5 years post sleeve… Now what???

Was your surgery a while ago? Are you doing well or have you noticed some of those old habit creeping back in? Have you regained a little weight? Ah! I get it…. It’s really common to feel unsupported or like you’re “expected to know what to do by now”, but life changes! So, let’s look at what to do now you’re a bit further down the track and thinking long term after sleeve gastrectomy.

What we know about long term sleeve results

The research consensus seems to be that after a sleeve people will lose around 55-60% of their excess weight, up to 5 and even 10 years after the surgery. This means the sleeve is a viable surgery for long term weight loss.

For example, in 2016 a study was published with 10 year post op data from Europe. These authors found that of those 47 who only had a sleeve recording an average weight loss of 62.5% excess weight. In this study 25% (16 people) were had further surgery such as a bypass and in those patients, they found 81.7% excess weight was lost which is great.

A systematic review of 16 studies looking at weight loss outcomes after VSG for 492 patients published in 2013 found the percentage of Excess Weight Lost (EWL) to be 62.3%, 53.8%, 43% and 54.8% at 5, 6, 7 and 8 or more years of follow-up, respectively. These numbers show a slight rebound and weight regain over time. So if this is you, you’re not alone!

The biggest problem we have looking at data like this is that the the longer studies try to follow people after surgery the less people we have available to study! This could be for a number of reasons. We could have lots of people out there who are happy and haven’t gained any weight and they don’t see the need to go back in for post op follow up appointments in the long term. Or there could be people who don’t go back in because they have gained weight and they feel hopeless or like they have “failed”.

Hopefully over time, we will have more and more good quality, large studies that follow patients over 10 and 20 years. But for now, let’s look at some of the most common reasons for weight regain in the long term post op.

Reasons for weight regain long term post op

So what about weight regain long term after surgery? There seems to be a few reasons why people might regain weight after a sleeve ranging from anatomical reasons to lifestyle habits. 

Anatomical

If you do feel like you are regaining weight it is really important that you get back in and see your surgeon. The first thing we want to rule out is an anatomical reason for weight regain. Your surgeon will do a barium swallow and have a look at the size of your sleeve and how it’s functioning. This can be very reassuring for your surgeon to say that you haven’t stretched it or to know if there needs to be some further action taken.

Medical

The second thing to do is to go back to visit your GP to rule out any medical reason for weight regain. Is there something else going on with your hormones, medications or your bloods? Perhaps you feeling exhausted because of an iron deficiency and so you can’t exercise and that has a big flow on effect on your lifestyle behaviours.  There are also other medical options such as medication to control appetite that can be trialed before we jump back in and opt for something more radical like revisional surgery.

Lifestyle habits

Finally, the most important thing is that to take a moment to reflect on your lifestyle behaviours. It’s so easy to be really strict and motivated in the first 12 months, then either forget or slowly slip back into old habits. Being able to talk about this with someone, whether that is your dietitian or surgeon or GP, is really important.

What to do if you need a change

It’s important to remember that obesity is a chronic condition that needs to be managed in the long term. Whilst the sleeve or weight loss surgery is a great option, it is not the only option and continued support is crucial in the long term.

1. Check in with your team. First check in with your team to rule out anatomical or medical reasons for weight regain and check for additional surgical or medical options. Don’t be embarrassed to go back in to see your team – that’s what they are there for!
2. Do a back to basics habit check. Rather than jumping straight into Optifast, do a habit check first. Having a look at what you have been doing and what old habits have crept back in is the key to awareness and identifying where your focus should be. You can download my habit checklist below if you need somewhere to start.
3. Do a habit reset. Pick 1-3 things max you want to focus on and work on that, rather than trying to do a full overhaul which may not last. Some of the most common habits I see in people that are regaining weight are:
   1. Grazing throughout the day,
   2. Not getting enough sleep and lots of stress,
   3. Not exercising enough, and
   4. Increased portion sizes and speed of eating.

Should I just start Optifast again?

If you need convenience, then using a meal replacement once or twice a day is a good option. However, there has been some interesting research that found that WLS patients who went back onto meal replacement shakes long term had an increase in their appetite hormones. This is likely because the body goes back into starvation mode where it pushes you to search for food. Doing a restrictive Optifast phase may also bring out all the diet mentality demons which can have a negative impact on your mental health.

The bottom line

In summary, it is common to regain a little weight long term after a sleeve. To stop it continuing to creep on we want to rule out any anatomical or medical reasons and reevaluate your daily habits. The good news it that it is possible to lose more weight long term however as long as you have good support so book in to see your team or discuss with a WLS dietitian asap!