Weight Regain

Without question, my greatest concern for any patient who has undergone a sleeve gastrectomy is weight regain after surgery.  While it is certainly possible after a roux-en-y gastric bypass, it happens more often after a sleeve gastrectomy.  

Most people look at weight regain after surgery as the result of a patient returAning to his or her old habits.  While a failure to adopt a new, healthier nutritional and exercise plan after surgery will certainly increase your risks of weight regain, there are other factors that are equally important.  Just as we’ve come to recognize that weight gain and obesity are unfair discriminators, we find that weight regain after bariatric surgery follows a similar pattern.  In my practice, I’ve found that some patients have a very strong hormonal response to surgery and easily maintain their weight loss, while others are very compliant with our high nutrient Pound of Cure program and still manage to regain a few pounds every year.  Just as weight gain is not always an accurate indicator of someone’s diet, weight regain also may be caused by other factors beyond what a patient eats.

My experience and an increasing number of studies show that the Sleeve Gastrectomy offers less of a hormonal response to surgery that results in a less tightly anchored set point, compared to a gastric bypass.  Many patients view the Sleeve Gastrectomy as a procedure that offers lifelong restriction, weight loss and long term weight maintenance by permanently limiting your ability to eat large servings of food.  While a Sleeve Gastrectomy does initially offer a patient excellent portion control, over time, this effect wanes, allowing patients to eat as much as two-thirds of the volume of food that a patient with a normal sized stomach can consume.

Shortly after surgery, Sleeve Gastrectomy patients are able to eat only a few bites of food to satisfy their appetite.  In the immediate months after surgery, patients typically eat fewer than 800 calories daily.  When this low calorie diet is paired with the set point lowering effect of the surgery, patients are able to easily lose a significant amount of weight.  As time passes and the patient’s body weight approaches their new, lowered set point weight, their hunger and appetite returns.  A failure to understand this long term change can lead patients into a dangerous way of thinking that I refer to as the “Portion Control Trap.”  

The Portion Control Trap can be best explained by examining a postoperative patient’s relationship with one of America’s favorite foods, pizza.  Around six months after surgery, patients will often report to me that they will eat pizza once or twice a week, but it’s only a few bites, so what’s the harm?  When we look forward, we find that this behavior can put a patient on track to significant weight regain.  At six months, they can only eat a few bites, but if we fast forward to a year after surgery, we will find that the same patient now requires one small piece of pizza in order to satisfy his appetite.  At two years out from surgery, it will require two small pieces, and at five years out, we will find the same patient consuming 2-3 normal sized pieces of pizza twice a week.  

Weight regain after surgery is an insidious disease that is often the result of a slow and gradual return to your pre-operative diet.  As we will learn in a later section on eating after surgery, a solid postoperative nutritional plan focuses on the quality of food, rather than the quantity.  The processed foods that fill the aisles of our grocery stores and are served up daily in most restaurants are largely responsible for our country’s obesity epidemic and are a threat to the postoperative patient’s ability to maintain the precious weight loss that the surgery has provided.  Rationalizing a return to eating these foods postoperatively on a regular basis by explaining that you are only eating a few bites represent the first steps on the path to weight regain.  This Portion Control Trap is a threat to all postoperative patients, but particularly Sleeve Gastrectomy patients.

A patient who undergoes a gastric bypass will often experience abdominal pain, bloating and diarrhea after eating processed foods, while Sleeve Gastrectomy patients rarely suffer these negative consequences.  Both Sleeve and Bypass patients will experience an increase in appetite in the years following surgery, but the Sleeve patient is particularly subject to the Portion Control Trap because their return to eating America’s diet of processed foods will be well tolerated.  If your preoperative diet does not include significant amounts of processed foods, then the Sleeve Gastrectomy represents an excellent choice since you are at low risk for falling into the Portion Control Trap.  However, if you are looking at a Sleeve Gastrectomy simply as a tool that will prevent, or block you from eating for the rest of your life, you should closely reexamine your procedure choice.

Many patients spend a considerable amount of time worrying about choosing the correct procedure.  While one procedure may represent an ideal choice, it is rare that this decision alone will determine whether or not you meet your goals after surgery.  In the end, success after surgery is determined by your commitment to a healthier lifestyle and you ability to make good choices about food and exercise every day after surgery.

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