Why Am I Not Losing Weight After Gastric Sleeve Surgery? 4 Tips to maximize weight loss.

You had a surgery that was supposed to be a sure way to lose weight. Yet, you don’t see the scale budge as quickly as you would like, or it has stopped moving altogether. Weight loss plateaus and slow weight loss can lead to frustration and guilt after surgery.  Self-doubt can start to creep in, leaving you feeling like a failure. This article addresses why you are not losing weight after sleeve gastrectomy and what to do about it.

The first thing to do is stop looking at how much weight other people on the internet have lost. 

After working with thousands of patients, we guarantee that everyone has a different journey. The keyword here is average. The monthly weight loss after a gastric sleeve is around ten pounds per month. With the fastest loss being within the first month. 

However, weight loss is not a guarantee. Below are the most common mistakes we see people make with their weight loss journey.

1. Work with a bariatric nutritionist

Bariatric nutritionists are experts in what they do. They have exclusive experience in setting expectations for before, during, and after the weight loss period. A bariatric RD (registered dietitian) will cover calorie and protein goals for the first several months after surgery and beyond.

Immediately after surgery is the best window of opportunity for maximizing weight loss.

We recommend going as low-carb as possible in the first three months.

This is when the hunger hormone effects of surgery are more pronounced. 

Another benefit of a low-carb diet is for treating any unresolved SIBO (small intestinal bowel overgrowth). SIBO is a gut condition that often contributes to weight gain, poor sleep, a weakened immune system, and sugar imbalances.

Scientific research has found many bariatric patients have a gut imbalance before surgery. Gut imbalances impact calorie burning, hunger, mental health, inflammation, and the body’s immune system. Following a low-carb diet after surgery resets the gut microbiome and prepares you to repopulate it with beneficial bacteria—yet another benefit of bariatric surgery, an opportunity to reset gut imbalances making it more difficult for obesity to occur again.

Don’t rely on restriction for portion control.

The first few months after WLS is considered the honeymoon period. Weight loss feels effortless. Celebrate this and prepare yourself for change. Often a person experiences hunger and appetite that matches the new smaller size and restriction of their stomach. However, over time this side effect wanes, and you can’t rely on restriction alone to bring you to your goal. 

Mashed potatoes, cream of wheat, and cream-based soups are not on the post-op menu.

For two major reasons: 1) A diet of mashed potatoes can leave you even hungrier, which will lead to more calories consumed. 2) Creamy and soft foods contain simple carbohydrates, which lead to unhelpful spikes in insulin (weight gain hormone) and cause an upset stomach. 

Working with a bariatric dietitian on an ongoing basis is key to staying on track and making nutrition adjustments as needed.

2. Are you drinking liquid calories or too many protein shakes? 

Liquid calories are frequently mentioned at some point in a person’s weight loss journey. We like to define them as beverages containing more than 35 calories from sugar, but closer to zero is always preferred. Since most drinks have calories from sugar, they can cause inappropriately reactive spikes in insulin (there is that weight gaining hormone again), leading to feeling shaky and hungry.

Consuming excess sugar causes insulin spikes and leads to cravings and consumption of even more calories.

While this can happen to people before surgery, it becomes especially pronounced after a sleeve or gastric bypass.

Liquid calories are also in your protein shake. These supplements can be both helpful and detrimental. For the first 6+ months after bariatric surgery, protein supplements can be very useful in reaching daily protein goals. However, they can be abused and overused. 

Ask yourself if your protein shakes are genuinely serving you anymore. 

Are they helping you stay healthy and safe, or are you using them as a crutch because you don’t want to cook or are craving something sweet? 

If you become too reliant on meal replacements, you are displacing the beneficial nutrients your body needs to function correctly. No meal replacement shake or bar will ever really replace the benefits of a whole foods meal. 

In addition to robbing you of health benefits, they can also lead to an unbalanced way of eating. Some people find that protein shakes help curb their hunger, while others find that they eat more later on in the day. If you find yourself eating increased calories throughout the day or evening, see if your morning protein shake is throwing you off balance. 

3. Are you exercising too much or too hard? 

Say what? 

As contrary as this may sound, hear us out. The early postoperative period should induce a very low-calorie state, about 600 per day for the first 6-9 months. Immediately post-op, you work up 600 calories a day, and most people start around 300 in the first weeks to months. Exercising too intensely increases your need for more nourishment, and in return, increases hunger hormones. 

Exercising too intensely too soon can lead you to feel tired, dizzy, and hungry unless you get those extra calories.

On the contrary, your intake of extra calories and exercise puts your body into a fat-burning state. Which is good! However, too much exercise can stall your weight loss. Additionally, intense activity increases growth hormone for muscle and bone density. Altogether, growth hormone drives increased calorie consumption to maintain mass.  

Please understand, exercise is fantastic for the body. Moderate exercise such as walking, hiking, or light resistance exercise allows you to drop weight faster in the first six months. Once you are at maintenance you can start to make more in-depth decisions about your fitness goals. Generally a year after surgery is where your calorie intake has stabilized for maintenance of your weight loss. We have tips for this phase too in our Restart Programs.

4. Are you eating for gut health? 

Ah, gut health. Finally, we are on to our favorite topic that we never tire of talking about. Your gut is the missing link to weight loss and improving health. Remember from above; we recommend two distinct phases after bariatric surgery. Firstly, the low-carb phase clears any undiagnosed SIBO, and secondly, repopulate your gut phase with beneficial bacteria. 

How do you repopulate your gut?

Fiber, ferments, and fiber! We can’t stress that enough. Eating foods rich in slow carbohydrates, also known as fiber,  will feed beneficial gut bacteria in the gut. With healthy gut function, you lose more body fat and improve overall well-being. A gut-friendly diet is the antidote to health problems associated with obesity. 

If you’ve had no weight loss three weeks after a sleeve, never fear. This can be due to extra fluids, trapped air, or a variety of other factors. Your weight loss should start soon after as long as you are following our tips above! 

Whole foods. Body Love. Gut Health. We’ve got your back! 

If you didn’t lose as much weight as you hoped after surgery or are struggling with weight regain, consider joining our Restart Coaching Program, our online bariatric nutrition course. We will help facilitate the unlearning of bad diet advice. Our course comes with gut healthy bariatric meal plans, and endless support so you can make healthier choices. This course is best for 9 months and beyond after surgery.

Learn more about the Restart Course here

Having surgery at a program that isn’t meeting your expectations?

Don’t wait to stall-out after weight loss surgery. Instead, prepare your body and mind for the transformation with our complete step-by-step process. Included is a 100+ page client handbook on everything weight loss surgery, guided week-by-week meal plans for before and after surgery to maximize weight loss, and six months of lifestyle and coaching support from us – a bariatric surgeon and dietitian with all the knowledge to help you be successful. This program is for the pre-op phase or immediately after surgery. 

Learn more about our Bariatric Surgery Prep Course here

yours truly,

Bonnie Buckingham, RD, MS, CDE & Dr. Erika La Vella, DO, FASMBS

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