Bariatric surgery is the only effective long-term treatment for obesity. Studies show that most who undergo bariatric surgery keep at least 50% of their weight off for ten years or longer. And with that weight loss, there are many improvements to health, vitality, and quality of life. But, the reality is that some people do gain a portion of their weight back. What causes that, and what can you do to prevent it?
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Expect a Slight Gain
Our bodies are set up to store energy in fat cells for times of famine. Weight loss surgery works by disrupting the tenacious survival mechanisms that the body has in place by:
- Limiting the amount of food that can be eaten at one time.
- Influencing hormonal changes that promote weight loss.
- Motivating positive lifestyle changes as weight is rapidly lost.
Over time, however, there is a slight increase in food intake. The hormonal help is not as strong. And people tend to resort back to some not-as-healthy lifestyle habits. Due to these and potentially other factors, about half of the people see some regain after two years. The average weight gain is eight percent.
Some Things are Out of Your Control
Set your weight expectations based on individual circumstances. Some of the factors that influence weight are out of your control. They may limit the amount of weight you initially lose and the amount you can keep off. Consider:
- Although weight loss often cuts the number of pills needed for a wide range of health conditions, some “weight-positive” drugs may be required. Review your medication list with your primary care doctor and discuss possible substitutes for any that have weight gain as a side effect.
- Physical Activity Limitations. A robust activity level helps to boost metabolism. Injuries, painful conditions, or merely a lack of time may constrain the amount of movement done each day. Be sure to move as much as possible with the limitations you have.
- Older people may see a slower rate of weight loss and fewer pounds lost. Keep in mind that even smaller amounts of weight loss provide many health benefits and improve life quality.
- Medical Conditions. Some medical conditions, such as hypothyroidism, PCOS, metabolic syndrome, and diabetes, involve the body’s energy balancing systems. Work with your primary care physician to manage these conditions so optimal weight can be lost.
It is All about a Healthy Lifestyle
Studies have found that most regain is not from factors out of one’s control or problems with the surgery itself. It is mainly due to poor compliance with healthy dietary and lifestyle practices. To lose weight and keep it off, this is where you need to focus your attention.
Take Advantage of the Rapid Weight Loss Phase
Year one is often referred to as the honeymoon period. Even if you don’t exercise or follow the “rules,” you’re likely to see significant weight loss. But, sliding through with minimal effort isn’t in your best long-term interest. It is time to ramp up your efforts, reach your weight loss goals, and develop habits that will help you stay healthy. Make these efforts during year one:
- Regular exercise increases weight loss and decreases muscle loss—setting you up with a higher metabolism to help offset the natural decrease in hormonal help.
- Rather than just eating smaller portions of highly processed foods, establish healthy eating habits that will fuel your success long-term.
- Work on coping skills to navigate stressful situations without leaning on food for comfort.
Habits are formed from repetition. At first, they require a conscious effort but eventually become automatic. We all tend to eat what is easiest at the moment. By doing a little planning and prep, healthy foods become the easy choice—no willpower required. Healthy eating habits after surgery include:
- Between meals, drink calorie-free fluids. Shoot for at least 64 ounces a day-more if possible. Avoid fruit juice, sugar-sweetened drinks, and alcoholic beverages.
- Eat without distractions (TV, computer, etc.), so you can eat slowly, chew thoroughly, and focus on feelings of fullness. Stop eating when you feel comfortably full or sense that one more bite will be too much.
- Measure or weigh foods most of the time to keep portions in check. Be aware that meal size tends to get slightly larger over time. Using smaller plates, bowls, and eating utensils also helps.
- Drink between meals rather than with meals. Practice the 5/30 rule in which you stop sipping on fluids 5 minutes before a meal and don’t resume until 30 minutes after the completion of the meal.
- Plan 6 small meals/snacks. Eat every 2 ½ to 3 hours. Skipping meals does not increase weight loss.
- Avoid calories between planned meals and snacks. This time is reserved for calorie-free fluids.
- Choose high-quality foods that are mostly prepared at home. Build your diet on lean protein sources; add fresh vegetables, fresh fruits, and small amounts of whole-grain foods and healthy fat sources. Use the Barix Meal Planning Guideline or Barix Food Guide to help you plan.
- Eat the right carbs. Limit foods with added sugar and highly processed foods. Your body thrives on the right amount of carbohydrates from fresh vegetables and fruits, low-fat dairy, and whole grains.
- Keep late-night snacking from derailing your weight loss. Plan a healthy protein-rich snack in the evening and keep “snacky” foods out of the house.
- One of the most effective habits is to keep a food (and exercise) log. Doing this increases awareness of eating patterns, food choices, and calorie intake.
- Weigh weekly. Weight naturally fluctuates within a few pounds. Set an acceptable top weight. If you reach that weight, it is time to take action. Look at what has changed and reach out for help. Weight gain does not mean that you have failed. It means that you need to make some changes and get back on track quickly.
- Attend scheduled follow up appointments. Your healthcare team is there to support you. Regular check-ins help keep you well-nourished and on target.
- Support groups and accountability partners can help you keep a healthy mindset. There will be bumps along the way, and those who have gone through the same thing are often the best ones to help.
- Be mindful when you eat. Pay attention to bite-size, chewing well, and stopping when comfortable.
- Work on building skills and putting strategies in place to limit emotional eating, late-night eating, and triggers that lead to poor food choices.
Increased physical activity is associated with more weight loss and a higher quality of life after surgery. Inversely, a low activity level is a crucial predictor of weight regain. You’ll want to build up to at least 10,000 steps a day and add strength training 2-3 times a week. Here are some easy ways to increase your activity:
- Park farther away. Walking into a store or your office from the far end of the parking lot can boost your heart rate. If you live close enough—give up the car altogether and walk or bike instead.
- Have a sitting job? Make efforts to stand more often, take mini walks, or do 3 minutes of exercise (leg lifts or squats—or bring in a set of dumbbells) each hour. Can you work at a standing desk? After just 2 hours of sitting, metabolism slows by 25-50%; blood sugar levels increase, good cholesterol decreases, and circulation slows. Use your lunchtime to take a walk or to work out right at your desk.
- Schedule it into your day. Exercise deserves a priority status—after all, it is an investment in your health and well-being. Put it on the calendar and treat it as an essential appointment.
- Get up a little earlier. Morning exercise rocks–start your day more energized and focused.
- Multi-task. Walk with a friend to socialize and exercise at the same time. Watch a TV show, inspirational video, or educational clip as you cycle or walk on a treadmill.
- Use a fitness app for structured exercises adapted to the time, space, and equipment you have available.
- Are you watching TV? Walk in place during the show or bust out some sit-ups and squats during the commercials.
- Sign up for a charity 5K with a buddy. Once you have the date on your calendar, the training begins. With a goal ahead of you and a friend by your side, it’s easier to stay motivated.
- Tracking exercise helps to motivate (Wow, I’m up to 20 squats!), measure progress, and keep you on track.
- Sometimes you need to choose something over nothing. If you cannot get your full workout in, do what you can. Short spurts of effort can add up. It is all about the habit. When there is a time carved out for exercise, use it. That way, the routine stays in place, even if the workout isn’t an all-out effort.
- When you need to communicate, make a phone call instead of sending a text or email. Get up and walk around the block, or pace while talking on the phone.
- Turn up the tunes and turn household chores into a workout session. Sweep faster, scrub harder, add in some bicep curls between tasks, and you’ll be working up a sweat in no time.
Build up stress management skills before you need them. Practice healthy ways to cope with small stressful situations, so when more significant stressors show up, you’ll be able to limit or avoid emotional eating.
Sleep has a massive impact on weight. Sleep deprivation has been found to change the regulation of appetite and energy expenditure. Without eating one single extra morsel, a sleepless night can increase weight. A string of sleepless nights can add up. Adjust your lifestyle to make sleep a top priority.
Knowledge and Skills
It is easy to improve knowledge and skills in 2020. The information and help needed are at our fingertips.
- Learn while you exercise by watching videos or podcasts.
- If you don’t know how to prepare foods from scratch-learn.
- Spend time reading labels and ask questions when you’re not sure.
- Read up on emotional eating and practice stress management techniques.
Get it off and Keep it off
Having weight loss surgery is about so much more than reaching a healthy weight. It’s about transforming your life, reclaiming your health and well-being, building your confidence, having new opportunities, and living life to the fullest.
The commitment and daily efforts to make healthy food choices and get enough intentional exercise are well worth the payoffs. Not surprisingly, the lifestyle habits that help you maintain a healthy weight also help you live a long, full, vibrant, and active life.