Top 10 Reasons for Weight Regain After Sleeve Gastrectomy

It is quite common to to experience weight regain after sleeve gastrectomy and it is nothing to be ashamed of! Most importantly – this isn’t failure (that’s giving up). Knowing about and being aware of the common reasons for weight gain is a proactive way to prevent it or to help you lose some of the weight you’ve already regained. This blog isn’t designed to chastise anyone! This blog is simply to provide you with information, options and solutions to navigate those pesky habits and get you back on track towards your long term weight goals! I also recorded a version of this for our Facebook Community – you can watch it below if you prefer video!

1. Grazing

If you graze in between meals you are eating more calories than you need and you might also not eat your main meals properly, leaving you hungry sooner and most likely snacking some more. Most have a tendency towards savory foods after surgery that you might not have had before, like chips and shapes for example. Instead of grazing on snacks throughout the day, you need to set yourself up for success by having 3 good meals a day and great nutritious alternative snacks on hand that still meet that craving and fill you up. 

Hot Tips:

• Try pickles, crackers or veggie sticks with salsa. Or go for high protein savoury options like a tin of tuna or two slices of cheese. 
• Portion out your snack! A snack should be half of what your meal would be, which is ½ cup. Make sure to concentrate when you’re eating and pay attention. Avoid eating on the run because it’s easy for those foods to disappear without you registering that you have eaten them, making it more likely for you to overeat.

2. Drinking calories

Similar to drinking with meals, drinking calories don’t fill you up for very long, even protein shakes, milk and juices. The research also shows that we don’t adjust for the calories we’ve drunk, and instead eat the same as we would at our next meal – and not eating less calories at the next meal to make up for it. Overall over the day we have consumed far more calories than we need. Sugary drinks like soft drinks, juice or cordial in particular can add a lot of extra calories without adding many nutrients. Instead, focus on getting your nutrients in your food, rather than drinks. If you’re struggling to drink plain water, read this post for some easy tips to make it easier and if you are struggling with your protein, add a clear flavourless protein powder to a cup of tea or water.

3. Drinking with meals!

Doing this interrupts the satiety you get from main meals. After surgery your stomach is like a little pipe, not a sack, so your eating habits must be different too. Learning not to drink and eat at the same time is tricky, but if you understand why, it will be easier. Drinking and eating at the same time does two things: when you have food and drinks at the same time there is not enough room for you to eat the normal portion of your main meal. This means you end up eating less. It also speeds up the emptying of food into your small intestine. So basically, once that food has passed through your intestines, you are more likely to be hungrier sooner than what you would have been if you ate the full portion of your main meal without a drink. It is important to drink between meals instead, to make sure you’re hydrated. 5-10mins before a meal, stop drinking and leave 20-30mins after a meal before having a drink. 

4. Avoiding solid meats.

This one also has to do with the texture and speed of food through your stomach. Solid meats take longer to digest (due to the texture), so they hang around for longer, making you feel more satisfied. This limits the snacky feelings between meals and will help you to reduce grazing and keep your daily calories under control. If you are choosing softer meats (mince etc) you are going to be feeling hungry sooner. If you’re more than 8 weeks post-op, try to start introducing solid meats like chicken, steak, pork or turkey. BUT… eat it carefully – chop it into thumbnail-sized pieces, chew it well and alternate mouthfuls with your vegies to make it most comfortable. 

5. Skipping meals.

Skipping meals can actually slow your weight loss (even though it sounds counterintuitive) because your body goes into starvation mode and tries to hold on to everything in anticipation of the next meal. You become really good at storing energy rather than using energy and your metabolism will slow down to adjust for the lack of calorie intake. Now you don’t need to eat every 3 hours, but you should still try to eat your three meals each day, even if you’re not feeling hungry because sometimes you won’t ever feel hungry after surgery! Another reason to not skip meals is if you are not having 3 meals a day after a sleeve, given the portion sizes that you can eat, you then put yourself at a high risk of nutrient deficiency. This can be easily prevented by eating 3 good meals a day and taking your supplements.

6. Trying to get too much protein.

The ASMBS recommends 60-80g protein each day. Sometimes putting too much focus on protein means you miss out on other nutrients or end up eating too much overall. Instead of trying to squish protein into every moment of the day, stick to your three meals a day with ½ – ⅔ your plate a protein food and a snack containing protein if you need to and you’ll do just fine! For more on protein read this post.

7. Overdoing healthy snacks.

Eating when you’re not hungry, no matter how healthy it is, isn’t a good habit to get into! A good example is nuts – nuts are a good source of protein, but also high in fat so they are high in calories. So, instead of relying on nuts or nut butter as a snack, especially because they are so moreish and it’s easy to overeat, make sure you’re mixing these up with some other options like fruit, vegetables or dairy. Try having a few nuts and a yogurt or a fruit and nut mix or adding a few nuts to a salad instead. 

8. Struggles with the family.

When the family isn’t on board or not able to help because they aren’t informed, making the necessary changes become difficult. It is so important to have good supportive friends and family to make those lifelong habit changes. You can’t rely on just the surgery to do the changing. You need to work on the mental side and change your habits. Be open with your family, have conversations with them, get them involved and ask for their help and support. This is super important to a) keep you sane and b) keep the weight off in the long term. If you have a loved one you need a bit more support from, you can show them this post.

9. Lack of side effects post op.

Quite often people assume they will get side effects post op, such as dumping, nausea, taste changes and diarrhoea, however many people don’t get these. If you do get those strong feelings of nausea and discomfort that’s going to be motivation for you to stop eating those foods that caused the problems (often those sweet or rich foods). But if you don’t get side effects, you need to look more closely at mental changes. So, what is your motivation, you need to find this for yourself – you want to be around for your grandkids for example. Think about your future self and be accountable. Finding some way to stay motivated is going to be really important for long term weight loss – without that you will slip into old habits before surgery. If you listen to podcasts, this one by Gretchen Rubin on her Happier podcast talks about using your future self as a motivator – I love this idea!

10. Not enough support or education.

When I hear that people haven’t had any dietitian support throughout their journey, I think – “well no wonder you have regained some weight!”. It’s so important to have help, support and knowledge so you can make the most of your new stomach and the opportunity it brings for lifestyle changes. We can’t expect that taking the stomach out but then still continuing old habits is going to result in successful weight loss long term. If you haven’t seen your team for a while, please call them, and if you’ve never seen a dietitian associated with your surgeon and you’d like to, I am more than happy to help! Check out the range of support options available here.