloon leak, pouch or stoma dilatation, poorly constructed bypass with short limb or poor pouch construction, bariatric surgery intolerance (chronic nausea and vomiting, acid reflux, difficulty swallowing chronic abdominal pain, or excessive weight loss), poor initial choice of operation for the patient.
These are potentially correctable problems, but may require additional surgery for a Bariatric Weight Loss Revision or conversion to another operation and carry additional operative risk compared to the first operation. These problems will require an evaluation and testing to identify. Approximately 50% of Lap-band patients and around 10% of Gastric Bypass patients won’t lose sufficient weight or will be dissatisfied with their initial procedure. Recent studies and our own experience indicate around 25% of Lap-band patients will have their band removed due to weight loss failure or band problems.
What can you do to deal with post-op weight regain?
1.Go back to the basics!
2.Exercise 3 times weekly for 45 minutes. Aerobic exercise with sweating and increased heart rate over 110. Walking, Shopping, Gardening, House cleaning, Playing with the kids, etc is not aerobic exercise.
3.Restrict carbs and re-institute the rules for eating post-op.
4.Get counseling if you’re eating to deal with emotions.
POST OP DIET TO IMPROVE WEIGHT LOSS
Reduce “simple” carbohydrates to two days per week. (Like Tuesday and Saturday). Simple carbs cause a rise in blood sugar and hunger in 45 minutes after eating. If extra calories are absorbed in a meal with simple carbs the calories will be immediately converted to fat cells and either weight gain or a slowing of weight loss.
Simple carbs are any food in the BREAD, RICE, POTATOES or PASTA family. These food groups are usually white but it doesn’t matter if they are white or brown or any color.
Concentrate on eating meats, fruits and colored vegetables. Colored vegetables are complex carbohydrates and the body must burn calories to digest them so it takes longer to absorb and doesn’t cause increases in blood sugar, late dumping syndrome, and “craving” or hunger after 45 minutes.
Your surgery works by filling your pouch with coarse foods like meat, green beans, and carrots etc which stay in the pouch for at least 30 minutes. This sends a signal to the brain you’re full and will control your hunger for 3-4 hours and then you will be hungry again. This is why we have you eat every 4 hours and don’t drink with meals which will wash the pouch out and make you hungry again in 45 minutes. Soft mushy foods like mashed potatoes, yogurt, and soups slide right through the pouch and do nothing to control your appetite and may actually make you hungrier.
Remember
1.Eat 3 meals per day and a healthy afternoon snack: something every 4 hours.
2.Use a small plate to limit portion size and slow down. It takes 30 minutes to feel satisfied, and stop when you’re full: don’t clean your plate!
3.Limit simple carbs to 2 days per week.
4.Don’t skip meals: you lose less weight by slowing your metabolism.
5.Eat your protein first and then any veggies or fruit.
6.Nuts are a terrible snack.
7.All liquids must be low calorie and no liquid protein supplements after 6 weeks post-op.
8.NO DRINKING WITH MEALS!!
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