Reasons You’re Not Losing Weight After Bariatric Surgery

Severe obesity is unfortunately all too common in the United States, and the evidence suggests it’s still on the rise. Over the last few decades, it has become clear that traditional interventions for obese patients (e.g. dieting and exercise routines) are mostly ineffective at helping people reach their weight loss goals. In light of this, weight loss surgery has emerged as a much more reliable and effective way to promote long-term, sustainable body weight management. The weight loss procedure that is often considered the “gold standard” is known as gastric bypass. Yet as highly regarded as gastric bypass is, there are many people who get to a point where their weight loss journey has stalled.

What Is Gastric Bypass Surgery?  

In general, bariatric procedures are designed to help patients with severe obesity make the kinds of lifestyle changes that promote weight loss. The goal of any of these surgical procedures is to either limit food intake, reduce nutrient absorption, or both. Most of the time this is accomplished by making permanent surgical changes to the stomach or intestines that physically prevent the ingestion of too much food. With such changes, the patient’s ability to overeat—the main driver of obesity—is impaired and they are more likely to be in a calorie deficit.

Though it has become less common in recent years, one of the most popular types of bariatric surgery is known as Roux-en-Y gastric bypass. During this procedure, the bariatric surgeon creates a small stomach pouch at the top where the stomach connects to the esophagus. The remainder of the stomach is removed, and only about 20-25% of the original stomach volume is retained. With the stomach size being so much smaller, the bariatric patient is physically unable to eat as much during each sitting. 

This alteration of the stomach is the aspect of the procedure that limits food intake, but the gastric bypass procedure involves additional steps aimed at reducing nutrient absorption. During this second stage of the surgery, the doctor will divide the small intestine into two sections, distal (lower) and proximal (upper). The proximal section is connected to the newly formed small stomach pouch, and this allows food to pass directly from the pouch into the upper part of the small intestine; this bypasses the majority of the stomach and the duodenum.

Next, the distal portion of the small intestine is reconnected to the lower part of the small intestine. This is done so that digestive juices and enzymes from the bypassed stomach and duodenum can still mix with food farther down the digestive tract. The splitting of the small intestine in this way is the source of the “Y” in the name of the procedure; food from the smaller stomach pouch and digestive juices from the duodenum come together in the distal small intestine before the food proceeds as normally to the large intestine.  

How Does Gastric Bypass Lead to Weight Loss?

As noted above, bariatric surgery promotes weight loss through either limiting calorie intake or reducing nutrient absorption. The Roux-en-Y gastric bypass procedure actually uses both of these mechanisms; the small stomach size limits the amount of food that can be eaten, and that can positively affect the hormones responsible for feelings of hunger and satiety. Also, because the small intestine is the primary site of nutrient absorption, bypassing a long section of it limits the amount of time food is able to be absorbed. 

Obviously anyone could theoretically just choose to eat less, but eating habits and the potential for food cravings are affected by a variety of hormonal, physical, and emotional factors. So for a person carrying a large amount of weight, it is extremely difficult to just suddenly make the necessary changes. When a patient opts for bariatric surgery, however, the functional nature of the changes makes it much more likely to adjust one’s diet and eat less. And this is simply because the smaller stomach size can literally fit less food.

Indeed, many people on a post-op diet discover they have less of an appetite for many of the foods that were so hard to turn down before the surgery. The instinct to overeat may still be strong, but trying to eat as much as before is just not possible. Over time, this leads to eating smaller portion sizes of foods that tend to be more filling and more nutrient dense. This rather sudden change to eating far fewer calories is the main reason that some people with severe obesity are able to see rapid weight loss in the few months that follow having the surgery.

Common Reasons For a Weight Loss Plateau or Weight Regain       

As relatively effective as bariatric surgery is known to be, it’s not uncommon for patients to either stop losing excess weight or even to gain weight back again in the years following the surgery. Below are some common reasons why a bariatric patient might experience weight gain even after initially having success with surgery:

• Non-linear: A basic truth about weight loss is that it isn’t always linear or predictable. So even if you do everything asked of you, it’s still entirely possible to hit a weight loss plateau.
• Metabolic adaptation: One possible reason for a stall in weight loss is that your body’s resting metabolism has slowed in response to carrying less body weight. Additionally, the body often burns some muscle tissue as well as fat, and that can further erode the basal metabolic rate.
• Changes in eating habits: Directly after surgery, bariatric patients are required to adhere to an all-liquid diet before switching back to solid foods. This period after the surgery typically leads to new eating patterns that last for a while. Eventually, though, old habits may reemerge and calorie intake increases to unsustainable levels.
• Dietary choices: Even apart from how much you’re eating, the types of food choices you make are just as important. “Highly palatable” foods that we associate with cravings are usually high in refined carbohydrates or fat, and that means they are less filling and won’t sate our hunger for long. For a gastric bypass patient, this might mean continually snacking on smaller amounts of high calorie foods.   
• Lack of physical activity: Even though gastric bypass is ultimately about what you eat, getting a sufficient amount of regular exercise or physical activity is crucial for long-term success. Avoiding physical activity and maintaining a sedentary life can definitely promote a weight loss stall and can negatively affect overall health. 
• Not enough water: Dehydration can sometimes be mistaken for hunger, leading to increased calorie intake. Staying well-hydrated is important for overall health and can help control appetite.

Alternatives to Gastric Bypass     

Losing weight is hard no matter who you are, but procedures like gastric bypass have given many people a chance to make the necessary changes. It’s important to note, though, that even relatively safe surgeries like gastric bypass or sleeve gastrectomy are not without risks. Laparoscopic surgery may be considered minimally invasive, but it still requires incisions that can bleed and become infected, for example. In fact, the inherent dangers of surgery make it not even an option for some severely obese patients with other medical conditions. 

All of this is why True You Weight Loss offers a state-of-the-art alternative to standard bariatric surgery: endobariatrics. This is a set of weight loss procedures that are done with an endoscope, a flexible tube inserted through the esophagus that doesn’t require incisions and the resulting long recovery time. To learn more about how endobariatrics can help you finally find the freedom you’ve been looking for, please contact us today to request a consultation.