Weight Regain After Bariatric Surgery

Matthew Weiner, MD

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 noise” makes it nearly impossible to stick to a nutritional plan.

If you find yourself gaining weight after Gastric Sleeve 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 lossand 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

• Medications
• Injury and Inactivity
• Pregnancy
• Menopause
• Genetics
• Yo-Yo Dieting
• Genetics
• Stress
• Depression
• Processed Foods
• Lack of Sleep

Is Your Diet the Cause?

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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 for treating weight regain after VSG or RYGB than they do in treating weight gain in people who’ve never had surgery.GLP-1 medications, when paired with nutritional change and muscle building lifestyle changes can often help peoplereach 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.

• Revision to Gastric Bypass: This is an excellent choice for those patients suffering from GERD, heartburn or frequent vomiting, but weight loss results vary. Some patients lose a lot of weight after revision to a Gastric Bypass, while others lose only 20-30 lbs.
• Revision to SADI: The SADI procedure is the newest surgery that is being offered regularly toi treat weight regain after VSG.and there is little in the way of long term data
• Revision to Duodenal Switch: The Duodenal Switch is the most malapsorptive procedure peformed. Some patients experience excellent weight loss after this procedure, however, many patients develop nutritional deficiencies and other health concerns that outweigh the value of weight loss.

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

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

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

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

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

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.

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The Pound of Cure Platinum Program

To help you get access to expert weight loss care, and GLP-1 medications in the most cost-efficient way possible,  we created the Pound of Cure Platinum Program.

Our program allows most patients to save at least 50% (and often more) off the cost of their GLP-1 medications. Our program allows you to use real GLP-1 medications (not compounded), and takes advantage of inefficiencies in our medication pricing system.

Sign up for our free webinar

The Platinum Program allows you unlimited access to Dr. Weiner and Zoe to ensure that your medications are prescribed to maximize weight loss efficiency and minimize side effects. You can meet with Zoe as often as you’d like to ensure that you’re also making the important nutritional changes necessary for long term success and comfort.

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

• Unlimited visits and portal messages with Dr. Weiner without additional copays or charges
• Unlimited group and individual sessions with Zoe
• Any prescriptions necessary and guidance on how to reduce your prescriptions costs
• Access to our insurance concierge service for GLP-1 medication coverage if you want to use your insurance
• Access to the Pound of Cure Weight Loss app that includes Sage, an AI dietitian trained to create meal plans and recipes based on your food preferences
• Access to our unique caloratio food logging system

Pricing

• It’s simple. Get started with a $75 consult. No surprises. No commitment if you decide not to continue.

Your Initial Consultation Includes:

• Your visit with Dr. Weiner
• Review of medical history
• Personalized treatment plan
• Credit towards your program fee if you choose to continue
• No surprise bills

If You Choose To Move Forward:

• $129/month for the first six months and then $59/month
• Most patients are able to access GLP-1 medications for between $150-$300/month
• $99 rejoin fee for past members
• Cost does not include medication