What Can Cause Weight Gain After Gastric Bypass?
Just about everyone has heard of a relative or friend of a friend who had weight loss surgery and “gained it all back.” The truth is, studies show that roughly half of bariatric patients regain weight, but not as much weight as you might think. Only approximately 5% of excess weight was regained after two or more years following surgery. When a patient has lost weight in the range of 100 pounds, or more, a regain of 5 pounds over time is perfectly normal. At some point, active weight loss will slow and your body will find a new normal. Portion sizes will grow from what you were able to eat in the early months after your procedure, and your body will enter a maintenance phase. This will be different for each patient, as every journey is unique.
While weight loss surgery is a great and effective mechanism for weight reduction, we try to stress that the surgical procedure is not magic. Your procedure, whether you choose the gastric sleeve or a gastric bypass, does not work independently of the effort you put in. The lifestyle changes recommended by our office include intense alterations to your diet and daily routines. While most patients are able to lose weight initially due to the mechanics of the procedure, without adhering to the modifications that need to be made, long-term success is less likely as the body adapts to its new anatomy.
I feel like I am regaining weight, where do we start?
When any bariatric patient is struggling with weight regain after surgery, we first evaluate if the regain is cause for concern. Sometimes when a patient is used to being in weight loss mode, a stall or slight regain can cause panic. Together, we will work together to determine if any regain you’ve had is normal and healthy, or if taking steps to redirect is appropriate.
If there is something to be done, we dive in by evaluating your diet and lifestyle. For most, old habits making their way back into daily life is the culprit. There are many foods that you can eat, but it doesn’t mean you should eat them. There are also bariatric specific changes we make, like avoiding drinking while (or shortly before or after) eating. We sometimes find patients have neglected to prioritize physical activity. As you establish your new life and new metabolism, it is important to incorporate healthy diet and exercise into your routine and let those both become life long habits. Once you reach a healthy weight, the journey isn’t over. If you neglect to keep up with healthy habits, you can regain weight.
Stress can also creep in, so sometimes we recommend working with a psychologist or counselor to help manage your mental health as well. Establishing routines and staying organized can also help you stay on track.
What if diet and lifestyle factors look good, but I’m still gaining weight?
For some patients, diet just isn’t the case. There are, albeit rarer, circumstances where the procedure itself has failed. For some, a physical change may have happened following the procedure and secondary surgery may be required to correct it.
One instance of this is a complication called a fistula where the body forms a new, alternate pathway from the one created during surgery. Here, the pathway to bypass the larger portion of the stomach or the upper limb of small intestine is not being followed meaning the surgery’s intended effects are not occurring. This complication is typically associated with other symptoms including abdominal pain or fever.
For patients who have specifically had the gastric bypass procedure, also known as the roux-en-y, a more minor complication called gastrojejunal stoma dilation can occur. During bypass surgery, the sphincter that sits at the bottom of the stomach, the pylorus, remains with the remnant stomach and a new connection is surgically created from the pouch to the small intestine. This new connection is gastrojejunal stoma. Studies have shown that this opening can widen, or dilate, and result in increased weight regain over time. This can be surgically corrected when necessary.
For others, a “failed procedure” means the procedure they choose initially may not have been the best fit for them. Revisional surgery, often to remove a lap-band and revise to a stapled procedure or to increase the restriction or amount of intestine bypassed, may be appropriate for some.
I feel like a failure and I don’t want you to judge or be disappointed in me!
Weight regain that is rapid or seems to come out of nowhere can be cause for concern, but any unwanted or unexpected regain is appropriate to bring up with your surgeon and care team. Never be afraid of disappointing us with what you perceive as “failure.” Bariatric surgery is not just a major surgical procedure, but also a tremendous life change. We are here to support you and help you, especially when you feel you have stumbled.
Successful bariatric surgery is typically defined in the bariatric community as 50% or more of excess body weight lost, sustained at 5 years post surgery. That being said, the way medicine measures “success” is different than a patient or individual provider might define it, and ultimately success is in the eye of the beholder. Patients are often more apt to identify and measure their success in terms of changes in health conditions or renewed ability to participate in life more fully.
When you gain a pound, or ever ten, remember how many pounds you have lost. You didn’t gain all of your pre-surgery excess weight in a day. You also did not lose it that quickly either. If you notice a change, reach out for support. We are here and ready to walk the journey with you.