Expectations after Surgery

Here is a great blog from fellow member Cindy Jouper on the “real” phases after Bariatric Surgery 

 

Transcript:

10 years ago I was a young dietitian in a bariatric clinic. I loved my job. One thing I would ask in a new patient visit was about their goals. Patients would tell me of their hopes to cross their legs, not need a seatbelt extender, or comfortably play on the floor with kids and grandkids. Then we would talk about if they had a goal weight in mind. Some patients would have a really specific goal weight. Other patients struggled to answer that question. Our clinic didn’t have a set goal weight for them because we knew the body needed to respond how it was going to. We would aim for below a BMI of 30 to get out of the obesity category. We also said there was a little bit of regain to be expected but to focus on the goals that improved their life and not just the scale. At the end of the day, none of us had a crystal ball to show us exactly how much weight we would lose after surgery.

We still don’t have a crystal ball but we can look at data for big-picture insight into what happens after bariatric surgery.

After weight stabilizes maybe 18 months after surgery, studies have found about 30% of patients begin to regain their weight back. At 10 years after surgery, on average patients have regained 20 to 25% of weight loss back. Nearly all patients regain some amount of weight back at some point after surgery.

What I want you to hear is this: you aren’t alone and nothing is broken.

You may have heard surgery is called “the last resort” which I feel is misleading in a few ways. Surgery is not the final stop, it’s an effective treatment option and a wonderful tool for managing obesity. Regaining weight after surgery is now found to be quite normal and so is losing weight again. So if you haven’t heard it already, let me be the first one to tell you that it is not too late for you because it’s never too late. Managing weight is something we do lifelong which also means, it’s never too late to improve how you’re managing your weight.

We have also come a long way in the treatment of Obesity as a disease since my early days as a dietitian. If using the word disease is confusing for you, you can replace it with the term medication condition. If you’ve been at a weight in your life that has put you in the Obesity category, we know that your body is predisposed to the medical condition of obesity. Just like any other medical condition, it takes consistent care and a toolbox of treatment options.

Some clinics now have Bariatricians who are physicians specializing in the disease of obesity. We also now have anti-obesity medications to support further obesity management after surgery, which we will talk about in this course. The story is simply not over if someone gained weight after surgery.

If you haven’t already, do get back to your bariatric team to help you through this process. I know it can be hard to show up after regaining weight but trust me, they are in this line of work to be ON your team. If you don’t feel you have the right fit, call other bariatric programs in the area and ask if they take transfer patients. And if nothing else, contact me to help you find a bariatric dietitian licensed in your state and have your primary care doctor take yearly bariatric labs which are linked below this video.

Perhaps if we talked more about the likelihood of weight regains in the post-op journey, it could help normalize it and stop the feelings of shame that come with it.

Before we move further into the course lessons, I want to take us back to the basics of goal setting and the scale.

Take a moment and think or even write down…. What goals matter to you?

We often have expectations in life like expecting a vacation to go a certain way and experiencing disappointment when it doesn’t. And when it’s something WE expected of OURSELVES we struggle more deeply with feelings of guilt and shame.

That’s why I want to start this course off with this conversation. Before we talk about losing regained weight, let’s talk about what to expect and where to give yourself some grace.

The goals you have to improve your quality of life like traveling or keeping up with your kids- are the goals to keep front of mind. They are what matters more than any number on a scale.

Goal weights are confusing for a reason – we don’t control them.

In business, it’s called leading and lagging indicators.

A leading indicator is something you can do something about. Drinking water, getting in movement, and planning your meals are all leading indicators when it comes to your health.

A lagging indicator is what may come after that as a result. The scale moving down is a lagging indicator after a month of making healthy changes.

 

Although, you don’t technically control that lagging indicator.  Just like a company can plan out a big marketing campaign but they don’t control how much money they will make because of it. You can control the inputs, you don’t technically control the outputs. When the lagging indicators aren’t what you wanted, you re-evaluate the leading indicators to see if the output can improve.

The human body is complex and obesity is multi-faceted. It’s not just lifestyle choices it’s also genetics, environment, medical factors, and more. This means that eating less and working out harder are simply not the full story. So please, don’t be hard on yourself and pat yourself on the back for taking this step to watch this video course to get more information.

I want to talk about a theory about body weight called the set point theory.

This is a theory that the human body tries to maintain its weight in a preferred range.

Bariatric surgery causes changes in metabolism, hormones, hunger, and more which enable your body to have a lowered set point. Surgery is the most effective treatment for the disease of obesity because it can change the body’s processes and allow a new set point, even more than other diets you may have tried.

The thing is, you don’t control what that new set point is, just like you didn’t control your previous set point. You can utilize the surgical tool but your body is likely to level off where it’s most comfortable. You can lose regained weight and create a new setpoint for your body. More on that in a moment but my point is that when patients put a specific goal weight in their mind and then they don’t reach it because the body leveled off at a different spot, they might get discouraged and think negatively about how they did. Negative thinking and self-talk are very hard for staying motivated.

When it comes to setting a goal of losing regained weight, start with losing what you’ve regained instead of a goal you made for yourself that you didn’t reach. I don’t say that to be deflating!!! I say that it is in case you are holding expectations over yourself to reach a goal your body has not experienced before.

You can help find your new set point when you get back to consistent healthy post-op eating habits and movement. Yes, it is possible to reset that set point but it’s more of a slow, consistent lifestyle change so your body adapts and recreates its set point. There is never a “maintenance phase” when it comes to managing weight. Just like we have to manage our money, we have to manage our weight, and even more when we have a history of obesity. Let’s all agree to demote the scale and focus on the habits that help us feel our best instead of looking at the numbers to be our guide.

Take some time to think about what goals matter to you. How will you measure how those things are going? How often do you want to look at the scale and how much do you want that number to matter to you? My encouragement is to use a wide variety of ways to see your progress. Your endurance or strength, photos, measurements, flexibility, sleep improvement, lab work, and the scale sometimes too.