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Some Dieters Are Set Up to Regain Weight Appetite Hormone Levels May Predict Dieters' Success By Denise Mann WebMD Health News Reviewed by Laura J. Martin, MD Sept. 9, 2010 -- Weight regain is the bane of many a dieter's existence. Often dieters who regain weight after losing it are viewed as failures and judged for their lack of willpower, but new research may put an end to this blame game. Weight regain may not be solely a willpower issue. Some people may actually be programmed to gain weight back based on their levels of two key appetite hormones, leptin and ghrelin. The new study appears in an online version of the Journal of Clinical Endocrinology & Metabolism. "This knowledge could be used as a tool to personalize weight-loss programs that could guarantee success in keeping off the weight," says study author Ana Crujeiras, PhD, of Compejo Hospitalario Universitario de Santiago in Spain, in a news release. Slideshow: Simple Secrets to Portion Control and Healthy Eating Setting Dieters Up to Win, Not Fail In the new study, 104 obese or overweight men and women ate a low-calorie diet for eight weeks and were followed up with six months later. Their body weight, ghrelin, leptin, and insulin levels were measured before, during, and after the diet. Ghrelin is the "go" hormone that tells you when to eat, and leptin is the "stop" hormone that tells you when to stop eating. On average, study participants dropped about 5% of their body weight while adhering to the low-calorie diet. Six months later, 55 people maintained their weight loss, while 49 regained 10% or more of the weight they had lost. Those individuals with higher leptin and lower ghrelin levels before dieting were more prone to regain weight, the study showed. While this may seem counter-intuitive based on the actions of these hormones, the researchers suggest that it may be a matter of some people being resistant to the effects of these hormones. Their brains may not be getting the fullness or satiety messages that these hormones are delivering. You may have a lot of leptin, but your brain is resistant to its effects; much like people with type 2 diabetes become resistant to the effects of the hormone insulin. Going forward, "these hormone levels could be proposed as biomarkers for predicting obesity-treatment outcomes," the researchers conclude. "Our findings may provide endocrinology and nutrition professionals a tool to identify individuals in need of specialized weight-loss programs that first target appetite hormone levels before beginning conventional dietary treatment." Fullness Resistance Syndrome Louis Aronne, MD, founder and director of the Comprehensive Weight Control Program at New York-Presbyterian Hospital/Weill Cornell Medical Center in New York, agrees. "There is something physical going on in people who regain weight," he says. "Resistance to these hormones is a risk factor for weight regain," he says. Aronne dubs this condition "fullness resistance" and says that your brain is resistant to signals that come from your stomach and intestines telling you that you are full and to stop eating. Fullness Resistance Syndrome continued... "With leptin resistance, you don’t feel full and the more you eat, the hungrier you may get," he says. "We need to stop blaming people and start recognizing the physical basis of weight regain and manage it so people do better," he says. The new research likely applies to significant numbers of people who are finding the battle of the bulge to be an uphill one. "We are getting down to some of the final choke points of our weight regulating system, and these should apply to large numbers of people," he says. Drugs aimed at leptin resistance -- and there are some in the pipeline -- may help, he says. 'Ample Evidence' "There's no question that most people who easily gain weight, and/or quickly regain weight after losing it are different from other folks," says Scott Kahan, MD, co-director of the George Washington University Weight Management Program in Washington, D.C., in an email. "The general public tends to think of 'fat' people as lazy and as having no willpower [but] it couldn't be further from the truth." "Ample evidence, now including this study, suggests that there are physiologic reasons for weight gain, difficulty at losing weight, and rapid weight regain after a diet," he says. "There is no question that certain people are preconditioned to gain weight more easily and more quickly regain weight after dieting, just as some people are predisposed to having their blood pressure spike after eating salt whereas others can eat all the salt they want without having problems with hypertension," Kahan says. "This study is another small step toward ultimately ... [devising] new strategies for weight management and disease prevention that work with our bodies' physiologic makeup, rather than against it." When I brought up the issue of grehlin and leptin with my former surgeon he just rolled his eyes - which is one of the many reasons he is my former surgeon. I believe that I have a problem with these hormones because it has always taken a lot of food to get me to the point of satiety and that whole "wait 20 minutes" after eating to get full never worked for me. Sometimes if I ever do achieve satiety AFTER eating it can take 90 minutes or more. That's IF. To achieve a satisfied feeling while eating would take way too much food.

Im doing a preop diet also. Im on day 10 of the diet, and have lost 11 lbs. I bet you can do it too. I personally think that two weeks is too long, let alone 16 days. Best wishes!

1 week of clear liquids pre op, 1 week of full liquids post op. Then I went on to pureed food 10 days, soft food 10 days.

my doctor made me lose 10 % of my excess body fat before allowing me to have the surgery. it was not an insurance requirement. Every insurance is different and so is every doc. nothing is written in stone (would be sooooo much easier if it were). best of luck with your fill.

I felt terrible yesterday. Pain, nausea, and GERD. Called WLC and they guided me through the GERD. I stayed in bed all day. I'm a little better today, but very tender. Took one big nap. I feel like I've been set back from recovering. It almost feels like day 1. Anyone get sick this early?

Thanks for the replies ladies. I currently wear a size 8 -8/12 in shoes depending on the style and a 9-10 in sandles and wedges due to my feet being so wide. I can't wear standard size boots becasue I have 18" calves, they arent even flabby. I have pretty muscular legs with barely any jiggle. Sigh, I cant wait until I get a surgery date.

I have gone through this every morning of my six-month pre-op diet. I won't get an accurate weight until after about 10:00am or so. I am still ridding my body of liquid until that point. If I weigh super early (before 7am), it can easily be a 2ish pound difference. I've learned to know that and accept it -- but it was a hard pill to swallow in the beginning!

I agree it seemed less invasive and more straightforward my doctor also said the risk for complications is higher in bypass then with sleeve also my aunt had gastric bypass about 10 years ago and has been really sick also I didn't like the malabsorption Factor the dumping syndrome and the fact that it seemed like I would have to watch what I ate even more closely with gastric bypass like what if I'm at a new restaurant and it has something my new couch wouldn't agree with dumping syndrome byterrified me and the thought of my intestines being rearranged I didn't like that I am higher BMI patient BMI 52 but I love to workout so I don't see this being an issue but that is what led me to my decision.

I have had no problem with tacos or chips...however I used to eat like 3 or 4 tacos and a bag of chips...Now I can eat like 1/2 a taco and about 10 chips... Banded 5/14 and the scale is down 30 pounds!!!! I had my first fill on 6/10 ( 2ccs in a 10cc band)

Hi,I had my surgery last Wed 2/6/10 and it seemed to go well.I had a Hiatus hernia repaired at the same time.Unfortunately i had a cold all week as well so still feel a bit under the weather.I have some left shoulder tip pain and have been taking Paracetamol only so far since discharge as well as in hospital.I did not have any gas pain just some tightness around my sternum and I was wondering if anyone has any idea how long the shoulder tip pain goes on for ?I have been using hot packs for it but it is really annoying.Also is it normal to feel a bit lightheaded and have a slight headache all the time even though it is 5 days after surgery? Any ideas would be great.

Are you taking an antibiotic post op?I got thrush in my mouth post op but I was taking antibiotics for 10 days post op.Do get some meds for the thrush but start taking some sort of live culture (pills you can open and take directly on your tongue if you are not eating yet.)There is also drinking yogurt with live cultures in them that should help.

LOL! #10 is soooo true!

So, my one year surgiversary was in August and I've been thinking of how to Celebrate the success of the past year with my Bariatric Pal friends. What can I add to what hasn't already been said? What were my experiences that can inspire and help newcomers? What were the challenges I faced and overcame? What makes my story so much more special than anyone else's? I came to the conclusion that the answer to all of those questions is, everything and nothing. For all of us the journey is unique and it's our most special accomplishment, but all of our journeys are very familiar and the same for many who came before us. But if I left this post right here, you'd say he lost his enthusiasm along with his weight, so let me tell my story (I promise to keep it short but sweet). I've been overweight most of my life, I made countless attempts at getting it under control, I'd lose 10- 50 lbs. and slowly lose ground only to gain it all back. Sound familiar? In the meantime life went on, career, marriage, kids, house, bills, you know, right? Being young we feel invincible, yeah I was heavier than fit people but I could handle the weight. Of course, I was more of a spectator than a participant but I always figured I'd take care of it some day. Family, job, good times and bad times,there's always something that took priority over losing just a few pounds. But time rolls on, and occasionally I'd try another perfect weight loss answer, but ultimately it wasn't permanent and it was just another failed attempt. When I hit my fifties I noticed more muscle pulls, back injuries, knees were aching more, out of breath sooner, heart was working harder. So in my mid fifties I was put on meds for elevated blood pressure, shortly after statins for cholesterol. At sixty I was put on a CPAP for sleep apnea, and meds for pre diabetes. It was getting real, I was seeing the damage of carrying all the extra weight, but my doctor was keeping things under control, no worries. Then my hips began failing, I could hardly walk, I needed a cane to get in and out of chairs, I didn't want to move. I went to see an orthopedic doctor and he said the pain was from compressed cartilage caused by my weight, so I asked what we could do, he said "nothing, the damage is done". I think that's when I said enough is enough, I'm destroying my body and my future was heading towards life as a sick and handicapped old man. So I had a serious talk with my PCP, looked at my options, did research and made my decision to go with WLS at 62 years old. On my day of surgery the surgeon asked if I was ready, I said "let's do it", and I never looked back. Here I am 14 months post surgery, no more meds, no more CPAP, no more diabetes, I walk miles with almost no pain,and otherwise feel fantastic. I'm now doing things at 63 that I wouldn't have tried doing at 53, I went from feeling like an 80 year old to feeling better than I ever remember. I was in size 3XL shirts and pants with waist size of 46", today I can wear large to medium shirts and 34" waist pants, now I can shop off the "normal" racks. I've gone from the sidelines and into the game, I'm stronger and I have more energy, I can walk, run, and climb, and play, I feel young again. I'm still not used to the face that stares back at me in the mirror, there was a heavy guy looking back for the last 40 years or so, now I see a leaner more vibrant looking man, it's strange but I'm getting more used to him. So that's what makes my journey a special success to me, yours may be similar and it may be different, but it will be your special journey. I'm still learning to live with my sleeve, you can't erase years and years of lifestyle overnight, but after a year it's becoming more normal to listen to my sleeve and pay attention to what and how much I eat. If I can offer any wisdom, its to make your decision and then own it, go ahead and commit 100%. I know a lot of people regret not doing something sooner, but we can't change the past, we can only change the future. Best of luck to you all and thank you for your stories and experiences, I have learned and still learn from them.

Oh my that's not good. I pray everything goes well for you!!!! HT: 5'6" HW: 251lb -1/25/17 SW: 230lb -7/19/17 CW: 228lb -7/22/17 GW: 140lb

I got out of surgery at 11am. Woke up around 1-2 in so much pain. Had tons of back pain cause of the oxygen. My voice was raspy cause of the intubation. Stomach hard and swollen as a ball. I questioned my decision to every nurse and Dr I saw. They gave me Morphine in a machine which I press the button and it gives me morphine every 15mins. Feeling much better now. I started walking around 9pm when the anasthesia was wearing off. Was dizzy but I made It through. Finished phase 1: liquids yesterday. Today I start stage 2: protein shakes started peeing soon after I started walking. I was retaining all my urine after that first pee. Decided to walk more now I am a non stop pissing machine lol. Only problems I'm having now are gas pains. In which I'm taking gas x for. Having passed gas yet but hopefully I will this AM so I can go home tonight. They brought me all liquids at 8; SF Jello, Water bottle, Veggie broth, green tea. 3 sips of broth and I was full. (Such an amazing feeling since I still don't believe I had the bypass done, so bittersweet) Now trying to figure out how to pass gas [emoji618]️ HT: 5'6" HW: 251lb -1/25/17 SW: 230lb -7/19/17 GW: 140lb

hmmmmm-a pic of me?I dont know-I tended to shy away from cameras in the last 10 years but what the heck-I'll see what I got but be warned Im chopping my head off since Ive told NO ONE(except hubby and best friend) in my personal life I had this done-not even family.I feel like Im having an affair or something-lol.

Ive gone over and over this in my head a thousand times. What should my goal weight be. I tried to set something reasonably attainable for myself. I settled on 170 for the time being. Short term i focus on 10 pound increments at a time. Im sure at 170 i will still be viewed as being overweight.......but......i just dont know without having a plastic surgery intervention if anything to much lower then that is going to be a realistic expectation! So i say focus on somthing attainable!

I"m so proud that I decided on weight loss surgery and my husband was so inspired that he decided to have it as well. He had his surgery yesterday. Check out my video blog: YouTube - WLS Week 30 5/12/10 - Husband get's Lap band Surgery as well

That's awesome. I'm one week post op and I can already feel the difference. Congratulations!! Sent from my XT1635-01 using BariatricPal mobile app

Who did you see? How long after your goal weight did you have surgery? I’m past goal (reached normal BMI at 6 months). Now down another 10 lbs. I feel like the excess skin is making me think I can’t just try to maintain.

@@Ruth1ess What you are asking is if you can bio-hack your way to more weight loss. No one can give you an answer to that. The 60-70% is an average, It is a completely arbitrary number. Doctors use it because that is the average and its is a good number. Losing that amount of weight is life changing for obese people and can end a lot of medical problems. If you use a calculator like this http://www.obesitycoverage.com/weight-loss-surgeries/gastric-bypass/how-much-can-i-expect-to-lose This is what the calculator estimates I can lose at my starting weight This is what the calculator estimates I can lose from the weight I am at right now. I have lost 101 lbs in 6.5 months with the sleeve. The weight lost estimated from my start is 222. The weight lost estimate from where I am right now is 182. The start weights are 101 pounds apart but the end result is only a 40 pound difference. Is it worth it to wait and have to lose weight taking the chances on being hungry, to possible lose an little extra? It might be to you. The amount of weight you will be able to lose on your own before surgery is unlikely to be that much so the differences will be minor. I would have never lost 100lbs on my own. I would never lose more than 30-50 on my own and I always gained it back. I am only 6.5 months out and I have lost 101 lbs basically effortlessly. I haven't been hungry, and after the first 6 weeks I have had plenty of energy. I am more active, but I don't run. I walk, I do yoga, and I lift weights. I do things that don't stress my body and I am still losing at a fast pace. The way I am dropping weight right now 10-14lbs a month and it isn't slowing, as I lose more weight and am more active, it is coming off faster. I expect that I will blow right past that first lost estimate from my start of 365 to 222, I will probably be past 222 long before my one year anniversary. I expect to keep losing long after my 1 year anniversary just because I would have to be really dedicated to eating, basically eat all day to get above my resting metabolic rate. So try that calculator and see if you think the difference is worth waiting for. Just remember it is just an estimate and it is arbitrary.

Lots of folks here have lost 90 - 100% of their excess weight. IMHO, it doesn't matter how much of it you lose pre-op or post-op. I know you think you're being clear, but I think there's a big misunderstanding. You seem to think there's a finite limit to how much weight you can lose (and no more) that's defined as a percentage of your current weight. Also, there's not deadline or expiration date on your ability to lose weight. How much weight you can lose is a function of a lot of things you said you understand and that you can control and (perhaps) a few things you can't control. Consider that I'm 5'5" tall, lost 19 pounds pre-op (11 pounds on my own 2-month diet and 8 pounds on my surgeon's 2-week diet). My surgery day weight was 216 pounds. I reached my goal (150 pounds) at 8.5 months post-op. In the 9+ months since then I've slowly lost another 15 pounds and now weigh 135 pounds. My BMI is now 22.5. That means I've lost 90 - 100% of my excess weight. And as I said earlier, many people here have done the same. EDIT: P.S. The "frustration" you anticipate "toward the end" would be completely self-imposed. The interesting thing is that this trip you're about to start actually never ends. It just goes on and on and on ....

Good morning! I've been doing some thinking, wanted to pick the brains of the veterans in here. I'm still pre-op with no date, probably about two months out. I've lost 10 lbs in the past month by working with my nutritionist. I could probably lose another 10-20 lbs before my surgery, which is awesome! But, wanted to ask, if in your experience, the pre-op weight loss is included in the ~60-70% of anticipated weight loss I can expect to lose with my sleeve? OR is it on top of that? As in, is it worth delaying surgery a little while so I can lose more weight, then my sleeve would bring me down even further than it would have before? I'm wondering if that anticipated 60-70% loss of excess weight is because that's how far my body will want to go, period (so weight lost beforehand factors in as well and I will lose less on my sleeve). Any insight you can give would be great HW: 296 CW: 285 HT: 5'7" BMI: 46

Thanks for all of your comments to my blogs. I try to respond to as many other people's blogs as I can because when I get home from work, the first thing I want to do is read your comments. So I figure, other people want to read comments to the blogs they write. Anyway, as you know, my surgery was on 6/21/10. I have not had a fill yet because everytime I was scheduled (3) I went to have the fill, but after my discussion with the doctor or nurse practioner, we postponed the fill. They kept saying I wasn't ready yet. Today for lunch I had 9 large shrimp, 6 cherries and an entire banana. This was the largest meal I have had since the surgery. Tonight's dinner was 4 oz of steak, a little broccolli and some romaine lettuce with grated cheese and dressing, on the side of course. I am full now, but I can't believe how much I had for lunch. My first actual fill is scheduled for 9/1 and I think by then I will be ready. We'll see how it goes. If I am not losing, eating more or hungry between meals, I will not walk, but I'll run to get the fill. I am so afraid of not losing or even worse, heaven forbid, gaining some back. I've worked to hard to get where I am now, so I refuse to go backwards! Have a great evening everyone. I'm going to watch some TV, relax and get to bed early.

Hi Sharon, I live in Oregon and I am home as of last night. It was a long trip home due to road closures and having to take the coast to get home in the rain. It makes me nervous to ride in the rain in the motorhome. Anyway, I haven't been scheduled yet but I have my nutrition class left to complete and then I will be submitted for insurance approval. I start this week on that. I gained an additional 8 pounds so now I have to lose that and then from 5 to 10 pounds. GRRRR! Why did I do that to myself!! The road from Reno to Vegas is pretty snowed in, be careful.