Maybe the regain has nothing to do with emotional eating or bad food choices?

[setoo 2]

Hey friends!

I often read that people are regaining weight a few years after having the gastric sleeve. Mostly after 2 years or so (roughly).
Mostly the people blame themselves for regaining the weight. They think it's the emotional eating/head hunger, or bad food choices, or grazing and eating more often.
While I 100% agree that these things might not be the "healthiest" way of eating, I do not think that these are the cause of the regain. Before presenting what I have found out, I want to say, I have NO IDEA if what I'm saying might be true or not, I'd rather just start a discussion with you guys on this, so please hear me out.

I just registerted a few days ago and started a thread already and had gotten great input, thanks for that! Since that I have been researchin the gastric sleeve day in day out (I'm off work for a few weeks haha).

Like I said,I have been researching the gastric sleeve surgery quite a bit for the past week and especially looked for studies, and luckily I could find quite a few great studies on it! Even long term studies ranging from 5-13 years post op (on request I will post these here)!
What almost all these studies have in common (I think, I'm not a pro at reading studies, but they put a comprehensive conclusion at the end, which really helps understanding it), after 2, 3 or 5 years people regained weight compared to after 1! The overall weight loss got less! So for example, year 1 people lost 70% of excess weight, in year 2 that dropped down to being only 60% and by year 5 it was down to 50% (these numbers are close-ish to the ones in the study).

So after 2 or 3 years the MAJORITY, if not all, are regaining weight. Ain't that something? Do they all decide to give in to emotional eating and bad food choices right at the same time? I do not think so. I rather think, that after 2 or 3 years the body naturally WANTS to regain weight and sends us more signals to consume more food. Just because we lost all that weight after 1 year, does not mean our body wants to stay at that weight happily ever after.

So what I'm trying to say is, it might just be a natural part of the gastric sleeve to regain some of the weight and it has nothing to do with personal "errors", its just the weight our body wants to be. Most of the studies show, after 10 years, people will still have lost around 50% of their excess weight. I know, it's not perfect, but hey, that is pretty damn good!
I know the "It must be my fault, that's why I'm regaining, I did something wrong"-mentality is the go to for a lot of people . Did we not learn exactly that by calorie restriction and then "failing", because we started to eat more? Thinking WE messed up, but in reality it was just our body not wanting to put up with any of this dieting and restriction.

These are just my thoughts, I might be totally off, but I had to atleast write it down. I would love to start a discussion on this and appreciate any input, I also hope the point I was trying to make came across rightly (english is not my first language).

Cheers!

Edited December 29, 2017 by setoo

[Introversion 1,876]

I'll start by mentioning I'm nearly 3 years out. Per a recent resting metabolic rate (RMR) test, I'm able to eat approximately 2200 calories daily without regain.

As an active 120-pound female in my mid 30s with more muscle mass than most females my age, I've been able to eat that much without regaining as long as I maintain my activity levels.

Not everyone who is 3, 5 or 10 years out regains. The research studies tend to throw everyone into the mix including the maintainers and the regainers.

I've read hundreds of regain stories on these forums and other sites. The common theme is backsliding into old habits. There's usually some mention of falling off the wagon, eating more fast food than usual, indulging in sweets, or grazing mindlessly on sliders (chips, popcorn, crackers, cookies).

Sometimes the person downplays the poor food choices by saying, "But I exercise 60 minutes daily!"

60 minutes of jogging at 5 miles/hr burns 500 calories, yet we can eat back 1000 calories in only 10 minutes by enjoying 2 apple fritters, or 2 slices of deep dish meaty pizza, or 2 Starbucks frappuchino drinks. Newbies: many people at 3 to 5 years out truly can eat this much since these foods are soft.

Don't get me wrong...I'm definitely not blaming the victim of a massive regain. However, I haven't met a single WLS patient who regained on a daily diet of lean rigid Protein and non-starchy veggies.

Yes, my hunger returned at 8 to 9 months post-op. However, I can consciously choose to eat more baked chicken breasts to conquer the hunger. I can also choose french fries or Doritos.

The choices we make contribute heavily to our maintenance successes or failures. Again, it's rare to hear of someone who regained on a diet of turkey and steamed veggies.

[setoo 2]

@Introversion
Thanks for the input, this is what I was hoping for!

Would you mind sharing your activity level and what your diet looks like? I think that would be very interesting, especially since you are so good on maintaining your weight loss (good job on that, btw!).

I agree that not everyone regains weight, but I think it is safe to say that the majority is regaining weight to some extent.

It is true what you are saying, one can decide which food to use to satisfy the hunger. What I'm just wondering, does there come a point where the body is craving something highly caloric, because it wants to be at a higher weight or more calories to feel good?
So regarding that I think you could offer more experience than me! Do you feel that with eating lean Protein and vegetables as the majority of your food (if I understod right?), your body is truly satisfied after all that weight loss? By that I don't mean it just fights off the hunger and you feel ok-ish, I really mean being satisfied and content with the food eaten and energized and ready to be productive.
If one is not satisfied, I would see the same danger as in calorie restriction. Low caloric food is eaten to keep hunger at bay, but mostly it does not create a good overall well-being, because the body demands more.

What I should clarify, I don't support eating junk food all the time after the sleeve, that's not what I'm getting at at all. I'm just wondering if all those people that are saying their change in lifestyle/food choice is the cause of the regain, might actually be driven by underlying urges from the body, which does want them to eat more.
This reminds me of regular dieting in some way, you restrict, you get hungry because of the restriction, you eat high caloric food as a consequence, you blame it on yourself and your bad food choices/self control, while it's actually just your body demanding food, but one interprets this as making dietary "mistakes" or "giving in".

/edit
What I forgot to add, if the choice of eating lean protein and veggies and not fast food is what makes a success or maybe a failure regarding the maintenance, what exactly did gastric sleeve do then? One could skip the gastric sleeve and make those changes, no? But that does not work.
So the gastric sleeve changes the weight our body wants to be at and it really makes me wonder how one has to be so very rigid with the diet, to maintain that weight, if the gastric sleeve should do a big part in that? The reason that comes to mind is, that the body does not really want to stay at that low of a weight. Maybe eating a less rigid diet will lead to a higher weight (still a great weight loss I'd say, for example 50% excess weight lost), but at least one gives the body the chance to settle. But I'm just rambling now hah

Edited December 29, 2017 by setoo

[Creekimp13 5,838]

I think the OP has challenged us to look at reality. it can be a little discouraging to do this while you're working really hard and looking for the best outcome possible.

Statistics back up most of what s/he said in the OP. People do regain weight. Statistically, it's a fact.

There are also people like Introversion...who almost replace their food addiction with a health obsession. No offense, Introversion, I absolutely admire you....but you're unusual. Most 120 pound women are not as active as you, not doing the cardio you do...and certainly can't eat 2200 calories a day. You're in top athletic shape and that's incredibly cool....but you're not the norm.

I think we can learn a lot from studying outcomes of whole surgery populations, particularly long term studies.

If you've ever looked at the "estimated weight loss" calculators...you know that different people have different results. There's a big difference in weight loss between the top 20% and the bottom 20%. Some can be attributed to behavior and choices, and some seems to be the luck of the draw (or the curse of the draw...lol...depending on which way you go).

I know one thing that has changed recently, is how doctors and dietitians are approaching calorie intake in the weeks after surgery. The old school of thought was to take advantage of inappetence and have patients lose as much weight as possible during the honeymoon phase of surgery by restricting calories severely. There used to be more tendency to limit patients to 500-800 calorie diets for months after surgery. And yep, people lost weight fast.

What we're learning now, however, is that that rapid weight loss and super low calorie diet can reset the metabolism to a starvation level that actually can inhibit weight loss after a while, and can be correlated with more regain years down the road.

A newer strategy being increasingly embraced in the bariatric community is to move patients up to a 1200 calorie diet as soon as possible after surgery, and encouraging exercise early on. This idea is to reset the metabolism to burning through a normal number of calories ASAP...and giving patients the energy to exercise hard and safely. Food choices are extremely important, but addressing exercise habits in resetting metabolism is becoming increasingly more important.

Bariatrics is an emerging science. We're learning so much about the science of gut flora interactions, the roll of hormones and addictive behavior, genetics...all sorts of variables.

Will your body pick a set point that is difficult to overcome? it's an excellent question. One I don't think we have a solid answer to, yet.

Lot of different theories and a lot of studies to consider. It's fascinating stuff.

[ShelterDog64 2,364]

2 hours ago, setoo said:

So regarding that I think you could offer more experience than me! Do you feel that with eating lean Protein and vegetables as the majority of your food (if I understod right?), your body is truly satisfied after all that weight loss? By that I don't mean it just fights off the hunger and you feel ok-ish, I really mean being satisfied and content with the food eaten and energized and ready to be productive.
If one is not satisfied, I would see the same danger as in calorie restriction. Low caloric food is eaten to keep hunger at bay, but mostly it does not create a good overall well-being, because the body demands more

This is DEFINITELY the case for me. Nothing satisfies my need for food (which is far different than hunger) better than a dense Protein and a vegetable. It might be cheese, it might be chicken, maybe beef, but if I eat my protein portion and then vegetables for the rest of my meal, I'm fueled up for whatever comes after. Some meals I also eat a grain like farro or a little brown rice along with the vegetable. But when I decide that a slice of thin-crust pizza is what I'm going to eat, I KNOW I'll be looking for a snack in a couple of hours.
I lost all my weight (100 lbs) in 9-ish months with the sleeve. I've now been maintaining in a 3 lbs swing range for another 9 months. I *can* eat more per meal, but my activity level seems to be high enough that there's no gain...for example, at 6 months out, I could only eat 2-3 oz chicken, now I can eat 4-6 oz. My program advocated getting up to about 1000 cals/day by 4 months or so, and I followed that advice. Now I eat more like 1600-1800/day. I've had my plastics work done that I wanted, so now I'm finally getting to 'real' life with this sleeve and my more cooperative body. I'm active (but not running miles a day), I have energy, I drink a little wine and have a piece of chocolate every now and then. I eat meat, eggs, cheese, butter...I don't drink Protein Shakes much anymore and I don't use artificial sweeteners. I truly believe this is how healthy people live and eat...whole foods, small portions, very little junk food, Desserts are rarities instead of daily, get up and move every day in a meaningful way. My sleeve gave me the ability to restrict my intake until I could train my brain and my body for this way of life instead of my old stomach that screamed for food constantly, and was killing me by doing it.
As to regain, I'm not sure I agree with your premise but it's an interesting posit. Did you look at only sleeve data or did you include roux en Y as well? Among my small sample set of support group members, every gain seems to be precipitated by out of control eating, not drinking enough Water, slacking on exercise...all the things we all know will cause issues down the road.

[catwoman7 10,856]

I've been hanging out on various bariatric forums for about five years. Most people who regain say it's because they've fallen back into old habits. They're eating too much and they're eating crap again.

[Xerox 14]

I would have thought that after a few years your body adjusts to being able to consume more food, and may even increase your hunger hormone production. So in that time you want to develop a healthier relationship with food and adopt a healthier lifestyle.
Then it is up to you.
I used to be a binge eater, I would think up exactly what food I wanted on the way to the store and then go eat it in private, but I shook off those habits many years ago and I feel like I cant physically consume as much food as I used to and thats without WLS!
These things most definitely are not set in stone but you have to put the effort in!
I also beleive that there is a correlation between poor mental health and obesity, my most positive changes coincided with improvments to my mental health, and I know many obese people with mental health problems. So if you dont tackle those issues then it wouldnt surprise me if you fall back in to those habits.
As an example, if you are a hermit with social anxiety, you might lose the weight, but if you continue to stay cooped up in your house and never tackle your issues with anxiety then that isnt a healthy way to live and you will most likely gain weight back if you are turning to food to fill the void of regular human interaction.

[Creekimp13 5,838]

"A Surgery for Obesity and Related Diseases study looked at how successful gastric sleeve surgery was at helping patients keep weight off for an extended period. It looked at the results of patients who had the surgery five years ago. Things such as total weight loss, how quickly weight was lost, quality of life and complications were all evaluated. The average amount of excess weight loss for those studied in this professional study was 61.5% after just one year and 61.1% after just two years. The average for all five years for 57.4 percent (pretty close to the expected weight loss surgeons usually tell patients at their consultation)."

Say you're a 250 pound woman who should be a 150 pound woman.

Statistically, with sleeve....you'll lose 61 pounds. You'll end up being a 189 pound woman 18 months after sleeve.

After five years...you'll gain a bit back....and end up being around 193 pounds.

These are the median results for this surgery. You could do a little better than 50% of the people who've had the surgery, and you could do a little worse.

But for the most part....if you start at 250, 5 years later, you'll end up around 193.

Still, a really good, life impacting reduction that might not make you "skinny", but will definitely improve your health and quality of life.

Sounds good to me.

[Creekimp13 5,838]

While people usually don't lose as much weight as they hope to lose...

They typically only gain back about 5% of their excess weight.

I actually think that's pretty encouraging!

Obviously individuals are individual....but this seems to be consistent in three studies I've found so far...give or take a couple percent.

[Introversion 1,876]

10 hours ago, setoo said:

So for example, year 1 people lost 70% of excess weight, in year 2 that dropped down to being only 60% and by year 5 it was down to 50%

During year 1, the amount and rate of excess weight loss (EWL) is mostly dictated by genetics. Those with two copies of favorable genetic markers on chromosome 15 will lose rapidly, regardless of what they eat. These blessed souls will lose weight while grazing on Krispy Kreme donuts and chili cheese fries.

However, since these people failed to adopt healthy habits during year 1, a.k.a. the "honeymoon phase," they usually begin regaining weight during year 2 as the influence of genetics decreases.

It's also important to be mindful that the 50%-to-70% excess weight loss (EWL) statistic places all sleeved persons into the same statistical cluster, resulting in an average.

So, people who lose and maintain 100 percent of excess body weight (EBW) are clustered with everyone else, including average responders who lost 60 to 70 percent of EBW, and the poorest responders who lost less than 30 percent of EBW. After all numbers are crunched, the result is 60 to 70 percent EWL.

Therefore, the results of a person like me who attained goal weight and lost almost 100 percent of EBW are placed into the same statistical data mine as the hypothetical woman with undiagnosed depressive disorder who only lost 40 pounds post-op in year 1 (and regained it all by year 3) by self-medicating her depressed mood with chocolate-covered peanuts and Mountain Dew soda.

Most people don't lose 60 percent of their EBW and call it a day. Some lose 100%, some lose 75%, and some lose only 25% of EBW.

[Creekimp13 5,838]

MOST people lose about 60% of their excess body weight. That's what median means. That's where the MOST people are clustered statistically......around one side or the other of 60%.

People who lose 100% of their excess body weight are on the fringes....like less than 2% of people accomplish that.

Out of 100 people attempting weight loss with surgery......only 2 of them will have the results you did, Introversion.

That's the reality.

You're an inspiration and I wanna be a little more like you because I admire your dedication.....but I'm never gonna be the fitness enthusiast you are. Few people will.

[catwoman7 10,856]

26 minutes ago, Creekimp13 said:

4

People who lose 100% of their excess body weight are on the fringes....like less than 2% of people accomplish that.

studies I've read have said 10-13%

[Creekimp13 5,838]

would love to see one, Catwoman. Can you link me?

[catwoman7 10,856]

6 minutes ago, Creekimp13 said:

would love to see one, Catwoman. Can you link me?

I'll have to find them again. I work in a research library, so they may have been in our licensed databases (e.g. Medline Plus), in which case I can't send them because of licensing agreements, but I can send the citations. I''ll have to wait 'til I get back to work next week.

[Creekimp13 5,838]

Excellent, thanks! If true, I'll be shocked. And really encouraged:) But yeah...100% excess weight loss? I've never seen that over 2%. I'll be extremely interested to know the source and read the studies! Am writing a paper currently, and have searched medical databases at UMich, myself.