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With the advent of ever-improving bariatric techniques and technologies and the GLP-1 medication craze in Wegovy and Zepbound, many people are losing weight more quickly than ever. While this may seem like a great “problem” to have, it is possible to lose too much weight too fast. Let’s dive into why we want to moderate our weight loss and how to do so.
The problems with losing weight too fast
Losing weight too fast is unsustainable. For many patients, this means a severely restricted diet, potentially over-exercising, or a combination of both. Unfortunately, these habits aren’t sustainable, and at some point, the patient will begin overeating again and slowing their exercise routine. Pushing too hard for too long can lead to burnout and, ultimately, a rebound in the form of weight regain. We preach moderation in EVERY part of life after bariatric surgery.
Speedy weight loss often means patients are not performing their strength training and exercise as prescribed. Remember, muscle is denser than fat, so there is typically slower weight loss or even weight regain when patients start their strength training routine. If we see precipitous weight loss, it’s often because patients are not working out or doing strength training as they should, which can lead to bone and muscle mass loss. The result may, at best, be an aesthetically unpleasing body shape, but at worst, it may cause serious musculoskeletal problems.
Very rapid weight loss isn’t fun for most patients. This kind of weight loss is not setting them up for an enjoyable post-operative life, and that can have far-reaching consequences, even in their relationships. Part of long-term weight loss is finding a groove that balances diet and exercise while enjoying each phase of the process. Weight loss is challenging, but we certainly don’t want you to experience a lifetime of worrying about every calorie.
Losing weight too quickly can increase the risk of excess or hanging skin. The faster you lose weight, the less time your skin has to adapt and shrink. This typically manifests in significant arm, neck, and abdominal laxity. Parts of this risk are genetic, but we want to give our bodies as much of a chance as possible.
Lastly, you risk nutritional deficiencies if you exercise too much or eat too little. Postoperative life is a delicate balance between nutritional intake and caloric expenditure. Patients often do not consume enough protein, carbohydrates of good fats, resulting in problematic dietary deficiencies. Calcium, protein, B12, Vitamin D, and other vitamins must all be closely watched. Be sure to speak to your dietitian or nutritionist to determine whether you are on the right track and keep all your post-op visits to avoid any possible nutrition-related concerns.
Proper Weight Loss Goals
The goal for long-term weight loss depends on several factors, including how much excess body weight you have and the weight loss method you’ve chosen. Body weight loss from GLP-1 injection medications typically maxes out around 20% – many patients can get there around 6 months after starting. Bariatric surgery, on the other hand, tends to allow significantly higher weight loss potential, especially in higher BMI patients. Take the goal you and your surgeon set and divide that over one and a half to two years. This is the ideal time period in which to lose weight. You will likely lose significantly more weight in the first couple of months after surgery, as your nutritional intake will be limited. As you start to stabilize your diet with a modified full diet, you’ll want to aim for between one and 2 pounds of weight loss per week.
Secondly, as mentioned above, very rapid weight loss also tends to include significant muscle loss. Patients often find they do not achieve their ideal body shape without good muscle tone. While the numbers may look good on the scale, patients may still have a significant body fat percentage and a “skinny fat” look. In addition, muscle tone can fill out some excess skin caused by rapid weight loss, serving an aesthetic purpose. Skin tone is also reliant on underlying muscle tone.
Finally, setting appropriate weight loss goals can avoid eating disorders that may be triggered by the frustration of not getting there fast enough. Beyond that, avoiding frustration by setting achievable goals keeps patients on track over the longer term and happier with their progress. Losing 100% of your excess weight is not a reasonable goal. In fact, if you lose that much, you have probably lost too much weight. If you can reduce your BMI to even the low 30’s or high 20’s, you will be successful.
The Bottom Line
Ultimately, how much weight a patient should lose and how fast depends on their starting weight, how much they want to lose, genetics, and many environmental variables. With that said, it’s important to remember that just 2 pounds of weight loss per week represents over 100 pounds of weight loss for the year. That’s genuinely fantastic by any standard. Anything more than 2 pounds per week (except in the early recovery days) can cause potential issues, including bone and muscle mass loss and nutritional deficiencies. If you’re ever in doubt, speak to your nutritionist, dietitian, or your bariatric surgeon to understand the best way to lose weight to maintain your health and ensure long-term success.
