Guest Blog By: Dr. Lillian Craggs-Dino, DHA, RDN, LDN Experiencing a weight loss plateau and weight regain is common following metabolic and bariatric surgery. According to research, a weight loss plateau is commonly observed around the 6-month mark for individuals following reduced caloric intakes. (1) Additionally, weight regain can occur as early as 12-18 months after metabolic and bariatric surgery or shortly after reaching the lowest weight point. However, instead of becoming discouraged, it is essential to view this as an opportunity to develop a range of strategies that can help prevent prolonged plateaus and avoid abnormal weight regain in the long term after surgery. What is a Weight Loss Plateau? Why do weight loss plateaus happen in the first place? A weight loss plateau is when weight loss slows down or comes to a temporary halt. It often occurs after an initial period of significant weight loss following surgery. During this phase, you can experience reduced weight loss despite adhering to recommended dietary and lifestyle changes. Weight loss plateaus can be frustrating, as they create a sense of stagnation or hinder progress toward achieving further weight loss goals. However, with the appropriate adjustments to eating habits, exercise routines, and lifestyle habits, overcoming the plateau and progressing toward weight loss goals is possible. Post-Op Weight Gain Besides the emotional toll of weight regain, a significant concern is that even a modest regain of 10% can lead to weight-related comorbidities, such as diabetes, insulin resistance, high blood pressure, high cholesterol, and sleep apnea. (2) Contrary to a common myth, not all patients who have undergone metabolic and bariatric surgery regain all their lost weight. In fact, research shows that 93% of patients with roux-en-Y gastric bypass (RYGB) managed to maintain at least 10% weight loss from baseline, with 70% maintaining a 20% weight loss and 40% sustaining a 30% weight loss after 12 years (3). Compared to conventional dieting approaches, the success of metabolic and bariatric surgery reinforces its position as the primary and effective treatment for obesity. However, it is worth noting that 1 in 6 patients (around 16.7%) experience weight regain of 10% or more after surgery. (3) Weight Loss Plateaus and Regain: Understanding Factors at Play To continue making progress in your weight loss journey and maintain your health goals, it’s crucial to understand contributing factors. Genetic Factors Weight plateaus and weight regain can naturally occur after significant weight loss. As you reduce your caloric intake, your body adjusts by lowering your metabolism, known as metabolic adaptation. The “set point theory” also suggests that people are genetically predisposed to a particular weight. While metabolic and bariatric surgery appears to reset the set point, some may face challenges. Another critical aspect influencing weight plateaus and excess weight gain is hormone homeostasis. Individuals dealing with obesity often experience imbalances in hormone secretion, including leptin, ghrelin, GLP-1, PYY, and CCK. While metabolic and bariatric surgery has shown temporary positive effects in restoring hormone balance, research indicates that individuals who regain weight may revert to their original hormone profile. (3) Understanding these factors can help you develop effective strategies to overcome weight plateaus and regain control of your weight loss journey. Taking Charge: Factors Within Your Control While the causes of weight loss plateaus and weight regain may seem beyond your control, numerous factors within your reach can help prevent abnormal weight regain. One of the most essential aspects is to maintain regular follow-up visits with your bariatric program and actively participate in support groups. Research suggests that engaging in both activities is associated with better long-term outcomes after metabolic and bariatric surgery. (4) In addition, maintaining the habit of consistently self-monitoring your daily food intake and establishing a regular exercise routine are crucial factors for achieving long-term success. Adhering to the principles of the bariatric diet, including adequate protein intake, proper fluid consumption, and sufficient vitamin and mineral supplementation while limiting simple carbs and fats, can offer significant benefits in sustaining weight loss. Studies indicate that grazing and frequent snacking can contribute to weight loss plateaus and lead to weight regain. (5)* If you find you are struggling with depressive symptoms or binge-eating disorders, considering a referral to a behavioral health specialist can provide valuable support and guidance in addressing these issues. By focusing on controllable factors, you can proactively work towards maintaining your weight loss and achieving long-term success on your weight management journey. Summary If you are experiencing weight regain that impacts your overall health, having an open conversation with your healthcare provider is important. They can explore options such as weight loss medications or determine if you are a suitable candidate for bariatric revision surgery. However, it’s essential to recognize that adherence to a healthy lifestyle remains crucial even with these solutions. Remember, metabolic and bariatric surgery is a treatment option for obesity, but its success relies on your active participation. Controlling what is within your power and making informed decisions regarding eating behaviors, physical activity, and self-care are vital for reaching and maintaining your goals. References J Am Diet Assoc. 2007; 107(10):1755-67 [PMID: 17904936] J Am Assoc Nurse Pract. 2017; 29(Suppl 1): S3–S14 [PMID: 29024553] Surg Endosc. 2021; 35(8):4069-4084 [PMID: 33650001] Obes Surg. 2010; 20(3):349-56 [PMID: 19554382] Obes Surg. 2021; 31(4):1755-1766 [PMID: 33555451] *These statements have not been evaluated by the Food & Drug Administration (FDA). These products are not intended to diagnose, treat, cure, or prevent any disease. This blog is for information and education purposes only. This information is not intended to substitute professional medical advice, diagnosis, or treatment. Please consult with your bariatric surgeon or another qualified healthcare provider with any questions in regards to a medical condition. A qualified healthcare professional can best assist you in deciding whether a dietary supplement is suitable based on your individual needs. Dr. Lillian Craggs-Dino is a retained consultant for Bariatric Fusion.