Stalled After WLS? Factors That Could Help Produce Results!

June 26, 2023

Reality is setting in, hunger is back, stress hits....again, old thoughts and emotions have returned.  Now what?  At some point, the excitement and effects of weight loss surgery wane. Stalled after WLS. This is normal. But it can be downright scary for some. If you arm yourself with information, understand physiology, develop a flexible mindset and start with what is easy you can push through barriers, setbacks and fear to maintain the results you want. 

There comes a point in everybody's journey where the 'rubber hits the road.' When it is up to you to carry the load vs. relying on your surgery. After scouring the research and sitting across from thousands of patients over 20 years, here is what we know works if you are stalled after WLS:

Don’t get me wrong, it is fun when people come in hitting all of their goals, but when they struggle is when they need us the most.  Most people if they hit a plateau or even regain a few pounds, cancel appointments and don’t come back.  They may think “I have to lose these 5 lbs before I see my surgeon.”  Before you know it, 5 pounds becomes 10 or more!  If you had diabetes you would never cancel an appointment with the endocrinologist if you had ice cream the day before, so why cancel with your bariatric team for weight regain or early stall?  This is when we, surgical teams, do our best work.  The more in contact you are with us, the better your outcome. The earlier we can help intervene the better the outcome for you.  Throw away all of the past shame, guilt and fear of judgment.  They didn’t serve you before surgery and they won’t work now!

It is more difficult to lose weight the closer you are to goal.  This is a hard reality to swallow.  The margin to create a calorie deficit becomes more narrow as you lose weight.  You are actually burning fewer calories now than you did prior to surgery.  The majority of calories burned every day is just to stay alive, this is called Basal Metabolic Rate. Yes, you may be more active, but activity counts for a small portion of calorie usage.  You are no longer fueling an extra 60-150 pounds or more! This is not a ‘slowing of your metabolism.’ In fact, this is exactly what your body is supposed to do! 

Obesity is a chronic, relapsing disease. Even with surgery, it is only put into remission.  If you notice weight plateau or regain, keep a food log for a few days and see where your total intake is. People are often quite surprised that you can overdo “bariatric foods” and over consume energy.  Just like any other disease state, check ins, monitoring and due diligence are required.

For decades we have been sold a story that says we have to eat less and move more.  So many times, people come into the office and say they upped their exercise but haven’t lost more weight. This can trigger old feelings of inadequacy and ‘nothing works for me’ which, for some, leads to cessation of positive changes and self sabotage.

The two ways of creating a calorie deficit, intake and movement, are not equal.  Calorie intake (food) drives weight loss. Period, end of story. Exercise, on the other hand, is associated with weight maintenance; once you hit a lower weight will you stay there?

Of course you still have to move your body.  Exercise is one of the most powerful ways to transform physical and mental health.  It improves most chronic disease states, longevity and is a potent antidepressant, anti-anxiety and pro-sleep tool.  Lay the foundation for it to become a habit early post op.  Get into the routine, fall in love with something you enjoy and stay consistent.  Also consider weight training to help with retention of muscle mass which improves quality of life, daily function, bone density and total caloric output.

Snacking can creep back in.  Many snack foods, even if bariatric friendly, can sabotage results.  Oftentimes, people who are stuck will overdo cheese sticks, low carb bars/shakes, nuts, seeds and trail mixes.  Do not consider nuts a 'protein food.’  They are a fat.  1 cup of peanuts is 830 calories!  If you have nuts, eat a 1-2 tablespoon portion with a meal. They are quite healthy.

Typically what we see is a snacking pattern with these foods.  It’s a handful here, cheese stick there, cutting up a protein bar and slowly eating it for something sweet.  All bariatric procedures are designed to limit portion size.  By eating small amounts of food all day long, your procedure will never have a chance to work.  It’s like a drippy sink, at the end of the day you have a large puddle of water.  You will actually eat more calories snacking and picking vs. sitting down and having lunch or dinner.

Wonder if this is going on?  Commit to keeping a food log.  Use the mantra eat it, write it. Don’t wait until the end of the day to remember what you had. Raise awareness so you can make moment to moment decisions. Most people don’t even realize this is a pattern engaged in, it doesn’t register with your brain you are eating.

If it looks like a duck, walks like a duck and quacks like a duck, it’s a duck!  There are many companies out there peddling bariatric/low carb food-like products.  Bariatric pop tart seems too good to be true?  It is!  It is glorified junk food. Foods that are whole and close to nature contain more nutrition and will be more satisfying in the long run.

Protein, fiber and water.  These are the key ingredients that help your surgery help you!  They increase satiety, fullness and suppress hunger in between meals.  In addition, they are full of nutrients, vitamins, and antioxidants. Most are naturally low calories such as vegetables.  Choose foods that have a wide variety of color and minimal ingredients.  There is no logic in justifying eating a bariatric brownie but say a strawberry or carrots are “bad.”

So many times when people look to get back on track, they pick the most audacious difficult goal(s).  This sets you up for failure.  When you can’t do it, it will reinforce old dieting beliefs and negative self-talk. 

Don’t throw out everything in your pantry, purchase a massive water container, set the alarm for 4 am to go all in on Monday morning.  Instead start with what is easiest.  Prove to yourself you are capable of follow through and success.  Think back to a time you felt successful, what were you doing and what was easiest? Start there.  Master 1 aspect of healthy living and more will follow. Atomic Habits by James Clear provides an excellent framework and understanding of long term habit change.  By feeling successful again you begin to change your identity and shed the old diet mentality and fears. Live your life by focusing on what works versus what doesn’t. 

Tina Musselman is founder of The Pointe and has been working in weight loss, wellness and bariatric surgery since 2004.

ABOUT THE AUTHOR Tina Musselman is founder of The Pointe - Profoundly Improving Lives helping pre-op and post-op WLS patients set health and wellness goals. She has a BS Human Nutrition and Dietetics, University of Illinois at Chicago 2003 and has been working in weight loss, wellness and bariatric surgery since 2004.

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