Not Losing Weight After Gastric Sleeve: Why?
Not losing weight is a problem that can occur after undergoing bariatric surgery, typically due to not following postoperative guidelines. A good bariatric surgeon will make sure that their patients understand all of the benefits and the risks associated with gastric sleeve surgery (sleeve gastrectomy). When patients know what to expect before surgery is performed, they are able to make realistic expectations for themselves. One issue that a patient may have is the lack of weight loss following their gastric sleeve surgery. There are five common reasons why a patient may not be losing weight after their bariatric procedure.
Reason 1: You are Not Eating Enough Calories
Yes, I know this is a mind stopper. It is hard to believe that not eating enough calories can contribute to not losing weight. After weight loss surgery one of the major hunger hormones; ghrelin is removed so you don’t feel hungry and your stomach has just went from the size of a flattened foot ball to the size of your thumb. You have no desire to eat so you don’t. Many people think, the less I eat the faster I will lose weight. Unfortunately, not the case for many. When your body is not nourished properly, your body will start burning fat as well as muscle for energy. The more muscle you lose the harder it is to keep losing weight and the increased chances of stalls or plateaus. Also, your body begins to think you are starving it so your body begins to work against you, making it harder to lose weight. It will hold on to every ounce increasing the number and time frame that you experience stalled weight loss.
How many calories you want to aim for depends on how far out you are after surgery. It is helpful not to force the food but to have goals. First, do not stress about your intake just be mindful of what you are consuming. You will not focus on calories until you are at least 3 weeks post surgery. At three to four weeks assess where you are at and your first goal being 800 calories, 1,000 and 1,200 calories. Twelve hundred calories really is the base line for everyone. Eating below this will slow down weight loss long term. Many of you will need more than this depending on your individual needs.
Reason 2: Lack of balanced meal planning
If you are four or more weeks out, it is important to slowly incorporate more solid proteins and healthy fats into your meal plan. The first step is to make sure you are getting enough protein. You can determine your baseline protein needs by taking your ideal healthy weight and dividing by 2.2. For example, if your goal is to weigh 150 pounds you would take 150 divided by 2.2 and your goal for protein would be 68 grams. Remember, this is a general baseline recommendation, for best fat loss results you may need a higher percentage of protein.
After determining protein needs, look at overall balance of macronutrients. A common question many people ask is how many grams of protein, fat and carbohydrates should I have for optimally fat loss. There is no exact number that will work for everyone so it is important to take theses general guidelines and play with the percentages until you find what works best for you. The general guidelines for recommended percentages for optimal fat loss is as follows: 10 – 35 percent carbohydrates, 30 – 40 percent fat and 35 – 50 % protein. Also, be sure that you over all total sugar intake is less than twenty five grams per day.
Reason 3: Too many slider foods:
After surgery, many people have a difficult time transitioning to whole food based solids. I often hear people say they can’t eat chicken or any solid protein foods. Over time they develop a food aversion to solid proteins. When this happens they end up choosing what I call slider foods. These are foods that are easy to go down like yogurts, potatoes, tomato or cream soups, ice cream, etc… These type of foods lack balance and substance which cause you to feel hungrier faster and many times have more simple processed carbohydrates than lean proteins and fats. Look at your overall intake of foods and if you are predominately eating “slider based” foods, this may be affecting your weight loss.
Reason 4: Exercising too much too soon:
Once you make the decision to have bariatric surgery, you are focused and ready to have this extra weight gone. You are eager to experience the fast results that you have read about in many cases after having weight loss surgery. With this eagerness you are ready to hit the gym and start running. Believe it or not, if you are not eating enough calories and you start an exercise program you may be hindering your weight loss. Walking post surgery is always encouraged and helps you in many ways. Outside of a walking program you want to make sure you are healed before starting any other forms of exercise. General recommendation is to wait six to eight weeks post surgery before you start an exercise routine. You also want to make sure you are eating your baseline calories before you go into extreme exercise. If you are not eating a minimum of 800 calories I would stick to a walking regimen. Focus on increasing your calories at a minimum of 800 to 1200 and once your calories are in check then incorporate an exercise routine.
Reason 5: I don’t like to lift weights:
Although I tell people you can never out exercise a bad diet and that diet is at least 80% and exercise being 20% it still impacts the efficiency and the rate at which you burn fat. This does not mean just running on the treadmill. Building lean muscle increases your metabolism because it takes more calories to maintain muscle. The more lean muscle you have the faster you burn calories. If you are six to eight week out and you are eating a proper amount of calories resistance training may be the thing you are missing to take you to that next level of fat loss. If you do not know anything about resistance training to build muscle it may be beneficial to hire a personal trainer for a few sessions to create a plan for you. If you do not like going to the gym you can create a home workout. If you are reading this and thinking, “I don’t want to get bulky”; trust me, you won’t. It takes a lot of work and a consistent balanced meal plan to build muscle.
Over all you want to be patient with the process. You did not gain the weight over night and although for many this is rapid weight loss it will not come off overnight either. Stalls or plateaus are a normal part of the process. For many of you, you are weighing yourselves daily or every few days and if you don’t see the scale change you are quick to say, “I’m not losing weight”. Give yourselves a few weeks for your body to adjust and process the fat that has been utilized. Patients is a very important part of this process.
It is important to remember that each one of you is a unique individual with specific needs. There are general guidelines that can steer you in the direction for optimal fat loss but there are many factors that can affect the rate at which you burn calories and fat. It is important to know that over time you will need to tweak this information to make it work specifically for you. There is no one specific diet that is perfect for everyone.
Sometimes patients are discouraged when they aren’t losing weight as fast as another patient. It’s important to remember that everybody works differently and there are many differences that affect the weight loss rate. Consult with your bariatric dietitian if you have any specific issues related to your rate of weight loss after your surgical procedure.
If none of the above seem to be the reason for not losing weight, then the surgery may have not been the surgery for you. Revisions can be made with a second surgery to make the stomach pouch even smaller or you may need a different type of bariatric surgery to fit your needs. A professional surgeon will work directly with the patient to ensure the safety of another procedure.
What Does a Bariatric Balanced Meal Plan Look Like?
For optimal fat loss, macronutrients will vary for each person. Ranges will be between 10 – 35% carbohydrates, 30 -40% fat and 35 – 50% fat for most individuals. These are general ranges to start with.
Soft Solid Phase Meal Plans:
Until you can eat six to eight ounces at one meal, you will have to eat six or more small meals throughout the day. Between three and four weeks most people can eat around three ounces at one meal. These sample meal plans are based off of 3 oz. at each meal. If you can not eat three ounces you can increase the number of meals per day. You can not force the food but it is important to work at getting proper nourishment.
Provides 831 calories, 80 grams protein, 45 grams carbs, 34 grams fat (40% protein, 22% carbohydrates, 38% fat):
- Meal 1:
2 eggs (3 ounces)
- Meal 2:
½ cup Plain Greek Yogurt
1 TBSP Barlean’s Omega Swirl
- Meal 3:
Canned Salmon (3 ounces)
2 TBSP Salad Dressing: Asian Toasted Almond
- Meal 4:
Protein Powder providing 20 – 26 grams of protein
6 ounces Fairlife Whole Milk (lactose is removed and has an extra enzyme added)
½ small banana
- By adding 1 TBSP of natural peanut butter to your smoothie and adding one more meal of a ¼ of an avocado, you increase your calories to 1000. (84 g. protein, 51 g. CHO, 48 g. fat. 35% protein, 21% carbohydrates, 44% fat).
Provides 898 calories, 89.3 grams protein (37%), 50.7 grams carbohydrates (21%) and 45.6 g. of fat (42%)
- Meal 1:
¼ cup oatmeal
6 ounces Fairlife whole milk
¼ cup pumpkin puree
Cinnamon to taste
- Meal 2:
½ cup 4% cottage cheese
2 TBSP sun dried tomatoes
1 tsp. basil
- Meal 3:
3 ounces tuna fish
1 TBSP real mayo
salt, pepper, seasoning to taste
- Meal 4:
Protein Smoothie with protein powder 20 – 26 grams protein
6 ounces Fairlife Whole milk
Meal plans based on one Month and Beyond:
Meal plans based on 4 to 6 ounces of food per meal and 1200 calories
Provides 1,209 calories, 112 grams of protein (36%), 73 grams carbohydrates (23%), 58 gramsfat (41%)
- Meal 1:
1 ounce cheddar cheese
2 TBSP black bean and corn salsa
1 small tortilla
- Meal 2:
2.5 ounces (½ can) of white shredded chicken
salt, pepper and seasoning of choice
8 crackers of choice
- Meal 3:
3 ounces grilled salmon
½ cup green beans
1 tsp olive oil
seasonings of choice
- Meal 4:
protein powder with 26 grams protein
6 ounces Fairlife whole milk
¾ cup frozen mixed berries
If you are a former Mexico Bariatric Center patient and are struggling with not losing weight, we recommend you visit our United States Staff page. Here you can find the contact information of Prudence Ticknor, our bariatric dietitian and health coach.