Weight Loss Management Without Regain
March 22, 2021Learn About Weight Loss Management Without Regain: One of the most common questions our patients have for us is “How can I keep from regaining weight after my surgery?” The question is also clearly a focus for folks trying to lose weight regardless of whether or not they undergo bariatric surgery.
My answer, I’m afraid, is not what they hope to hear. My answer is: You can’t keep from re-gaining weight after surgery. What I mean to say is: Almost EVERYONE will gain SOME weight after any form of weight loss.
Role of Obesity and Weight Gain
There is a higher likelihood of being able to limit this weight gain and either maintain or lose the excess if they understand one key element of obesity. It is a chronic disease. This is a long game. A marathon. Heck, an ultra marathon even.
Fluctuations in energy expenditure are an integral part of the human body’s homeostasis (or ability to maintain equilibrium). There are natural, physiological states in which positive caloric deficit is often required, including puberty, pregnancy, menopause, illness, among others. These hormonal changes that drive this positive caloric deficit will return to normal when the physiological state is no longer a problem.
When the metabolism is not functioning at its normal capacity (as in the disease of obesity), the ability of the metabolic derangements that cause weight gain to rear their ugly head again even after a successful “reset” of the hormonal pathways is common.
Weight Regain
I say this to my patients because, first and foremost, I believe the hardest part of bariatric surgery is not the teaching, not the surgery, not the relearning how to eat and drink and changing your food culture. THE hardest part is managing expectations surrounding the results of surgery.
This is also the most vital part of what we do as a multi-disciplinary team because it will determine a patient’s ability to cope with unintended weight gain down the road. If they know that it’s a possibility they will regain some weight, they will be less likely to feel responsible, and even guilty.
Thinking you should never regain can lead to a feeling of hopelessness, and some eventually even give up on a healthy food culture because they feel “Nothing I do matters anyway, I can’t keep the weight off no matter what I do.”
Reframing your expectations to include the ups and downs of weight loss and regain can help you stay on track more easily by allowing less stress and anxiety attributable to the journey itself.
The most important place to start when evaluating any weight gain after surgery is usually dietary factors, but many people forget that the etiology of obesity (and therefore) recurrence of obesity is vast and varied in every person.
Not only does genetic and epigenetic risk come into play. Things like stress, muscle mass, age, sleep patterns, medications, and microbiome changes contribute to our resting metabolic rate (RMR), which is the engine that drives fat storage and the number of calories burned.
When evaluating dietary factors, often patients find themselves back in the old habit of trending towards nutrient-poor, high-calorie ultra-processed food products.
And because patients are not eating AS MUCH of it as they used to, they believe it will not affect their weight. But the problem is that these food products DO affect the signaling pathways in which we process caloric intake and they alter the microbiome (bacteria) of the gut, which leads to further dysregulation of these pathways.
The focus should always start with returning to natural, whole, unprocessed, or minimally processed foods. Within that, of course, the focus on the three macronutrients (protein, carbohydrates, and fats) must be reiterated.
Our body works much harder to break down a gram of protein than it does carbohydrates and fats. Protein needs to remain the star of each meal to get the most out of what is known as the “thermogenic effect of food.”
Also, it is important to remember that protein, healthy fats, and fiber are the things that make us feel more satiated and help balance our blood sugars throughout the day. This allows for a more consistent eating pattern without cravings for high carbohydrate and sugary food products.
Stress
Stress is an inevitable part of our lives. Managing stress is not something we are taught growing up and often becomes a chore for us when we are adults, instead of something that comes naturally. Trying to find ways to decrease our stress levels, whether it be asking for more help at work or at home, taking time for yourself for a few minutes per day for meditation, walking, or even just spending some time outside every day, can help decrease cortisol (the stress hormone that stimulates weight gain).
Along the same lines, focusing on healthier sleep habits can allow our circadian rhythms to function normally again. Going to bed at a decent hour every night and waking up at the same time every day, avoiding screen-time before bed, and utilizing your bed for sleeping only can help with this. Night shifts are notorious for disrupting these patterns, commonly leading to weight gain.
Many of our patients take medications that lead to weight gain. Discussing these medications with your bariatric surgeon or primary care physician can help determine if alternative medications are an option or, perhaps you can work to get off the medications altogether.
Insulin is an example of an extremely weight-promoting drug. Working to control blood sugars with oral medications and nutrition counseling can help avoid the use of insulin when working closely with your doctor.
Exercise
Oftentimes, patients believe that they gained weight because they stopped exercising. Although both aerobic exercise and strength training is necessary for weight maintenance, it does not usually lead to long-lasting weight loss. It must be considered an adjunct to dietary changes and improving overall causes listed above.
Strength training is a very underappreciated part of weight loss management. Building muscle mass can help create a sort of insurance program for weight regain. The more muscle mass you have, the higher your resting metabolic rate and, therefore, the more calories you burn every day. In addition, stronger muscles can help stabilize joints and decrease chronic knee, hip, and back pain that otherwise debilitate patients on a daily basis.
There are many things to focus on to avoid weight regain and have good weight loss management. My advice to my patients is to choose one or two to focus on and improve over time.
Human habits are very difficult to change and often will require falling off the horse several times before success. The goal is to continue to keep trying to understand that we are human and will never be perfect.
Your Take-Away: Weight Loss Management
Despite what happens with your weight or overall health, you will feel better, healthier, both mentally and physically, if you are gracious with yourself. Regarding your weight loss, my advice when you find yourself walking through a difficult part of the journey is just to keep going.
 | ABOUT THE AUTHOR Christine Lovato, MD, FACS is a board-certified surgeon specializing in bariatric surgery at Banner -University Medicine Obesity and Bariatric Surgery Center in Phoenix, Arizona. Dr. Lovato is passionate about helping her patients take control of their life and the disease that has plagued them for so many years. |
