Regain after Gastric Bypass

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jnmalsch
jnmalsch Posts: 21 Member
in Health and Weight Loss
I am finding it hard to find information on how to deal with regain after gastric bypass. How does it come off, do you need to do anything different etc... I am here #1 looking for those going through the same thing because I feel pretty alone in this and #2 to find other who have succeeded in losing the regain. Join me here if you are going through the same thing http://community.myfitnesspal.com/en/group/123661-regain-after-bariatric-surgery
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  • garber6th
    garber6th Posts: 1,894 Member
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    This is a good group of people who have been through the surgery process and going through the same things http://community.myfitnesspal.com/en/group/637-gastric-bypass-vsg-lapband
  • lucerorojo
    lucerorojo Posts: 790 Member
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    I read through Quasita's post. Thank you for explaining it. In her case she did go on pre-op diets, and in 6 months only lost 22 lbs. And she weighed over 400 lbs. Considering what MFP says, that one can lose 1% of one's body weight. At 400 lbs. + she should have been losing 4 lbs. a week, (16 lbs. in a month). In 6 months, she should have lost somewhere between 70-90 lbs. at her weight. Definitely, I can understand why the surgery was necessary in her case. Even under an extreme doctor monitored diet she was losing extremely slowly. At that rate, it would have taken her 4-5 years to lose 200 lbs--IF she could even do it without the surgery. And that's a big IF. With the surgery she lost 150 lbs. in just 9 months.
  • lynn_glenmont
    lynn_glenmont Posts: 9,996 Member
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    Quasita wrote: »
    lynn_glenmont wrote: »

    Serious questions, because I've never understood how this is supposed to work:

    Suppose a WLS patient is perfectly compliant, does everything right, and reaches a healthy weight, eating 800 to 1000 calories a day. What do they do then? Surely they don't continue eating such a small amount and drift down to an unhealthy underweight situation? Do they have to have another surgery to reverse whichever WLS they had, so they can eat enough to maintain a healthy weight? Or do they then have to start eating eight or 10 times a day so that they can consume enough calories in the small "meals" that their post-op condition allows? What if they decide to become more physically active now that they have lost weight -- is it even possible to eat often enough in those small amounts to sustain an active lifestyle and, say, training for a half-marathon and not go on losing weight?

    Also, if the prospective WLS patient learns all these great techniques and loses weight pre-op (which in my understanding is required to get the surgery, or at least to get insurance to pay for the surgery, to demonstrate an ability to adhere to the post-op regime), why can't the patient just continue with those techniques and continue losing weight without surgery, with taking on the risk of surgery (and all surgery involves risk)?

    1. A perfectly compliant WLS patient will not lose all of their weight on 800-1000 calories a day. A perfectly compliant WLS patient incrementally increases their intake to a normalized amount of food over time. I can only speak to a gastric bypass in detail, so we'll use that as an example... all my statements, as it were. Keep in mind that there are many different kinds of surgery, including a few that allow for no change to intake calorie amount.

    Initially after surgery, a patient may have an intake of 0-300 calories per day, focusing on protein shakes and water only. As the first weeks go by, you add fluid ounces. At about a month out, you're looking at 3 shakes a day, which is hovering 400-600 calories per day, depending on your shake option. By 6 months, most people are in that 800-1000 range, but they don't stop there. Calorie intake increases as the volume increases for each meal. Initial meals are 1-2oz in size, by 6 months they are 4oz, and so on. No WLS patient following the protocol that seems to be pretty standard across the programs I'm familiar with would ever continue on an 800-1000 for longer than *maybe* the first year.

    The FDA guidelines for post-op WLS patients is that a patient not maintain on a diet under 1100 calories, this being with heavy supplementation. The expectation is that with time, your stomach will naturally loosen, relax and expand to accommodate 8oz+ of volume at one time... which is still 1/5 of the normal stomach, but accommodating. Someone who gets a sleeve, for example, their post-op stomach is 6-8oz and they are immediately able to eat more and tend to stop losing weight earlier as their diet normalizes. To put it in perspective, your typical frozen dinner is 10oz. You have two of those plus some breakfast, you're already at 1100 calories easily, unless you're making a concerted effort to eat less than that.

    Anyway, after only maybe 2 months, you are re-introducing normal foods stage by stage, and eventually will eat basically a smaller version of a well-rounded diet. Smaller particularly in comparison to pre-surgery diet, but not necessarily distinctly noticeable from the average diet. Plenty of normal people eat a routine 1600 calorie diet.

    WLS is not intended to bring a patient to a healthy weight either. At most, with the most aggressive surgery available, you're talking about maybe an 80% excess weight reduction attributed to the surgery itself. All patients that reach a healthy weight did so out of perseverance and personal commitment to a healthy, balanced diet after their stomach and diet have normalized.

    Just like non-surgical weight loss, the maintenance calories changes as the weight reduces... The intake number, however, is different. Non-surgical people routinely drop their intake to continue the loss pattern, whereas surgery people routinely and systematically increase their intake over time after surgery. As you get closer to goal, the difference between intake and maintenance numbers decreases, until they are one in the same. While it may be true that surgery lowers that maintenance number (this is not a founded statement, just a conjecture if anything, but it would make sense to me), it would not be down to anorexia nervosa levels (average AN patient eats 900 calories a day).

    It's not as hard as you might think to add an extra protein shake or what have you on high exercise/activity days. Even at my stage, I'm able to accommodate if necessary.

    However, it's rare to have a WLS reversal. Most of the surgeries cannot be reversed. My option of reversal is simply because I've had malnutrition issues in the past... so it came up as a concern. Most patients are able to go on and exercise, have babies, the whole deal of life without excessive concern of appropriate intake.

    2. When it comes to a patient succeeding in the pre-op program, you have to remember that pre-op weight loss is very small for most. Most programs do require some weight loss... Some insurances put a number to that. However, most programs, at the least, require stable weight more than anything, and the majority of pre-op weight loss tends to happen in the pre-surgery prep diet, in the last 2-4 weeks before surgery, because you go from a balanced diet to full liquids (well, many of us do, this tends to depend on the program you're on).

    If you were extremely successful before surgery with the training you get there, I think you'd actually be unlikely to get insurance approval for surgery, because it would be an indicator that all non-surgical avenues have not been exhausted and proven to fail. A patient that still insisted on surgery in this situation would possibly also fail their psychiatric evaluation because they would not be able to recognize important indicators of success and failure.

    Standard requirement is that you have to have an established history of failed weight loss under monitored supervision... This is sometimes taken from the pre-op prep courses, yes, but failure would be weight loss that doesn't match the documented deficit. It does happen.

    For example... I did pre-op diet for a long time rather than just 2 weeks. I did 2 protein shakes a day (breakfast and lunch) with a piece of cheese for a snack and a high protein dinner with veggies for 5.5 months. In that time frame, I lost about 10 lbs. I weighed 440lbs, and was regularly exercising as well. I switched to full liquids 2 weeks beforehand, and in those 2 weeks, I lost another 12 pounds. So, in the course of 6+ months of eating a major deficit, I lost only 22lbs, which was statistically, significantly less than what I should have lost. RNY changes how you metabolize sugars, carbohydrates and how you absorb some fats, along with the restriction, and that's what we attribute my weight loss change to, more than anything.

    I hope this helps at least a little bit. I can't speak to why everyone chooses to do what they do... I can say that I've met a number of people that should never have been approved for surgery. I strongly believe that a person should go through counseling for more than just an evaluation pre-op... Have to really dig in to the why of their food habits. I spent 5 years overall preparing and considering surgery, but made the decision to do it a year and a half ago. I don't regret it at all.

    Editing to add:
    As with all surgeries, medications and procedures, utilizing the method is considered and determined to be in a state where the benefits outweigh the risks. You don't get to have WLS just because you asked for it, and you don't get to have it simply because you're overweight. Not all insurance companies are the same... Mine asked for a BMI of 35+ or 30+ with comorbidities... My BMI at the time was over 50 but I still got rejected initially because insurance said I wasn't sick enough... Even though there was no pre-op weight loss requirement or anything specific, that was all my surgery program. Insurance did eventually require me to prove that I quit smoking though.

    Generally speaking, WLS is considered an option for the extremely obese or for those that have illnesses that warrant an aggressive approach to weight loss. Yeah, there are people with only 50lbs to lose that go have surgery (I know I said "only" but in comparison to some WLS patients, this is a tiny amount) but there are reasons for everyone. Sometimes the reason is that the weight loss simply cannot wait for standard approaches and Weight Watchers. For cases like mine, studies are demonstrating more and more that excessive obesity, at a certain point, practically requires medical intervention in some form.

    Like me, even if I had never had WLS, I would still need medical help because I'll have to have my abdominal muscles tightened and a lot of skin removed. Overall though, I'm proud of both of my weight loss eras, and I feel the whole effort was worth it in the end.

    Thank you for all the information, and I'm glad you've had so much success.

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