Will I Regain Weight After a Gastric Sleeve?

Obese woman holding measuring tape to her waistband

When considering bariatric surgery, weight regain is at the top of many patients’ minds. After all, the whole point of surgery is to drop the pounds, get back to a more normal weight, and improve or eliminate the diseases associated with obesity; there are horror stories on the Internet discussing significant regain and reversal of the benefit achieved through surgery. It is one of the issues that stops most common issues stopping patients from getting surgery.

Let’s discuss weight gain and whether you should be worried about it now that you are considering bariatric surgery.

Noncompliance With the Postoperative Diet Is the Most Common Reason for Weight Regain After a Weight Loss Surgery

You’ve probably heard it repeatedly – bariatric surgery is not the easy way out, and it is not a magic bullet—quite the opposite. Bariatric surgery will require effort after surgery. This means an improved diet as well as regular exercise. That’s not to say bariatric surgery won’t help you achieve that. The surgery gives you a motivational boost and induces hormonal regulation, making dieting and exercise far easier. It’s one of the reasons why bariatric patients typically lose a considerable amount of weight over the first two years after the procedure. So, if you are sure to follow the post-operative packet provided to you by your bariatric surgeon, you have a pretty good chance of keeping that weight off over the long term. But remember, obesity is a lifelong struggle, both mental and physical. So, you must look at postop change as a lifelong challenge.

Does the Pouch Stretch Over Time, or Is the Esophagus Being Filled?

Your stomach is divided when you have a sleeve, leaving about 25% of its original volume. Overindulgence can lead to reflux, vomiting, hiatal hernia, or your body to purge (also know a dumping). But non-compliance, especially by overeating, snacking, or drinking carbonated drinks regularly will allow you to consume additional calories and that is what causes the weight gain.

Hormonal Changes

The hormonal benefit of the gastric sleeve in the form of suppressed ghrelin production begins to wane after a couple of years. If you have researched the gastric sleeve, you know that by removing the stomach’s fundus, we can limit this hunger hormone’s production. However, the body eventually compensates by producing ghrelin in the small intestine. While you likely did not feel hungry for many months, you may start feeling those hunger pangs again sometime after the 18 months to the two-year mark. This does not mean that you are going to gain additional weight. You must be aware and tailor your diet to this new reality. Now it is more important to stay with the food intake rules of protein first then fruits or vegetables and eating the proper amount of food at one sitting. It also means not getting calories from liquids and focusing on proper hydration with water.

When the Procedure Fails

While we preach postop compliance, there are occasions when the procedure fails. This rare occurrence usually happens when a patient has their procedure performed at a center with lax oversight or with an inexperienced surgeon. Having an experienced bariatric surgeon nearby is beneficial so you can consult with them about potential issues early on and do not have to travel far to get care. This is not to say you can’t travel for your surgery, but your bariatric practice needs to be responsive and have a comprehensive postop plan for you as an out-of-state or out-of-area patient.

Patients with a Lap-Band® the brand name gastric band are most susceptible to postop complications. We see lots of band patients who are no longer receiving the benefit from their procedure due to slippage or erosion. This is not to say that every band patient will fail. In fact, most patients will enjoy decent long-term results. However, for those band patients with postop issues, the procedure can be converted to a gastric sleeve or gastric bypass.

On rare occasions, and typically because of inexperience, the bariatric surgeon may not remove as much of the stomach as they should, meaning that the sleeve does not offer enough restriction to give patients the full benefit of the procedure.

It’s important to remember that the vast majority of well-qualified (physically and psychologically) bariatric surgery patients do exceptionally well not only in a couple of years after their surgery but for decades and even the rest of their lives. Surgical techniques and technology have reduced the likelihood of major complications to those of simple gallbladder removal. And every year, it just gets better. However, patients concerned about weight regain should attend one of our seminars and speak to Dr. Chang about long-term considerations. We’ve done this a thousand times and can confidently tell you how to lose weight and keep it off. Contact us to learn more and meet with Dr. Chang.