What changes?

[Bandedbut 25]

It appears that VSG is quite successful, with weight loss well over 100+ pounds common in the first year. But I've also read that maintaining that loss after the 2 year mark is difficult, and gaining weight back is common. This doesn't appear to be the case with the bypass so what causes this? I know it's a TOOL, but why is the tool so successful for 1-2 years and then not? What changes and why and what can be done to prevent it? Obviously maintaining healthy habits and continuing to work at it, but what physically or mentally causes this shift? I've heard the stomach stretches out so there isn't as much restriction, but then I read where that is not possible? Having experienced regain after countless diets I want to set myself up for success.

[GreenTealael 25,377]

Are you ready for a deep dive because the answers are complex. Here’s an article that is very technical but can explain some differences between the two surgeries.

https://www.nature.com/articles/s41467-020-20301-1

Edited February 28, 2023 by GreenTealael

[pintsizedmallrat 473]

I don't think this is true across the board; I am 18 mos out and while my weight loss has slowed considerably, it's because I am trying to maintain and still losing. I was ready to stop losing 8 pounds ago. My hunger has not returned, if anything I am completely disinterested in eating at all and have lapsed back into forcing myself to eat shakes and bars just to keep myself nourished.

[catwoman7 11,214]

you can gain weight with any and all types of weight loss surgeries if you let old bad habits creep back in. Weight loss surgeries are just a tool, and you have to keep up with your part of it for it to work. And they work extremely well as long as you follow the rules.

a rebound weight gain of 10-20 lbs during year 2 or 3 is VERY common. That's more your body settling in to a weight it's comfortable at. If you're diligent, you'll stabilize there - or you may even lose some or all of the rebound if you work at it. But when old habits start up again, you can definitely gain weight again - sometimes a lot of it. And sometimes all of it.

what WLS mainly does is control how much you can eat AT ONE SITTING. This is an example I've used a lot: Before I had surgery, when my husband and I ordered a pizza (always a large...), we'd each eat half of it. I can't do that anymore. I can eat 1-2 pieces. It's physically painful for me if I try to eat more than that. But it would be very easy to eat 1-2 pieces at 5:00 pm, and another 1-2 pieces at 8:00 pm, and yet another 1-2 pieces before bed. So....half a large pizza. THAT is the kind of stuff you have to watch out for - that, and mindless snacking (planned Snacks are fine - but mindless snacking has consequences...).

so to respond to your question about whether or not maintaining after two years is difficult, yes, it is. I constantly watch what I eat. If I notice the number on the scale starting to head north - esp if it gets above my "oh crap" number (the number I do NOT want to ever go over again), it's all hands on deck until it's back under control. So yes. Obesity is a very complex, chronic condition, and we do have to keep working at it to keep the weight from coming back. But the surgery DOES make that easier. There is no way I could have ever lost over 200 lbs and maintained that loss for several years (well, mostly - I did have a rebound) without this surgery.

[catwoman7 11,214]

2 hours ago, pintsizedmallrat said:

I don't think this is true across the board; I am 18 mos out and while my weight loss has slowed considerably, it's because I am trying to maintain and still losing. I was ready to stop losing 8 pounds ago. My hunger has not returned, if anything I am completely disinterested in eating at all and have lapsed back into forcing myself to eat shakes and bars just to keep myself nourished.

you're one of the lucky minority whose hunger never came back. For most of us, it comes back sometime during the first year. I was hoping I would have been one of the people whose hunger never came back, but no - unfortunately not. It was so much easier those first few months when I was never hungry and didn't give a flip about food!

[catwoman7 11,214]

P.S. I don't think gaining all your weight back is that common, but it DOES happen if people aren't careful. A majority of us do have that 10-20 lb rebound in year 2 or 3, though. And I've known a few people who've gained 40, 50, or 60 lbs (due to old habits). It's easy to do if you don't watch it.

[Bandedbut 25]

4 hours ago, GreenTealael said:

Are you ready for a deep dive because the answers are complex. Here’s an article that is very technical but can explain some differences between the two surgeries.

https://www.nature.com/articles/s41467-020-20301-1

That is quite the deep dive! Most of it is over my head, but but what I got out of it is thatGLP-1 Reacts/restores differently between the 2 surgeries. So there is actually a physical reason.

[GreenTealael 25,377]

9 minutes ago, Bandedbut said:

That is quite the deep dive! Most of it is over my head, but but what I got out of it is thatGLP-1 Reacts/restores differently between the 2 surgeries. So there is actually a physical reason.

Yes it is a deep dive but there are actual cellular/hormonal differences between the two.

[Arabesque 7,313]

The long term success of either surgery depends upon you. Many of the initial benefits of bariatric surgery fade over time. Your hunger comes back, your restriction can soften, it is possible to eat around your smaller tummy & your body’s new set point, etc. What the surgery does do is give you time. Time to make changes to your relationship with food: the why you eat, what you eat, when you eat, how you eat. Time to understand your cravings & develop strategies to better manage them. Time to establish new habits about eating & exercise. Time to work out how you want to eat in the future & what works for you & your body.

Regain occurs for many reasons: psychological, physiological, behavioural. Bounce back regain (usually 20%+/- of the weight lost) around the third year is common. It can be because your body settles into the weight it is happiest at (your set point). Medication changes. The crap life can throw at you (employment, relationships, health, pandemics). Complacency. A too restrictive way of eating or too demanding exercise regime. Not dealing with your relationship with food. And for some it can be a deliberate choice as they themselves feel happier at a higher weight or they make adjustments to their food choices to better suit their life. Not failure of the surgery but the impact of outside factors.

The average weight loss for both sleeve or bypass at the three year mark is about 65% of the weight to be lost. Of course as with all statistics there are some who lose more & some who lose less. If you are considering revision surgery of sleeve to bypass as a sign of the failure of the sleeve, remember many who have revision surgery do so because they developed GERD not necessarily weight gain.

I have a sleeve & lost more than my goal and have pretty much maintained though at only almost 4 years post surgery I’m still somewhat of a bariatric baby. I settled at 49kg (48.5-49.5). I unexpectedly gained about 2kgs about 18months ago (50.5-51) but recently we discovered I wasn’t absorbing my HRT meds. Changed to a patch & my weight is slowly decreasing (49.2-50). Small numbers I know.

Has it been difficult? No, not really. It was very obvious what I had been doing wasn’t working for me & I needed to make changes. I put myself & my health first. I changed my relationship with food. Made a decision to change what, when & how I ate. It became a new mindset. The changes have been sustainable & haven’t restricted my life. I still enjoy food & eating but my desire is for healthier, more nutritious foods. And no I’m not running marathons or spending hours in the gym just some at home stretching & resistance bands.

Sorry long post.

[catwoman7 11,214]

19 hours ago, GreenTealael said:

Are you ready for a deep dive because the answers are complex. Here’s an article that is very technical but can explain some differences between the two surgeries.

https://www.nature.com/articles/s41467-020-20301-1

I'm currently taking a graduate-level nutrition course on obesity and weight loss, and this article is pretty typical of the stuff we have for readings - i.e. written in highly specialized language that you'd practically have to have a chemistry degree to understand! Fortunately, I'm not taking the course for credit, because I sure wouldn't want to be tested on these articles!

at any rate, I do know that with sleeve, the fundus part of the stomach is removed, and that's the part where most of the ghrelin is produced, so hunger levels go way down (because the ghrelin level is what lets the brain know that your body needs food. If the level is low, your brain knows that you need to eat, and you feel hungry. If the ghrelin level is high, then nope - not hungry - don't need to eat). Ghrelin is produced in other parts of the stomach as well, but a majority is made in the fundus, so levels automatically go way down - and stay low - once that part of the stomach is removed.

the fundus isn't removed in RNY (in fact, none of the stomach is removed - it's just sectioned off), but I don't know how just having the major center of ghrelin production in the part of stomach that is no longer used affects ghrelin levels in your blood. I don't think researchers necessarily know that, either. Maybe it does, maybe it doesn't. Although most RNY patients lose their hunger as well. But they think it could also be due to the actions of some of the other hunger-related hormones, like leptin and GLP-1. They do know that RNY causes leptin levels to increase (and leptin is a hormone that causes a feeling of satiety. I can't remember what exactly GLP-1 does, but it has a role in hunger and satiety, too). At any rate, there have been research studies on RNY patients who are a year out, and their ghrelin levels are very low compared to "normal" people. So suffice this to say, ghrelin levels are abnormally low in RNY patients, too - but not for the same reasons that they are in sleeve patients. It could be that the major ghrelin-producing area is now in the remnant section of the stomach - or it could be that changes in some of the other hunger-related hormones could cause changes in the ghrelin level. (Or maybe it's due to a little of both...)

Edited March 1, 2023 by catwoman7

[Bandedbut 25]

1 hour ago, catwoman7 said:

I'm currently taking a graduate-level nutrition course on obesity and weight loss, and this article is pretty typical of the stuff we have for readings - i.e. written in highly specialized language that you'd practically have to have a chemistry degree to understand! Fortunately, I'm not taking the course for credit, because I sure wouldn't want to be tested on these articles!

at any rate, I do know that with sleeve, the fundus part of the stomach is removed, and that's the part where most of the ghrelin is produced, so hunger levels go way down (because the ghrelin level is what lets the brain know that your body needs food. If the level is low, your brain knows that you need to eat, and you feel hungry. If the ghrelin level is high, then nope - not hungry - don't need to eat). Ghrelin is produced in other parts of the stomach as well, but a majority is made in the fundus, so levels automatically go way down - and stay low - once that part of the stomach is removed.

the fundus isn't removed in RNY (in fact, none of the stomach is removed - it's just sectioned off), but I don't know how just having the major center of ghrelin production in the part of stomach that is no longer used affects ghrelin levels in your blood. I don't think researchers necessarily know that, either. Maybe it does, maybe it doesn't. Although most RNY patients lose their hunger as well. But they think it could also be due to the actions of some of the other hunger-related hormones, like leptin and GLP-1. They do know that RNY causes leptin levels to increase (and leptin is a hormone that causes a feeling of satiety. I can't remember what exactly GLP-1 does, but it has a role in hunger and satiety, too). At any rate, there have been research studies on RNY patients who are a year out, and their ghrelin levels are very low compared to "normal" people. So suffice this to say, ghrelin levels are abnormally low in RNY patients, too - but not for the same reasons that they are in sleeve patients. It could be that the major ghrelin-producing area is now in the remnant section of the stomach - or it could be that changes in some of the other hunger-related hormones could cause changes in the ghrelin level. (Or maybe it's due to a little of both...)

Thanks for the English! breakdown of the article. This is all fascinating! What I don't understand is if the fundus is removed, and hunger levels go way down, how does hunger return for some people then?

[The Greater Fool 2,039]

1 hour ago, Bandedbut said:

Thanks for the English! breakdown of the article. This is all fascinating! What I don't understand is if the fundus is removed, and hunger levels go way down, how does hunger return for some people then?

Our bodies learn to cope and compensate.

Good luck,

Tek

[GreenTealael 25,377]

3 hours ago, catwoman7 said:

I'm currently taking a graduate-level nutrition course on obesity and weight loss, and this article is pretty typical of the stuff we have for readings - i.e. written in highly specialized language that you'd practically have to have a chemistry degree to understand! Fortunately, I'm not taking the course for credit, because I sure wouldn't want to be tested on these articles!

at any rate, I do know that with sleeve, the fundus part of the stomach is removed, and that's the part where most of the ghrelin is produced, so hunger levels go way down (because the ghrelin level is what lets the brain know that your body needs food. If the level is low, your brain knows that you need to eat, and you feel hungry. If the ghrelin level is high, then nope - not hungry - don't need to eat). Ghrelin is produced in other parts of the stomach as well, but a majority is made in the fundus, so levels automatically go way down - and stay low - once that part of the stomach is removed.

the fundus isn't removed in RNY (in fact, none of the stomach is removed - it's just sectioned off), but I don't know how just having the major center of ghrelin production in the part of stomach that is no longer used affects ghrelin levels in your blood. I don't think researchers necessarily know that, either. Maybe it does, maybe it doesn't. Although most RNY patients lose their hunger as well. But they think it could also be due to the actions of some of the other hunger-related hormones, like leptin and GLP-1. They do know that RNY causes leptin levels to increase (and leptin is a hormone that causes a feeling of satiety. I can't remember what exactly GLP-1 does, but it has a role in hunger and satiety, too). At any rate, there have been research studies on RNY patients who are a year out, and their ghrelin levels are very low compared to "normal" people. So suffice this to say, ghrelin levels are abnormally low in RNY patients, too - but not for the same reasons that they are in sleeve patients. It could be that the major ghrelin-producing area is now in the remnant section of the stomach - or it could be that changes in some of the other hunger-related hormones could cause changes in the ghrelin level. (Or maybe it's due to a little of both...)

They are hard to read! I remember during grad school thinking who the hell do they write these papers/journals/articles for? Them selves 🤣

You’re right so much is still unknown but A team of researcher actually looked at this and found that the division of the stomach causes ghrelin levels to drop (tested during surgery).

What I’m still trying to find information on is what changes occur after revision surgery from VSG to RNY.

Edited March 1, 2023 by GreenTealael

[GreenTealael 25,377]

30 minutes ago, The Greater Fool said:

Our bodies learn to cope and compensate.

Good luck,

Tek

Absolutely

[GreenTealael 25,377]

2 hours ago, Bandedbut said:

Thanks for the English! breakdown of the article. This is all fascinating! What I don't understand is if the fundus is removed, and hunger levels go way down, how does hunger return for some people then?

Mainly because the levels of hormones vary by person. Some people may experience different hormonal change from others and perhaps why people lose and maintain different rates of loss.

Edited March 1, 2023 by GreenTealael