I never thought that I would need to write a second edition of this book. I initially lost 88 pounds, dropping down to 220 pounds, then I started to gain the weight back. A few pounds every week. No matter what I did. I even went back on the shakes, but nothing worked. I increased the distance of my walks. I bought an indoor training bicycle, but my bad knees prevented me from riding long enough to make a difference. My knees also prevented me from running. I even purchased a VersaClimber, but my knees and hips prevented me from making any headway. So, several thousand more dollars were spent on equipment that I can’t use. Before the surgery, my max weight was 308 pounds. My rebound weight was 285 pounds. So I spent $18,500 plus more money on gym equipment. All just for 23 pounds of weight loss, I found a clinic where I could get Ozempic/Semiglutide SQ injections. I lost 45 pounds, bringing my weight down to 240 pounds, where I have been holding steady. Unfortunately, thanks to a national shortage of the medication, my supply dried up. So I am 40 odd pounds short of my goal weight of 200 pounds.
When I was in my forties, I could drop weight just by thinking about it. Now that I am in my sixties, and my metabolism is just a step above that of a three-toed sloth, that 40 lbs might as well be a thousand pounds.
With the regain of weight, individuals experience relapse of weight-related medical comorbidities, thus contributing once more to socio-economic and direct health care costs. This cycle of weight loss and regain is frustrating to individuals. Despite our understanding of the biological and behavioral defenses mounted by the body to maintain weight, there still exists a pragmatic gap for individuals who are directly affected.
More weight means more pressure
When we walk or run, a lot of pressure is put on our joints. Your knees work especially hard – the amount of pressure put on your knees with each step is equal to 1 ½ times your body weight. That amount increases if you climb stairs or run. So when you gain weight, it means a lot more pressure on your knees and other joints. Your body will normally develop and strengthen the joints as a normal weight is maintained, but it is not a fast process.
Being overweight by only 10 pounds increases the stress on your knees by more than 30%! If you gain weight in a relatively short time, the cartilage is especially stressed. Cartilage wears down from the extra pressure and can cause osteoarthritis. In fact, one out of three obese people have osteoarthritis – a form of arthritis where the cartilage gets worn down, causing bone on bone friction. Unfortunately, this can lead to needing hip and knee replacement surgery.
The success rate for joint replacement in overweight people is less than for patients with weight in the normal range. They may not be good candidates for minimally-invasive surgery, and recovery takes longer. In some cases, an orthopedic surgeon will want a patient to do physical therapy and weight loss before surgery, to help ensure that the new prosthetic joint will not have to endure the same weight load as the natural joint did.
Excess weight creates inflammation
Adipose fat cells create proteins that can cause systemic inflammation. Chronic inflammation decreases the immune system’s ability to respond to a real threat, as it is working overtime from the fat cell protein secretions. This can also be a problem in your joints. Obesity is linked with gout, which causes extremely painful episodes of joint inflammation. It most often occurs in the big toe but can affect other joints as well. As fat causes a reduction in the effectiveness of insulin, the proteins that are normally broken down by insulin can build up. Uric acid is one substance that is normally secreted by the kidneys but is prevented by insulin. Gout is caused by excess uric acid in the body.
Rheumatoid Arthritis and Extra Weight
People with rheumatoid arthritis (RA) have additional concerns with weight gain. RA is an autoimmune disorder where the body attacks and erodes synovium in the joints. It causes inflammation throughout the body as the immune system responds to the joint damage. Proteins released from fat cells also contribute to chemicals already in excess from RA. This can make inflammation worse. People with RA are already at greater risk for cardiovascular disease, so it is even more important to keep weight in check since being overweight is a contributing factor to heart disease.
So what happened? Why did I gain the weight back?
What Causes Weight Gain After Gastric Sleeve Surgery?
The gastric sleeve procedure, more properly called sleeve gastrectomy, is one of the most popular and effective laparoscopic bariatric procedures out there. A typical patient can expect to lose 50-60% of their excess weight within the first year after surgery. It’s a less expensive alternative to gastric bypass, a more effective alternative to gastric bands or gastric balloons, and is effective in promoting sustained weight loss. Despite this, some patients do report gaining weight after gastric sleeve surgery. Gastric sleeve weight gain is a contentious issue, primarily since weight loss was the very reason the patient decided to undergo the procedure in the first place. What causes weight gain after gastric sleeve surgery? And what can be done about it?
Unfortunately, patients can gain weight after gastric sleeve surgery. Regain after bariatric surgery is a common issue and can occur due to various factors. Most weight gain is temporary, though, and usually shows up as slight blips. For example, a patient who has undergone a gastric sleeve and has fully recovered from the procedure may find that they have gained two pounds from the previous week. This situation is not something to be concerned about. However, some patients report sustained weight gain and an increase in caloric consumption after getting the surgery.
Stress Eating
Old habits die hard, and many people end up obese due to using food as a way to cope with stress and emotional trouble. Bariatric surgery may reduce the hunger response, the ability to eat in one sitting, and (in the case of some procedures) the absorption of calories, but it does not change the stressors or the coping mechanisms that one comes up with to deal with those stressors. Tackling stress eating should be treated more as an issue of mental health, not one of nutrition. Seeking psychiatric treatment or counseling is highly recommended for those who find themselves stress eating even after surgery, as it can help them lose weight and maintain their progress.
Stomach stretching
The body adapts to the surgery, potentially leading to increased appetite and changes in hormone levels that regulate hunger and satiety. Although both gastric bypass and gastric sleeve reduce overall stomach volume, the stomach pouch (or reshaped stomach) can still stretch to fit more food. This happens when the body adapts to eating larger portion sizes. In normal stomachs, stomach size is not correlated with obesity. But, if you’ve recently had surgery to shrink stomach volume, it could have lasting effects. Reduce overall portion size, and don’t drink water with meals. Instead, continue to sip water throughout the day just as you were instructed to during the post-op diet to help maintain your lost weight.
The figure above showed gradual increase of remnant stomach volume after gastric sleeve.
Lack of exercise
Implementing an exercise routine is one of the best things a patient can do after bariatric surgeries for their weight loss. It was found that bariatric patients who implemented an exercise routine lost more weight than those who did not and were able to keep it off as well. If you have reached a weight loss plateau or are starting to regain old weight, try adding exercise to your routine. Or, if you’re already exercising, try adding more strenuous workouts such as HIIT or resistance training to help assist in additional weight loss.
Lifestyle Adjustments
Lack of physical activity and neglecting dietary recommendations can also play a role.
Alcohol and Caffeine
High intake of alcohol and caffeinated beverages, which often contain empty calories, can contribute to weight regain.
Resources
mdbariatrics.com, “What Causes Weight Gain After Gastric Sleeve Surgery?“;