One Year+ Post-op: Now what?

Presented by Dr. Monica Ganz, director of events and support groups for OH

Losing weight after the weight loss stops
When you first have surgery, your pouch is about the size of your thumb – mainly because of swelling and irritation from the procedure. The pouch takes a year to 18 months to heal, and healing allows increased food intake.

Another cause of post-op weight gain is that some people start to be less diligent with exercise after a year. It’s typical to consume more a year after surgery. You have more foods available to you, because you’ve spent the first year experimenting with new foods and now know what you can and can’t tolerate. Some people think they are hungrier, which is unlikely if there is decreased activity. Also, many post-ops never experienced true hunger before surgery because they were eating all the time. Monica says they were never truly hungry yet never truly satisfied either. Eating more nutrient-dense foods also leads to eating more calories.

Statistically, 50% of WLS patients will gain back more than 50% of the excess weight lost by five years. Twenty percent will gain back 20% of their weight loss immediately upon reaching their goal weight.

Calories in minus calories out equal a change in weight: When you take in the same number of calories you expend, your weight stays the same; when you eat more calories than you expend, you gain weight; and if you eat fewer calories than you expend, you lose weight.

Inadequate Weight Loss
Calorie intake too high/hunger: Are you planning your meals and spacing them apart appropriately? Are you making good food choices? The surgery doesn’t fail the patient; the patient fails the surgery.

Metabolism too low/hypoglycemia: Are you eating frequently enough? Are you making sure you eat protein-rich foods? You should have six planned eating events per day. That includes meals and protein supplements. Micronutrient deficiencies can also affect metabolism. Skin can be very sensitive to tape two years after surgery because of micronutrient deficiencies.

Why do we stop losing?
Again, it’s about calories in vs. calories out. Each of us has set weight that our body prefers. Not everyone is meant to be a size 4 after surgery. It can be done, but some post-ops find that the sacrifices required to keep body weight that low isn’t worth it in the long run.Eliminate excess or empty calories. Look for ways to cut out unnecessary fat and calories without compromising your nutrition. That means, cut out simple carbohydrates not protein. Don’t go crazy counting calories; realize that you need to improve your lifestyle, you are not on a diet. Pay attention to the glycemic index and pick foods that score lower.

All calories are NOT created equal
Energy density, water content, fiber content, absorption, processing and storage all contribute to the effects of calories on the body.Fruits and veggies are high in fiber and water and low in calories. Crackers, cheese and fatty meats contain a lot of calories relative to how heavy they are.
Foods that have a high water and/or fiber content add bulk to your meals, so you’ll feel satisfied without eating more calories. For example, a quarter-cup of raisins has the same calories as 1.75 cups of grapes, but the grapes will be more filling. 100 calories: 23 M&Ms, quarter-cup of raisins, 5 oz. Jell-O or 2.25 cups of strawberries. Obviously, the strawberries are the best option as a filling food. McDonalds large fries is 540 calories, which is equal to 22 cups of raw broccoli, 135 baby carrots, 17.5 oz. chicken breast or 4.5 whole sweet potatoes.

Soft carbohydrate syndrome
Soft carbs are the arch enemy of WLS patients and are the cause of weight gain or plateau in the majority of patients. If you can crush it, and it crumbles, stay away from it. That’s a sure sign of simple carbohydrates, which travel through the pouch easily and offer very little nutritional value or satisfaction.