Expert Speak: How To Maintain Your Weight After Bariatric Surgery
Due to the decreased stomach capacity following bariatric surgery, a new nutritional strategy is essential.

Maintaining weight loss after bariatric surgery requires dedication and a focus on long-term lifestyle changes.

According to a 2018 report by the Obesity & Metabolic Surgery of India (OSSI), more than 20,000 bariatric surgeries are performed annually in India. The IFSO Global Registry report published in the same year confirmed India as the largest hub in the Asian continent for bariatric and metabolic surgery. It is the most effective treatment for long-term weight loss, with significant changes observed in 12-18 months post-surgery. Studies conducted in 2015 and 2017 found that a favourable outcome of bariatric surgery results in a loss of 50 70 per cent of excess weight (EWL), a 20 30 per cent reduction of the patient’s baseline weight, or a BMI of less than 35 kg/m2. Conversely, in 7 to 10 months post-surgery, 37 per cent of patients showed a weight regain of approximately 20 to 25 per cent of their initial loss, as revealed by the SOS study. However, mitigating the risk of weight regain is possible by adhering to straightforward yet effective strategies, thus ensuring the surgery’s long-term success.

Factors That Contribute To Weight Regain

Weight regain after bariatric surgery can be attributed to various factors, and understanding these factors is essential for long-term success. Here are the ten common contributors to weight regain and the failure of bariatric surgery:

  1. After bariatric surgery, some patients exhibit maladaptive eating behaviours, including grazing (uncontrolled snacking between meals), loss-of-control eating (compulsive eating when not hungry), and binge eating. Studies reveal that a significant portion of pre-surgery binge eaters shift to grazing behaviour after surgery. Grazing prevalence varies from 17 per cent to 47 per cent, linked to weight regain. Loss-of-control eating is associated with subjective distress and poorer outcomes, including weight regain.
  2. Overeating or eating too quickly can expand the stomach pouch created during surgery.
  3. Failing to incorporate regular exercise into the routine.
  4. Not following dietary and lifestyle recommendations from healthcare providers
  5. Neglecting essential vitamin and mineral supplements recommended after surgery
  6. Consuming calorie-dense liquids like sugary beverages
  7. Using food as a coping mechanism for stress or emotional issues
  8. Unresolved psychological issues or a lack of mental health support
  9. Not engaging in support groups or seeking help from healthcare professionals
  10. Developing medical conditions that affect metabolism or promote weight gain

Tips for Long-Term Success

Maintaining weight loss after bariatric surgery requires dedication and a focus on long-term lifestyle changes. Here are some essential tips to help you keep off the gained weight:

  1. Continuous Guidance: Having your surgeon and dietitian as steadfast partners ensures that you receive ongoing guidance, support, and tailored strategies to help you maintain your weight loss and avoid regain post bariatric surgery.
  2. Compliance with Medical Advice: It’s imperative to schedule post-operative follow-up sessions with your bariatric surgeon. These meetings enable progress to be tracked, problems to be resolved, and treatment plans to be modified as needed.

    Commit to Lifestyle Changes: Understand that bariatric surgery is a tool, not a quick fix. Commit to permanent lifestyle changes in diet and exercise.

  3. Healthy Eating Habits: Due to the decreased stomach capacity following bariatric surgery, a new nutritional strategy is essential. Patients should adhere to a structured diet emphasising whole grains, vegetables, and protein-rich food. It’s important to stay away from foods that are heavy in calories and lacking in nutrients.
  4. Portion Control: Continue practising portion control to prevent overeating. Use smaller plates and utensils.
  5. Mindful Eating: Pay attention to hunger and fullness cues. Avoid distractions while eating, such as TV or devices.
  6. Proper Hydration and Medications: Following weight loss surgery, the patient could be given various medications to manage discomfort or pain, prevent infection, and improve digestion. To avoid deficiencies, patients may need to take vitamin and mineral supplements as directed by their surgeons. Imperatively, staying hydrated promotes general health and helps to avoid problems.
  7. Regular exercise and physical activity: Keeping the changed metabolism high is only possible by maintaining the physical activity. Combine moderate-intensity aerobic activity with strength training for at least 150 minutes weekly to maintain muscle mass.

    Stress Management: Develop healthy stress management strategies like meditation, yoga, or deep breathing exercises.

  8. Recognise Red Flags: Look for difficulties or relapse indicators, such as rapid weight gain, digestive problems, or mental discomfort. If you have any worries, speak with your doctor right away.

    Celebrate Non-Scale Victories: Acknowledge and celebrate milestones beyond the scale, such as improved energy or clothing size.

  9. Self-Monitoring: Keep track of your weight, dietary habits, and physical activity. Regular self-monitoring helps identify issues early on.
  10. Positive interest in your health and physical well-being: Respect for your body, regular weight and condition checks, attendance at post-surgery follow-up appointments that are advised, participation in age-appropriate screenings (such as for breast or cervical cancer), vaccinations, quitting smoking, etc. For instance, weighing yourself weekly is associated with maintaining weight loss.
  11. Attending support group meetings: Most bariatric teams schedule regular support group sessions for patients recovering from bariatric surgery. Patients communicate with one another in these gatherings, which inspires, motivates, and increases enthusiasm for developing and sustaining healthy habits.
  12. Long-Term Perspective: Understand that maintaining weight loss is a lifelong commitment. Be patient and seek support when needed.

The Bottom Line

Remember that slip-ups are inevitable but don’t have to become major setbacks. Bariatric surgery results in a weight loss of approximately 50-70 per cent of your excess weight. However, the responsibility for maintaining this weight loss lies with you.

Long-term weight management requires a commitment to changes in diet, consistent exercise, emotional stability, and ongoing support from medical professionals and loved ones. People can live a healthier, happier life by sticking to these tips and being committed.

(This article is authored by Dr Aman Priya Khanna, Co-founder & Medical Director, HexaHealth, General, Laser, Bariatric and Minimal Access Surgeon)

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