June 26, 2023
Reality sets in, hunger is back, stress is hitting…once again, the old thoughts and emotions have returned. Now what? At some point, the excitement and effects of bariatric surgery wear off. Stalled after WLS. It’s normal. But it can be downright scary for some. If you arm yourself with information, understand physiology, develop a flexible mindset, and start with the easy, you can overcome obstacles, setbacks, and fear to maintain the results you want.
There comes a point in everyone’s journey when the “rubber hits the road”. When the burden is on you rather than relying on your surgery. After scouring the research and sitting across from thousands of patients for over 20 years, here’s what we know that works if you’re stalled after WLS:
Stay in touch with your surgical practice, dietitian, therapist and support system.
Don’t get me wrong, it’s fun when people achieve all of their goals, but when they struggle, that’s when they need us the most. Most people, if they hit a plateau or even gain a few pounds back, cancel their appointments and don’t come back. They may think “I need to lose those 5 pounds before I see my surgeon.” Before you know it, 5 pounds becomes 10 or more! If you were diabetic, you would never cancel an appointment with the endocrinologist if you ate ice cream the day before, so why cancel with your bariatric team for weight regain or an early dropout? This is when we, the surgical teams, do our best. The more you are in contact with us, the better your result will be. The earlier we intervene, the better the outcome for you. Throw away all past shame, guilt and fear of judgment. They didn’t work for you before surgery and they won’t work now!
It is more difficult to lose weight the closer you get to the goal. It’s a hard reality to swallow. The margin for creating a calorie deficit gets narrower as you lose weight. In fact, you burn fewer calories now than before the operation. The majority of calories burned each day is just to stay alive, this is called basal metabolic rate. Yes, you may be more active, but activity accounts for a small portion of calorie use. You are no longer feeding 60 to 150 extra pounds or more! It’s not “lowering your metabolism.” In fact, that’s exactly what your body is supposed to do!
Obesity is a chronic and recurrent disease. Even with surgery, he is not put into remission. If you notice a plateau or weight regain, keep a food diary for a few days and see where your total intake stands. People are often quite surprised that you can overdo “bariatric foods” and consume too much energy. As with any other medical condition, controls, monitoring and due diligence are required.
Diet and exercise are not 50/50!
For decades we’ve been sold a story that says we need to eat less and move more. So many times people come into the office and say they’ve increased their physical activity but haven’t lost more weight. It can trigger old feelings of inadequacy and “nothing is working for me,” which for some leads to stopping positive change and self-sabotage.
The two ways to create a calorie deficit, intake and movement, are not equal. Calorie (food) intake leads to weight loss. Period, end of history. Exercise, on the other hand, is associated with weight maintenance; once you reach a lower weight, will you stay there?
Of course, you still have to move your body. Exercise is one of the most powerful ways to transform physical and mental health. It improves most chronic disease states, longevity, and is a powerful antidepressant, anti-anxiety, and pro-sleep tool. Lay the groundwork for it to become a habit soon after the operation. Get into a routine, fall in love with something you love, and stay consistent. Also consider strength training to help with muscle mass retention, which improves quality of life, daily function, bone density, and total calorie output.
Monitor snacking: choose 3 meals a day.
Snacks may reappear. Many snacks, even if bariatric-friendly, can sabotage results. Often, stuck people overindulge in cheese sticks, low carb bars/shakes, nuts, seeds, and trail mixes. Don’t think of nuts as a “protein food.” They are a fat. 1 cup of peanuts equals 830 calories! If you have nuts, eat a 1-2 tablespoon serving with a meal. They are quite healthy.
Typically what we see is a snacking pattern with these foods. It’s a handful here, a stick of cheese there, cutting into a protein bar and eating it slowly for something sweet. All bariatric procedures are designed to limit portion sizes. By eating small amounts of food throughout the day, your procedure will never have a chance to work. It’s like a dripping sink, at the end of the day you have a big puddle. In fact, you’ll eat more calories snacking and picking than sitting down and having lunch or dinner.
Wondering if this is happening? Commit to keeping a food diary. Use the mantra, eat it, write it down. Don’t wait until the end of the day to remember what you had. Educate yourself so you can make moment-to-moment decisions. Most people don’t even realize it’s a pattern they’re engaged in, it doesn’t register with your brain that you’re eating.
Not choosing satiating, nutrient-dense foods.
If it looks like a duck, walks like a duck, and quacks like a duck, it’s a duck! There are many companies selling products similar to bariatric/low carb foods. Bariatric pop pie sounds too good to be true? It is! It’s glorified junk food. Whole, close-to-nature foods contain more nutrients and will be more satisfying in the long run.
Protein, fiber and water. These are the key ingredients that help your surgery help you! They increase satiety, fullness and suppress hunger between meals. Plus, they’re packed with nutrients, vitamins, and antioxidants. Most are naturally low in calories like vegetables. Choose foods that have a wide variety of colors and a minimum of ingredients. There’s no logic in justifying eating a bariatric brownie, but let’s say a strawberry or carrots are “bad.”
Start over with what’s easy.
So many times when people are looking to get back on track, they choose the most daring difficult goal or goals. It sets you up for failure. When you can’t, it will reinforce old dieting beliefs and negative self-talk.
Don’t throw everything in your pantry, buy a huge tank of water, set the alarm for 4am to refill on Monday morning. Instead, start with what’s easiest. Prove to yourself that you can go all the way and succeed. Think back to a time when you had success, what were you doing and what was easiest? Start there. Master 1 aspect of a healthy lifestyle and more will follow. James Clear’s Atomic Habits provides an excellent framework and understanding of long-term habit change. Feeling successful again, you begin to change your identity and let go of the old mindset and fears related to food. Live your life focusing on what works versus what doesn’t.
Tina Musselman is the founder of The Pointe and has worked in the field of weight loss, wellness and bariatric surgery since 2004.
ABOUT THE AUTHOR
Tina Musselman is the founder of The Pointe – Profoundly Improving Lives, which helps preoperative and postoperative WLS patients set health and wellness goals. She received a bachelor’s degree in human nutrition and dietetics from the University of Illinois at Chicago in 2003 and has worked in the field of weight loss, wellness and bariatric surgery since 2004.