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.
My body is in denial then..haha. Post bariatric surgery 12 years..had an traumatic accident 7 years out..changed everything. Now menopause/age..Im vegan..for stomach/ ethical. reasons…but struggle with blood sugar drops. I’ve used your reset..first time it worked fantastic..second time nope..HELP
After a few years, the taste changes disappear and your left with your good habits. It sounds like your accident disrupted all of this. If you’re struggling with blood sugar drops, beans can help a lot – perhaps you should try the metabolic reset diet again with a lot of beans this time?
I fell off program, which makes me sad because Pound of Cure made so much sense for my body!!!! I’m afraid to start over with MRD for fear all of the work will not work. Will MRD most likely work again to get things back on track?
Yes, it works well for this
I don’t qualify for weight loss surgery but I am significantly overweight. I am 185 4”11 female age 49. Is there a way I can lose weight without surgery that can change my set point.
The metabolic reset diet from my book, A Pound of Cure, is designed specifically to do this.
I had a gastric sleeve 4 months and I’m so excited to be learning this information. Is it too early to start with your plan ?
No, it’s not too early, but you’re going to have to modify it a little. You’ll have to focus more on protein and less on vegetables at first and slowly transition toward more vegetables and less animal protein.
How many months Out before one can be off animal protein? And thank you for your reply much appreciated
No hard and fast rules – you need 80 grams of protein daily – if you can do this without animal protein, go for it!
I’m curious how your metabolic thermostat, or your brain, determines what your new set weight will be after surgery. I know everyone is different, but does things like % of lean mass, bone density etc impact the resetting of the set weight point? I would love to hear your thoughts on this as I am sure everyone will be different.
A lot of different factors, but genetics is the dominant one.
Howdy, I am 7 months out from a gastric bypass and have lost 70% of excess weight but have plateaued since month 5. But now I’m getting into eating sugary foods again – though around a veg based diet. I have had very loose stools since the op and my team are worried and suggesting I put carbs back into my diet. I’m about to start a re-set plan (pound of cure) any advice please? Thank Susan
I agree, you should start on the metabolic reset diet
Want sleeve surgery but I get blood clots from time to time none since 2015. I want the surgery have began the set point eating enjoying adding bean and fruit to my eating plan feel stronger already
before trying to diet I felt weak hoping I can find a good gastric surgery Dr
5 years post Sadi-S. Hw-460 sw-351 cw-280. My lowest was 240 my first six months. I know my sleeve isn’t as narrow as most (doc said), should I get a consultation for revision? Family is on keto 5 days and low carb 2 days. 5’4 age 51. I want to lose another 100 lbs. Labs are great always take my vitamins (about 10 a day).