October 4, 2019

How to Keep the Weight Off After Bariatric Surgery

Practical tips for success

Plate with three different bite size portions

If you’ve had bariatric surgery, one of your greatest fears may be that you’ll regain the weight.


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Unfortunately, the truth is it’s easy to regain weight. People typically start gaining weight 12 to 18 months after their surgery. And it can happen for a variety of reasons.

“Maybe they didn’t choose the right procedure,” says bariatric dietitian and support group coordinator Lilian Craggs, DHA, RDN, LDN. PhD. “Or they had the gastric bypass and developed a fistula (an abnormal opening) that allowed food to enter the bigger stomach. Or the sleeve or pouch got stretched.”

However, Dr. Craggs says those are exceptions. “In the majority of cases, weight regain is diet-related.”

How weight is regained after bariatric surgery

In the first year after surgery, most patients are diligent with diet and exercise. They eat proper portions of 3 to 6 ounces. If they eat out, they bring most of their meal home with them. But as they start to tolerate a wider variety of foods, many begin to eat more and exercise less. Their weight loss slows down and plateaus before beginning to climb.

“When you weigh more, you require more calories to function,” Dr. Craggs explains. “After bariatric surgery, your metabolism decreases, and your need for calories drops as you lose weight. You can’t eat the same number of calories at 150 pounds that you did at 300 pounds, or you’ll gain weight.”

Most weight regain boils down to eating habits. Researchers recently reported five of 13 eating behaviors were largely responsible for a greater-than-normal amount of weight loss:

  • Binge eating.
  • Eating when feeling full.
  • Eating continuously all day.
  • Out-of-control eating.
  • Eating fast food.

How can you prevent regaining weight after bariatric surgery?

While weight gain is common, it’s not inevitable. Here are 8 tips for maintaining your weight loss:

  1. Recognize that obesity is a chronic, multifaceted condition that programs your body to gain weight. A dedicated bariatric team is your ally in the fight to lose weight and be healthy.
  2. Don’t be embarrassed if you start regaining weight. Reach out to your bariatric team.They will help you determine why this is happening. “They want you to succeed,” adds bariatric surgeon Raul Rosenthal, MD. “You may benefit from one of the new FDA-approved weight-loss medications or simply need some support and coaching.”
  3. Schedule regular visits with your bariatric team to keep your weight loss on track.
  4. Follow your recommended nutrition plan diligently to ensure you receive adequate nutrition and maintain muscle mass. “The ultimate goal is to eat a regular diet in smaller amounts,” says Dr. Craggs.
  5. Avoid snacking or grazing. It prevents you from feeling full, and the extra calories will add up to weight gain.
  6. If you have trouble maintaining recommended lifestyle changes, seek a bariatric support group. Your peers are struggling with the same issues.
  7. If you feel you would benefit from one-on-one support, ask your bariatric team to connect you with someone has succeeded in maintaining weight loss to mentor you.
  8. If you gain weight, reach deep inside your heart and locate the impetus for seeking bariatric surgery in the first place. Then recommit yourself. “We say ‘Pick yourself up, dust yourself off and let’s start again,’” says Dr. Craggs.

Bariatric surgery is a tool, not a magic wand

These findings underscore that bariatric surgery alone isn’t a permanent solution to obesity. It’s a tool for losing weight. Once it occurs, you need to exercise and eat smart to stay slim.

“It’s not a magic wand,” Dr. Craggs says. “You have to eat healthy foods, follow the bariatric protocol for nutrition and stay active, or the disease and its comorbidities will recur.”

Your health risks increase if you regain the weight

Bariatric procedures produce rapid and substantial weight loss. The result? Diabetes, hypertension, high cholesterol, sleep apnea and other medical issues linked to obesity may disappear, lowering the risk of heart disease, stroke, premature death and many forms of cancer.

In some ways, bariatric surgery reverses the clock.

“We found that detrimental changes to the heart reverse themselves with rapid weight loss,” Dr. Rosenthal explains. “This dramatically lowers the risk of cardiac arrhythmias and heart attack.”

So as weight climbs again after weight loss surgery, so do the risks of developing cardiovascular disease and cancer.

How much weight do you have to keep off for bariatric surgery to be a success?

The health risks associated with weight regain are proportional to the amount of weight regained. In this respect, most bariatric procedures are successful.


“Success is defined as retaining 50% of your weight loss five years after the initial procedure was performed,” Dr. Rosenthal says. “Rarely do patients gain all their weight back.”

Although bariatric surgery is considered the only route to permanent weight loss, variability in the surgical procedures themselves can affect success.

“The procedures are still evolving, and there is no standardization,” Dr. Rosenthal says. “We are still learning what matters and contributes to success. Also, some patients choose, or are advised to undergo, the wrong procedure and do not realize the same benefits as they would have realized with a different bariatric procedure.”

This article was adapted from Cleveland Clinic Heart Advisor.

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