Bariatric surgery is a tool that can help people lose weight and lead healthier lives. In my surgery practice, most of the patients I work with start off with a weight-loss goal in mind — and many of them ultimately achieve it. But reaching that number doesn’t always happen as quickly as they expect.
In fact, it's common for patients who’ve had bariatric surgery to experience “plateaus” in their weight loss. These stalls, which occur when a person stays at the same weight for three weeks or longer, are particularly common about one to two years after surgery.
Many of my patients experience weight loss quickly after surgery and expect this to remain steady until they reach their weight goal. A pause in this weight loss can be discouraging or frustrating — and understandably so. The best thing a patient can do is to expect and learn how to ride out these “stalls,” and give their body the best possible support until their weight loss continues.
Why plateaus happen after weight-loss surgery
Learning more about how the body responds to bariatric surgery often helps my patients understand their plateaus and respond in a way that's healthy and effective.
Bariatric surgery reduces the size of the stomach and, in some cases, how the body absorbs nutrients. This, combined with eating smaller portions and lower-calorie foods, results in the body receiving significantly fewer calories than it had been getting before surgery.
These changes trigger a cascade of biological responses to which the body must adapt. Pounds may fall off quickly immediately post-surgery, but the body will ultimately transition to a new normal and tell the body’s digestion to slow down.
These digestive slowdowns are common and should be expected. Simply put, when we eat fewer calories, the body will initially try to slow down to use fewer calories. But if a patient sticks with their weight-loss plan, particularly by incorporating exercise, their body will adjust to the new normal and weight-loss will resume.
While plateaus are often the result of normal bodily responses, we work to support patients to follow their weight-loss plan and help to guide them if they’re struggling, especially if they are finding themselves eating more food than is recommended. This is something to be aware of, as a patient’s post-surgery stomach can “stretch” to accommodate the pre-surgery volumes of food, which can slow or completely stop weight loss.
How to clear weight-loss plateaus
When a patient comes to us with concerns about stalled weight loss, I first commend them for being proactive. Recognizing a plateau is the first step toward moving past it. Once we confirm that they're dealing with a plateau, we strategize our next moves. Here's what I like to recommend:
- Pay attention to food intake. When you stick with your recommended diet plan, your body will adjust. If it's possible your food intake has crept up, commit to measuring and weighing everything you eat and drink. Track it in real time with your food-tracking app so nothing gets overlooked.
- Prioritize protein. You should eat between 60 and 100 grams of protein per day. Foods rich in lean protein preserve lean muscle mass while giving you energy and fuel. Plus, eating more protein leaves less room for sugary or starchy foods (which should be avoided). Aim to have protein at every meal and eat it before anything else on your plate.
- Drink 64 ounces of water every day. Drinking enough water helps your body metabolize fats. It can also avoid dehydration symptoms, such as nausea and fatigue.
- Aim for at least 30 minutes of exercise daily. Regular physical activity is another tool for maintaining lean muscle mass, and it can help boost metabolism. Keep your exercise routine challenging by regularly changing up the frequency, intensity, and duration.
- Get 6 to 8 hours of sleep each night. You're better able to manage food cravings when you're well rested. Adequate sleep supports a healthy metabolism, increases energy, improves mood, and even supports memory.
- Manage stress. It's easy to turn to food when you're feeling frazzled and heightened stress hormone levels can directly contribute to weight gain.
- Maintain realistic expectations. It's normal for weight loss to slow as you get further out from your surgery, but you should remain in contact with your bariatric team so you can ask them for support in how to navigate these prolonged plateaus.
- Focus on the positive. Surgery alone won't lead to sustainable weight loss. But if you keep up with your healthy diet and lifestyle habits, you can succeed. Your body may need time to adjust to the drastic changes it has undergone. It can help to focus on the incredible benefits you've already reaped in the meantime. In addition to losing some weight, you're likely experiencing more energy and may have been able to decrease or eliminate some of your medications. These changes are just the beginning, and there are more good things to come.
Revisional surgery: A last option
When a patient commits to a healthy diet and lifestyle, bariatric surgery is usually successful. But in some cases, a second surgery may be considered.
However, I typically recommend revisional surgery only for patients who are experiencing a complication, like severe acid reflux, from their initial surgery.
It's important, too, to consider the benefits of revisional surgery against the possible risks. These procedures are complex, and patients may be at higher risk for complications than with their initial surgery.
The bottom line on weight-loss plateaus
Stalled weight-loss can be a normal part of the post-bariatric surgery journey, but try not to let them discourage you too much. If you stay vigilant with your diet and lifestyle habits, your body will adjust and your weight loss will get back on track.
Attend a free seminar on bariatric surgery
At Temple Health, we encourage anyone who is interested in having bariatric surgery to attend our free, online Bariatric Surgery Seminar. Our experienced bariatric surgeons give an overview of weight-loss surgery and the lifestyle changes necessary for achieving success.