Before undergoing bariatric weight loss surgery, it is hard to imagine that we could become one of “those people” who gain weight after losing it with the help of surgery. Unfortunately, at some point, most patients who undergo gastric surgery as a last hope for weight loss eventually gain some weight back. It can happen quickly and without fanfare. Here are three red flags to watch out for that can lead to weight regain:
- Eat soft carbohydrate snacks. Over the past 10 years, countless bariatric patients have told me: “At first it seemed harmless to eat some pretzels (crackers, chips, crackers, etc.), but pretty soon I was eating them all day and the weight started to come back on.” This is a common mistake weight loss surgery patients make that eventually leads to regaining some of the weight previously lost with weight loss surgery. We turn to soft carbs because, in most cases, they feel comfortable in the stomach pouch, taste good, and are readily available. Unfortunately, bland carbohydrates shut down the function of the stomach pouch. When we eat a meal rich in lean protein and plant carbohydrates, the food stays in the stomach pouch and we feel a feeling of fullness or tightness that tells us to stop eating. Soft carbs, on the other hand, quickly pass through the bag and a feeling of fullness is not achieved, so we can eat soft carbs seemingly all day. The first rule of weight loss surgery is “Protein First” and the number three rule is “No Snacking”. Remembering these rules will help us refrain from snacking on bland processed carbohydrates, a habit that can lead to weight gain in bariatric patients.
- Drink liquid with meals. Generally speaking, 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. The fluid restrictions are intended to keep the mealtime focus on a high-protein diet of lean animal, dairy, and vegetable proteins. High-protein food fills the gastric pouch and maintains satiety better when there is no fluid. When we consume beverages with our lean protein meal, the food is washed out through the gastric pouch before being fully digested. Nutrients are lost as food is eliminated and hunger returns more quickly. As we progress after weight loss surgery, we tend to relax fluid restrictions because eating food without fluid is uncomfortable and dinner conversation is difficult with a dry mouth. An occasional small sip of water with meals may be acceptable and is unlikely to cause weight gain. However, going back to full drinking 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 weigh themselves frequently because it is exciting to measure our weight loss on the bathroom scale. In fact, for some patients who are losing weight, the relationship with the scale becomes almost an obsession. Unfortunately, as lifelong dieting bariatric patients we intuitively know when the pendulum has swung from losing weight to gaining weight. Avoiding the bathroom scale is a strong warning sign 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 getting fat. Patients who establish a weekly ritual of weighing in on the same day each week at the same time and place tend to be more responsible for weight gain and are more likely to correct behaviors that lead to weight gain at an early stage. Patients who avoid the scale are encouraged to participate in a self-assessment to identify the cause of weight gain and correct behaviors quickly.
Before weight loss surgery, we are told that gastric bypass, adjustable gastric banding (gastric banding), or gastric sleeve procedures are just a 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. Just as surgery is a tool, humans are prone to the ups and downs we call life. Red flags are also tools -alert tools- which, when observed, give us the opportunity to make a correction and move in a favorable direction.