For many years, we’ve been telling patients that Bariatric (Weight Loss) Surgery works by preventing people from eating too much and by blocking the absorption of calories in the intestine. These two mechanisms, labeled “restriction” and “malabsorption” have laid the foundation that has driven much of the advice we’ve given to our postoperative patients as well as the basis for several new treatments.
In the last decade, this conventional wisdom has been challenged, and today, we now recognize that restriction and malabsorption are secondary factors behind the weight loss that occurs after Bariatric Surgery. The primary mechanism that drives weight loss after surgery is hormonal changes that occur in your brain, fat cells, intestines and nervous system that are triggered by the anatomic alterations made during surgery. These changes adjust your taste for certain foods, your metabolic rate and your desire to eat, making weight loss effortless.
I’ve found that the best way to discuss these changes is though a concept I refer to as your Metabolic Thermostat. Just as you change the setting on a conventional thermostat to adjust the flow of warm or cold air into a room to keep the temperature constant, your Metabolic Thermostat works to keep your body weight constant by adjusting your metabolic rate, appetite and preference for certain foods.
This concept explains why weight loss plateaus occur on calorie restriction diets and why it’s easy to lose the first few pounds, but really difficult to lose more and keep it off. Your Metabolic Thermostat has a set-point that it tries to maintain. Any time your weight drifts away from that set-point, your metabolic thermostat adjusts your metabolism and appetite to bring your weight back to the original set-point.
Weight Loss Surgery works by lowering the set-point on your Metabolic Thermostat, so that your brain is tricked into believing that your weight should be 50, 75, 100 or even more pounds lower than your current body weight. The morning after Weight Loss Surgery, you will still be the same 250 lbs, but your brain now believes that you are only 150 lbs. All of the efforts that your body had taken to prevent weight loss in the past no longer exist. Instead, your brain and hormonal state are now pushing to drive weight loss, not to prevent it. During this magical time period when your body weight is much higher than your Metabolic Thermostat’s set-point (referred to as the Honeymoon years), your body will give you the very best advice you’ll ever receive on the best foods to eat to lose weight.
Before we discuss these important taste changes that occur during the Honeymoon years, there’s an important conflict to point out. Particularly early in the Honeymoon years (the first 6 months or so after surgery), it is best to consume lots of protein to prevent the hair loss and fatigue that rapid weight loss can trigger. Most patients don’t want to eat proccessed protein shakes or large amounts of animal protein during this period, but it is important for their recovery from surgery. Most patients report that their taste for processed foods has decreased significantly after surgery and their ability to enjoy fruit, vegetables, nuts, seeds and beans has increased. My Pound of Cure program was developed by understanding these favorable hormonal shifts that occur after Weight Loss Surgery and listening to my patients during the Honeymoon phase express their new food preferences.
The Pound of Cure program represents my observations of the foods that patients tend to prefer and those they tend to avoid during the Honeymoon Years, but there will definitely be some differences between individuals. This is because no one diet is right for everyone – obesity is probably a hundred different diseases that all have the same symptom – excess body fat. Some people’s physiology may benefit from a low-carbohydrate diet, while others may benefit from a very low fat or even vegan diet. During these Honeymoon years, if you listen closely, your body will tell you everything you need to know about how to eat for the rest of your life to reach the lowest weight possible.