In the eight years I have spent as a bariatric dietitian I have had more patients than I can count come into the office or call me, because years after their weight loss surgery they are gaining weight. Often patients are surprised and think that there is something wrong with their stomach/surgery. Most of the time (99.9%) there is nothing anatomically wrong with the patient. What is wrong is how they are eating.
I hear many patients say “after the surgery I did x,y, and z”. Now I don’t do those things. Maybe they used to make sure they drank enough water, now they don’t. Maybe they made sure they ate three meals a day, but now they skip meals. I find that patients are very diligent after the surgery for fear of getting sick or “messing up” the surgery. As years go by, patients find that they feel normal and they don’t get sick. Diligence fades away and not so good habits creep in. Weight loss surgery patients who gain weight generally are not doing one thing wrong. There are usually multiple factors.
- Skipping meals: when you skip a meal you miss out on the calories and nutrients your body needs at that time of day. You physically cannot eat more at your next meal like you may have done prior to surgery. Eating less and less calories will not help you lose more weight. You will actually stop losing weight and decrease your metabolism. A lower metabolism at some point in time will equal weight gain.
- Snacking on junk foods: A lot of my patients crave salty and crunchy foods. My theory is that (1) many of a post-operative meals consist of softer foods and you simply want to bite down and hear that crunch of a pretzel or chip. (2) with a better eating pattern many patients have very low sodium diets. This is great, however for some, their bodies are trying to tell them, “hey I need some salt in here!” The problem though is that the snacking becomes more frequent and causes healthy foods to decrease in the diet. More food is being consumed that is not of great nutritional value.
- Drinking calories: liquids do not fill you up like food does. Beverages that contain calories will add up and can easily create excesses that lead to weight gain.
- Not exercising: weight loss is said to be approximately 80% diet and 20% physical activity. Exercise is important to weight loss and to weight maintenance. In my experience exercise becomes more important in the maintenance phase then the losing phase.
- Unbalances meals – eating too many carbohydrates and not enough protein. The optimal make up of a meal for satiety is protein, carbohydrates and healthy fats. This combination increased your level of fullness and leaves you fuller longer.
Once you lose weight following your surgery your journey does not end. You need to continue to be mindful by monitoring what you eat, how much you weigh, and how you exercise. Weight loss surgery is just a tool. Surgery will only get you so far. It’s up to you to use that tool wisely.