why do some people regain after wls

I have been reading a lot of post of people *****gain after a while and want to have another surgery to lose the extra 30 or more pounds, I see where people start gazing or eating what they use to eat again and gain the weight back. I am almost 2 years out and I am maintaining, I have lost 185 pounds.. I was just wondering did you stop excising, When you saw that you had gain like 10 pounds, why did you not start to watch what you ate . And why would another surgery help you to lose weight again, if the first surgery help you but you did not follow Thu on it;; I am not being cruel, I really would like some input on this, It is scary, I do not want to gain my weight back , but I have notice that people seen to let things slip once they get to their weight and they stop exercising and follow healthy eating habits like in the beginning. I think when you get to your goal that is when it gets hard and it is not the time to slack off and stop doing the things that help you to reach goal in the first place.. Please give input to this-- once again I am not saying this to be mean, I really would like to hear what happen so maybe I can avoid the pitfalls of gaining my weight back  :)

I understand exactly what you are asking.  I just had my surgery on March 26th and I am already worrying about regaining the weight back. It's so scary!! I hope you find the answers you are looking for.

I think alot of people buy into the belief that you can eat anything you want in moderation and maybe quit exercising for any reason (like I'm too busy or the membership is too expensive.) and it happens.

I think the basic reason is addiction. An addict just can not stop consuming their drug of choice..it's really all about that, I feel. It looks and feels just like the AA 12 step program.. I have found that I can maintain pretty well if I treat my problem with white carbs like a drug or alcohol addiction.

Actually, all of your questions are valid for people who have not had WLS surgery as well.  You could be a normal student off to school facing the "Freshmen 10."  The reasons, I'm sure are also the same.

Let me just say it...there is only one way to lose weight:  eat less and excercise more.  The whole "diet industry" is predicated on convincing you there is an easier way that doesn't involve these two unpleasant activities (eating less) or (excercising more).  Ultimately, when you think about it, WLS is a tool that allows....no....forces you to eat less.  You daily intake in the months after surgery are like 500 calories.  I'm pretty sure any human alive eating 500 calories per day will lose weight.

Surgery seems to offer a sense of satiety even when eating only 500 calories, that is a huge benefit.  Depending on surgery you might also be malabsorptive which also helps tremendously.  I've been told that after time the body can adjust for the malabsorptive deficiences and also you lose the satiety benefits.

So, once that honeymoon period is over, THERE IS NO FATE BUT THAT WHICH YOU MAKE.

Hopefully you've used this time to master your addiction, develop a life long excercise habit, and made changes to your eating habits.  If not, if you do what you always did you will get what you always got.

The way to not gain weight isn't really a mystery:  don't eat more calories than you need.

Some of us get severe RH 1-2 years post op RNY. And eating become an issue.  Real issue. If I do not eat enough or often enough - my BS will drop, if I eat too many carbs - my sugar will drop, if i eat only proteins - my sugar will drop... and so on...
The very fine line where I have to eat enough to make sure my BS is stable and not too much to gain weight. And the "fun" is every day. And exercise - yea --- that is tricky also - any serious exercise - and my BS drops.
Reactive hypoglycemia and Hypoglycemia. There are no "save" carbs for me (except fiber), there are no "good carbs'  and "bad carbs". Some are worse than others.  Some will always make my BS drop some - some times only and with combination of other things, an only if I eat too many of them.
Post op RNY... regain due to insulin overload.. how fun...

Now most people do not have as severe RH. Some have - but just do not know it - they get the shakes - they eat, eat - graze carbs all day - because they get hungry... very hungry...
When your BS drops below "save level" - first you get hungry.... (my BS will be app 60?) I still can wait... and try to ignore that..but at 55-60 the normal survival instinct kicks in and you have to eat. But if that drops to 40'3 or 30's or even below... that's when the real "fun" begin... (horrible panic like attack, possible seizures, blackouts, etc...)

I do try to follow a very well balanced - low carb, high fiber, high protein moderate fat diet.  Every meal has to be balanced.  I am on a "very strict permanent diet" for the rest of my life...


New Data on Weight Gain Following Bariatric Surgery

Gastric bypass surgery has long been considered the gold standard for weight loss. However, recent studies have revealed that this particular operation can lead to potential weight gain years later. Lenox Hill Hospital’s Chief of Bariatric Surgery, Mitchell Roslin, MD, was the principal investigator of the Restore Trial – a national ten center study investigating whether an endoscopic suturing procedure to reduce the size of the opening between the gastric pouch of the bypass and the intestine could be used to control weight gain in patients following gastric bypass surgery. The concept for the trial originated when Dr. Roslin noticed a pattern of weight gain with a significant number of his patients, years following gastric bypass surgery. While many patients could still eat less than before the surgery and become full faster, they would rapidly become hungry and feel light headed, especially after consuming simple carbohydrates, which stimulate insulin production.

The results of the Restore Trial, which were published in January 2011, did not confirm the original hypothesis – there was no statistical advantage for those treated with suturing. However, they revealed something even more important. The data gathered during the trial and the subsequent glucose tolerance testing verified that patients who underwent gastric bypass surgery and regained weight were highly likely to have reactive hypoglycemia, a condition in which blood glucose drops below the normal level, one to two hours after ingesting a meal high in carbs. Dr. Roslin and his colleagues theorized that the rapid rise in blood sugar – followed by a swift exaggerated plunge – was caused by the absence of the pyloric valve, a heavy ring of muscle that regulates the rate at which food is released from the stomach into the small intestine. The removal of the pyloric valve during gastric bypass surgery causes changes in glucose regulation that lead to inter-meal hunger, impulse-snacking, and consequent weight regain.

Dr. Roslin and his team decided to investigate whether two other bariatric procedures that preserve the pyloric valve – sleeve gastrectomy and duodenal switch – would lead to better glucose regulation, thus suppressing weight regain. The preliminary data of this current study shows that all three operations initially reduce fasting insulin and glucose. However, when sugar and simple carbs are consumed, gastric bypass patients have a 20-fold increase in insulin production at six months, compared to a 4-fold increase in patients who have undergone either a sleeve gastrectomy or a duodenal switch procedure. The dramatic rise in insulin in gastric bypass patients causes a rapid drop in glucose, promoting hunger and leading to increased food consumption.

“Based on these results, I believe that bariatric procedures that preserve the pyloric valve lead to better physiologic glucose regulation and ultimately more successful long-term maintenance of weight-loss," said Dr. Roslin.

http://www.lenoxhillhospital.org/press_releases.aspx?id=2106