I had heard that there were a certain % of patients undergoing bariatric surgery that will regain the lost weight. This sounds really disturbing- how the heck is a person capable of gaining so much weight when their stomach capacity is so reduced?
I was talking to my trainer about this, and the short answer is: the body adapts.
Along with the bypass surgery, you are put on a pretty restrictive diet. Particularly in terms of how much (I don’t remember if there were also restrictions on what the make up can be, I think there are some there as well). So not only limited by your new limited capacity, you are also limited by this imposed diet.
My trainer was telling me that this all works great for about 3 to 4 months. But if you do not adhere to new diet, you can start “pushing” your intake. And though it may take longer, it is very possible to put back on most, if not all, of the weight that is lost. Even with the bypass, the body is apparently able to adapt to accomodate the additional intake.
The basic problem is discipline. People who get the surgery think that, after they lose all the weight, that they can start eating crappy, non-nutritious foods because they just won’t eat that much. But then they start to push the limits, and the body accomodates.
It’s pretty sad, but apparently the numbers are reasonably high of people who, after having spent all that money on the surgery, put it all back on again.
No cite, but I heard someone on TV talking about bariatric surgery saying something like “yeah, you may only be able to get a cup of food in at a time but if you fill that cup twenty times a day you’re still gonna be fat.” Even if you’re not overeating, you still have to eat healthy foods and reasonable amounts of calories.
There are a lot of factors at play. The first factor is, what kind of bariatric surgery are we talking about? The most common type for high weight-regain is the proximal Roux En Y (hereafter abbreviated RNY). The proximal RNY bypasses very little of the intestines, allowing the patient to absorb pretty much all of the calories from what he or she eats. A couple of common problems in weight re-gain are:
Stretching of the stoma (the stoma is the artificial opening made between the “pouch” created to hold food, and the digestive tract). If the stoma stretches out, then putting food in the pouch is like pouring it down an open drain. It goes right through, still leaving you hungry, which signals you to eat more; lather, rinse, repeat.
Disruption of the staple line. In all forms of RNY surgery, the stomach is stapled off. But if a couple of the staples break, then food can be going into the large stomach, and you’ll have a physiological need to fill that stomach, as if it had never been stapled. This can lead to re-gain of all the weight.
Another common form of bariatric surgery with a fairly high regain rate is the gastric band, which uses a saline-filled silicone band to close off most of the stomach. A somewhat common problem with this procedure is that what goes down easiest for some patients is fattening, soft stuff like custards, ice creams, puddings, etc. Some people who have a gastric band have major problems digesting meats, raw veggies, etc.
The Distal RNY not only creates a tiny pouch, but also bypasses a lot of the intestinal tract, meaning that you won’t absorb a lot of the calories and nutrients from the foods you eat. This procedure seems to produce better long-term results.
Yet another bariatric procedure is the Fobi Pouch, which is a combo of the RNY and the gastric band. It creates a tiny pouch, and then puts a gastric band around the bottom of it to keep it from stretching out.
One last one, the Biliopancreatic Diversion with Duodenal Switch (or just DS) cuts out most of the stomach, leaving a natural functioning tiny stomach (about 2-4oz. depending on the surgeon) and bypassing a lot of the intestines. Because the pyloric valve is left intact, the natural governing of the emptying of the stomach remains intact; there is no stoma to stretch; also, the bypassed intestines help to malabsorb a certain percentage of calories and nutrients.
But even the most dismal of statistics for the bariatric procedures seems to put about 50% of proximal RNY patients regaining most or all of the lost weight, which is not nearly as dismal as a 95% regain in weight for behavioral changes alone (known as the “eat less exercise more method”).
Yeah, I had bariatric surgery, and did my homework. How did you guess? 
Well sure, but if followed precisely, the “eat less exercise more method” works 99.9% of the time. There are no external factors for you to [del]blame your failure on[/del] worry about. That’s one thing I like about it: If it’s not working, I can realize that, make an adjustment, and watch it start working again. If I have a $20k surgery and the band slips off…it doesn’t seem so easy to get back on track.
Well, I never claimed that the “eat less, exercise more” doesn’t work if followed faithfully. It’s certainly always worked for me; I just lacked whatever it takes to follow it faithfully.
Frankly, I didn’t want the band, because it seems less effective in people above a certain BMI. So, I did my homework and chose the surgery that has the lowest risk of regain.
At any rate, the stuff about how any bariatric surgery is still statistically more likely to keep the weight off, was just a throw-away remark. Mostly, I was trying to explain how one goes about re-gaining a lot of the weight lost after such a surgery.