How To Restart Weight Loss After Gastric Bypass

Feet on a bathroom scale

Photo by Bill Branson, National Cancer Institute, Public domain, via Wikimedia Commons

How To Restart Weight Loss After Gastric Bypass

Gastric bypass is a weight-loss surgery that makes the stomach much smaller and reroutes the small intestine, which leads to rapid weight loss. Most people regain some weight in later years, usually a small amount compared with what they lost, but some regain more.

Gastric bypass.

In this bariatric surgery, the surgeon staples the stomach to create a small upper pouch, about the size of a walnut, that holds roughly 1 ounce of food. The small intestine is then divided and connected to this pouch.

Food skips most of the stomach and the first part of the small intestine. No stomach or intestine is removed in a gastric bypass; it is bypassed.

Because food skips part of the small intestine, your body absorbs fewer calories, which adds to weight loss. The bypassed section still delivers digestive juices further down.

Gastric sleeve surgery is a different operation. In a sleeve, about 80% of the stomach is removed, leaving a narrow, banana-shaped tube.

Weight-loss surgery is for people with obesity who haven't been able to lose weight by other means, such as diet and exercise. According to the NIDDK, it may be an option for adults with a BMI of 40 or more, or 35 or more with a serious obesity-related health problem.

Restart weight loss after gastric bypass.

A stall or some regain is a common challenge on the road to weight loss after surgery. Weight loss after surgery is not a straight line, and plateaus can last weeks or months.

If you stay committed to the eating and exercise plan from your bariatric team, you can usually get back on track.

According to MedlinePlus, most people lose about 10 to 20 pounds a month in the first year, and the pace slows over time. Many lose half or more of their excess weight (not their total body weight) in the first 2 years.

Here are a few tips to restart weight loss.

Alter the number of daily meals.

Many bariatric programs recommend several small, planned meals instead of grazing all day. Ask your dietitian what pattern fits your stage after surgery.

Join a weight loss support group.

This is one of the most effective ways to restart weight loss. You'll get emotional support and practical advice, which helps motivation.

Muscle fitness and strength training

If your routine doesn't include strength training, add it. Building muscle helps you keep your metabolic rate up as you lose weight.

Re-evaluate your sources of proteins.

Focus on lean, high-quality protein such as fish, chicken breast, eggs, Greek yogurt, and beans. Eat the protein part of your meal first.

Check your macronutrient mix. Many bariatric programs recommend about 60 grams or more of protein a day. Follow your program's target, and cut back on sugary and refined carbs.

How to maintain weight loss after gastric bypass

Join a gym class or another exercise group.
Limit refined carbs such as white bread, white rice, and sweets.
Exercise regularly.
Avoid pregnancy during the period of rapid weight loss after surgery; ask your surgeon how long to wait.
Keep your follow-up visits with your surgeon and dietitian.
Stay well hydrated.

Reasons for not losing weight after the gastric bypass surgery.

A larger pouch or connection.

The pouch or the opening between the pouch and the intestine can stretch over time, or may have been made larger than intended. This makes it easier to eat bigger portions, so your bariatric team may need to check it.

Food intake still needs to stay small for weight loss to continue after gastric bypass surgery.

Not following the diet plan.

Have you been following the diet plan your bariatric team gave you? If not, the problem may start here. Eating large portions, grazing, or choosing high-calorie foods and drinks can stall weight loss.

Surgical changes over time.

Rarely, problems with the surgery itself, such as a stretched or abnormal connection, can affect weight loss. This can make it challenging to limit portions, so your surgeon may want to evaluate it.

Medical or genetic reasons.

Genetics, hormones, medications, and other health conditions can slow weight loss after gastric bypass surgery. Some can even cause weight gain, so tell your doctor if your weight changes unexpectedly.

Risks and complications of bariatric surgery.

Blood clots in the legs, which can travel to the lungs
General anesthesia side effects.
Post-operative pain.
Infection
Bleeding
Nutritional and vitamin deficiencies.
Saggy or loose skin
Gallstones, which can form after rapid weight loss
Diarrhea and dumping syndrome, especially after sugary or starchy meals

Gastric sleeve surgery complications.

Leaks from the staple line.
Narrowing (stricture) of the sleeve.
Acid reflux.
Vitamin and iron deficiency.

Gastric bypass surgery complications.

Leaks where the stomach was stapled.
Ulcers, gastritis, and heartburn.
Bowel blockage from scar tissue.
Changes in how the body handles alcohol, with a possible higher risk of alcohol problems.
Higher risk of vitamin and iron deficiency because part of the intestine is bypassed.

Guidelines to follow after your gastric bypass surgery.

Take the recommended supplements and medicine prescribed by your bariatric team.
Eat slowly.
Eat small amounts of food and stop when you feel full.
Chew food thoroughly.
Drink enough water to stay hydrated.
Avoid foods that are hard to digest, such as tough meat and doughy bread.
Avoid carbonated drinks.
Sip fluids rather than gulping them.

Pros and cons of gastric sleeve surgery.

Pros

Significant weight loss, though usually a little less than with bypass.
Dumping syndrome is less common.
No rerouting of the intestine.
Fewer short-term complications than bypass.
Lower risk of nutrient absorption problems than bypass.

Cons

It can't be reversed because most of the stomach is removed.
Weight loss is usually somewhat less than with bypass.
Acid reflux is common and can start or worsen after surgery.

Pros and cons of gastric bypass.

Pros

On average, produces more weight loss than the sleeve or band.
Often improves type 2 diabetes and other obesity-related conditions.
It can be reversed if medically necessary, although this is difficult.
Fewer calories are absorbed because part of the intestine is bypassed.

Cons

More complications in the first month after surgery than the sleeve or band.
Dumping syndrome is more common.
Higher risk of vitamin and mineral deficiencies, so lifelong supplements are usually needed.
Follow-up procedures are more common than after a sleeve.

Which type of surgery is perfect for you?

The best type of surgery for you depends on:

Your goals and expectations.
Your general health.
Your medical history, including reflux and diabetes.
Your weight and BMI.

Restarting weight loss journey with a pouch reset.

Your stomach pouch stretches to some degree when you eat and relaxes afterward. Over time, eating larger portions can make it easier to eat more.

A "pouch reset" is a short period of going back to the early post-surgery eating stages. There is no good evidence that it physically shrinks the pouch, but it can help you break grazing habits and refocus on portions and protein.

Do a pouch reset only with guidance from your bariatric dietitian or surgeon.

Guidelines when doing a pouch reset

Eat slowly and carefully.
Drink plenty of water between meals.
Don't drink liquids with meals; stop about 30 minutes before and wait about 30 minutes after eating.

A typical pouch reset lasts about 10 days. It is much shorter than the gradual diet progression right after gastric bypass, which takes weeks.

Day 1

Clear liquids, such as broth, herbal tea, and water.

Day 2 to 3

Full liquids, such as milk, thin yogurt, and protein shakes.

Day 4 to 6

Pureed foods, such as pureed soup, soft scrambled eggs, and cottage cheese.

Day 7 to 9

Soft foods, such as tender stewed chicken or beef, flaky fish, cooked vegetables, and avocado.

Day 10 and further.

Return to your regular post-surgery diet, built around lean protein and vegetables.

Reintroduce foods slowly, in small amounts.

Eat slowly.

Consult your bariatric surgeon.

The bottom line

Restarting weight loss after gastric bypass takes steady effort with portions, protein, and activity. See your bariatric team regularly for guidance, and tell them about any regain early.