Before undergoing bariatric weight loss surgery, it is hard to imagine that we can become one of the “those people” who gain weight after losing it with the help of surgery. Unfortunately, at some point, most patients who undergo gastric surgery as their last hope of losing weight eventually regain some weight. It can happen quickly and without fanfare. Here are three red flags to watch out for that can lead to weight regain:
- Consume soft carbohydrates. Over the past 10 years, countless bariatric patients have told me: “At first it seemed harmless to eat some pretzels (crackers, chips, cookies, etc.), but soon I ate them all day and the weight started to regain.” This is a common mistake weight loss surgery patients make that eventually leads to regain some weight previously lost with weight loss surgery. We turned to soft carbohydrates because, in most cases, they are comfortable in the stomach pouch, they taste good, and they are readily available. Unfortunately, soft carbohydrates defeat the function of the stomach pouch. When we eat a meal based on lean proteins and vegetable carbohydrates, the food remains in the stomach pouch and we feel a feeling of fullness or tightness that tells us to stop eating. Soft carbohydrates on the other hand pass quickly through the bag and the feeling of fullness is not achieved, so we can eat soft carbohydrates seemingly all day. The first rule of thumb for weight loss surgery is “Protein First” and rule number three is “Don’t snack.” Remembering these rules will help us refrain from eating processed soft carbohydrates, a habit that can lead to weight gain in bariatric patients.
- Drink liquids with meals. In general, bariatric patients are instructed to stop consuming fluids 30 minutes before and 30 minutes after eating. Also, they are told to refrain from drinking beverages with meals. Fluid restrictions are intended to keep mealtime focus on a high-protein diet from lean animal, dairy, and plant-based proteins. Protein-rich food fills the stomach pouch and maintains satiety better when there is no fluid. When we consume drinks with our lean protein meal, the food is washed through the stomach pouch before being fully digested. Nutrients are lost as food is washed away and hunger returns more quickly. As we move forward after weight loss surgery, we tend to loosen fluid restrictions because eating food without fluid is not comfortable and conversation over dinner is difficult with a dry mouth. An occasional small sip of water with meals may be acceptable and you are unlikely to gain weight. However, going back to drinking completely with meals almost always leads to a weight loss plateau or eventually weight gain.
- Avoiding the scale. During the first weeks and months after weight loss surgery, patients find themselves weighing frequently because it is exciting to measure our weight loss on the bathroom scale. In fact, for some patients in the weight loss phase, the relationship with the scale becomes almost an obsession. Unfortunately, like lifelong dieters, bariatric patients intuitively know when the pendulum has swung from losing weight to gaining weight. Avoiding the bathroom scale is a strong red flag that weight gain is imminent. This is understandable, we have worked hard to lose weight and avoiding the scale allows us to deny or ignore what we already know: we are gaining weight. Patients who establish a weekly weigh-in ritual on the same day each week at the same time and in the same location tend to be more responsible for weight gain and are more likely to correct behaviors that lead to weight gain at one stage early. Patients who find they avoid the scale are encouraged to self-assess to identify the cause of the weight gain and quickly correct behaviors.
Before weight loss surgery, we are told that gastric bypass, adjustable gastric band (gastric band), or gastric sleeve procedures are just one weight loss tool. We are instructed to adopt a lifestyle that includes modifications in diet and physical activity. This new lifestyle must be followed for the rest of our lives to maintain weight loss and achieve better health. As much as surgery is a tool, humans are also prone to the ups and downs that we call life. Red flags are also tools – warning tools – that when observed give us the opportunity to make a correction and move in a favorable direction.
