How to overcome your weight loss plateau after gastric sleeve surgery

Written by Emily Burch, RD and medically reviewed by Dr. Stephen Boyce, MD

The sleeve gastrectomy or gastric sleeve is a very popular form of bariatric surgery that promotes weight loss and often the remission of obesity-related diseases. Due to the high rates of success, you might start to think that the gastric sleeve is a quick fix, and that excess body weight just seems to fall off and stay off following surgery. However, that isn’t usually the case. Your weight loss journey following the gastric sleeve will have its ups and downs. 

One area of concern is hitting a weight loss plateau following surgery or even beginning to gain some of the lost weight back. This can be very discouraging, but you should know that it is a normal part of the weight loss journey. There are some ways to help you get back on track and to promote long-term successful weight loss. In this article, we are going to discuss some of the best ways to overcome a weight loss plateau and to prevent weight regain following the gastric sleeve.  

Weight Loss vs Weight Gain after gastric Sleeve

What is the gastric sleeve and how does it work?

The gastric sleeve is a form of bariatric surgery that involves the removal of about 75-80% of the stomach. Once this portion of your stomach is surgically removed the remaining part of your stomach will be a tube-like structure or a “sleeve”.

Gastric Sleeve Anatomy how to restart weight loss after gastric sleeve

There are two primary ways that the gastric sleeve promotes weight loss:

First, by shrinking the size of your stomach. The newly formed sleeve will hold about 5-6 oz of food or liquid. This physically reduces the amount of food that you can consume at each meal which leads to less food intake. 

And second, the removal of the outer portion of your stomach alters hunger-related hormones which can lead to decreased appetite and food intake.

What will the weight loss journey look like?

In those first 6 months to a year following the gastric sleeve, you will likely experience rapid weight loss. This “honeymoon phase” is a period where weight loss comes relatively easily, obesity-related diseases may improve or resolve, and you can gradually do more physical activity. 

How to restart weight loss after gastric sleeve timeline

During this time, excess body weight just seems to fall right off because your body, hormones, and diet are dramatically altered following surgery.  Your food and calorie intake are restricted due to your post-op diet, the changes in the size of your stomach, and your hunger-related hormones. As you begin to recover and lose weight, physical activity should begin to increase as well. All these factors contribute to rapid weight loss following the gastric sleeve.

However, after that honeymoon phase, some new challenges regarding weight loss and motivation may begin to set in. Your weight loss may start to plateau or level out, your appetite and food intake may begin to increase, and your motivation may begin to dwindle. 

Appetite after honeymoon phase after gastric sleeve

This is normal. After the first 6 months of surgery, you should be settling into your stabilization diet and workout regimen. As you are doing this your body is learning to adjust to everything that it has been through.  Your metabolism will adjust to the rapid weight loss, dietary changes, and increased physical activity. And your weight will likely begin to stabilize or even start creeping back up. 

There are some things you can do to promote long-term weight loss success. 

Try not to cut corners on your diet

Once you have fully recovered from surgery and progressed through the first 3 phases of your post-surgical diet you should begin to settle into Phase 4 or the stabilization diet. This is the long-term diet or lifestyle that will support your nutrient needs and help to prevent weight gain.

While following this diet/lifestyle it is important to try not to consume excessive amounts of processed foods and foods high in fat and/or sugar. Try to keep your portion sizes small and do not consume a lot of liquids around mealtimes.

Temptations after gastric sleeve surgery

Now you may be thinking… This is what I do. I have followed my diet, not cut corners, and I am still having trouble losing weight or maintaining my current weight. 

Well, there are a few additional options to try!

Try a Pouch Reset Diet

The pouch reset diet is designed to help you combat unwanted weight gain and reduce stretching that may occur after bariatric surgery. This diet was created with the idea to “shrink the size of your gastric pouch”. There is no evidence that a physical change in the size of your gastric pouch will occur. 

However, research suggests that the pouch reset diet can still be effective because it resets your hunger levels, eating habits, and weight loss.

Resetting your hunger levels means that you should feel fuller and more satisfied with less food intake which will lead to a reduction in the amount that you eat during mealtimes. This will help to reduce weight gain and to prevent stretching of the gastric pouch. 

The pouch reset diet is a short-term, low volume, high protein diet. The high-protein element will help you to feel fuller longer and provide your muscles with adequate support while on the diet.

pouch reset diet explainer image

Click here to read more about The Pouch Reset Diet

Make sure to stay active!

Physical activity is a very important factor in your weight loss journey. It is important to incorporate the right kinds of physical activity in the right amounts to optimize long-term weight loss. 

If you hit a plateau or begin to experience weight regain, it is important to evaluate your current exercise regimen. As you recover from surgery, your physical activity should slowly begin to increase and once your incisions are healed and your body has recovered, you should be released to do regular exercise. 

Exercise schedule after gastric sleeve

It is important to incorporate both cardio and resistance training in your workout routine. You should aim to get at least 30 minutes of physical activity 5 days a week. This hour can be broken into different sessions throughout the day. Resistance training should be incorporated 2-3 times a week to promote weight loss and to build muscle. On your days off try to get some movement in whether it be a nice walk or some stretching. 

Maintain a healthy lifestyle!

You may think that diet and exercise are the only two factors in a healthy lifestyle, but there is so much more! 

Other factors have been shown to impact weight loss or promote weight regain following bariatric surgery. These factors include high-stress levels, alcohol intake, grazing, sleep deprivation, and television watching. 

Factors that impact weight loss

Television watching, alcohol intake, and sleep deprivation have all been linked to less restrictive eating behaviors. This implies that when you are sitting on the couch watching TV or when you are drinking alcohol, you are more likely to be snacking on foods, eating unhealthy food options, and potentially over-eating. 

Lack of sleep and stress can also have a negative impact on your dietary habits and hunger levels. These two factors have been associated with disturbances in circadian rhythm and insulin resistance promoting weight gain. Poor sleep and stress also have a noted impact on appetite, food cravings, gut hormones, and hormone signaling. It is important to find healthy ways to relieve stress and promote good sleep to help reduce cravings and help your body to function properly. 

Don’t be afraid to go to therapy!

There are different types of therapists or interventions that you can try to help with your diet and lifestyle. 

Behavioral therapy has been shown to help with binge eating and grazing. Seeking help from a behavioral therapist can help you to make those necessary lifestyle changes and to identify any triggers or areas that you may need to adjust to promote weight loss. 

Therapy to help with weight loss after gastric sleeve

Nutrition Therapy is also another option if you feel that you are struggling with your diet. Working with a Registered Dietitian should be part of your weight loss journey pre-and post-surgery, but don’t think that you can’t speak with a dietitian more often than is requested if you are having difficulty following or understanding your diet. 

Support groups are also an option for accountability and motivation. Finding people like you who are going through or have gone through the same things can help you to stay accountable in your weight loss journey. 

More Intensive forms of weight loss intervention

If you have made modifications to both your diet and lifestyle that should lead to weight loss, but you aren’t getting the results, then there may be a couple more options out there for you. These options should be discussed with your physician and are not right for everyone!

Research shows that pharmacotherapy or the use of medication to promote weight loss can be promising in overcoming a plateau or preventing weight regain. If you are trying this option, you should only do it as part of a medically supervised weight management program or as directed by your physician. Success rates of pharmacotherapy were higher than that of behavioral therapy alone, but long-term follow-ups and success are yet to be determined. 

Another option, that should only be done under careful consideration and as recommended by a physician is having a second surgery or a conversion to another form of bariatric surgery. This option is for patients with morbid obesity (BMI >60 kg/m2). 

Considering revision surgery after gastric sleeve

When having a second surgery some physicians prefer to wait until plateau occurs to optimize the effects of the first procedure and others prefer to perform the surgery after a set time interval. The Gastric sleeve can be converted into the Roux-en-Y gastric bypass (RYGB), the duodenal switch (DS), and gastric banding.

These two options are more intensive and are not recommended for all bariatric patients.

 In conclusion  

Weight loss following the gastric sleeve is not always going to come easy. There are times when you will have to fight to lose or maintain weight. Don’t let those moments overcome you and cause you to lose motivation or discipline. If you are struggling with weight loss, take an honest look at your diet and lifestyle and find areas for improvement. If you don’t feel there are areas to improve you can try to reset your weight loss with the pouch reset diet, a form of therapy, or both! Don’t hesitate to reach out to a team of bariatric health professionals and ask for help! Long-term weight loss success is possible and you can achieve it!

Options for restarting weight loss after gastric sleeve

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