Weight Loss in the First Year after Bariatric Surgery

There is a “Magic Year” after a bariatric operation is your year to get your weight off.

Gastric bypass and gastric sleeve patients will lose nearly all of the excess weight that they will lose from their operation by the end of one year after the operation. (Gastric band patients also lose most of the weight they will lose in the first year but their weight loss is usually slower and it takes about 3 years to reach a stable lower weight.)

In our practice it is common that patients lose about 20 lbs a month for 2 or 3 months then 15 lbs for a couple of months then 12 lbs for a couple of months and so on slowly decreasing the amount of weight they lose over the first year until their weight is stable. Our patients lose about 80% of their excess weight at one year for both of these operations. The most frequent BMI I see from patients having these operations a BMI of 28.

After the one year time period the operation will help the patient to keep the weight off but is unlikely to cause very much more weight loss.

Do not miss your year of opportunity! This is your year to get your weight off.

The weight loss stops because after one year a patient is able to consume enough food to meet their caloric needs and weight loss will probably soon come to a halt.

This is why it is so important to do everything your bariatric surgeon ask of you especially during that all important first year after the operation.

In our practice we ask patients to start their exercise program at 3 to 4 weeks after the operation and avoid liquid calories whenever possible and keep the portion size of each meal at an appropriate level and follow the directions of the dietitian. Other suggestions to lose or maintain weight loss can be found on the June 4, 2010 posting on this blog: “8 Rules for Long Term Success after Bariatric Surgery”.

We want all bariatric surgery patients to obtain their best result so make sure you are determined to make the most of your “Magic Year” after bariatric surgery.

Remember, where your weight is at 1 year is probably where you can expect it to stay if you do what is asked thereafter.

Advice from Steve Myers, MD, bariatric surgeon in Columbus, Ohio

8 Rules for Longterm Success After Bariatric Surgery

1). NO FLY ZONE
Identify your food triggers. Those foods that are very difficult for you stay away from. If you are like me it is the cookies. For others it may be pizza or soda. These foods should not be brought you’re your home or onto your property. Your property should be a NO FLY ZONE for these foods; “they just don’t fly here “ Find suggestions like these in the great book, Exodus from Obesity.

2). PLAN BEFORE YOU ATTEND
Before attending a wedding or another special event where you know food will be a major part of the event make sure you plan ahead. Plan what you will eat and drink and what you will stay away from.

3). SOLIDS FIRST
Start with solids, especially protein, before you move on to other foods. This will make sure you get the most important foods in first and there will be less room for high calorie carbohydrates.

4). AVOID CALORIE CONTAINING LIQUIDS
Cream soups, ice cream, milk, soda and other high calorie liquids should be avoided. Regardless of which operation you choose, liquids will move through the pouch, band or sleeve without resistance and all those calories will be absorbed very quickly. These high caloric liquids can blunt your weight loss and keep you from reaching your goals.

5). RULE OF 30’S
Chew 30 times before swallowing, wait 30 seconds between bites and wait 30 minutes after completing a meal befor taking most of your liquids.
6). SMALL PLATES DEVIDED IN 4 QUADRANTS
Choose a small plate for your meals and visualize the plate being divided into 4 quadrants. One quadrant for protein, (fish, meat or beans), One for starch, (bread, rice, potatoes, corn or carrots) and then the other two quadrants should be for green vegatables.

7). STAY ACTIVE
Make arrangements for 30 to 60 minutes of vigorous exercise 3 to four days per week.

8). WEIGH YOURSELF AT LEAST EACH WEEK
Those who weigh themselves frequently are more likely to keep their weight off long term.

What suggestions do you have for keeping your weight off after a Roux en-Y Gastric Bypass or Gastric Sleeve operation?

This is a very important question that nearly every bariatric surgery patient asks. Let me fist explain to you that weight loss from a gastric bypass or a gastric sleeve occurs over about 1 year following surgery.
The operation will help you maintain your weight but will not help you loose weight after about a year. (A patient with an adjustable gastric band is on a different schedule and will be discussed in a separate posting on this blog). So it is very important that you put your best effort into doing "all the right things" in that first year and continue them thereafter. Therefore it is important that you are truly ready for surgery and get help for problems, (such as binge eating or unresolved emotional trauma, or stress eating), that may keep you from being successful even before you have surgery and you should lose as much weight as possible before surgery so you arrive at a weight near ideal weight at the end of the year after your operation.
So what are "all the right things" to do in the first year after surgery and thereafter?
1). Do not drink your calories. I find that this is one of the most frequent errors people make. Although for the first 8 weeks or so you are likely to need to take liquids since most other things will not go through the connection between the gastric pouch and intestine, once you are able to eat solid food I would strongly suggest you avoid calorie containing liquids. This includes avoiding milk, (even skim milk since it still has sugar calories ). cream soups. ice cream, fruit drinks and all soda products. Drink liquids like crystal lite, tea with sweetener instead of sugar and water. I once had a patient that was upset that she was not losing as much weight as she was expecting. She said her main fluid intake was only coffee and she would drink several coffees a day. She even brought in a "coffee" with her into the exam room and it was a large cafe latte with regular milk! Of course the amount of milk she was consuming was blunting her weight loss! You should start your meals with solid food especially your protein and drink only between your meals.
2). Avoid eating too much carbohydrate such as mashed potatoes, junk food or other carbohydrates.
3). Establish a "NO FLY ZONE" for foods that are too tempting for you and are foods that trigger overeating. Just tell your family and anyone also that come onto your property that your home is a "NO FLY ZONE" for pizza, cookies or what ever you have difficulty with and these items won't fly here. Also make strategies for eating out or going to social gatherings such as which foods you will and will not eat or how you might tell the server you are 'eating light and please bring a container to the table with the food" so you can take some of the food off the plate before you start eating. These are great suggestions from "Exodus From Obesity" by Paula Peck and you can probably get her book on Amazon.com.
4). Be aware of your portion size and listen to your body. Use your eyes and brain to determine how much you should consume at any one time. Do not expect to have your operation tell you you have eaten too much. If you do you probable have already exceeded what you should have eaten. Most patients will be able to eat about 1 cup, (pressed down), of food at any one time. Eating more than this with keep you from being successful.
5). Get in an exercise program using an exercise therapist or personal trainer and work out 3 to 5 times a week. In our program this is an integrated portion of the overall program and our offices are even in the McConnell Heart Health Center which is a medically oriented fitness center. Only tell you this to reinforce how important I think this component of your recovery really is. You will be losing muscle mass while you loose fat mass after your bariatric surgery. A great exercise therapy program will help you to build muscle, lose more weight and look better as you fill out some of the space with muscle that used to be filled with fat mass. You also may me less likely to need plastic surgery!
I find that if patients in my practice are following these directives they will lose on the average about 20 lbs. per month for the first 3 months and then a little less each month. Therefor they have lost about 60 lbs. in the first month and about 80 % of their excess weight at 1 year. The most frequent BMI I record for our patients at 1 year is a BMI of 28. I let them know this is their goal at the end of a year and that way they can "shoot" for that goal. The great thing is almost everyone in our practice reaches that level of weight loss and it is very infrequent to have one of them regain significant weight back. I don't tell you this to brag, although I am very proud of the work our patients and the staff put in, but to give you some bench marks to try to make happen in your own life.
Please feel free to leave other suggestions you have found helpful by clicking on "comments" at the end of this posting and may you experience all the success you deserve as you travel this jouney to better health.