Why Am I Gaining Weight After Bariatric Surgery?

After having metabolic and bariatric surgery (MBS), like the gastric sleeve, gaining weight can be a common fear.

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And in truth, it happens. All too easily.

People typically start gaining weight about a year after their surgery. And it can happen for a variety of reasons.

“Weight recurrence can happen with any of the metabolic and bariatric surgeries and for many reasons. First and foremost, obesity is a chronic and relapsing disease, and while MBS provides a durable tool, patients need lifelong follow-up with their MBS program,” says metabolic and bariatric dietitian and doctor of healthcare administration Lillian Craggs-Dino, RDN, LD.

That can be a tough pill to swallow. We get it.

But there is hope. And understanding why and how people gain weight after gastric sleeve can help you stay on track (or course-correct, if that’s where you are).

Dr. Craggs-Dino offers advice.

Why you may gain weight after gastric sleeve surgery

In the first year or so after surgery, most people are diligent with diet and exercise. They eat proper portions. If they eat on the go, they bring a big box of leftovers home with them. And they keep their bodies moving with regular exercise.

But as time goes by, it can be tough to keep up.

Little by little, you start to lose sight of those healthy habits. Not because you can’t do it. But because it can be immensely difficult to keep up new habits.

You may start to tolerate a wider variety of foods. You may start eating more. You might exercise less. In time, your weight loss slows down. It plateaus. And begins to climb.

Before you know it, you’re back to your pre-surgery habits. And you don’t even know how you got there.

“When you weigh more, you require more calories to function,” Dr. Craggs-Dino explains. “After metabolic and bariatric surgery, your metabolism decreases. You need fewer calories as you lose weight. When you eat the same number of calories at 150 pounds that you did at 300 pounds, you’ll gain weight.”

Most weight recurrence after gastric sleeve surgery boils down to eating habits, like:

Binge eating.
Eating even when you feel full.
Eating continuously throughout the day.
Eating high-fat, high-calorie foods.

But diet isn’t the only factor.

“Sometimes, weight recurrence isn’t related to diet and exercise at all,” she points out. “Weight recurrence can happen with taking certain medications, or if the health of the patient changes. Pregnancy after MBS can also bring on weight recurrence.”

5 ways to stop weight recurrence after gastric sleeve surgery

Weight recurrence following surgery is common. Some studies suggest that as many as 76% of people experience weight regain within six years.

But it’s not inevitable.

Dr. Craggs-Dino offers these tips to help.

1. Follow a healthy post-surgery diet

Gastric sleeve surgery can be a game-changer for people living with obesity. But as you probably already know, it’s not a magic wand. Developing long-term, healthy habits matters.

Metabolic and bariatric surgery alone isn’t a permanent solution to obesity. It’s a tool for losing weight. After surgery, you need to eat well to maintain a healthy weight.

“The ultimate goal is to eat a healthy and varied diet that’s centered on lean proteins, vegetables, fruits and whole grains. The MBS tool will help you reduce portions by allowing you to feel restriction,” Dr. Craggs-Dino clarifies.

Follow your recommended nutrition plan diligently to ensure you get adequate nutrition and maintain muscle mass. Opt for whole foods over processed ones. Limit your sugar intake. And avoid snacking or grazing. It prevents you from feeling full, and the extra calories will add up.

Not sure where to start? Learn what constitutes a healthy, balanced diet. Consider following a Mediterranean diet. And talk with a registered dietitian to get on track.

2. Exercise regularly

Exercising is critical to a healthy lifestyle after gastric sleeve surgery. It can help you maintain your muscle mass, keep hunger at bay, reduce your stress and more.

But if exercising didn’t play a big role in your life before surgery, it can be tough to know how to get started with a new routine.

Set yourself up for success by choosing exercises that fit into your life, rather than trying to plan life around your workouts.

If you’re an early riser, start your day with a walk or jog around the block. Or a morning yoga session.

If a midday workout fits better into your day, try hitting the gym at lunchtime. Or sign up for an after-work exercise class.

Whatever you choose, commit to it fully.

“The goal is to include 300 to 400 minutes of exercise per week, including both cardio and strength training,” Dr. Craggs-Dino states.

Missed a day here or there? Or a week (or more)? It happens.

Remember, perfection is the enemy of progress. Every bit helps. Remind yourself why exercise matters for your health. And get back on the horse (or treadmill, elliptical, bike or hiking trail).

3. Care for your emotional well-being

When you lose faith in yourself and your ability to overcome the disease of obesity, it’s harder to keep up with the habits that matter to managing your condition.

You engage in emotional eating. When you gain weight, you blame yourself. When you blame yourself, you seek comfort in food and lose motivation to work out. And the cycle continues.

Obesity is a chronic, multifaceted condition that programs your body to gain weight. It’s not a moral failing, and it’s not your fault. But know that you have the power to manage it.

Bumps on the road are likely to happen. But they don’t have to derail your progress entirely.

“We say ‘Pick yourself up, dust yourself off and let’s start again,’” Dr. Craggs-Dino reinforces.

Caring for your mental and emotional health is of utmost importance. If you’re struggling with self-blame, guilt or other feelings that are affecting your ability to maintain a healthy lifestyle, don’t hesitate to seek help from a mental healthcare professional.

4. Keep your team close

Having regular visits with your metabolic and bariatric team can help keep your weight loss on track.

If you notice that you start gaining weight, reach out to them. They can help you determine why it’s happening and find a route to success.

They want you to succeed. And they may be able to offer new strategies to support you, like additional support, coaching or FDA-approved anti-obesity medications.

And the earlier the better. Weight recurrence is easier to manage in its initial stages.

5. Remember you’re not alone

Your bariatric surgery team is on your side. But so are lots of other people. And they can help support you in your journey.

Join social networks and online forums for people who’ve had gastric sleeve surgery. They understand your experience and can offer advice and cheer you on.
Ask your team if they offer support groups or know of groups in your area. Or if they can connect you with a weight-loss mentor.
Talk about your goals and involve your friends and family in your healthy habits. Invite a friend to take a walk in the park with you. Ask your partner to join an exercise class with you. Make them part of your efforts. It’s more fun that way. And more motivating.