One of the greatest fears of patients seeking weight-loss surgery is the fear of weight regain. This is understandable considering that virtually every patient that has undergone weight-loss surgery has at some point been a “Yo-Yo Dieter” during their weight-loss journey.

It is not uncommon for a surgical candidate to relate stories of losing 10 pounds, 20 pounds, sometimes even 50-100 pounds with dieting attempts, only to see it return over time.

The good news is that with weight-loss surgery, the weight-loss seen post-operatively can maintain throughout a long period of time. However, it is important that patients keep in mind that obesity is a chronic disease that is not cured by surgery. Surgery provides a powerful tool for significant weight-loss, but without proper care “the tool” can lose its effectiveness, leading to weight regain.

There are several causes of weight regain after weight-loss surgery, most of which if addressed properly, results in a loss of the gained weight and resumption of weight maintenance. In this article, I would like to share with you my thought process in dealing with the patient who experiences weight regain.

Keys to Prevention of Weight Regain
The key to prevention of weight regain is education and follow-up. Both before and after weight-loss surgery, patients need to be taught how to use their surgery to optimize their success. The optimal education should involve counseling in dietary, behavioral health and exercise issues.

I believe one of the most important things that a program can do to promote long-term weight maintenance is to create an environment in the clinic where a patient feels comfortable coming, not only when they are doing well, but also when they are struggling. By creating an environment where patients feel safe to share their struggles, we can often intervene early-on before the patient regains a significant amount of weight.

When I initially see a patient who regained some weight, I congratulate them for having the courage to come in to see me. My main focus of the visit is to begin to get an understanding of whether their weight regain is due to an anatomical problem (something wrong with the surgery), a medical problem or a behavioral problem (returning to old habits). It is extremely helpful if the patient brings a food journal to the visit.

I find the following questions to be quite helpful when sorting out the issue of weight regain:

1. How many times a day do you eat?
2. How many times a day do you get hungry?
3. Do you ever feel full and if so, how long does it last?
4. How much can you eat in one sitting?
5. Are you having heartburn or reflux?
6. Have you started any new medicines?
7. How has your energy level been? Your sleep?
8. Are there any new or ongoing stressors in your life?
9. Why do you think you are regaining weight?

If a patient is suddenly able to tolerate much larger meals, experiences an increased frequency in the sensation of hunger or develops new or recurring acid reflux, then I am much more concerned that I am dealing with an anatomical problem (something wrong with the surgery). Anatomic problems are best diagnosed with an upper GI series or an upper endoscopy. The following are some anatomic causes of weight regain:

Anatomic

• Pouch dilatation
• Anastamotic dilatation
• Adjustable gastric band system problem (balloon leak, hole in tubing, port disconnection, etc.)
• Gastric-gastric fistula due to staple line breakdown

There are certainly some medical conditions that can lead to weight regain as well. I have listed some common ones below. Most of these will be diagnosed with a good medical history and blood work.

Medical

• Pregnancy
• Thyroid issues
• Adrenal issues
• New medications
• Kidney and/or heart problems

In my experience, anatomic and medical causes of weight regain after weight-loss surgery are rather uncommon, but they certainly should be considered. In the vast majority of patients, weight regain is the result of the patient slipping back into old, unhealthy habits.

The good news is that by intervening early and addressing the particular patient’s issues, we can often prevent the patient from regaining a significant amount of weight.

About the Author: 
Lloyd Stegemann, MD, is a private practice bariatric surgeon with New Dimensions Weight Loss Surgery/Weight Wise in San Antonio, TX. He was the driving force behind the Texas Weight-Loss Surgery Summit and in the formation of the Texas Association of Bariatric Surgeons (TABS) where he currently serves as President. He has been very active in the Texas state legislature trying to increase patient access to weight-loss surgery. Dr. Stegemann is a member of the American Society for Metabolic and Bariatric Surgery (ASMBS) and the OAC Advisory Board.

You can start improving your health today by choosing just one of these tips for good health . . . make it into a habit . . . and then part of your healthy lifestyle. You will be amazed at the quick results!

One: Drink more water - get yourself an easy to use water bottle. You want one that you can keep with you and that you like using. The bottle should hold at least 16 ounces of water. Fill the bottle each morning (add some freshly squeezed lemon if you like) and drink 16 ounces of water before you have your breakfast.

As you go through the day, drink three more 16 ounce bottles of water. Keep your water battle with you all the time. Take a little sip here and a little sip there. You will be surprised at how easy it is to drink four 16 ounce bottles of water each day. You will also be amazed how staying hydrated decreases your appetite and improves you health!

Why will this work for you? Your body is 70 percent water. When it's dehydrated your brain sends a signal that it needs water. To most people, this "feels like" a hunger pang. And so they do the natural thing, which is to eat. But then the brain sends another signal because the body still wants water. So more food is consumed . . . and the cycle continues.

When your body is well-hydrated and your stomach is partially filled with water, you will not want to eat as much food. You actually get full faster. People who are well hydrated eat 30 percent less food! That's a great incentive to drink more water, plus you are giving your whole body what it needs to function properly.

Two: Eat only whole grains - in this article I can't go into all the details about why whole grains are so much better for you. But know that whole grains were specifically designed by God to give your body what it needs for good health and to feel satisfied. White flour and white rice have been stripped of the most valuable parts of the grain. The only portion left is the starchy and flavorless portion. But whole grains retain all the goodness, make you feel full and more satisfied with less food, plus they provide your body with adequate fiber to keep your systems clean and balanced.

When you eat adequate portions of whole grains on a regular basis, you will very likely start clearing your body of harmful cholesterol. Plus, you will be more satisfied, eat less and lose weight.

Whole grains, along with fruits and vegetables, are excellent sources of fiber. The fiber isn't fully digested and instead works in your digestive system like little sponges to soak up and clear out excess cholesterol. If there is not enough fiber, the cholesterol goes back into your bloodstream and then starts causing a waxy buildup in the vessels which can lead to a heart attack or stroke. Adequate fiber clears the body of excess cholesterol so it can't go into the bloodstream.

Why will this work for you? Whole grains include the vitamins and micronutrients your body needs for optimal health. When your body doesn't receive what it needs then it is still hungry for the nutrients. You don't feel satisfied, even when you've had plenty to eat. So you try to satisfy the hunger . . . but if you aren't giving your body what it needs, the cycle continues and then you have weight gain.

Three: Go meatless one or two days a week - a little known fact: cholesterol is made in the liver - either by your own liver so your body had what it needs for good health (you do need some cholesterol in your system). Or it's made by other mammals and is in the animal products you consume and the cholesterol enters your body to be metabolized.

When people go on the Daniel Fast, a completely plant-based eating plan, they are often amazed that their cholesterol counts go downs so quickly. But most people don't want to adopt a vegan way of eating every day of their lives. However, you can choose to have one or two days a week "meatless." A growing trend is "Meatless Monday." The foods you can have are healthy, appetizing and satisfying!

You can also cut back on all high-fat foods to consume fewer calories and bring your body into better alignment with the way your Creator designed it to operate.

Why will this work for you? When you consume less food from animal products you reduce the amount of cholesterol you are bringing into your body. Plus, protein-rich foods from plants (beans, whole grains, green leafy vegetables, etc.) have the fiber your body needs to rid your system of excess cholesterol.

Four: Chew your food - I realize this sounds kind of silly. But the truth is most people don't chew their food very much. We've become a fast-food nation by quickly eating food that's been prepared quickly! I had to face this issue myself a few years ago when I realized I had the poor habit of eating too fast.

Food should be enjoyed! And a bigger bite doesn't taste any better than a small bite that can be chewed well. Studies show that people who chew their food well and eat slowly consume 30 percent fewer calories than those who don't chew their food well! Plus, digestion starts in your mouth. That's one of the primary functions of saliva - to start the breakdown of food.

Why will this work for you? When you chew your food well, you don't eat so fast. So your body has time to start the digestion process and time to tell your brain when it is satisfied (it takes between 15-20 minutes). You will enjoy your food better and you won't eat as much.

Five: Take a walk - you don't need to run a marathon to be in good health. Taking a 30 minute walk each day can give your body a significant boost for your improved health. Studies show that 75 percent of men and women who walk in the morning stick with their workouts after a year! That's motivating! Plus, walks in the morning keep you invigorated throughout the day as you gain more natural energy.

Regular activity also increases production of brain proteins that increases your mental acuity! Wow, that's great news! And, people who choose walking as their exercise plan are more likely to stick with it compared to those who choose different exercise regimes.

I am a walker. I have a treadmill for the very hot and very cold days . . . and I live on a country road that invites nice, long walks. When I'm on my treadmill I often listen to audiobooks and the time seems to whiz by. When I walk outside, I prefer to "prayer-walk" and have time with the Lord.

I recently read an article about a young Christian woman who started eating a healthy diet (as I've described here) and started walking using Leslie Sansone's Walk at Home DVD. She also use prayer and God's Word for motivation and guidance. In a little over a year she lost more than 149 pounds and significantly lowered her blood pressure! Her results are not unusual for men and women who commit to health for their lives. Many men and women use a modified Daniel Fast for their healthy eating plan with stunning results.

Why will this work for you? Our bodies are designed to move! But our lifestyles have become sedentary and slow. Plus, for most adults, time is at a premium. Walking can be a wonderful time to chat with your spouse or a friend or have quiet time for yourself. You can listen to teachings, worship music or talk with the Lord and pray. You will boost your energy level and if you walk in the morning your metabolism will be revved up to burn calories all day long!

I encourage you to choose at least one of these tips and practice it for the next week. As you work toward this change, pray to your Father and thank Him for the transformation that is taking place in you as you move toward health and vitality. Then next week, choose more healthy habits to adopt and continue on your road toward health until healthy habits become your lifestyle!

Hey Fam! I just uploaded some photos. I pray it moivates you the way it motivates me to see such awesome change. How are you guys maintaining in your journey so far?

I was reading this site and it was so empowering and I wanted to share a short blurb with you:

"When we fought to get the surgery we were personally empowered. We had to be, there aren't many advocates out there fighting on the behalf of the morbidly obese.

Yet somehow, if we get to comfortable in our post weight loss surgery life there is a tendency to lose that hell-bent determination. Perhaps we take it for granted. Maybe we just get bored or distracted. Maybe we get discouraged because life after surgery has not been without struggle. Any of these things can cause us to lose hope or feel like failures. I have gone through periods of sadness and suffered feelings of failure since my weight loss surgery. Don't we all? This despair only festers if we regain some weight or sit on a plateau for an extended length of time.

But just like we can work a plan to test the pouch and get back on track, we can mentally train our mind to get back to being hell-bent determined to take personal control of our health. http://www.5daypouchtest.com from Kaye"

This is why Support is necessary. We have to stay connected to a group of people that believe the way we beleive and want the same things. When you fall off the truck you need someone in your corner that is not going to condemn you but empowering you to pick yourself up, dust yourself off and don't look back but look forward. We are in this together but you have to develop the mindset and the heart that you can be victorious in this thing. You already have the tool....Now work it!

Coach Kahala B.