Features June 2019 Issue

Don't Let Bad Eating Habits Sabotage Weight Loss After Bariatric Surgery

Bariatric surgery resolves many cardiovascular factors. You'll forfeit these benefits
if you pack on the pounds.

If you are prone to carrying a substantial amount of extra weight, you have likely tried and failed multiple diets. Even if you were able to lose those unwanted pounds, it's unlikely you were able to keep them off with diet alone. That's where bariatric surgery can help. For a high percentage of people, it is the only successful and durable long-term treatment forobesity.

Bariatric procedures produce rapid and substantial weight loss. The result? Diabetes, hypertension, high cholesterol, sleep apnea and other medical issues linked to obesity may disappear, lowering the risk of heart disease, stroke, premature death and many forms of cancer.

In some ways, bariatric surgery reverses the clock.

"We found that detrimental changes to the heart reverse themselves with rapid weight loss," says Raul Rosenthal, MD, Chief of Minimally Invasive and Bariatric Surgery at Cleveland Clinic Florida. "This dramatically lowers the risk of cardiac arrhythmias and heart attack."

It's Easy to Regain Weight


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Bariatric surgery can produce enough weight loss to lower the risks of heart disease. However, keeping it off is hard, and those risks begin to rise as weight is regained.

In order to reap the medical benefits of bariatric surgery, you must maintain your weight loss. That's not easy to do. People typically start gaining weight 12 to 18 months after their surgery. It can happen for a variety of reasons.

"Maybe they didn't choose the right procedure," says Lilian Craggs, DHA, RDN, LDN, a bariatric dietitian and support group coordinator at Cleveland Clinic Florida. "Or they had the gastric bypass and developed a fistula that allowed food to enter the bigger stomach. Or the sleeve or pouch got stretched. However, those are exceptions. In the majority of cases, weight regain is diet-related."

Risks Increase

As weight climbs, so do the risks of developing cardiovascular disease and cancer.

In a 2018 study of 1,406 adults who underwent the Roux-en-Y gastric bypass procedure, results showed that in the year following maximum weight loss, 10 percent saw their diabetes progress, 26 percent experienced a rise in cholesterol levels and 46 percent saw their blood pressure goup.

Five years after achieving maximum weight loss, 35 percent had diabetes, 68 percent had high cholesterol and 72 percent had hypertension. Sadly, 42 to 45 percent said their physical or mental health had deteriorated along with their quality of life.

Gauging Success

The health risks associated with weight regain are proportional to the amount of weight regained. In this respect, most bariatric procedures are successful. "Success is defined as retaining 50 percent of your weight loss five years after the initial procedure was performed," Dr. Rosenthal says. "Rarely do patients gain all their weight back."

Although bariatric surgery is considered the only route to permanent weight loss, variability inthe surgical procedures themselves can affect success.

"The procedures are still evolving, and there is no standardization," Dr. Rosenthal says. "We are still learning what matters and contributes to success," says Dr. Rosenthal. "Also, some patients choose, or are advised to undergo, the wrong procedure and do not realize the same benefits as he or she would have realized with a different bariatric procedure."

The Typical Pattern

In the first year after bariatric surgery, most patients are diligent with diet and exercise. As they start to tolerate a wider variety of foods, many begin to eat more and exercise less. Their weight loss slows down and plateaus before beginningtoclimb.

"When you weigh more, you require more calories to function," Dr. Craggs explains. "After bariatric surgery, your metabolism decreases, and your need for calories drops as you lose weight. You can't eat the same number of calories at 150 pounds that you did at 300 pounds, or you'll gain weight."

Why Do People Regain Weight?

Most weight regain boils down to eating habits, researchers recently reported in the Annals of Surgery. In a study of 1,278 adults who had undergone Roux-en-Y gastric bypass surgery, they found five of 13 eating behaviors were largely responsible for a greater-than-normal amount of weight regain. These were:
- Binge eating
- Eating when feeling full
- Eating continuously all day
- Out-of-control eating
- Eating fast food.

Surprisingly, a large number of patients reported these behaviors. More than half said they ate fast food at least once a week, and one-quarter said three times or more. Half also ate continuously throughout the day, 25 percent said their eating was out of control and 20 percent had a problem with binge eating.

These eating habits led to a median weight regain of 23 percent of maximum weight loss. Other lifestyle habits, including a sedentary lifestyle with long periods of daily television watching, contributed.

A Tool, Not a Magic Wand


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These facts underscore that bariatric surgery alone is not a permanent solution to obesity. It's a tool for losing weight. Once it occurs, you need to exercise and eat smart to stay slim.

"It's not a magic wand," Dr. Craggs says. "You have to eat healthy foods, follow the bariatric protocol for nutrition and stay active, or the disease and its comorbidities willrecur."

Keys to Maintaining Weight Loss

- Recognize that obesity is a chronic, multifaceted, pathophysiologic condition that programs your body to gain weight. A dedicated bariatric team is your ally in the fight to lose weight and be healthy.

- Don't be embarrassed if you start regaining weight. Reach out to your bariatric team. They will help you determine why this is happening. "They want you to succeed," says Dr. Rosenthal. "You may benefit from one of the new FDA-approved weight-loss medications or simply need some support and coaching."

- Schedule regular visits with your bariaric team to keep your weight loss ontrack.

- Follow your recommended nutrition plan diligently to ensure you receive adequate nutrition and maintain muscle mass. "The ultimate goal is to eat a regular diet in smaller amounts," says Dr. Craggs.

- Avoid snacking or grazing. It prevents you from feeling full, and the extra calories will add up to weight gain.

- If you have trouble maintaining recommended lifestyle changes, seek a bariatric support group. Your peers are struggling with the same issues.

- If you feel you would benefit from one-on-one support, ask your bariatric team to connect you with someone has succeeded in maintaining weight loss to mentor you.

- If you gain weight, reach deep inside your heart and locate the impetus for seeking bariatric surgery in the first place. Then recommit yourself. "We say, ‘Pick yourself up, dust yourself off and let's start again,'" says Dr. Craggs.

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