Who has ever described losing weight as effortless?
Most of us know very well that weight loss at any stage of life can be an arduous task. It’s even more difficult with a higher BMI (body mass index) because the excess weight causes mental and physical fatigue. Disruptions in the body’s delicate balance of hormones and the presence of obesity-related comorbidities make it very challenging to follow diets and prescribed activities that are absolutely essential for losing excess body mass.
For many who have spent years – sometimes decades – trying to lose weight, the energy and effort to keep up with structured programs is tough to sustain. Even with a strong start or early success, weight fluctuations can get frustrating, old habits creeping in can be discouraging, and weight regain can feel like failure.
Is There a Way Out?
If you’ve spent any amount of time exploring this website or other online resources dedicated to bariatric surgery and non-surgical medical weight loss options (current non-surgical heavy-hitters are GLP-1 medications like Wegovy or Zepbound), you might get the impression that they make weight loss easy.
Saying it’s easy or hard is subjective, and we’re not here to judge it one way or another. But what we can offer is a clearer picture of what weight loss really looks like when supported by surgery or medication, including the effort, mindset, and ongoing lifestyle changes that make results last.
How Hard Is It to Lose Weight With Bariatric Surgery?
Bariatric surgery is a tool, plain and simple, and it helps individuals lose a significant amount of excess body weight – anywhere between 25% and 80%, depending on the procedure performed.¹ Patients who are exceptionally dedicated to their postoperative program can lose all of their excess body weight, and we’ve certainly had patients achieve this goal; it is attainable.
Virtually all patients will lose a significant amount of weight in the early days immediately following the procedure, typically within the first year after their surgery. This is because the physical changes induced by surgery cause both mechanical and hormonal shifts, making it relatively easy to lose weight. For some patients, 15 or 20 pounds per month in the first few months is possible. Plateaus will occur, but most patients persevere through them and ultimately get near their weight loss goals within 18 to 24 months.
But truth be told, we have to keep in mind that these are averages, and studies are conducted under the most ideal conditions. Not everyone will hit those numbers, for reasons besides effort, and may feel disappointed. Enter the nuance of uncontrollable factors such as genetics, hormonal imbalances, metabolic adaptations, underlying medical conditions, medication side effects, and even psychological or environmental stressors – all of which can influence outcomes despite a person’s best intentions and available statistics.
Success is better measured by improved health markers and quality of life than by a number on the scale.
Is Weight Loss on Glp–1 Drugs Any Easier?
The beauty of GLP–1 medications is in how they work. These drugs mimic the body’s natural glucagon-like peptide-1 hormone, prolonging the time food stays in the stomach and slowing its passage through the gastrointestinal tract. This artificially induced gastroparesis, as we call it, increases satiety and decreases appetite, making it feel easier to eat less, especially in the early days. Many people will drop weight quite effortlessly because they don’t crave many of the foods that cause weight gain.
With surgery, the experience isn’t identical for everyone. Individual results vary. Some people lose far more than average, while others see only modest changes despite taking the same dose and following a similar plan. The same can be said for people who undergo the same weight loss operation.
GLP-1 drugs often come with side effects such as nausea, constipation, and abdominal discomfort – symptoms that can limit how well patients tolerate or adhere to treatment. In some cases, weight loss plateaus as the body adapts to the medication, and regains occur after discontinuation.
The real success with GLP-1 therapy, as with bariatric surgery, is in comorbidity improvements and learning how to maintain a healthier balance once the medication stops doing the heavy lifting.
When it seems to stall…
For the most part, it’s not those first few months after surgery or medication use that make the weight loss process hard; it’s more the longer-term weight loss that poses the greatest challenge.
As you lose weight, it’s easy to be excited about your progress. The weight coming off means you’re looking and feeling better, fitting into smaller clothes, and life is good. During this exciting time, sticking to your diet is a no-brainer. Why would you want to feel any other way? In fact, we sometimes have to work with patients to ensure they don’t overdo it with their diet and exercise program.
However, once weight loss begins to plateau, maintaining progress becomes more challenging. After two or three years, patients often begin to liberalize their diet and decrease their exercise program because they’ve kept their lower weight for such a long time. But this is not a given. The lifestyle change is lifelong.
Most of the bariatric procedures performed today, including the gastric sleeve, duodenal switch, and SADI, all involve removing a significant portion of the stomach. Removing this outer portion of the stomach to create the sleeve also eliminates a main production center of the hunger hormone known as ghrelin. As a result, most patients experience far fewer hunger pangs after surgery.
It can happen gradually, so some patients don’t realize their intestinal tract begins to adapt to the absence of ghrelin and eventually produces small amounts of the hormone again, roughly two years after surgery. As a result, some are surprised to find their appetite returning after a long period of reduced hunger. Understanding this is a normal physiological response, and staying committed to healthy eating and regular activity, can help minimize the risk of weight regain.
Whether you have undergone surgery or are taking medications, there are several key aspects of the weight loss process that you should be mindful of. Setting realistic goals and appropriate projections from the start can help you avoid discouragement and stay committed when the scale plateaus or fluctuates.
Mindful eating. Consistent daily movement. Follow-up care. This is the work you must put in. Ongoing effort and sustainable habits are what turn temporary results into lifelong success. It’s important to recognize the hard work that goes into an “easy” fix, so that you can set encouraging expectations.
It Doesn’t Work Without Diet and Exercise
There’s no way around it: rapid weight loss without a proper diet and exercise is problematic.
Why does this matter? The weight you lose should be from fat, not muscle and bone. Eating enough protein and exercising regularly reduces the likelihood of muscle wasting and bone density loss.
Preserving and even building muscle during the weight loss process helps create a foundation for long-term weight maintenance. Muscles consume calories even at rest and allow you to maintain a healthy weight more easily or bounce back from a problematic day or two of cheat-eating.
Bone density, particularly for middle-aged and menopausal patients, is crucial for long-term health. Osteopenia and osteoporosis, in which the strong lattice of bone begins to break down, are significantly increased in patients who lose a substantial amount of weight but do not counteract this change with proper nutrients and resistance training-based exercise. Left untreated, osteoporosis dramatically increases the risk of broken bones and fractures, which in later life can be fatal.
Staying on track
With medication or surgery, and each alongside diet and exercise, the first few months (when you’re most focused and dedicated to lifestyle change) are usually the easiest. As time passes, staying on track becomes increasingly challenging.
This is not to say it can’t be done. In fact, many of our patients look back years or even decades later and feel very satisfied with the long-term results of their bariatric surgery. Similarly, patients who dedicate themselves to lifestyle changes while on GLP-1 medications eventually come off the drug and maintain their weight loss long-term. But this does require hard work.
The initial, easier weight loss over the first year or so after bariatric surgery or starting GLP-1 therapy helps you return to baseline, where you feel better, look better, and have the mental and physical motivation to push through. Then the hard work begins, because maintaining the weight you’ve lost comes along with an unrelenting desire to sustain the lifestyle changes.
Of course, you have the team at SAMPA and your personal support network to guide you through this process, but you have to be prepared for a new, permanent lifestyle status quo in order to achieve long-term success.
So, is weight loss easy with bariatric surgery or medications? In some ways, yes, and in others, definitely not.
Be sure to consult with your surgeon and other bariatric patients to understand the key factors that can make your weight loss long-lasting and reduce frustration along the way.
- Aderinto, N., Olatunji, G., Kokori, E., Olaniyi, P., Isarinade, T., & Yusuf, I. A. (2023). Recent advances in bariatric surgery: a narrative review of weight loss procedures. Annals of medicine and surgery (2012), 85(12), 6091–6104. https://doi.org/10.1097/MS9.0000000000001472.
