What most preoperative patients don’t recognize and many postoperative patients don’t expect is that the impact weight loss surgery has on your hunger, metabolism, ability to eat and weight loss changes substantially over time. I’ve broken these postoperative changes down to four stages, and added the equally important preoperative planning and decision making stage as well to describe the five stages of your life before and after surgery. Each stage offers unique opportunities that can help you make a lifelong change in your nutritional and exercise habits.
Stage 1: Preparing for Weight Loss Surgery
The first stage occurs before surgery and consists of the time spent making decisions about which surgeon to choose, whether to have surgery and which procedure you should choose. Just as importantly, there is a lot of preparation that goes into a successful surgery including changing your diet slowly over time so that you have a good sense of your postoperative nutritional plan, researching the financial obligations that surgery may present and working with your primary care doctor to optimize your health and medications. This stage is perhaps the most important since it sets the stage for all that will follow and provides you an opportunity to establish a well thought out plan for your success after surgery. Anyone who finds themselves in this stage should consider picking up a copy of my new book (available in late February, 2019) called “A Pound of Cure: Preop. Everything you need to know before undergoing weight loss surgery.”
Stage 2: Recovering from Surgery
The second stage occurs during the first month or so after surgery as you recover, start back on normal food and make plans to go back to work. While this stage is often the most anxiety provoking period of time, it’s probably the least important stage when it comes to ensuring your long term success. However, there is one very important skill that you can develop in the weeks after surgery that you can carry with you for the rest of your life: mindful eating. Because you must eat very carefully in the first few weeks after surgery, you are forced to pay close attention to every single bite of food. During this stage, the difference between a comfortable meal and one that causes nausea, pain and vomiting can be only one bite. How well you chew your food, how long you wait between bites and when you choose to stop eating are critical decisions that can have very unpleasant consequences if you go wrong. A mindful eating strategy is a requirement during this stage, but you shouldn’t look at this as a temporary obstacle, instead, it’s an opportunity to learn this valuable life long skill.
Stage 3: The Honeymoon Years
The Honeymoon Years refer to that wonderful period that starts around a month or so after surgery and lasts anywhere from 18 months to 5 years after surgery. A Gastric Bypass tends to offer a longer honeymoon period than a Sleeve Gastrectomy does. During this stage, you have excellent appetite control, lose weight easily and have tons of energy. The surgery is working in overdrive and you begin to feel that your weight loss struggles are finally over. Your body will never give you better feedback about what and how much to eat than it does during this stage. Food that is fried, greasy or sweetened is unappealing while you crave Pound of Cure friendly foods like fruit, vegetables, nuts, seeds and beans. You have two choices during this stage – you can embrace your new taste preferences and recognize them for what they are – a temporary gift that offers you a unique opportunity to change to a healthier diet, or you can fight them and falsely believe that the surgery only works by limiting portion size and resume your pre-surgical diet, just in smaller amounts (I refer to this as the Portion Control Trap). Your new, lower weight and your increased energy provides a great opportunity to start an exercise program as well.
Stage 4: The End of the Honeymoon
Unfortunately, all good things must come to an end and the Honeymoon years are no exception. Eventually, all weight loss surgery patients will experience a return in their appetite, food cravings and lack of enthusiasm for exercise – it usually doesn’t ever go back to where it was preoperatively, but there is definitely a distinct change (contrary to popular belief, It’s not caused by stomach stretching). It’s critical that you recognize that this is a normal part of the postoperative process, not than a sign of impending weight regain. This stage is a lot like when you first learned to ride a bike. You’d practiced your balance and got comfortable with the pedals and the feel of the bike, but it wasn’t until that person who was running along side you helping you balance finally let go that you really learned how to ride. This stage provides you an opportunity to demonstrate to yourself and the world that you can maintain your weight on your own when you get back on the plan you established before surgery and practice the good nutritional habits, exercise and mindful eating strategies that you learned in the previous stages.
Stage 5: Managing Weight Regain
Every postoperative patient will eventually struggle with weight regain. It’s very uncommon that it’s a substantial amount of weight, but struggling with 5, 10 or even 20 lbs. of regain is a reality for many patients. When weight regain happens, it’s an opportunity to intervene early and re-establish those habits that you promised yourself would change after surgery. When I work with patients struggling with weight regain after surgery, I find that a systematic approach is critical – often times there is a clear, understandable and often reversible reason for the weight regain. Getting back to good nutritional habits, as much exercise as possible and identifying all of the different reasons for weight gain can help you come up with a solid plan to get the scale to move in the right direction. Medications can often be helpful as well.
Understanding the different stages of life before and after weight loss surgery is the first step to finding success. The impact surgery has on your body changes over time and harnessing the power of these changes and recognizing their shortcomings is perhaps the most important component of long term success.
This is a great article for people thinking about wls and people who have been thru it. It was nice to have something touch on 3+ years out. Very good info. ????
What type of medications are you talking about? Hunger is back full force for me 3 1/2 years out and 15 lb regained
There are a few options, none are perfect. There are 2 videos that go over your options, one is included in the weight regain course which you can purchase (probably best to also get the metabolic reset diet course too). There’s also a free video here (you just have to register for a free account): https://www.poundofcureweightloss.com/courses/about-a-pound-of-cure/lessons/how-to-lower-your-setpoint/topic/medications-2/
My Dr has prescribed phentermine for me, it has been a game changer. I was in a appetite overload. Food was all I could think of, gained 10 lbs. Lost 22 so far in 4 months, I see the RN every month, and the NUT every 2 months.
Sounds like a great result for phentermine. Not every patient has the same experience, glad it’s working for you.
I had Lap Band Surgery in 09 and did really well until the past three years when I retired and find myself more sedentary than normal. I have health issues now with my legs and feet so the walking I used to do no longer works. I initially lost 106 pounds after surgery. I have not over the past three years put 50 back on. I have re-read my books from the surgery and have tried to re-jump start my weight loss. I am very frustrated because I cannot get back on track and want to have the band removed because of the difficulty in eating.
The problem is much more likely to be because of your band, not because of your diet. Here are two videos that may help you figure things out. If you live in Arizona or Michigan, I’m available for telemedicine consults as well.
Revision Surgery After Gastric Banding
I’m only 8 months postop and my hunger is back in full force! Do you know why the honeymoon phase was so short? Any suggestions on how to get it back under control?
Sleeve? Often sleeve patients have relatively short honeymoon periods. The best way to deal with it is to accept your hunger and eat as much super healthy food as you want and work to eliminate all of the processed crap. If you eat lots and lots of fruits and vegetables, you are more likely to lose weight than to gain it.
Do you ever sleep?
No gastric bypass????
But I’m sure you would advise the same…? Or would you suggest any meds?
Avoid meds except maybe Benadryl, work on good sleep habits, and daily exercise helps a lot
I’m 2 years out (sleeve) I have always had hunger since surgery, but cannot eat much, I only lost 30lbs and have regained 10. My problem is I’m having trouble with evening snacking. I have just recently found your book and have been following the healthy eating habits ( limiting the animal protein) for 1 week now. My question is I just recently had blood work done and my cholesterol has gone (since surgery) from 265 to 325, why would it have gone up instead of down?
It sounds like you are one of the unfortunate 5% of patients who do not respond well to a sleeve. Following the metabolic reset diet is the first step, high intensity exercise is also important. I’d also make a thorough review of your medications to see if any of them are causing weight gain. My guess is that your cholesterol went up because you are eating lots of animal protein. My nutritional plan will fix this.
Hello. I had gastric bypass in 2004 so 16 years ago this month. I am 5’8″ and I weigh 163. Before surgery I was 330lbs. I take iron supplements every day. I currently practice Keto way of eating. Maintaining my weight is really difficult. How do you feel about intermittent fasting and keto?
I had a banded rny surgery. Would like to know how long is the band safe to be in the body. It’s a fixed silicone band. Should I get it removed at some point.
Fixed silicone bands are very unusual. I would need much more information before I answered this question. I offer telemedicine appointments for these types of issues.
I had gastric bypass 7 weeks ago, and I have only lost 15 pounds. How can I speed up my weight loss? I feel like I could have lost 2 pounds a week without surgery!
Sadi-s surgery 2016. 355 down to 260. Majority of extended family (15-20) is severely morbidly obese (300 and over) I have limited mobility (Fitbit shows average of 1,200-2,500 steps a day) and slowly gaining weight back. Doctors have no interest in helping me get mobility back. I want to live life but I’m stuck. I do low carb and eat more fish and seafood than other meats. No fried foods, only air fryer. No soda, bread, pasta, rice or dairy. I use coconut milk. What do you advise?
Hello Dr. Weiner! I bought your book A Pound of Cure about 2 years ago and just recently rediscovered it and all your wonderful online content! I have been plant based for the past year and am so glad to find bariatric doctors supporting this lifestyle for post-ops.
My question is related to lap band removal for those of us who don’t have any complications (YET) and also about whether i’d be able to revise to sleeve after band removal if I’m no longer obese.
I’ve had my lap band since March 2008 and it has changed my life. I struggled with my weight since early childhood and after years of yo-yoing, i looked to weight loss surgery not so much to help me lose the weight, but to help me KEEP IT OFF once and for all. I lost the majority of my weight in the first 6+ months (from 200lbs down to 140lbs, i’m 5’2″) and managed to stay within a maintenance range for the the next 12 years, which included 2 pregnancies and overcoming my fair share of 5-15lb regains along the way.
In the past year, I changed to Plant Based diet, and that helped me drop another 15-20 pounds leaving me at about 120-125lbs at 5’2″. I do not have any trouble with heart burn, am able to eat even more now that i’m plant based, but occasionally i do “throw up”. My last barium swallow was in 2018 and the band looked good according to my PA.
After watching your “Gastric Band” video that you linked in a comment above, I am finding myself finally wondering…is it only a matter of time before my band should or needs to be removed? And, if it is safer to remove it, could i revise to a sleeve even though i am at a healthy weight?
I am TERRIFIED that without a revision to a sleeve, that i am destined to regain all the weight i have spent the last almost 13 years losing. I’m not sure i could emotionally survive that.
Would it be possible for me to revise from lap band to sleeve without being obese?
It is possible, but insurance might not cover it. It is very likely at some point your band will cause trouble, but it doesn’t sound like it is right now. If you were my patient, I’d survey you with regular endoscopies to make sure you aren’t developing severe esophagitis or Barrett’s esophagus, keep your band on the loose side and keep an eye on things until the band does cause trouble, then I’d likely encourage you to revise to a sleeve. Don’t buy yourself trouble – sleeves have problems too – get the most that you can out of your band and only move forward with a revision when it’s necessary.
Thank you so much for getting back to me and for the helpful advice! I love that you are teaching bariatric post ops (especially those 2+ years out) the ways that plants can satisfy our protein needs. I also think your advice about having patients use the honeymoon period to practice their good habits for life is key. I know i would not be where i am right now without years of practice with healthy habits.
The more i think about it, just about everything you say resonates with my own experience and i have really enjoyed reading your perspective on set points and the ways in which bariatric surgery really works. Thanks for putting great info out there!! It is greatly appreciated.