Everyone who contemplates weight loss surgery hopes that their weight loss struggles will end. For many people, the struggle continues and some will gain all of their weight back. There is not one cause of weight gain, but many that contribute. Below are the top 6 causes of weight gain after weight loss surgery.
In the 10+years I have spent as a bariatric dietitian I have had more patients than I can count come into my 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 that they have returned to their old habits.
I hear many patients say “after the surgery, I did x,y, and z”. “I used to” is a common phrase used. Now they 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.
Top 6 Causes of Weight Gain After Weight Loss Surgery
- 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 fewer 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. The longer you go without eating the hungrier you will become. Hunger leads to overeating and/or poor food choices.
- Snacking on junk foods: A lot of my patients crave salty and crunchy foods. My theory is that (1) many postoperative 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!” Another issue is that snack foods are easy to tolerate. Food that crumbles or melts won’t take up a lot of room in your small stomach, which makes them easy to eat and easy to overeat. 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 as 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. Even though the percentage is low, 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. Exercise builds muscle which is metabolically active. This means that the more muscle you have the more calories you burn at rest. Basically, your metabolism becomes more efficient.
- Unbalanced meals – eating too many carbohydrates and not enough protein. The optimal composition of a meal for satiety is protein, carbohydrates, and healthy fats. This combination increases 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.
This post was originally published in 7/2015. The post has been updated as of 1/28/2019
Judy says
I had a gastric sleeve done 5 years ago and know I’m have stretched my stomach - I have regained 22kg of the 37kg I lost and am getting more and more depressed. Is it possible to have another sleeve surgery or does the fact that my stomach has stretched mean the stomach is now too thin?
Jennifer Lynn-Pullman says
Hi Judy, So sorry to hear that your weight loss hasn't been what you expected. I would reach out to your surgeon in order to have your sleeve evaluated. You can then discuss your next step. The surgeon's I have worked for would not do another sleeve, but generally convert to a bypass is possible.
Elizabeth says
Hi I had my sleeve done close two years
My question is how would know if stretched your stomach?
Jennifer Pullman says
Your surgeon would like do some test to see if your pouch has enlarged.
Angela says
Hi,I had gastric by pass surgery in 07 and I kept the weight off until I got pregnant . I was on bed rest with my daughter for my entire pregnancy and I gained 40 plus pounds. Just when instated to lose weight , I got pregnant with my son. My children are 10 months apart. I gained well over 80 pounds. Now I'm not making excuses, I know what happened too many calories in and not enough out . Poor food choices and I went from being completely active to being a stay at home mom , stuck in the house. Depression did sink in. My question is , if I follow a strict diet and exercise, will I start to see weight loss again? I'm unsure how to restart. Thank you
Jennifer Pullman says
Hi Angela! I think with the right food choices and proper exercise (cardio with resistance training) you can lose weight. Weight loss is 80% diet, so I would first examine your eating and see how you can improve it. Focus on protein and plants (fruit/veggies).
EC DC says
Junk foods and snacking are my problem ;/.
Jennifer Pullman says
Snacking is something that you need to get a handle on before you have surgery. Snacking especially on junk food after surgery will cause you to struggle.
Jodi Thompson says
I am 11 years out and for the most part, I'm within 10 pounds of what I weighed after I had my surgery goal, but NOW I've developed allergies to so many things including gluten, dairy, have to eat non-GMO, and grass fee items. What are your suggestions? I don't like the gluten-free items because a lot of them have so many carbs and sugars and to much sugar makes me sick. Any suggestions or recipes? I haven't seen or talked to a dietician in forever and don't take my vitamins anymore.
Jennifer Pullman says
You may want to reach out to the dietitian at your surgeon's office. I still see patients who had surgery years ago. If not, a dietitian in your area who specializes in food allergies. You definitely should still be taking your vitamins. This is for life!
Harleen Van De Car says
I just had my bypass 1 mo ago. I'm having an extremely hard time taking in protien as well as fluids. Every thing has to be room temperature n can't be over 2 oz at a time. I'm so frustrated because the wt seems slow going down. I loved the protien shakes but now they're too sweet. So I dilute it with nonfat milk. N then I can tolerate it but not more than 2 oz in 30-45 mim. Any suggestions?
Tanya says
I had sleeve surgery in 2016 over the last year I have gains 15 of the 70 that I had lost. Do you have any list of after surgery foods. I just want to eat all the time. How do I get back in track?
Ashley S says
I am 3 years out RNY and I am slowly regaining. I only lost for about 6 months after surgery and I have been around the same weight ever since. Lately the pounds are creeping back up. I have tried pouch reset and medications from my doctor. Not helpful. I am going to ask about a revision but I do not know if they will consider that????
Jennifer Pullman says
You would need to talk to your surgeon, however, I don't think a revision would be possible. After RNY there is nothing to revise to unless your pouch was too big.
Jennifer Asselin says
Hi there,
Do you do nutrition counseling on zoom or some other method of video chatting? I'm in sc and need a good nutritionist. Not quite 2 yrs from sleeve and have gained 25 pounds back....I NEED HELP
843 446 8204
Thanks, Jennifer
[email protected]
Jennifer Pullman says
Dietitians are licensed per state. I don't have a license in SC. You can check with your surgeon or insurance for a referral to a local RD.
Nicole says
I had gastric sleeve 09/2017 and I’m gaining weight. I know I’ve started up some of my old habits and not exercising. I was afraid that I stretched my stomach but the surgeon didn’t do any test but told me he doesn’t think I stretched that the remove the stretchy part when they do the sleeve that makes it harder to stretch.
I’m going to start eating heathy again and exercise starting Monday b/c I don’t want to gain all my weight back.
Do sleeve resets work? Do you recommend them to get you back on track? Or is it better just to start eating heathy? I just wonder which is more effective to get me on track.
Jennifer Pullman says
Most surgeons do say that it's pretty tough to stretch the stomach after surgery. As far as resets go plenty of patients do them. Is it a magic fix? No. Resets are generally safe as long as they are only done for a short period of time. The only thing I think a reset does is help you stop eating all the not-so-healthy foods that you may have started eating. You are basically starting over.