How does weight gain happen in those who had bariatric surgery?


My understanding was that since the stomach is a lot smaller, you can only handle small portion sizes and that’s how you end up losing weight and having it stay off. I do coding for a medical clinic and I see a fair amount of chart notes of people who had the procedure done (and not the temporary one where they can remove the band, either), and they end up gaining a ton of weight back a few years later.

How/why does that happen? Is it the body adjusting somehow?

In: 26

Bariatric surgery only affects how much the patient can eat at one time. If they go from eating three 1000 calorie meals to fifteen 200 calorie snacks, it’s the same intake.

Plus, people who get the surgery may not feel like they need to do anything else to stay at a lower weight, such as exercising or choosing healthy foods.

I’m a nurse who actually used to take care of people post surgery for this. The stomach is a muscle. Unfortunately that means it can stretch and get bigger or it can shrink and get smaller. So even though they originally make a much smaller pouch, the fact remains it’s still a muscle that can stretch and unfortunately bariatric surgery doesn’t solve the problem of why somebody is heavy in the first place so the need to eat is still there and a large portion of these patients go right back to it. They will slowly start eating more and more, even vomiting because their body can’t handle it, until they finally get their stomach stretched out enough that they can go back to eating how they like to eat. This is one of those surgeries I feel very mixed about because I realize it can be life-saving but I also realized it does absolutely nothing to solve the problem of why somebody became heavy in the first place and until that gets solved, obesity is going to remain in their future.

Interesting fact, for some of the people who remain thinner they develop a different addiction like alcoholism or gambling or whatnot. The emotional release they need from eating the food isn’t there anymore so they find another way to release it.

They eat more calories than they need to maintain their weight. You can eat 3000 calories a day with a small stomach if you eat 10x 300 calorie meals.

Also, over time the new small stomach can be stretched as the old one was.

Don’t treat this like a simple plumbing problem.

The success of these surgeries fall across a bell curve. Those who gain weight often figure out they just need to eat smaller portions all the time to overcome the reduced stomach volume.

Patient factors are also important. If you look at the longitudinal studies on Roen-en-Y bypass surgeries, almost everyone slowly gains weight long-term after the initial weight loss, and that initial weight loss only happened in 70% and only about 50% ever reach their target weight.

Demographically, those who had higher BMI and lower education gained the weight back faster, while those with lower BMI and higher education or got a tummy tuck kept it off or gained it back relatively slower.

Initially after that fast weight loss there’s a level of maintenance required from the patient. Initial weight loss comes from being on a mostly liquid diet of protein with lots of vitamins and supplements.

Once people go on solids, they can eat about as much as you could fit in the palm of your hand, which makes them entirely full.

When I had my surgery, I was told to eat very small meals more often. Over time, we may fall back into bad habits where larger meals are eaten, which ends up stretching the pocket of stomach attached to the bypass. Over more time, this allows you to hold more and more. For a small set of people who don’t develop any side effects from eating high calorie or high fat foods, this can mean that their intake outpaces their output and they will eventually gain weight.

For those of us who didn’t change our activity and just relied on dietary activity, this makes us more sensitive to those caloric imbalances.

I fluctuate 5 or so pounds every few days. My wife had the surgery and was down to 175 at her lowest, but has put on about a hundred pounds of the 200+ that she lost. She exercises regularly, but we’re all susceptible to falling back into bad easting habits. She’s working on it. She’s still healthier than she was and bariatric patients can do a “reset” which requires going back on a liquid diet for 1-3 weeks, essentially repeating our diet from right after the surgery to bring the stomach pouch close to where it was.