Weight Regain After Bariatric Surgery Is Treatable

Matthew Weiner, MD

250 Pounds

Weight Regain after VSG

153 Pounds

Lacey After

Weight regain after bariatric surgery, particularly following Vertical Sleeve Gastrectomy (VSG), can be deeply frustrating and emotionally distressing. Many patients feel a profound sense of defeat, sadness, and hopelessness as the weight they worked so hard to lose slowly creeps back. Even worse, the excellent control of your eating and appetite that you experienced after surgery now feels like a distant memory as constant “food nose” makes it nearly impossible to stick to a nutritional plan.

If you find yourself gaining weight after Sleeve Gastrectomy or Gastric Bypass, there is reason to be hopeful! The causes of weight regain after surgery are largely understandable and predictable, and in most cases, weight regain after Bariatric Surgery can be successfully treated!

By understanding and applying the setpoint theory of weight loss and implementing a comprehensive approach that includes dietary change, regular physical activity, behavioral support, and GLP-1 medications, most people can lose weight again and get back to their lowest post-surgical weight! No one ever told you that your weight loss journey would be easy! It is called a “journey” for a reason. It may be challenging and, at times, feel hopeless, but with persistence and the right strategies, it is possible to regain control of your eating habits, quiet the food noise, and get back to your lowest post-surgical weight.

setpoint theory and bariatric surgery weight regain

I have been using the setpoint theory of weight gain and weight loss in my practice for over a decade and find it invaluable in first, explaining why weight gain occurs, and second, developing a comprehensive, long term plan to help patients lose weight and keep it off. We cover all the different ways that you can apply setpoint theory to weight loss in our weekly “Pound of Cure Weight Loss” Podcast.

I wrote about Setpoint theory in my first book, “A Pound of Cure,” and much more extensively about it in my second book, “How Weight Loss Surgery Really Works.”

Our bodies have a natural tendency to maintain a certain weight range, known as your “setpoint.” This setpoint is regulated by a complex interplay of hormones, brain signals, and metabolic processes that control hunger, satiety, and energy expenditure.

Your setpoint can go up for many reasons, not just eating too much or exercising too little.

Common causes of setpoint elevation

Is your diet the cause?

how to lower your setpoint (again)

The first step of any treatment plan should be to minimize as many of the causes of setpoint elevation as possible Once you’ve done your best to eliminate the causes of your weight regain, you should focus on the four ways that you can lower your setpoint.

nutritional change for bariatric surgery weight regain

The Metabolic Reset Diet, as detailed in my first book, “A Pound of Cure” represents the fastest way that you can implement a significant nutritional change. This diet emphasizes a fundamental shift from calorie restriction to nutrient density, focusing on whole, unprocessed foods that naturally regulate hunger and satiety signals. By prioritizing fruits, vegetables, lean proteins, and healthy fats, the Metabolic Reset Diet helps recalibrate the body’s internal mechanisms that govern weight.

Our practice offers 25+ support groups per week, many of which focus on strategies to implement the Metabolic Reset Diet.

Unlike traditional diets that often rely on severe calorie cuts and temporary measures, the Metabolic Reset Diet aims for sustainable, long-term change. It encourages the consumption of nutrient-rich foods that not only support weight loss but also enhance overall health. By changing the quality of your diet, rather than focusing on calorie quantity.

The diet’s emphasis on unprocessed foods helps minimize the hormonal and neurochemical responses that typically sabotage weight loss efforts. By fostering a healthier relationship with food and focusing on quality over quantity, the Metabolic Reset Diet effectively supports lasting weight management, making it a superior strategy for those looking to lower their setpoint and maintain their weight loss achievements.

Build muscle and use it

Building muscle is a powerful strategy for lowering your setpoint, as increased muscle mass boosts your resting metabolic rate, helping you burn more calories even at rest. Engaging in regular strength training exercises, such as weight lifting or resistance band workouts, can lower your setpoint.

 However, it’s crucial to approach muscle-building exercises with caution to prevent injury. Proper technique, gradual progression, and appropriate rest are essential. Overloading muscles too quickly or using improper form can lead to strains, sprains, and other injuries that may ultimately result in weight gain. Consulting a fitness professional or physical therapist can ensure that your exercise regimen is safe and effective. Remember, if exercise results in an injury, it may ultimately result in weight gain, not weight loss.

glp-1 medications for weight regain

GLP-1 medications, such as semaglutide (Ozempic, Wegovy) and tirzepatide (Mounjaro, Zepbound), have revolutionized the treatment of obesity by working to lower your setpoint and drive weight loss. These medications mimic the action of glucagon-like peptide-1 (GLP-1), a hormone that plays a crucial role in regulating appetite and food intake. By enhancing the body’s natural satiety signals and slowing gastric emptying, GLP-1 medications help reduce hunger and promote feelings of fullness, making it easier for patients to follow the Metabolic Reset Diet.

 Our practice has extensive experience in leveraging GLP-1 medications to treat weight regain after surgery. Our experience has been that these medications work even better in post-Bariatric Surgery patients than they do in those who’ve never had surgery. GLP-1 medications, when paired with nutritional change and muscle building lifestyle changes can often help people reach a weight lower than their lowest post-surgical weight.

 However, GLP-1 medications are not a standalone solution. Their effectiveness depends on being integrated into a comprehensive weight loss program that includes nutritional counseling and physical activity. Regular follow-up to monitor progress and adjust the dose is critical to minimizing side effects and maximizing weight loss.

 These medications are also expensive and difficult to obtain insurance coverage for. Pound of Cure Weight Loss has developed several “creative dosing strategies” that help to minimize the cost without compromising your weight loss sucess. Our practice does not prescribe or sell compounded GLP-1 medications.

revisional surgery

Revisional Bariatric Surgery is not a decision to be taken lightly. Revision surgery carries significantly more risk and offers less weight loss than first time surgery does. Revisional options are dependent on your original surgery. Patients who’ve undergone Gastric Bypass surgery have very few revision options. Procedures like Endoscopic narrowing of the Gastrojejunostomy (ROSE procedure), pouch trimming and limb lengthening procedures have not proven to drive substantial weight loss.

 For those patients who have had a Gastric Sleeve, there are three revision options.

final thoughts

Weight regain after Bariatric Surgery is often associated with the same shame and self-blame that you experienced before surgery. Thankfully, there is hope. Our practice believes strongly in the motto: “We’re here for every step of your weight loss journey.” Sometimes your journey takes a detour and you experience weight regain.

 Our practice has worked with hundreds of weight regain patients and found that by removing the shame and self-blame and implementing a solid, evidence based comprehensive approach that involves nutritional change, building muscle, GLP-1 medications and, in rare circumstances, revisional surgery, we are able to help patients develop a plan to lose the weight again and keep it off for good

 Pound of Cure Weight Loss is a private practice, owned by Dr. Weiner which allows him to focus on providing the best treatment available for his patients without worrying about meeting hospital or venture capital set quotas for surgical volume.

what to expect from the pound of cure weight loss program

Grocery Bag

No more fad diets

The Metabolic Reset Diet is a sensible, healthy style of eating that maximizes your weight loss results from Bariatric Surgery and GLP-1 Medications

Food Noise

Quiet the food noise

It is nearly impossible to stick to a nutritional plan when you have obsessive thoughts about food all of the time. The Metabolic Reset Diet and GLP-1 medications both work to quiet the food noise.


Lose the weight for good

By identifying those factors that cause weight gain and eliminating them and implementing sustainable nutrition, exercise and medication programs, you can set yourself up for long-term weight loss success

Check out dr. weiner's books

Poc Cover

A Pound of Cure

Dr. Weiner's first book outlines the fundamental concept of your "Metabolic Thermostat" and the best nutritional strategy for durable weight loss

How Weight Loss Surgery Really Works Cover

How Weight Loss Surgery Really Works

This book expands on the concept of your metabolic thermostat's setpoint and explains the hormonal changes that drive weight loss after surgery.

Bariatric Cookbook Cover

The Bariatric Diet Guide and Cookbook

This cookbook is designed for pre and postoperative patients looking for help on eating after surgery. There are 100 recipes that help transition you to a healthier diet after surgery.

hear what our patients have to say

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"We are lacking in support in the field of Bariatric Surgery. The work that you are doing is changing people's lives. Dealing with the emotional side effects of obesity every minute of every day severely impairs you as a human. Thank you for the work that you do and the partnership that you offer."
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"Dr. Weiner and the entire staff at Pound of Cure Weight Loss are completely supportive and teach you everything you need to know to be successful with your weight loss journey. You are truely cared for and cared about here. They have been a lifesaver in more ways than I can count."
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"My name is Justine and I am a patient at Tucson weight loss. Dr. Weiner and his staff are amazing and very supportive. I have learned so much from having my membership and being able to sign up for unlimited classes and Zoe is amazing always giving suggestions and ideas and most importantly supporting you along your journey. I have also purchased all of Dr. Weiner's books which are very helpful to understand the process. The cook book is amazing and we use it daily."

the pound of cure nutrition program

Zoe Zoom

25+ support groups every week

The pound of cure platinum program

To help post-bariatric patients maintain their weight loss or get back to their ideal weight, we created the Pound of Cure Platinum Program.

 The solution is multifactorial and often involves nutrition, modification of weight-gaining factors, GLP-1 medications, and occasionally, revisional surgery.

 The Pound of Cure team will be fully dedicated to your success and do everything possible to help you change your lifestyle and obtain any medications necessary in the safest and most affordable way.

The pound of cure platinum program includes

request more information about the pound of cure platinum program

Surgery Meds 1