Will I Regain My Weight After a Gastric Sleeve?

You have decided to take healthy steps towards overcoming your obesity. Wonderful! After discussing the options with your surgeon, your gastric sleeve procedure has been scheduled, and you will likely have many questions.

• What will the recovery be like?
• When will I start losing weight?
• How much will I lose?
• Will it hurt?
• And many, many more

These are important and can be addressed with the help and support of your surgical team.

Weight Regain

Another common concern is whether the weight will eventually come back and can regain be prevented. One distinct benefit of bariatric surgery, and specifically the sleeve, is that it alters your digestive system, giving you the tools to lose weight. On the other hand, you can only be successful with a dedication to lifelong changes in diet and exercise. With lasting improvements in your lifestyle, the possibility of weight regain is significantly reduced.

Weight regain is always a concern, however, and we continue to learn more about why some bariatric surgery patients experience weight regain years after their procedure while others do not.

The first step to fully understanding how and if weight regain can occur after a gastric sleeve is to explore how the gastric sleeve works.

Around 80% of the stomach is removed along the greater curvature or outside of the stomach. The result is a long, barrel-shaped stomach, around the same shape and size as an average-sized banana. Somewhere around 200,000 Americans will have a gastric sleeve operation this year, which is proven effective in treating obesity. A typical adult patient in the United States can expect to lose around 60-70% of their excess body weight. In addition to restricting the amount of food a patient can eat after their procedure, the gastric sleeve also offers hormonal benefits.

What Is Normal Weight Regain?

It is important to note that rapid, extreme weight regain after a gastric sleeve is never normal and must be addressed immediately with your surgeon. Also, frequently alternating between weight gain and loss (yo-yo-ing) is very concerning, and you must call us. On the other hand, weight regain of about 5-8% several years after the sleeve procedure is normal and expected.

There Are Several Potential Causes of Weight Regain

• First, the stomach pouch may stretch over time, resulting in not feeling full as quickly. This is usually caused by chronic overeating and drinking carbonated beverages.
• Hormonal benefits in the first year or two after surgery include suppressing the hunger hormone ghrelin as the production center in the stomach, the fundus, is removed. When ghrelin is reduced, patients feel more satiated and may enjoy foods like vegetables instead of sugary treats. Over several years, however, the body might adjust and increase the production of ghrelin within the small intestine. This leads to renewed feelings of hunger.
• Another common cause of long-term weight regain is diet. Patients will likely stick to their diet in the early years after the gastric sleeve, but old habits might return over time. Eating high-calorie foods and sweets can lead to weight regain.
• Other potential causes of weight regain years later after surgery are lack of exercise and mental health changes. Several years after the surgery, it might be difficult to feel motivated in your physical workouts, and mental health challenges like depression and anxiety could lead to overeating. Why do we lump these together? Exercise is a potent anti-anxiety and anti-depressant tool.

The Bottom Line

If you find yourself regaining weight post gastric sleeve surgery, your surgeon is the most helpful person to turn to. Many options and support systems are in place to help you succeed in your weight loss journey. With the support of your surgical team, you may need to change your diet habits and incorporate appropriate exercise routines into your daily schedule. Be open and honest with your team about what you have been eating, and consider keeping a food diary to log your meals.

Your doctor may also suggest using weight loss drugs like Wegovy and Zepbound to suppress your appetite and restart the weight loss process. It’s important to remember that these weight loss drugs should be seen as a temporary assistive device as patients rework their lifestyles to better adhere to their dietary and exercise needs after surgery.

Surgical revision of the sleeve is generally performed as a last resort and on a case-by-case basis. That said, bariatric surgical revisions and conversions can be somewhat riskier because of the scar tissue that will have formed after the primary bariatric procedure. Employing a skilled and experienced revisional bariatric surgeon like Dr. Tsuda is critical to the effectiveness and safety of a second bariatric procedure.

For many bariatric patients, gastric sleeve surgery dramatically improves their health and starts a long-term journey toward a healthy weight and life. With the support of a dedicated team to monitor diet and lifestyle choices, we can effectively lower the risk of weight regain after a sleeve.