long term effect of surgery

[E-mom 10]

I hope I can communicate my question to you all. I am in a long waiting period for surgery like about a year. So I've been reading lots. My question pertains to people's tendency to regain. For those of you especially who are years out from surgery has your appetite come back as strong as it was prior to surgery? Do you have the desire to eat even more frequently to compensate for your smaller stomach or can you eat like you did before?

I have dieted so very many times in my lifetime with soul searching and introspection. I've been sure this was it to never to regain my weight back, several times. However, its never worked for me. So am I unrealistic to think that this surgery could be the physical help I need to help maintain weight loss? I guess I'm looking for insight as how the actual surgery worked for you long term. I know there is the change in eating but if that were all there were I would think more of you would be unsuccessful. Thank you in advance for any insight you can give me.

[alliel 2]

SD- 5/2018

SW-318

LW -180 didn’t stay there long & maintained roughly 190-195 for a long time.

CW 210

Yes your stomach will stretch back out

Yes it’s very hard work—FOREVER

I am torn like on 1 hand it was totally worth it. On the other hand It didn’t solve the issue that I desperately needed it to. That’s another story for another time. I am however slightly happier thinner. I wasn’t happy at 180 it was too small for me. I like me at 200 it is my happy weight but I am slowly gaining. For the past 1.5 yr I have been ⬆️ & down 10lbs usually gaining right before my menstrual cycle & then I lose its. Everything kinda comes back like my appetite is larger & I can eat just about anything. I don’t exercise persay but I live on a farm so I’m always working. I back to the same shitty eating habits eating once a day @ dinner like before WLS. I need to re train my mind make Protein intake a priority & more frequently. GOOD for u for taking this leap of faith. I’m sure that I wait is stressful in itself. I can’t believe it’s taking that long. It took me 2.5-3 mths from initial appointment.

[Tomo 1,193]

I will try my best to answer your questions. They are good questions.

I had the sleeve in 2015, I was revised to bypass due to gerd over a year ago. Years after the sleeve, my weight crept back up about 40 lbs but no where close to where I started which was over 320 lbs. Unfortunately, my appetite was never really supressed after the sleeve, but even years later, I could never eat a lot in one sitting. 10 ounces max no matter how hungry I was. I never ate around the sleeve either. That is, no milkshakes, donuts, cakes, slider foods that slide right through the sleeve. So the restriction was always there, thank goodness.

But then, I got gerd. Gerd is a horrible thing, it gnaws at your stomach and you feel you have to put something in it constantly just so the pain subsides. No medication worked. It was frustrating, painful, no sleep either.

Fast forward, I get an RNY and my severe gerd is finally gone. I still have silent reflux from time to time but it is not bad. Appetite is more suppressed compared to the sleeve but I could have happily went a lifetime with my sleeve and stay in a decent weight range if I didn't get gerd and had to revise. So, yes, appetite returns but if you can make the commitment to follow the basic rules of Protein first, no drinking during meals, no slider foods, you will do good.

[Arabesque 7,313]

Yes, your hunger does return. A bigger question that influences this is whether what you are experiencing is real hunger or head hunger. Head hunger comes from cravings, habit, boredom & emotions. Real hunger comes from your body needing nutrition & feels different. You’ll learn how it feels for you. For me I get restless, know something is wrong but don’t crave or want a specific food, texture or flavour.

Unfortunately while the surgery changes your digestive system, it doesn’t change your thinking. You have to do that part. Many find working with a therapist helpful with head hunger & the issues behind it.

Yes, the surgery does physically reduce the amount of food you can consume, boost your metabolism, change your body’s set point & temporarily reduce your hunger (not everyone though). The reality is if you aren’t ready to do the head work to reflect on how, what & what you eat you will gain weight again. The surgery isn’t an easy fix though it can give you the impetus to change. I realised what I was doing wasn’t working & that surgery was my last resort which made me want to embrace the benefits & not waste them.

Hope I haven’t scared you more. In many ways I eat more & more often than before (was a meal skipper). I worked out a way of eating that works for me, complements my lifestyle, provides my body with what it needs & has been sustainable. Some do regain some of their weight because how they initially chose to eat doesn’t.

The truth is the surgery can be amazing if you grab the opportunity with both hands. I’ve never been able to maintain my weight like this before & haven’t been this weight since I was 12 or 13. I look at food differently. Not as the enemy nor as a way to make me feel better but as a source of the nutrients my body needs to function effectively. And yes, I still enjoy food & eating .

[ShoppGirl 4,844]

The surgery is in no way a magic cure. It’s only a tool to help. You can buy all the tools you want though, and some fancy drill may make it easier than a hammer, but your deck is still not going to get built without you doing some of the actual work.

I think of the surgery more as a clean slate. Yes, the hunger does come back and no you will not be able to eat exactly like you did and keep the weight off. BUT, you will get this one time fresh start where you really do lose if you follow the plan and if you resolve to continue making those healthy choices most of the time you should be able to maintain it.

I’m not gonna lie and say it’s easy cause it’s not. I have to ask myself probably once a day do I really need this or do I just want it. But it’s totally worth it to be able to feel good in my own skin.

[catwoman7 11,214]

hunger/appetite usually come back sometime during the first year after surgery (and a minority of patients never lose it at all). After that, things get more challenging. It's hard work - but it does "work" as long as you're committed and stick with your program.

during year 3, most people experience a 10-20 lb regain as your body settles in to its new set point. Of course, some people can gain much more than that if they aren't careful.

basically, the surgery keeps you from eating a lot AT ONE SITTING. I'm over seven years out, and I can't eat nearly as much at one sitting as I could prior to surgery. As an example, before surgery, I could easily eat half a large pizza. Now, I can physically only eat 1-2 pieces. Again, at one sitting.

the major problem is grazing. If I eat 1-2 pieces of pizza at 6:00 pm, and another piece at 7:30 pm. and another piece or two at 10:00 pm - ta da! I've eaten half a large pizza. So you really have to watch that if you want to maintain your loss.

like others have said, though, it gives you a huge reset. I lost over 200 lbs, which I could have never done on my own. But after that loss, it's on you.

Edited September 4, 2022 by catwoman7

[RickM 1,747]

Yes, your body adapts to the changes made by surgery, and it will still want to gain weight, as it does now, but it is harder and slower to do so. This means that you have to adapt to to counter that tendency - the surgery will indeed help you to lose the weight that you can't lose now by yourself, but you still need to work at keeping it off.

This guy gives a pretty good presentation of how it progresses, and some ideas on how to live with those changes to help maintain things. You don't have to follow all of his recommendations, (I'm not so sure about his green smoothie thing....) but it helps to understand what is happening so that you can develop your own plan that makes sense for you.

My takeaway from him is that you will see increased ability to eat more at a meal, though not as much as pre op - his progression is consistent with my experience, though my wife maintains a greater restriction than I do, YMMV - is to fill in that increased ability/desire to eat more with bulky, low calorie veg to minimize and control the caloric increase over time. The salads that I make now for lunch have about the same amount of Protein - meat and cheese - that they did early on, but a lot more veg than earlier. Our protein needs doesn't increase over time - our "high protein" post op diet isn't really all that high, but rather a maintenance level of protein while everything else is dramatically reduced at that time.

I found that it really helps to work on your long term maintenance diet as early as possible - long before surgery if you can - to get used to how you should eat 5-10 years from now rather than just next month or next year. Learn how you should be eating for good weight maintenance (and satiety) and start developing those habits early - don't worry about rapid pre op weight loss, let the surgery do that.

If you are seriously concerned about your long term prospects on weight maintenance - if you have had a long history of yo yo dieting, and/or are starting at a very high BMI, you should also consider the DS, duodenal switch, surgery as that has demonstrably better regain resistance than the RNY or VSG, which are very similar in that regard. There are more trade offs involved - what in life doesn't have them - but it is worth considering ahead of time rather than as a revision later on, as the bypass is a difficult thing to revise.

[I♡BypassedMyPhatAss♡ 804]

What led me to weight loss surgery isn't what led most people here. I didn't (don't) have food addictions, etc. I had medically induced obesity due to auto immune disease and long term corticosteroid use. So, I got a Lap Band in 2013, and lost about one hundred and forty pounds. I never got to a "normal" weight. It's like I reached a new set point and stopped losing. I pretty much maintained that for about five years or so and then I developed GERD. As @Tomo said, the GERD associated with Lap Bands/Sleeves doesn't respond to meds and there's always a gnawing, hungry sort of sensation that makes you feel like you always need something in your stomach to stop the torment going on in there, and that led me to eating slider foods, because they felt the best to my GERD tormented stomach. So I regained maybe ten pounds during my GERD period. Then in 2021 I had the band removed, then I lost the ten pounds that I had gained, because the GERD eased up a bit and I was able to eat healthier fruits and veggies that my Band wouldn't tolerate before and kicked the carbs to the curb. I'm currently almost 7 weeks post op RNY revision and I've lost twenty-nine pounds. So the scale is finally moving after years of being stuck. I feel like I didn't regain weight even after my band was removed due to a change in eating habits and behaviors that I adopted when I got my Lap Band. I maintained those, and yes it was easier after my Band was removed because I could eat healthier again. My Band wouldn't tolerate fibrous, healthy veggies most of the time. So I would say maintaining success in the long term relies on a change of behaviors and eating habits. One other thing that I think helps a lot of people maintain success is lifetime tracking of calories/macros.

[E-mom 10]

Ok, I hear you all. And I get it I think.

The surgery is a tool to help you get to a point where your mind, willpower and new habits have to take over. Some of you seem to be saying that years down the road there is little difference, except for starting point and maybe some restriction, between having had surgery and just following a good healthy diet for weight maintenance.

I will try to follow a maintenance plan now and not graze. I suppose its good to know that I will always need to be diligent.

Thank you

[BigSue 1,389]

I'm two years post-op, and my appetite has returned, but not nearly to the extent as before surgery. In the beginning, it was easy to lose weight because I wasn't hungry at all and physically couldn't eat much, but that has gradually changed. It feels upsetting at times to see the portions that I am able to eat because I think, "I shouldn't have room for this big of a salad, " but I think my perception is skewed because I'm comparing my current portions to my initial post-op portions, not to what I used to eat pre-surgery.

I remember pre-surgery often feeling like my stomach was a bottomless pit, and no matter how much I ate, I could still feel like I was starving. There are times now when I eat a reasonably-sized meal and still feel hungry, but even then, it doesn't take much to get all the way full. I'm probably doing it wrong because we're not supposed to eat to the point of getting really full, but I'm not perfect. And sometimes it's still hard to tell whether it's real hunger or head hunger.

I can definitely see how people can regain a lot of weight after a few years, because I feel as though my stomach has stretched out quite a bit and I could over-eat if I'm not careful about what I eat. However, I have COMPLETLEY changed my eating habits and shifted toward low-calorie foods. I've been tracking everything I eat in MyFitnessPal for over two years, and I consider that the #1 key to my weight loss, other than surgery itself (in fact, I lost 70 pounds before surgery this way). I'm not stupid -- I know how to read a nutrition label -- but there's something about actually logging my food intake that makes me confront my choices and think about what is and isn't worth eating.

I still track my calories in MyFitnessPal and I'm afraid to stop, but I suspect that I would probably be ok without tracking because I've gotten into good habits. I've also found that at times I've eaten more than I should (e.g., eating at a restaurant or getting hungry between meals and having a big snack) and think, "I need to limit my calories for the rest of the day," I actually end up not being hungry for the rest of the day, anyway.

My tastes have also changed since surgery. I used to be kind of a picky eater, and I'm not sure if my actual tastes have changed or if I've just become more open-minded, but I eat all kinds of things now that I wouldn't have touched before surgery. I used to hate seafood and now I love it and eat fish almost every day. I used to hate a lot of vegetables, like squash, peppers, radishes, cauliflower, etc., and now I'll eat just about any vegetable. I consider cauliflower rice to be the greatest diet hack of all time because it simultaneously eliminates a high-carb food and sneaks a vegetable into the meal. Plus, if you buy the frozen stuff, it's faster and easier to prepare than actual rice. Before surgery, I turned my nose up at the idea of cauliflower rice, but now I eat it several times per week.

I suspect that a lot of people who regain the weight rely too much on the restriction and don't change their eating habits, so when the restriction wears off, they're kind of back where they started.

[Tomo 1,193]

What led me to weight loss surgery isn't what led most people here. I didn't (don't) have food addictions, etc. I had medically induced obesity due to auto immune disease and long term corticosteroid use. So, I got a Lap Band in 2013, and lost about one hundred and forty pounds. I never got to a "normal" weight. It's like I reached a new set point and stopped losing. I pretty much maintained that for about five years or so and then I developed GERD. As [mention=143904]Tomo[/mention] said, the GERD associated with Lap Bands/Sleeves doesn't respond to meds and there's always a gnawing, hungry sort of sensation that makes you feel like you always need something in your stomach to stop the torment going on in there, and that led me to eating slider foods, because they felt the best to my GERD tormented stomach. So I regained maybe ten pounds during my GERD period. Then in 2021 I had the band removed, then I lost the ten pounds that I had gained, because the GERD eased up a bit and I was able to eat healthier fruits and veggies that my Band wouldn't tolerate before and kicked the carbs to the curb. I'm currently almost 7 weeks post op RNY revision and I've lost twenty-nine pounds. So the scale is finally moving after years of being stuck. I feel like I didn't regain weight even after my band was removed due to a change in eating habits and behaviors that I adopted when I got my Lap Band. I maintained those, and yes it was easier after my Band was removed because I could eat healthier again. My Band wouldn't tolerate fibrous, healthy veggies most of the time. So I would say maintaining success in the long term relies on a change of behaviors and eating habits. One other thing that I think helps a lot of people maintain success is lifetime tracking of calories/macros.

This reminded me, something so critical for me through the years, and that is tracking calories, macros, weight.
Oh how I wish I was a mindful eater but unfortunately, I am not. I simply have never trusted myself and to keep the weight off, I absolutely have to log everything. It helps me keep track of my 7-13 fruit/vegetable servings that I need daily, as well as my Protein. On those bottomless hungry days, I like to look at what I ate because it helps me determine my physical vs head hunger too.

[summerset 5,265]

On 9/5/2022 at 12:26 AM, BigSue said:

I suspect that a lot of people who regain the weight rely too much on the restriction and don't change their eating habits, so when the restriction wears off, they're kind of back where they started.

IMO a major culprit is that people try to adopt unsustainable lifestyles in the beginning to lose weight as fast as possible and get down to that magic BMI number (we all know that number I guess), no matter what.

And then they burn out after - what time? - 10 to 14 months post-op seems to be a critical timespan for this. I've also read "and then life happened and I've fallen off the wagon" way too often. A sustainable lifestyle is sustainable even when "life happens" and the **** hits the fan. Anything else is temporary.

[redhead_che 824]

I too was revised to RNY for GERD issues. But also trauma regain. I eventually went back to using food to cope with much trauma from 2019-2021. I was eating like a “normie” clearing restaurant sized portions like I’d never even had the sleeve. It was pathetic. But during my revision I also had a hernia fixed I never knew about so lots of good is coming out of this journey.

One big rule for me: If you wouldn’t want to put it in your MyFitnessPal, don’t eat it. After about 8 months post sleeve I stopped tracking and my food intake started getting less and less bariatric friendly.