Before undergoing bariatric surgery for weight loss it is hard to imagine that we could possibly ever become one of “those people” who gain weight after losing it with the help of surgery. Sadly, at some point most patients who have gastric surgery as their last hope for weight loss eventually regain some weight back. It can happen quickly and without fanfare. Here are three red flags to watch for that may lead to weight regain:
- Snacking on Soft Carbs. Over the last 10 years countless bariatric patients have told me, “It seemed harmless at first to eat a few pretzels (crackers, chips, cookies, etc.) but pretty soon I was eating them all day and the weight started coming back.” This is a common mistake made by weight loss surgery patients that eventually leads to regaining some weight previously lost with weight loss surgery. We turn to soft carbohydrates because, in most cases, they are comfortable in the stomach pouch, they taste good, and they are readily available. Unfortunately, soft carbohydrates defeat the function of the stomach pouch. When we eat a meal of lean protein and vegetable carbohydrates the food stays in our stomach pouch and we feel a sense of fullness or tightness that signals us to stop eating. Soft carbohydrates on the other hand pass quickly through the pouch and the sensation of fullness is not achieved, therefore we can eat soft carbohydrates seemingly all day. The first rule of weight loss surgery is “Protein First” and rule number three is “No Snacking.” Remembering these rules will help us refrain from snacking on soft processed carbs, a habit that may lead to weight gain for bariatric patients.
- Drinking Liquid with Meals. Generally speaking bariatric patients are instructed to cease consumption of liquids 30 minutes before and 30 minutes after eating. In addition they are told to refrain from drinking beverages with meals. The liquid restrictions are intended to keep mealtime focus on a high protein diet of lean animal, dairy and vegetable protein. The high protein food fills the gastric pouch and sustains satiation best when liquid is absent. When we consume beverages with our lean protein meal the food is washed through the gastric pouch before fully digested. Nutrients are lost as food is washed away and hunger returns more quickly. As we advance following weight loss surgery we tend to relax the liquid restrictions because it is not comfortable to eat food without liquid 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 the return to full drinking with meals almost always leads to a weight loss plateau or eventually weight gain.
- Avoiding the Scale. During the early weeks and months following weight loss surgery patients find themselves weighing frequently because it is exciting to measure our weight loss on the bathroom scale. In fact, for some patients in the phase of weight loss the relationship with the scale becomes a near-obsession. Sadly as life-long dieters bariatric patients intuitively know when the pendulum has swung from losing weight to gaining weight. Avoiding the bathroom scale is a loud red flag warning that weight gain is imminent. This is understandable, we have worked hard for weight loss and avoiding the scale allows us to deny or ignore what we already know: we are gaining weight. Patients who establish a weekly ritual of weighing on the same day of each week at the same time and place tend to be more accountable for weight gain and more likely to correct behaviors leading to weight gain at an early stage. Patients who find them self avoiding the scale are encouraged to engage in 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 (lap-band), or gastric sleeve procedures are only a tool for weight loss. We are instructed to adopt a lifestyle that includes dietary and physical activity modifications. This new lifestyle is to be followed for the rest of our life in order to maintain weight loss and achieve improved health. As much as the surgery is a tool, so are we human prone to the ups and downs we call life. Red flags are also tools -warning tools- that when observed give us opportunity to make a correction and move forward in a favorable direction.