Are you sure, the weight will not come back? This is one of the 3 mandatory questions every bariatric patient asks me. The others(which I shall cover in next blogs) being the safety & cost.
What does everyone want to hear? The failings of past haunt obese like nothing else. I still get emotional when I recollect helplessness of a father whose beloved single child, a 21 yrs daughter, failed to maintain weight despite diet & working out in gym for, hold your breath, 4 hours a day. He provided best gym membership & diet counseling but inevitable rebound led her to avoid social gatherings, & outings with family & friends(as a young adult is expected). Of course she lost weight after surgery & her outlook changed completely.
We are aware that obese have tendency(inherited or otherwise) to gain weight even with moderate calorie intake. We have operated on many members of many families, confirming tendency related weight gain belief.
Most start believing that surgery will automatically result in continued weight loss, changes in lifestyle & disappearance of weight gain tendency. This is neither the target of bariatric surgery, nor feasible expectation from surgery. Surgery does not change genes, environment or psychological approach to food.
Does that mean that weight regain is inevitable? Definitely NOT. Please remember that surgery is an excellent ‘tool’ to help lose weight & all patients have indeed reported good weight loss.
However, we continue to consult patients with weight regain of 2kgs, 5 kgs or 10-12 kgs usually few years after surgery. All of them are indeed aware of reasons for their weight gain & most are able to take corrective actions as well.
What can cause weight regain after surgery? Even few years after surgery, the meal size remains small i.e. 1-2 chapatis/equivalent food. This is usually the meal that is prescribed by a dietitian for weight loss to a non-bariatric obese. Then how come abariatric patient eating even less gain weight?
This can only be explained by
- Consumption of calorie dense food on regular basis. These include alcohol, fried snacks, sweets & increased fat consumption in meals.
- Poor metabolic rate – With weight loss, most will lose fats & muscles both. Low muscle mass results in less calorie burnt by patients at rest, reducing the energy expenditure.
- Non-compliance of bariatric lifestyle – This primarily means inadequate chewing of food (resulting in stretching of pouch/stoma), drinking liquids with a meal & inadequate protein intake. These may result in excessive calorie intake.
These defeat the purpose of surgery since calorie intake exceeds expenditure & weight gain may happen in few.
Preventing Weight Regain
Can you prevent weight regain despite all the mentioned reasons – the answer is YES. 5 simple steps for weight maintenance are –
- Acknowledge that you have weight gain tendency, which does not change by surgery. Realise that surgery has NO magic but is an excellent TOOL to help you lose & maintain weight. Paste large ‘before’ pictures – surely you do not want to be like that again.
- Lifestyle cannot change automatically after surgery. It will change only if you work towards it by
- avoiding alcohol & calorie dense food(fried, sweets, snacks etc).
Read my blog on ‘Alcohol & Weight loss Surgery can be a bad Combination’
- b) avoiding liquids with meals
- c) chewing, chewing & chewing your food.
- Similarly protein, protein & proteins in each meal is essential to prevent muscle breakdown, provide fullness for longer duration & prevent sudden blood sugar spikes in diabetics.
- Exercise – Strength training helps maintain muscle mass with increased metabolic rate. This helps burn more calories even when one sleeps. Regular exercises not only make you look smart but also takes care of occasional indiscretion(s) without weight regain.
- Follow up – Few patients, after surgery, start believing that they have broken the ? code & do not require professional support. Weight maintenance is best in patients who are regular in their follow-up, attends support group meetings & interacts with bariatric team.
I do agree that law of diminishing returns apply when you re-visit but even small changes in technique or diet may avoid weight regain or a second surgery.
Am I sure, the weight will not come back? Yes, I am certain that with these 5 reasonably simple steps coupled with your will, each one can maintain their weight for a long time.
For more information watch Dr Ramen Goel’s Presidential address on Weight Regain at National Conference of Obesity & MetabolicSurgery Society of India at JW Marriott, Mumbai in January 2015