Question:
Any theories as to why some WLS patients gain weight over the years?

I'm just curious and I know I'm putting the cart before the horse as I am only 5 months postop and not even close to my goal. Occasionally I hear of people that have had the more updated surgeries like RNY but are gaining weight after a few years. Does anybody have any theories or facts as to why this happens? Have they stopped exercising after the weight loss? Does the body eventually adjust to the surgery and lower metabolism after a few years? Is it the result of surgery failure or patient noncompliance? Does the patient slip back into some old habits? If the surgery works well enough to help the patient lose weight why doesn't the patietn always keep the weight off? I don't want to tick anybody off with this question, I just want to do everything I can to keep the weight off once I get it off. I personally know a lady that had prox RNY (which is what I had also). She is almost 2 years postop and has gained about 30 lbs in the past year after losing around 100 lbs (I know sometimes if someone is underweight they might gain a little weight but this wasn't the case for her). I don't have the nerve to ask her why she gained the weight but I know she hurt her foot and probably wasn't able to exercise for a while. Please, when answering this question I don't really want to read a bunch of "my surgery is better than your surgery" posts that seem to prevail on this site. I'm sure there have been distal RNY and DS patients who have gained weight also.    — Kellie L. (posted on August 19, 2000)

August 19, 2000
You're very intuitive to recognize that yes, any surgery type can regain weight "IF" they're on a collision course to fail.. WLS is a tool.. If you start treating it like a cure.. then you will fail... The ones that I have seen gain some of their weight back have slipped back into old habits prior to surgery.. Yes, your new anatomy will figure out the new plumbing (that's a fact with "ANY WLS" surgery VBG, RNY (all forms) and DS) and adjust accordingly, to do what ever necessary to get more food intake.. Why do you think there is a "Window of opportunity" Use that window to reeducate yourself and your way of eating and you WILL succeed.. Now, having finished my preaching session ..Here is another possible idea to consider..If you're staying with the dietary program, eating what you're suppose too etc., exercising, and 64 oz of water day, and are not loosing weight and maybe even starting to gain some back and don't have the divided procedure on your RNY have your pouch staples checked for migration. You might want to visit with Michelle Currin on this she is very knowledgeable on that subject. I had the Fobi procedure (which is divided) and I don't expect that problem to arise, however, if it were to happen, I would be having it checked out..
   — Victoria B.

August 19, 2000
Hi Kelli... I had the DS. This was a big concern for me in the beginnign. I questioned my surgeon relentlessly about it. He assured me, that with all of his patients, all of which he keeps up with, the most late regain has been about 8 lbs. There were several of his patients who came to see me in the hospital... some were 5-10 yrs post-op and this was not an issue for them. Hope this helps.
   — Kris S.

August 19, 2000
Kellie, I'm 3 1/2 months post-op and shared you concerns. I used to always say "diets don't work." Well, diets CAN work, they just never worked for me. My college roommate lost 70 lbs and has kept it off for the last 7 years. She doesn't starve herself, just eats healthy and exercises. There are people out there (obviously not too many) that have been successful with dieting alone. Just like there are long-term successes w/ VBG, RNY, DS and other WLS. But there are also people who will have late regain with each procedure. Just the law of averages at work. NOTHING is 100%. I had the proximal RNY too. What I've tried to do is find successful post-ops (5+ years out) to find out what works for them. Their answers are pretty consistant. They seem to stay pretty faithful to the vitamins/protein/water and sensible eating program that got them there. I recognize that I'll eventually be able to eat more and tolerant a higher level of fats and sugars. So yes, your body does adjust. That's why there's a 18-24 month "window" for weight loss before you stabilize. That's ok as far as I'm concerned. My intention has always been to develop good eating habits (which I never had.) I came into this knowing that that would be the key to my success. Just remember MOST people succeed. Why would you think that you won't be MOST people?
   — Maxine E.

August 19, 2000
All of these answers are good ones. What I would add woudl be a simple list of the people I know personally. But first, there is a sort of "bounce back" for many. 5-10 lbs from the bottom wt to the stable wt. And that seems to be healthy. My low was 104, my stable wt was 112. I'd have PREFERRED 98, but hey, apparently this is not a democracy, huh? REgain is a very frightening thing. We see it first with staple line disruption. It's awful, but it happens to many and it happened to me. I guess I was one of the lucky ones in that the excess acid roaming freely nauseated me so much that I only regained 12# before I managed to get a revision. The other most common thing we see in these parts is lousy post-op nutrition. Patients who are not taught or who ignore the teaching on proper Fear of Sugar become casual about it and regain. Not being properly supplemented leads to irresistible cravings, usually sugar. I've seen even those as distal as I am regain 50 or more # when they drop low in protein and the sugar cravings drive them batty. Also, the lack of good nutrition can cause the body to try to "right itself", but stretching the pouch and elongating whatever common channel you do have. While I've heard some docs want you to try to normalize ASAP, that would NOT be what I would want! The whole object of RNY is malabsorption, so you defintely don't want to do anything to make your body work really hard to absorb more! But then, I look at everything from a nutritional standpoint, I think. Finally, grazing or drinking with meals can cause you to get MUCH more food on board, which in effect bypasses your bypass. And the side effect of that is that you never feel "satisfied", which is, after all, what we've been seeking all our lives anyway.
   — vitalady