Maintaining Weight Loss After Surgery
In this episode of Bariatric Friday, Kemal Erkan, founder of the American Surgery Center, and Dr. Isaias Irgau of the Christiana Institute of Advanced Surgery (CHRIAS) sat down to discuss the topic of maintaining weight loss after surgery. While patients can find great success with their initial weight loss post-procedure, it can sometimes be a challenge to maintain that number. Patients need to instill comprehensive lifestyle changes and be patient through plateaus to manage their weight long term.
In terms of why patients regain weight after surgery, Dr. Irgau explains that bariatric surgery is still the most effective treatment we have against obesity. Over some time, some patients may find themselves gaining back 10-15 pounds. When we talk about weight regain, this is not what we are referring to. We are talking about significant weight regain to the point where the patient is over 200 pounds again. Even with these top-of-the-line procedures, Dr. Irgau acknowledges that obesity is a tough opponent to beat.
Depending on the procedure that was performed, a few different things can happen. The small stomach pouch or openings to the stomach can stretch, which can leave room for more food. As the stomach gradually expands, this can lead to increased food tolerance and overeating. People may also revert back to old habits, such as consuming greasy foods and sugary drinks.
Next, Erkan asks about the most common nutritional mistakes patients make after bariatric surgery. Dr. Irgau asserts that one of the biggest mistakes that patients make is not reaching their protein goals after surgery. This is something that patients need to prioritize, as protein is paramount for a healthy body composition. Protein helps us preserve our lean mass and muscle, which also increases our basal metabolic rate. Dr. Irgau explains that this in turn burns more calories, even when we are resting. When lean body mass is lost, it also triggers survival mechanisms in the body and hunger can increase. To avoid that, it is important to be hitting those goals of 60-80g of protein per day. Protein also increases satiety, which is important for keeping cravings at bay.
Another common mistake that people make is grazing. Grazing refers to the act of eating small, frequent, and often unplanned amounts of food throughout the day instead of structured meals. While it may seem like a small number of calories, that uncontrolled, mindless eating can really add up.
Next, Erkan asks how regular exercise affects the body after weight loss surgery. Dr. Irgau emphasizes that regular exercise is required to maintain weight in the long term. Managing your diet is more important than exercise when it comes to losing it in the first place, but exercise is necessary to stay at that weight. He recommends focusing on getting in daily walks and movement, rather than extreme workouts. “You don’t need to become an athlete overnight,” he says. “Our goal is to make our patients active people.” Even if it just small steps, whatever will promote the habit building of movement will do the job. Even if you are sitting a chair all day, it is good to be conscious about moving our arms and legs around to get the blood moving. Both aerobic and anaerobic exercises are very important.
Another topic that Erkan brings up is the relationship between mental health and eating. Many bariatric patients use food to cope with stress. “How does emotional eating impact weight regain?” he asks. Dr. Irgau maintains that it is important to emphasize mental health just as much as physical health. He says that it is necessary to create new, healthier coping habits to get us out of old routines. There is an intricate relationship between emotional struggles and relationships with food. We want to separate these things as much as possible and make sure there are other outlets for stress, so that food does not become a crutch. Getting counselling or joining a support group can be invaluable.
Erkan also mentions the CHRIAS Monthly Support Groups, which patients can join from the website or by going to the CHRIAS Facebook page. There are many good tips and experiences being shared there, which can be a useful resource. It is also a great way to connect with others going through the same experiences.
Another concern that Erkan brings up is that many patients stop seeing their surgical team after the first year. “How often should patients follow up with their bariatric team after surgery?” he asks. Dr. Irgau talks about how at CHRIAS, bariatric surgeons will follow up with patients right after surgery, 2 weeks after, 2 months after, 3 months after, and then every 3 months after that. “Our patients need to be patients for life,” he says. He emphasizes that the patients who do the best long-term after the ones who are regularly following up yearly. During these checkups, the care tea is able to check on blood work and make sure patients do not have nutritional deficiencies. Regularly following up is not only encouraged, but necessary to be healthy long-term.