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It’s no secret bariatric surgery, including the gastric sleeve, offers an excellent long-term weight loss option for qualifying patients that is more long-lasting and effective than diet, exercise, or even weight loss medications alone. However, you will have heard repeatedly bariatric surgery is not magic, and weight loss and the consequent disease improvement or resolution do not come without hard work on the patient’s part. Further, you may have heard stories from friends or loved ones about someone gaining their weight back, which is certainly possible if you don’t follow your post-op directions, including changing your diet and exercise. Let’s discuss why gastric sleeve patients tend to gain weight a few years after surgery and what to do about it.
The Excitement Wanes
First is simply human nature. The excitement of bariatric surgery and significant weight loss keeps us motivated, and as we get closer to our goals, that excitement only builds. However, there is eventually a point where weight loss starts to slow or plateau, and this is a critical time in any patient’s journey. The plateaus will happen during the weight period from time to time before you reach your weight loss total. If you are not vigilant about maintaining your weight loss, you can fall into the trap of regaining weight.
Further, if you don’t realize there will be some fluctuations and times in which you do not lose weight here and there, you can get frustrated and give up those fantastic gains. The key here is to have developed an excellent support system and have people around you that keep you supported, motivated, and uplifted. These could be other bariatric patients or supportive family members and friends.
Liberalizing the Diet
You may also start to liberalize your diet because of your newfound confidence. Before surgery, many patients did not have full social lives, and this often changes as confidence builds. Going out and maybe even making up for lost time becomes the norm. Usually, this includes restaurants and bars, which can be big trouble if caloric intake is not monitored closely. After all, calorie reduction and maintenance may not be top of mind during these fun times. Further, how you feel afterward (think hangover) may make it less conducive to exercising and staying on your diet. While a miss here or there won’t make a difference, consistently eating and drinking too much can create significant weight regain.
Ghrelin’s Back
Around this time, one of the tremendous hormonal benefits of the gastric sleeve, the virtual elimination of ghrelin, also begins to wane. As you may know, ghrelin is the hunger hormone that makes us want to eat. When the fundus of the stomach is removed from the abdomen, so is the body’s main production center of ghrelin. However, the gastrointestinal system is adaptable, and the small intestine can begin to take over the fundus’ job of producing this hormone. This occurs sometime after two years and can take some patients by surprise because the onset of hunger is gradual. This is especially difficult if patients struggle with lifestyle modifications. The best way to ensure this does not derail you is by redoubling your efforts to change your habits early on – within the first year to 18 months – so that when those levels start to rise again, you have good habits ingrained in your mind and body.
Ask For Help
One of the fastest ways to get off track is not to ask for help. Often, because of embarrassment, frustration, or even depression, many patients do not talk about it when they start regaining weight. You should speak to us to understand why you may be gaining weight and get tips and advice on reversing it. You must also recognize that slight regain is perfectly normal. Ultimately, in our practice, there is nothing we haven’t seen after surgery, and you should not be ashamed of setbacks – we all have them. You are human, after all, and mistakes are not only OK but, frankly, expected. How you deal with those mistakes may make the difference between maintaining your excellent results and regaining some weight.
We look forward to helping you understand what may be causing your weight gain and are here to help if you have any questions or concerns. In the meantime, don’t get discouraged, and continue pushing toward your goals. You’ll be amazed at how resilient you are if you stay positive.
