Weight Gain After Gastric Bypass

Gastric bypass is widely considered the gold standard among all types of bariatric surgery. You can expect to lose up to 80 to 90% of your excess body weight on average within two years after surgery. However, not every individual will lose weight in the same degree, and a few people may even regain weight. Weight gain after gastric bypass surgery may occur for a variety of reasons, but with timely intervention it is possible to get back on track with your weight loss goals.

In this blog, we’ll delve into the reasons behind weight gain post-gastric bypass surgery and explore strategies to address and prevent it.

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Weight gain after gastric bypass roux-en-y

Roux en y gastric bypass usually produces rapid and substantial weight loss in the first 12 months. However, the surgery does not directly induce weight loss. It only creates physiological conditions that will make it easier for you to control your diet and adopt an active lifestyle. If you fail to follow the post-op bariatric diet plan, your risk of weight gain after gastric bypass increases.

Weight regain correlation with BMI

In excessively obese patients with a BMI of 50 or above, the chances of weight regain after gastric bypass are higher. The initial rapid weight loss may induce an inflammatory response in adipocytes in super obese patients, which could trigger weight regain. In ideal circumstances, you should decide to go ahead with Roux en y gastric bypass when your BMI is 35 with co-morbidities or 40 without any co-morbidity.

Related: Gastric bypass requirements

Weight regain is more common after first year

Following the gastric bypass surgery, most patients are initially committed to maintaining their post-op gastric bypass diet and fitness. They will measure their daily calories, eat smaller portions, and will quickly start winning their battle against obesity. However, as their food tolerance increases and diet normalizes, some of them may start going back to their pre-surgery lifestyle of eating more and following a sedentary routine.

What causes weight gain after gastric bypass surgery

Many patients want to know how do you gain weight after gastric bypass when the stomach size has been reduced by as much as 80% and the small intestine is no longer maximizing calorie absorption? The most common cause is the patient’s failure to diligently follow the prescribed post-surgery diet plan. However, there could be other causes as well for weight regain after gastric bypass surgery.

Dietary causes

• Eating even when you feel full
• Not measuring your calorie intake
• Emphasis on carbohydrates instead of proteins
• Snacking and grazing through the day Drinking sugary, carbonated, caffeinated beverages

Anatomic causes

• Gastric pouch has stretched
• Gastric fistula has occurred
• Anastomic dilation
• Inadequate pouch reduction during surgery
• Other post-op anatomic complications

Medical causes

• Thyroid problem
• Cardiovascular issues
• Pregnancy
• Adrenal problems
• Change of medications

Other causes

• Genetic factors
• Metabolic instability
• Mental health issues
• Socio-economic position
• Interplay between multiple factors

Weight gain after gastric bypass – What to do?

Some amount of weight fluctuation or regain after your gastric bypass surgery is not really a cause for alarm. The key is to keep a track of your weight loss progress, and identify when the progress has slowed or stalled completed, or is getting reversed. If you are wondering about what to do if you gain weight after gastric bypass, here are a few steps to follow:

• Don’t Ignore: Do not ignore your weight regain, and do not hide your condition from your bariatric surgeon. Obesity is a chronic disease – it is not your personal failure. Contact your weight loss surgeon, and make them a partner in your fight to eliminate obesity.
• Be Forthright: Share the actual facts with your surgeon and nutritionist about how diligently you pursued your diet plan or failed to follow their recommendations. Your bariatric team will treat you with empathy and compassion, and help you get back on track.
• Re-evaluate Diet: If you are having difficulties in following the current diet, revisit your diet plan with your surgeon and dietitian. They can customize the diet and make modifications to help improve your compliance with the gastric bypass diet.
• Enlist Support: Weight loss journey does not have to be a lonely and difficult experience. Enlist the support of your loved ones, and considering joining a bariatric support group. If necessary, you may seek mental health counseling to relieve stress and anxiety.
• Medical Tests: If your surgeon’s assessment shows that you have been maintaining your diet and exercise with fair amount of regularity, they may order a few medical tests to investigate the underlying cause of your weight gain after gastric bypass.

Related: Weight gain after gastric sleeve surgery

Slow weight loss after gastric bypass

The pace at which you lose weight after gastric bypass is going to vary in different phases of your post-operative weight loss journey. At the same time, no two patients are going to have an identical progression. Therefore, slow weight loss after gastric bypass surgery is not really a concern, unless the magnitude of weight reduction is too insignificant or the pace is slowing incrementally.

Is your diet and exercise plan realistic? 

It is possible that you may have set over-ambitious weight loss goals, which is having an adverse impact instead of speeding your weight loss. If you are trying to starve your body, it is not only unhealthy, but also unsustainable. Your craving for food will increase, and you may end up doing binge eating. Similarly, an unrealistic or extreme fitness plan may have a similar poor result in the end. Scientific balance is vital in these efforts.

Are you mindful of the energy gap? 

In the first few months after your surgery, you will shed off excess pounds at a dramatic pace. Sometimes this can create an energy gap, and your body’s defense mechanism may see it as an involuntary action rather than a planned weight loss. To protect you, the body will reduce your metabolic rate and trigger the appetite so you can fill the “energy gap” by eating extra calories. This could cause slow weight loss after gastric bypass surgery.

Not losing weight after gastric bypass surgery

How to stop gaining weight after gastric bypass is not the only concern among patients. Many patients also worry about not losing sufficient weight after gastric bypass surgery. If the condition is temporary, your surgeon may diagnose is at a weight loss plateau – where you are neither gaining or nor losing weight. However, if you are not losing weight after gastric bypass for an extended period, it is a cause for serious concern.

• Sedentary Lifestyle: While you may be complying diligently with your post-op gastric bypass diet plan, you may be avoiding the recommended exercise regimen. When your body is sedentary, the metabolic activity slows down. This means, you will burn fewer calories, neutralizing the effect of a low calorie diet.
• Type 2 Diabetes: Gastric bypass surgery is often advised to patients who suffer from obesity-related type 2 diabetes. Following your surgery, if you still need to take insulin or other anti-diabetic medications, they could induce cholesterol and fat production in your body. This may make it harder for you to lose weight.

Related: Gastric bypass cures diabetes: Fact or myth?

• Surgical Complications: Development of fistulas between your new gastric pouch and the balance stapled stomach can sometimes contribute to weight regain. Pouch re-stretching may also occur in some cases. So, on one end you might be losing weight with a strict diet plan, and on other end, you could be offsetting it because of post-op complications.
• Long-Term Effects: Gastric bypass surgery is not a magic bullet. You will need to follow your surgeon’s dietary and lifestyle guidelines in the long run in order to successfully lose weight and lead an obesity-free life. In the long run, some people may get tired of maintaining a balanced diet and exercise regimen. As a result, they may stop losing excess weight.

Related: Why am I not losing weight after gastric sleeve surgery?

Gastric bypass failure – Tips to avoid it

If your weight gain after gastric bypass is left unchecked, it may ultimately result in a surgical failure. It is not a happy outcome, and you certainly do not deserve it after having undergone a major bariatric surgery and recovery process. An ounce of prevention is worth a pound of cure. Here are a few useful tips that can help you avoid gastric bypass failure.

• Choose a qualified and experienced bariatric surgeon to minimize your risk of post-op complications and surgery failure.
• If you are struggling with a weight loss plateau, consider a 5-day pouch reset in consultation with your surgeon.
• Re-evaluate your prescribed diet plan in case you are failing to comply with it or it is not helping in weight loss.
• Reboot your lifestyle by incorporating walking and meditation in your daily routine, staying hydrated and improving your sleep cycle.
• Add a new exercise to your fitness regimen, take up a new sport, go swimming, or find other physical activities of your interest.
• Set realistic weight loss goals, and keep a careful track of what you eat, how much you exercise, and how much weight you are losing.
• Stay away from indulgent foods, such as fast foods, carbonated beverages, and desserts as far as possible.
• Maintain a healthy social life, which can motivate you to wear fitting clothes and look physically attractive and confident.

How to lose weight after failed gastric bypass

In rare circumstances, uncontrolled weight gain after gastric bypass can lead to surgical failure. However, a gastric bypass failure is not the end of the world, and there is still hope for you. You may consider a revision bariatric surgery, which can treat your weight regain successfully and help you achieve permanent freedom from obesity.

What is distal gastric bypass revision surgery?

The full length of the small intestine on average is about 750 cm. Unlike the primary gastric bypass, where the intestinal rerouting is done at about 250 cm, in a distal gastric bypass revision surgery, the rerouting is performed at about 500 cm – which is the very distal portion of the intestine. As a result, the calorie absorption gets substantially reduced compared to the primary surgery. This can help you achieve the desired weight loss after surgery.

What are the benefits of a revision surgery? 

With a distal revision procedure, weight loss after gastric bypass will be more drastic as well as durable. The risks involved in this minimally invasive technique are significantly reduced. The surgery is performed using a laparoscope, which means smaller incisions, high precision procedure, lesser discomfort, and faster recovery. However, it’s vital to take nutrition supplements lifelong in order to minimize deficiency risks.

Related: How to restart weight loss after gastric bypass

Final words on gastric bypass weight gain

Are you still worried about weight regain after gastric bypass – what to do? It is best to consult with a skilled and reputable bariatric surgeon with proven expertise in gastric bypass and revision surgery procedures. Do not feel disappointed with yourself, and focus on remedial measures to reverse the weight gain. Advanced bariatric techniques are now available to perform revision gastric bypass surgery in a safe and less invasive way.

Timely medical intervention may even avoid the need for another surgery, and you could achieve your weight loss goals simply through a renewed diet and exercise plan. Make sure you pursue this program under the supervision of a trusted gastric bypass surgeon. To win the battle against obesity, all you need is a strong desire to restore a healthy body combined with clinical support and guidance from a dedicated bariatric team.