losing weight regain

Losing Weight Regain By Getting Back On Track

March 30, 2021

Are you working on losing weight regain? What is the difference between people who maintain their weight loss after bariatric surgery and those who regain? Habits.

Studies show that people who maintain their weight loss after bariatric surgery have made a habit of following post-surgical guidelines [1]. They have regular follow up appointments, drink enough water, eat high fiber foods to help with satiety, pace their eating, and regularly assess their behaviors [1].

Successful weight loss and maintenance requires a lifestyle change. Sometimes we regain weight because we changed our habits temporarily, but we weren’t ready to change them for life. Sometimes we regain weight because old familiar unhealthy habits creep back in [1, 2, 3, 4].

If you’ve lost some weight or even got to your goal or lowest weight, then regained some weight back, use that frustration to get your habits back on track and start losing weight regain. Let’s look at how to make a change that will last.

Losing Weight Regain: How To Make Changes That Will Last

Readiness to Change

Many people shy away from change. We want to change, but making a change is hard, even when you know it can lead to the weight loss you want [5.] Our thoughts, emotions, and familiar habits may prevent us from changing, even when we know a change could improve our lives [5].

Studies show there are stages to change. We start with awareness of the problem, then move to contemplate how to change, then take action to change, and lastly, we work towards making that change a habit [6].

If you lost weight and later gained it back, what guidelines did you let go of? Let’s look at the post-bariatric surgical guidelines [4, 7, 8] to help determine opportunities for improvement.

What Habits Do You Need To Improve?

  • Consume 60-80 grams of protein per day or 1.1-1.5 grams per kilogram of your ideal body weight
  • Drink 64 ounces of non-caloric fluids per day
  • Eat 3 meals per day at least
  • Take daily vitamin and mineral supplements for life to prevent micronutrient deficiencies [9]
  • Exercise for 150 minutes per week or 30 minutes per day for at least 5 days per week
  • No snacking or grazing which consists of distracted eating (eating while watching TV or doing an activity) or eating for emotional reasons rather than physical hunger
  • Stop drinking 15 minutes before a meal then eat for 20-30 minutes then resume drinking 30-60 minutes after eating

Use Your Self-Assessment Skills

  • Regular weight checks at home or in-clinic follow-up visits
  • Tracking food intake and beverages on apps or on paper
  • Measuring and monitoring portion sizes
  • Balancing meals with 3 ounces of protein, ½ plate of non-starchy vegs, and 1-2 tablespoons of carbohydrates (or the same ratio)
  • Regular follow-up appointments
  • Monitoring lab results to prevent nutrient deficiencies
  • Support from family and friends or support groups
  • Professional support from RD, doctor, or psychological professional

In general, post-bariatric surgical guidelines focus on a high-protein diet and non-starchy vegetables, with limited amounts of sugar and high-calorie, low-nutrient carbohydrates or other starchy foods [10].

A high carbohydrate, low protein diet may cause a loss of muscle mass, causing a lower metabolic rate, which results in less weight loss [7]. That’s why researchers recommend eating more protein and non-starchy vegetables to help you with satiety or feeling full for more time after meals, increase your metabolic rate, and help you burn more fat [7, 11].  

Reviewing bariatric guidelines will make you aware of what we need to change. Awareness is the first step toward making lasting changes. Take a look at your current habits and ask yourself these four questions.

  1. What guidelines became a habit after surgery?
  2. What recommendations have you followed in part, but there’s room to improve?
  3. What guidelines have you let go of or not continued to do over a period of time?
  4. What guidelines do you need to start or restart?

Losing Weight Regain: Make It a Habit

Accepting you need to change is a step towards changing for life [2]. Once you identify what needs to change, the next steps are to decide to change and how to change.

What type of change do you need? Surgery was a one-time change, an all-or-nothing decision, but not all change happens at once. Changes to your diet and exercise may need to be incremental changes with identifiable steps. Other changes may be more gradual, noticeable over time. Gradual change focuses on the overall pace of change, which may be fast, a choice made today, or slow, steps taken over time.

Where you’re struggling shows you a place to start. Next, decide how you want to make that change. For example, if your goal is to drink 64 ounces of water per day and you’ve managed to make 32 ounces per day a habit, how will you add another 32 ounces? You could add 2 more bottles of water to your day or use a water bottle that measures 32 ounces and drink one in the morning and one in the afternoon. 

With exercise, if your joints or back are still causing pain and limiting your activity, break it down into increments you can do. Walk for 10 minutes and then rest until you’re ready to walk some more, or start with 10 minutes, then decompress or relax your back.

You also could try posture exercises to straighten your stance and when you can walk with better posture for 10 minutes, work up to walking for 12, 20, 25, or 30 minutes with better posture and less pain.

Another example would be handling cravings for carbohydrates. If eating pasta, crackers or other carbohydrates has crept into your diet, think about why? Are they easier to eat because of heartburn or other digestive issues? Are they simply cheaper or your favorite food?

What you’re struggling with is a place to make a change. If you need help, ask for ideas from friends, support group buddies, or bariatric dietitians and professionals.

Losing Weight Regain By Seeking Help

If you’re not losing weight regain and not confident in your ability to change or finding that you’re still resisting change, ask for help. Family, friends, people in support groups, or professionals in bariatric surgery are all sources you can tap into to overcome ambivalence.

Talk it out until your confidence in your ability to change and your desire to change grows enough to overcome the discomforts or doubts making a change will bring. When your desire to lose weight is greater than the discomforts, or you have a plan to overcome obstacles, you’ll be on your way to your goal.

Support from family and friends was cited frequently in studies on making lifestyle changes as beneficial to people’s efforts to adopt a healthy lifestyle [12, 13].

Do you need to understand more about how weight loss works or why the guidelines are necessary? Seek out a dietitian who specializes in bariatric surgery. People who sought nutritional counseling reduced their weight more than those who didn’t [7].

Don’t Give Up - Celebrate Small Successes

Expecting immediate results may cause you to give up on your efforts prematurely. If you aren’t seeing results right away, that doesn’t mean things aren’t working. Small changes make big things happen. It may mean change takes time [5].

Changing habits for life is a process. It takes practice to make a new habit. Giving up when things don’t work the first time, when things are uncomfortable and cause discomfort, is understandable, but it won’t get you the weight loss you want.

Pace yourself and be methodical about your steps towards your goals. Learn to value a slow and steady pace to get back on track rather than rushing to get what you want [5].

Celebrate small successes. Whatever recommendations you’ve made a habit already is a cause for success. Whatever you’ve decided to change is another. Celebrate any positive steps you make and, in time, you’ll find yourself celebrating you losing weight regain and adding weight loss success.

References

  1. Masood A, Alsheddi L, Alfayadh L, Bukhari B, Elawad R, Alfadda AA. Dietary and Lifestyle Factors Serve as Predictors of Successful Weight Loss Maintenance Postbariatric Surgery. J Obes. 2019;2019:7295978. Published 2019 Feb 12. doi:10.1155/2019/7295978.
  2. Maleckas A, Gudaitytė R, Petereit R, Venclauskas L, Veličkienė D. Weight regain after gastric bypass: etiology and treatment options. Gland Surg. 2016;5(6):617-624. doi:10.21037/gs.2016.12.02
  3. Sorenton KW, Herrington H, Kushner RF, Nutrition and Weight Regain in the Bariatric Patient. IN: Kushner RF, Still CD, EDS. Nutrition and Bariatric Surgery, 1st Ed, Boca Raton, FL: CRC press. 2015: 265-279.
  4. Faria SL, de Oliveira Kelly E, Lins RD, Faria OP. Nutritional management of weight regain after bariatric surgery. Obes Surg. 2010;20(2):135-139. doi:10.1007/s11695-008-9610-z.
  5. Morin, Amy LCSW. 13 Things Mentally Strong People Don’t Do: Take Back Your Power, Embrace Change, Face Your Fears, and Train Your Brain for Happiness And Success.  New York, William Morrow, an imprint of Harper Collins, 2014.
  6. Prochaska JO, DiClemente CC, Norcross JC. In search of how people change. Applications to addictive behaviors. Am Psychol. 1992;47(9):1102-1114. doi:10.1037//0003-066x.47.9.1102
  7. Faria SL, Faria OP, Buffington C, de Almeida Cardeal M, Ito MK. Dietary protein intake and bariatric surgery patients: a review. Obes Surg. 2011;21(11):1798-1805. doi:10.1007/s11695-011-0441-y
  8. Sherf Dagan S, Goldenshluger A, Globus I, et al. Nutritional Recommendations for Adult Bariatric Surgery Patients: Clinical Practice. Adv Nutr. 2017;8(2):382-394. Published 2017 Mar 15. doi:10.3945/an.116.014258
  9. Parrott J, Frank L, Rabena R, Craggs-Dino L, Isom KA, Greiman L. American Society for Metabolic and Bariatric Surgery Integrated Health Nutritional Guidelines for the Surgical Weight Loss Patient 2016 Update: Micronutrients. Surg Obes Relat Dis. 2017;13(5):727-741. doi:10.1016/j.soard.2016.12.018.
  10. Mechanick JI, Kushner RF, Sugerman HJ, et al. American Association of Clinical Endocrinologists, The Obesity Society, and American Society for Metabolic & Bariatric Surgery medical guidelines for clinical practice for the perioperative nutritional, metabolic, and nonsurgical support of the bariatric surgery patient [published correction appears in Obesity (Silver Spring). 2010 Mar;18(3):649]. Obesity (Silver Spring). 2009;17 Suppl 1:S1-v. doi:10.1038/oby.2009.28
  11. Pawlak DB, Ebbeling CB, Ludwig DS. Should obese patients be counselled to follow a low-glycaemic index diet? Yes. Obes Rev. 2002;3(4):235-243. doi:10.1046/j.1467-789x.2002.00079.x
  12. Nicolai J, Müller N, Noest S, et al. To change or not to change - That is the question: A qualitative study of lifestyle changes following acute myocardial infarction. Chronic Illn. 2018;14(1):25-41. doi:10.1177/1742395317694700.
  13. Blacke, M. Predictors of Weight Regain After Bariatric Surgery. Today’s Dietitian. 2019:21(4):46. Published April 2019.
Losing Weight Regain
Denise Carruth

ABOUT THE AUTHOR

Denise Carruth RD, is a bariatric dietician at the Surgical Weight Loss Center of UC Health in Aurora, CO. She works with a multidisciplinary team to assess patient readiness for bariatric surgery. She counsels bariatric candidates before their surgery to help them reach their pre-surgical weight loss goal, and assesses patients after their surgery to ensure that their diet is nutritionally adequate. Read more articles by Denise!