Bariatric Regain

It may be surprising for patients to learn that weight regain after gastric bypass is the most common post-operative complication. Many patients are told about the possibility of blood clots, leakages, or other surgical complications but the topic of regain is rarely discussed in detail. When the topic is broached it is usually given as a stern warning with no real support mechanism to help prevent the complication. These warnings are disguised as “make sure to follow the program regiment or you will have regain”. What happens when a person follows the program regiment perfectly and still has regain? Then what? That is what this article will discuss.

Regain and its stigmata, for better or worse, have at its core an assumption that the patient failed to comply. In most cases this assumption may be true. However, to say that all regain is associated with non-compliance of a regime is to say that all obesity is caused by chocolate. The reason for regain varies as wildly as the reasons for obesity itself.

Non-Compliance:
Non-compliance occurs when a patient fails to follow the regime set-forth by his/her surgeon. The programs are designed to help guide the patient to lose weight and therefore failure to follow the regime may result in weight regain. The amount of weight regain can vary depending on the severity of the non-compliance.

If a patient is only gaining slight amounts (less than five pounds) the surgical office or general physician might not consider this actual regain. Body weight can fluctuate up to five or more pounds on any given month. However, any regain that continues should be discussed with a physician.

One problem with non-compliance is the accuracy of the data. Most patients do not record in detail (or honestly) their food records. This makes the diagnosis of non-compliance difficult. However, if a patient has continued to gain weight for a period of more than 60 days the patient needs physician (or support system) intervention.

Another problem with non-compliance is the consistency of the regimes within the industry itself. Many patients will seek out other post-ops to help them with the surgery journey only to find that practice requirements (regimes) can be drastically different from surgeon to surgeon. This can exacerbate an already challenging life journey. The best rule of thumb in dealing with informational sources is to cling to your own surgeon and his / her regime. However, the program should be flexible enough to support individuals with needs that might fall outside the norm.

If you are a patient, you are following your program regime, and you are still gaining weight please keep reading as not all regain is due to non-compliance. There may be physiological issues that are causing your regain.

The Honeymoon is Over:
The ‘honeymoon’ phase of weight loss occurs generally in the first 12 – 18 months post-surgery. During this time many patients have been quotes as saying “I could have drank a milkshake twice a day and still lost weight”. This may be true. The initial physical shock to the system produced by the surgery causes what might be called a “reset” to the system. This is very much like flipping the breaker on a power box. The body simply resets itself and begins to relearn how to function with the new physiological make-up. This period is known to post-ops as the honeymoon phase.

This is the time when patients enjoy the most physical weight loss and the amount of work required is normally much less. Most patients record weight loss with little or no effort. Once the honeymoon is over many post-ops begin to notice that weight loss stops completely or a slight regain takes place. This is normally when most post-ops begin to panic and seek help online. This is a dangerous time for any post-op. The post-honeymoon phase is also the time that hunger or ‘cravings’ return. This is the body’s way of saying, “I am done resetting myself and I would like some of my old favorites please”.

Be careful in this post-honeymoon phase. This is when most regain begins. A pound here and a pound there ads up over time and before you know it, you’ve gained thirty pounds. One way to avoid post-honeymoon regain is to weigh yourself weekly, record your weight, and avoid the old foods (triggers) that caused your obesity. “Trigger foods” are foods that do not satisfy hunger but instead feed a craving. Trigger foods can include: bread products, chocolates, chips, cookies, ice cream and any other product that has low protein and high calories.

Your Unique Situation:
When your surgeon performs a surgery on you they will do so with the best of skill that has been given to them. For the most part (99%) of surgeries are performed nearly the same way (universally). This ‘one size fits all’ seems like the right choice because it offers the greatest degree of expected outcome. However, you are as unique as your fingerprint and your biological make-up means you might fair very well with one surgery type but not another. What does this mean to you? This means you and your surgeon should discuss the best option for you. This means that no guarantee can be given because despite our best efforts to make one surgery fit all cases; this simply is not the reality of obesity.

Obesity is caused by many factors and is affected via regain by many factors. You may experience regain because your surgical choice was not the right choice for your body and that cannot always be known prior to surgery. One thing that surgeons will not tell you is there is a science and an art to practicing medicine. The science means there is a set of rules to be followed but the art means there are times when you have to adjust the rules to fit the patient. Your regain might not be your fault. There may be a need for a second procedure. Your condition may require your pouch to be smaller or may require a revision with a different surgery type. Many post-op patients consider ‘revision’ equal to failure and that is simply not the case. Revision surgery exists to help continue you on the journey of proper weight management and if you find yourself in this scenario, please do not allow the fear or stigma to stop you on your journey.

What is a Weight Loss Surgery Failure?
This condition exists when the surgery type chosen by you and your surgeon fails to help you achieve a healthy weight. There is no one set answer here but any scenario that does not allow you to reduce your BMI to a safe level is either an incomplete solution or requires further intervention (surgery, medication, diet and exercise). You will need to consult your surgeon if you feel your surgery has been a failure. Your surgeon may ask very tough questions about your compliance, your habits, and your lifestyle.

If you are to be successful, you have to be prepared to be honest with your surgeon and yourself. If you have not been able to reduce your weight below 35 BMI or you have regained weight above a 35 BMI, then you should consult your weight loss surgeon.

Should You be Ashamed of Weight Regain?
You should not feel shame for regain. Shame is not going to help you rebuild your self-esteem. Shame or guilt will not help you gain control of poor eating habits that might have crept back into your life. Instead of shame or guilt, you should feel pride in your achievements.

If you lost 100 pounds only to regain 20 pounds then you are still down 80 pounds! This is a remarkable achievement and do not allow yourself to feel shame. Consult your surgeon, a dietician, or other support person. The fact is, you may have gained muscle mass and not fat. Do not allow the scales to be the only method of measurement. Never allow the scale to be your measure of self-worth and never allow the scale to determine your success. Instead, measure your success in the amount of life achievements you can now accomplish.

Article by: Bo McCoy, a nine year employee of ObesityHelp, holds the position of Vice President of Operations. Bo earned an MBA degree from University of Phoenix and is presently seeking a Doctorate of Management at University of Phoenix. In 2012, Bo accepted a (part-time) position as an adjunct professor at Daymar College located in Ohio. Bo married Jill McCoy in 2012. Together, they two raise three children ages five, six, and seven. For fun, Bo likes to cruise and travel to new destinations. Recently asked what his retirement plans were he responded, “I don’t have any retirement plans…once I become a tenured professor, I plan to teach until the day I die”.