Regain Be Gone: 12 Strategies to Maintain the Body You Earned After Bariatric Surgery

By Sameera Khan and Dominick Gadaleta

An experienced dietician shows how to keep the weight off after bariatric surgery.

With twenty years of training in the field of bariatrics, trusted dietitian Sameera Khan shares strategies toward a balanced, stress-free weight-loss journey so that readers can feel confident, powerful, and successful. Weight regain is a manageable setback that can be reversed with a little effort and guidance. The longer one ignores it, the harder it is to regain lost ground, so act now. Regain Be Gone is the only resource people need to help them keep weight regain at bay after bariatric surgery.

Praise for Regain Be Gone

“A great book and really good, comprehensive companion for both patients and practitioners.” —William S. Richardson, MD, FACS, FAMBS; Professor, University of Queensland; Section Head General Surgery, Ochsner Clinic, New Orleans, LA

“Sameera Khan is an incredibly knowledgeable guide on your weight loss journey following bariatric surgery. With decades of experience as a dietitian and physical assistant working with weight loss surgery patients, she is an invaluable resource.” —Allison M. Barrett, MD. FACS, FASMBS; Director of Bariatric Surgery at Penn State St. Joseph Medical Center, Reading, PA; Clinical Assistant Professor of Surgery at Penn State University

• Language: English
• Publisher: Open Road Integrated Media
• Release date: Dec 3, 2019
• ISBN: 9781642795844

Book preview

Introduction

Learn from the past and let it go. Live in today.

- Louise L. Hay

Most of my clients come to me, frustrated, confused, and dejected that the weight loss they previously had control over is gone. My goal is to ultimately help you reach your goals, learning lasting habits that you carry with you after you reach your potential. Your skills will be developed and your performance will be monitored as you advance in your journey.

•This book will help you navigate through the challenges while educating you to make better choices, toward a sustainable, and less frustrating journey.

•This book will pay attention to you and your personal goals whether it be losing weight, building muscle, increasing energy, sleeping better, or eating around restrictions.

•This book will offer you support that is crucial for your success where you never feel you are alone and have fun along the way

•This book will offer you lasting results and lifestyle changes with permanent results, building a sustainable relationship with food

Set Point Theory

With regards to obesity, there are many theories and reasons why it occurs. Many factors that are involved, such as environment, genetics, psychology, and even metabolic factors. Truly, there are many variables that will lead to obesity. It is not a one factor fits all theory after all.

One theory that explains why people tend to be overweight is called the Set Point Theory. According to this theory, the body has a complex system of hormones. Even more, it also has a complex system of bodily signals. These signals can control appetite, metabolism, and even digestion. Based on the theory, this complex system keeps our bodies at a steady weight or what is referred to as set point. Thus, when an individual reduces their food intake, the body then defends the established set point. It is a physical way to cope with a period where food is less available. Some evidence supporting set point theory is:

•Ghrelin seems higher in patients who have lost weight, causing increased hunger

•Metabolic rate decreases with weight loss

•Exercise needs increase from 150 to 250 minutes per day in patients who plan to lose more weight and maintain it

•It is a struggle to keep the weight off after getting off a diet. (Farias et al.2011,85-89).

Given how diverse we are, each of us has a different set point. Our bodies have almost similar ways to manage this set point, controlling cholesterol, blood sugar, and even blood pressure. This set point is still dictated by everyone’s genetic, psychological, and environmental factors. Should there be changes in any of these factors, it will lead to a higher set point that in turn can lead to more body fat storage (Farias et al.2011,85-89).

This theory also explains why diet and exercise are not enough for someone to lose weight. It is no wonder why then no matter how hard we eat less and exercise more often, reaching our desired weight can still be a difficult journey. This is because when we go on a diet, our body thinks it is being starved. When that happens, survival kicks in. This results in our body storing energy-rich body fat, hence, we don’t lose weight that easily (Farias et al.2011,85-89).

But there’s a way to be able to effectively lose weight. Bariatric surgery can truly make a difference. It helps to reset the body’s ability to manage weight, altering its complex relationships with behavior and metabolism. This paves the way to lasting change by changing the anatomy of the stomach and the intestines which in turn can help lower appetite and keep a person satiated. Even more, this can even bypass the body’s set point. (Al-Najim et al.2018,1113-14).

Inside this book, you will find

•Real patient scenarios and how they have kept the weight off after bariatric surgery

•Lose-Your-Regain activities to work on

•Easy to follow road maps for everybody, exactly what successful patients use

•Weight maintenance strategies so you never worry about weight regain again

•Tools to keep you focused during your weight-regain-loss journey

•All your concerns and questions answered

•Tricks and hacks on snacking smart, overcoming cravings, reducing stress levels, and staying hydrated

You and I are on this journey together as we revolutionize your weight loss after bariatric surgery. You have access to my resources and can benefit from my clinical knowledge. Welcome to the Weight-Regain-Losers-Club after bariatric surgery."

Figure One

For many patients, shedding the pounds soon after bariatric surgery is the easy part. It’s keeping it off that can be the ultimate challenge. Patients feel themselves bouncing on a trampoline, where the harder they try, the faster the weight returns. This kind of weight cycling is a common occurrence as patients progress over the years after bariatric surgery.

Pinpointing and tackling the precise reasons behind the weight regain can reverse the damage. This book reveals the most common weight maintenance saboteurs experienced by real life patients, and how they fight back against each.

The Honeymoon Period

The honeymoon period after bariatric surgery is the most crucial period you have in developing and building a bridge over troubled waters. Weight loss is dramatic during this period which may last anywhere from twelve to twenty-four months.

In the beginning, you might not understand when the bariatric team keeps emphasizing that surgery is only a tool. The tool will continue to work till you keep working it. It may not remain as shiny and new as it once was. The manual might be a little worn out and may need additional love and care to keep it in top form. Though surgery does cause lifestyle changes to a certain extent, it still does not prevent you from eating even when you are not hungry after the honeymoon period ends (Al-Najim, et al,2018,1113-14).

If you have passed the honeymoon period and have still not figured out the reasons for your pre-operative eating habits, you have a greater chance of regaining your weight back. You risk gaining momentum with detrimental behaviors like grazing, picking, and nibbling throughout the day. Slider food syndrome, involving processed carbohydrates like pretzels, potato chips, and crackers (foods that slide right through your pouch), gains momentum.

Figure Two

Staying on track in a culture loaded with food opportunities is not easy. Ups and downs are bound to happen and ongoing commitment is needed. It is common for patients to regain 10% to 15% of their initial excess weight loss after weight loss surgery.

However, if you regain more than this, it might be a red flag that you have not changed your lifestyle habits, are unable to manage the stress, and have given in to environmental challenges. This book might be exactly what you have been looking for.

In this book, you will learn actionable strategies that will mesh with your lifestyle to achieve lasting changes. Just eating less and exercising more is not enough.

Factors like genetics, environmental cues, emotional state, and drug interactions all contribute to a person’s weight regain.

Some of the challenges bariatric patients face as they move forward are:

1. Weight loss stall: As you lose weight after bariatric surgery, you also lower the number of calories your body needs. The key to losing more weight is to adjust your food intake and exercise regime in new ways. Prepare for inevitable plateaus by tracking your diet and activity every day.

2. Expect less support: When you start losing weight during the honeymoon period you are bombarded with praise and compliments. As time goes on, your weight loss is not news anymore, and the cheering squad disappears. This can lead to a lack of enthusiasm and interfere with progress. Continue to share small goals and keep inviting friends and family to celebrate your progress. Also, become your own source of rewards.

3. Stressful events: Bad days’ lead to bad weeks which in turn lead to bad months, and before you realize it, your life is turned upside-down. Negative emotions and stress cause you to skip workouts, give in to cravings, and find yourself moving toward your pre-surgical weight. It is imperative to maintain a daily relaxation habit, to reach out for help, and to make support groups an important part of your life.

Make Peace with the Energy Gap

As you keep losing weight after bariatric surgery, even though your body does not need as many calories as it did before you started plateauing, something frustrating starts happening. Your body can’t tell the difference between eating less and being stuck in a famine. Your metabolism slows and your body goes into a protective mode, stimulating your appetite to preserve fat stores.

Energy gap is a term that was coined to describe estimating the change in your energy balance point. This is knowledge you will need for reaching and maintaining successful body weight goals. It is useful for: 1) Prevention of excessive weight gain, and 2) Maintenance of weight loss (Hill, et al.2009, 1848-53).

•Once you lose weight after bariatric surgery, your body needs fewer calories to maintain the weight loss. This is called the energy gap. To avoid weight-regain, the energy gap is around hundred calories or less a day. Inability to keep that energy gap going inevitably leads to the weight creeping back on. (Hill et al,2009,1848-53).

•Re-determine how many calories you consume as you lose weight. The body needs fewer calories to maintain itself as your weight goes down, and keeping track of the energy gap helps maintain weight loss.

•Avoid compensating for your workouts. Refrain from resting more than you normally would or eating higher caloric foods after working out

•Calculate the net calories burned during workouts by subtracting the number of calories you burn when not exercising. To get an accurate number of net calories burned, if during a thirty-minute workout you burned 300 calories, you would subtract the calories spent if you had been sitting (twenty -forty calories). (Hill et al,2009,1848 -53).

***

Lose-Your-Regain Activity # one: Motivate Yourself with a Mantra

Mantras can comfort and support you during your transformation, helping you achieve your goals.

An inspirational mantra is a thought that you can repeatedly say to yourself three times a day for seven days keeping you motivated and focused on a weight loss challenge. Here’s how to create one:

•Think of one of your weight loss goals

•Come up with an inspirational phase or simple statement that motivates you

•Repeat it aloud when you feel discouraged, or stressed

Some ideas for motivational mantras are:

If we don’t change, we don’t grow. If we don’t grow, we are not really living. – Gail Sheehy

Transformation literally means going beyond your form. – Wayne Dyer

Motivation is what gets you started. Habit is what gets you going. – Jim Ryan

The way you think, the way you behave, the way you eat, can influence your life by thirty to fifty years. – Deepak Chopra

No Masterpiece was ever created by a lazy artist. – success.com

One year equals 365 possibilities – success.com

The best way to get something done is to begin. – success.com

Nothing changes if nothing changes – Gloria Sanderson

https://go.omadahealth.com/.

(Health, Omada. The Omada Program.n.d.)

***

Now, meet Jamal, who changed his life and his health with surgery. He believed in the improbable and made it happen. He is an extraordinary example of how change rewards you when you work for it. Read about how he visualized where he wanted to be and moved toward it. It is amazing how a world can open with the thought, I just want to live.

Figure Three

Jamal: My name is Jamal and my journey, just like everyone else, has been filled with ups and downs. But what makes my journey worth it is the fact that I have successfully added years to my life by using my surgery as a tool to help me improve. I started my journey at 586 pounds.

I stand today at 332 pounds and I’m still working toward my goals because when it comes to being healthy, everything is always under construction. There are many ways one could stay on track during their process, but what kept me going was the idea that I would have a future.

For so long, all I imagined for my future was being a grim, depressed person who was unhealthy and hated his appearance. But now, I believe that I gave myself a chance to grow old and experience life beyond food and comfort.

I get a chance at having a family and that is another thing that keeps me on track. Now, my motivation stems from the desire to be able to play with my children and help them with sports. I grew up playing sports and I feel that my future children deserve a father who will participate in their lives fully and not from the confines of a couch.

Good health is another huge motivator that keeps me on track. It’s a simple idea but you’d be surprised how we lose sight of how important health is when we’re thinking about food all the time. Being generally healthy is a big reason I keep going and I just want to live. I think what keeps me from going back to my old ways is the thought of an early death. I’m not afraid to die, not at all, but what I am afraid of is dying knowing I have so much to offer the world and that my death could’ve been prevented by simply eating healthier and exercising.

I have control and so do all of you by reading this book. During my workouts, I find it best to pace myself and not to over exert because when you over exert you become discouraged not necessarily because you can’t do something but because you may be physically tired. During this journey, you will feel discouraged at points because I did myself, but you must understand that it’s a battle of life and death.

I am a believer that slow and steady wins the race. I approach exercise in the same way I would approach my old eating habits. I ask myself how would I eat a Big Mac? And the answer is relatively universal, you eat it one bite at a time. That is exactly how I treat my exercise every day. Every set is one at a time, I try not to stress as much as I can since we can only control our future, never the past, so let’s keep one foot in-front of the other and continue to elevate.

Setting small goals that lead to a bigger one is a good way to approach weight loss. I look at it like this – it took me several years to gain so it will take several years to lose but with hard work and dedication, I will be able to overcome the obstacles and achieve great results.

Finally, the most important piece to this puzzle will be food itself. I have learned to eat to live and not live to eat. I practice portion control because good portion control coupled with better decision making makes everything easier.

This journey is quite like building a car you must put all the pieces together carefully and precisely. Once you do that, you add gas and that will determine performance. If you put bad gas in your dream car, it won’t sound or run as good. Think of your body the same way. Feed your body good things and it will be good to you. Your body is your temple so treat it as such. We’ve all been given the gift of life and if you have the power to save your life through better decisions, then it’s important for you to do so.

Chapter One:

My Story

Pay the farmer or pay the hospital.

– Birke Baehr

Ilove people

I love helping and guiding people after bariatric surgery.

I love health and fitness and all the intricacies of weight loss.

I guide. I coax. I motivate. I support. I talk to clients. I build dreams. I am your partner in your weight loss journey.

As a physician’s assistant and registered dietitian in the field of bariatrics, I have helped an endless number of patients lose the weight that they have regained years after bariatric surgery.

I have been in the field of bariatrics since 1998, and have worked with amazing bariatric surgeons. I have never given up on my clients.

Besides being an author, my bachelor’s degree is in nutrition, and I later did graduate studies to become a physician’s assistant and received a master’s in health care management.

When I am not working, you can usually find me out hiking the local trails, haunting the local bookstore, or exploring healthy new food products for my clients to try.

I currently live with my husband in New York, a city that provides me with constant inspiration, where I work as a bariatric coordinator.

I’m No Expert

Well, I am kind of an expert helping clients deal with weight regain after bariatric surgery. I have a bunch of letters after my name, though my most important qualification for writing this book is that I have been a part of the post-operative journey of many bariatric clients who have regained, helping them get over the speed bumps, rooting for them, and using my knowledge to approach their problems sensibly. I have tried to put everything that I believe would be helpful into this book.

When I was in school, my aunt was diagnosed with breast cancer and passed away six months later. I was extremely close to her and the shock and heartbreak made me wonder if there was anything she/we could have done to prevent or reverse the progression of the disease. In addition to obesity, diabetes and hypertension, being rampant in my family, this was something new. Though I did not jump into picking nutrition as my career path right away, it did spark a deep interest in me.

Fast forward five years later when, as a graduate student, I had a college roommate suffer a stroke at the age of twenty nine. A hectic lifestyle along with endless hours of studying, examination stress, eating from the vending machine, and having a sedentary lifestyle all led to her in the emergency room. Scans and an MRI confirmed the

Reviews for Regain Be Gone

[Melissa Fink · Rating: 2 out of 5 stars]

A lot of errors in the book. This book was a great read just a lot of errors.