Nutrition Strategies for Weight Regain After Bariatric Surgery
Bariatric surgery is a life-changing procedure often leading to significant weight loss and improved health outcomes. However, achieving long-term weight loss success depends on several factors, some of which rely on you and your choices – while others are due to surgical failure or a change in your medical status.
This is why following up with a bariatric health care provider every year after surgery is important to ensure you maximize this valuable and lifesaving tool.
In this post, we’ll explore the reasons behind weight regain after bariatric surgery and highlight strategies to build and maintain healthy habits. Then we’ll review three popular, evidence-based weight loss diets along with their pros and cons so you can choose which one will work for you!
Understanding Weight Regain
Weight regain after bariatric surgery is a common and concerning issue that affects many individuals. If you’re experiencing this, it’s important to know that you’re not alone. The reasons behind this can be complex and include both biological and behavioral factors.[1]
Factors Associated with Weight Regain After Bariatric Surgery
Lack of dietary planning: Not sticking to dietary recommendations post-surgery is one of the most common predictors. This includes the types of food eaten, meal timing, and frequency.
The most significant contributors seem to be:
- grazing (eating small to moderate amounts of food throughout the day)
- unplanned snacking
- drinking with meals
- regularly consuming sweets or high-fat foods
- not eating enough protein
Sedentary lifestyle: A lack of regular physical activity can contribute to weight regain. It’s important to incorporate regular exercise as part of a balanced lifestyle.
- Weight Loss Tip:
- Aim for a minimum of 150 minutes of planned activity per week
- 300 minutes per week is suggested for those trying to lose weight
Psychological factors: Mental health issues such as depression, anxiety, or unresolved eating disorders can affect post-surgery weight management. Emotional stress can also trigger unhealthy eating habits, which may contribute to weight regain.
- Weight Loss Tip:
- If you are experiencing any mental distress, please schedule an appointment with a mental health provider.
- Plan time for healthy self-talk each day. Each morning, sit with your eyes closed and acknowledge what you are grateful for in your life. Then, visualize yourself as your healthiest self.
- Throughout the day, as you catch yourself speaking unkindly or negatively to/or about yourself, stop and remind yourself of the things you are grateful for.
Surgical factors: Sometimes, the type of bariatric surgery or complications arising from surgery can influence weight regain. It’s important to discuss these factors with your health care provider.
Lack of follow-up care: Regular follow-up appointments with your health care team are essential to monitor progress and make necessary adjustments to your diet and exercise plan. Lack of consistent follow-up can increase the risk of weight regain.
For more information on this, and specific recommendations for lifestyle changes after bariatric surgery, read our blog Top Strategies for Success After Bariatric Surgery.
Dietary Plans for Weight Loss After Weight Regain
There are 15 different evidence-based dietary approaches to consider for adults who are trying to lose weight.[2]
All of these dietary approaches have been proven to be safe and effective when it comes to losing weight. For some people, this can create frustration as many just want to be told what to eat. However, we want you to see the freedom that this offers you.
You don’t have to follow a specific dietary plan to achieve weight loss after weight regain following bariatric surgery; there are several options to choose from.
As long as there is a calorie reduction from your current intake, any of these diets can help you lose weight. This allows you the freedom to try a plan you haven’t considered before.
Let’s review three of these diets together.
Meal Replacement Diet
The Diet: A highly restricted calorie intake that primarily uses meal replacement products for a short duration.
Who May Benefit: Those who want a “jump-start” to rapid weight loss, who want to stop thinking about what to eat for two weeks, and who enjoy meal replacement products.
Who Should Avoid: Individuals with a history of eating disorders or those unable to tolerate extreme calorie restrictions.
A very low-calorie diet (VLCD) is often used before surgery to prepare patients, resulting in a 10% preoperative weight loss and a 15–20% reduction in liver volume.[3] It has also been found to have a positive impact on improving cardiovascular risk factors in diabetic patients.
VLCDs gained popularity in the 1970s, but they started being used as early as the 1920s, making them one of the longest-studied diet plans for weight loss.[4] Initially, these diets emerged as a drastic solution for severe obesity, often lacking nutritional balance and consisting simply of water, lemon juice, and broth. Over the years, advancements in nutritional science have led to the refinement of these diets to ensure they meet the body’s essential needs while significantly reducing caloric intake.
Studies over the years have consistently shown the effectiveness of VLCDs for short-term weight loss outcomes.[5]
It’s important to note that these diets are not just about calorie restriction but are carefully designed to provide all necessary vitamins, minerals, and fatty acids, ensuring nutritional adequacy. We’ve created a free resource for you for following this specific type of diet if it resonates with you. Download it now, Back on Track.
Keep in mind that while VLCDs have proven to be effective for short-term weight loss, if used for longer than two weeks, they are typically utilized under medical supervision to manage potential risks and safeguard the patient’s health throughout the weight loss journey.
High Protein Diet
The Diet: Emphasizes protein-rich foods to promote satiety and muscle retention.
Who May Benefit: Individuals looking to preserve lean body mass while losing weight.
Who Should Avoid: People with kidney or liver problems, or those who struggle to digest dense protein foods like beef or poultry.
If you’ve had bariatric surgery, you’re no stranger to prioritizing protein. What can often happen is people struggle to consume dense protein sources like chicken or steak immediately after surgery, which can lead to a long-term aversion to those foods.
Unfortunately, consuming too little protein after surgery can impact your weight loss outcomes. Studies continue to show that patients with higher protein intake after bariatric surgery are less likely to experience weight regain.[6] Low protein intake has been associated with a loss of lean muscle mass, which can negatively affect metabolic rate and result in less effective weight loss and a higher likelihood of weight regain.
The American Society for Metabolic and Bariatric Surgery (ASMBS) recommends a minimum protein intake of 60 grams daily post-surgery to minimize muscle loss and optimize weight loss outcomes (Mechanic), with the preference being individualized protein goals based on ideal body weight.
However, it is estimated that only about 40 percent of patients can achieve adequate daily protein levels.[7] According to a recent long-term observational study, individuals who prioritized protein intake over lipids and carbohydrates after undergoing bariatric surgery demonstrated improved weight maintenance even after 10 years.[8] This finding suggests that making protein a focal point of postoperative nutrition may play a crucial role in long-term success, especially if you have experienced unfavorable weight regain.
In addition to promoting weight loss and lean muscle mass retention, high protein diets have been linked to improved satiety levels, making them a beneficial option for those looking to manage hunger and cravings.
If you’re looking for high-protein recipes, check out our blog 5 High-Protein Recipes for Bariatric Patients. Also, go to the recipe section on Baritastic for more than 100 dietitian-approved bariatric recipes!
Mediterranean Diet
The Diet: Centers on plant-based foods, whole grains, nuts, and healthy fats like olive oil with moderate consumption of fish and poultry.
Who May Benefit: People looking for a heart-healthy diet, improved mental health, and weight management.
Who Should Avoid: Those preferring a low-fat diet or anyone allergic to nuts, seafood, or specific grains commonly consumed in this diet plan. It can also require more frequent trips to the grocery store to keep fresh produce on hand.
Noted for its health benefits, such as reducing risks of cardiovascular diseases and promoting longevity, this diet is accepted globally.[9] The emphasis on variety, flavor, and the enjoyment of food makes this diet appealing to many.
With an abundant use of olive oil, high in monounsaturated fats, the Mediterranean diet contributes to better heart health by lowering levels of cholesterol and blood pressure.[10] The diet’s rich content of antioxidants and anti-inflammatory properties also make it a compelling choice for individuals with chronic conditions, such as rheumatoid arthritis. This diet offers a sustainable approach to eating, focusing on moderation and balance rather than excluding major food groups.
Although there is limited research on the application of this diet specifically to post-bariatric surgery nutrition, its underlying principles can align with the recommended dietary guidelines for long-term maintenance after surgery and can assist in weight loss after weight regain as long as a reduced calorie intake is achieved.
As with all reduced-calorie dietary plans, you should consult with your healthcare provider, or dietitian, to tailor the diet to your specific nutritional needs and health conditions.
Body Weight is Not the Only Measure of Success After Bariatric Surgery: You are More than A Number on the Scale
The benefits of bariatric surgery extend far beyond weight loss, as it brings significant and long-term health improvements. For example, it can lead to profound improvements in diabetes, reduced cholesterol levels, normalized blood pressure, and decreased medication needs, all contributing to an improvement in health.[11] It can also improve or resolve conditions like sleep apnea.
These positive impacts show that success is not just about body weight but about overall health and well-being. Remember to focus on all the positive changes to your life after surgery, not just the number on the scale.
To learn more about other areas to focus on beyond a simple number, check out our blog 30 Ways to Look Beyond the Scale.
Conclusion
Long-term success after bariatric surgery requires specific strategies and lifestyle patterns to produce the greatest results. By understanding the reasons behind weight regain and following proven strategies for success (link to Top strat for success blog once live), you can optimize your chances of achieving lasting weight loss results.
Additionally, exploring different diets and tailoring them to your individual needs and preferences can be a valuable tool in the journey toward a healthier and happier life. Remember, bariatric surgery is just the beginning; the real journey lies in embracing a lifelong commitment to your health and wellness, and learning how to make this tool work for you!
[1]Noria SF, et al. Weight Regain After Bariatric Surgery: Scope of the Problem, Causes, Prevention, and Treatment. Curr Diab Rep. 2023;23(3):31-42.
[2]M Morgan-Bathke, et al. Medical Nutrition Therapy Interventions Provided by Dietitians for Adult Overweight and Obesity Management: An Academy of Nutrition and Dietetics Evidence-Based Practice Guidelines. J Acad Nutr Diet. 2023;123(3):520-545.
[3]Colles S et al. Preoperative weight loss with a very-low-energy diet: quantitation of changes in liver and abdominal fat by serial imaging. Am J Clin Nutr. 2006;84:304–11.
[4]Herrington G et al. Obes Sci Pract. 2022;8(4):510-524.
[5]Brown, A, & Leeds, AR. Nutrition Bulletin. 2019;44(1):7-24.
[6]Moizé V et al. Protein intake and lean tissue mass retention following bariatric surgery. Clin Nutr. 2013;32(4):550-555.
[7]Moize V et al. Obese patients have inadequate protein intake related to protein intolerance up to 1 year following Roux-en-Y gastric bypass. Obes Surg. 2003;13(1)23–28.
[8]Sherf Dagan S et al. Do bariatric patients follow dietary and lifestyle recommendations during the first postoperative year? Obes Surg. 2017;27(9):2258–2271.
[9]Finicelli M et al. The Mediterranean diet: An update of the clinical trials. Nutrients. 2022;14(14):2956.
[10]Widmer RJ et al. Am J Med. 2015;128(3):229-238.
[11]Gulinac M et al. Long-term effectiveness, outcomes and complications of bariatric surgery. World J Clin Cases. 2023;11(19):4504-4512.
