Article By: Rachel Ignomirello, MS, RDN, CSOWM, LDN
Rachel Ignomirello is a Bariatric Dietitian and Board-Certified Specialist in Obesity and Weight Management.
Metabolic and bariatric surgery is the most effective and durable treatment for severe obesity. The surgery produces weight loss by means of restriction, malabsorption, or both. The American Society for Metabolic and Bariatric Surgery (ASMBS) considers bariatric surgery successful if a patient has maintained 50% excess body weight loss at least 5 years post-op.
Success comes from a partnership between surgery and the patient’s behaviors. This is why pre-op education and counseling are key in learning appropriate eating and exercise habits. If patients are not committed to long-term behavior changes, then it will only be a matter of time before weight regain happens. There are many aspects that successful bariatric patients have in common. In no particular order, here are my top six:
1) No grazing. There are many eating behaviors and food choices that I could list that often cause weight regain. Overeating foods high in fat or sugar, eating until overly full, eating to deal with feelings, etc. However, the one that impacts success the most is grazing. Grazing is a habit of eating small snacks all day instead of having actual meals. I often think of it as mindless snacking without purpose or portion. There is an association between grazing and weight regain after bariatric surgery, regardless of surgery type. Structured mealtimes and hunger awareness will help reduce this from happening.
2) Keeping follow-up appointments. Early after bariatric surgery, patients follow-up closely every few months for the first year. Beyond that, annual visits with their bariatric team are a must for better success. Obesity is a chronic disease, so these are vital visits. Long-term follow-up can provide additional support, education, medications, and more. In my experience, these visits are also important to monitor lab values. No matter how patients are doing, they should maintain their post-op appointments. For example, weight regain is nothing to be ashamed of and is much easier to treat when it’s just ten pounds – not an extra hundred pounds because of delayed follow-up.
3) Taking bariatric vitamins. Bariatric-formulated vitamins are key for long-term success. Patients who do not take vitamins every day suffer serious and possibly life-threatening diseases due to low vitamin or mineral levels. Common examples include osteoporosis, anemia, and neuropathy. To prevent nutrient deficiencies, bariatric patients often need to take a bariatric Multivitamin, Iron, Vitamin B12, Calcium, and Vitamin D.
4) Tracking intake. Self-monitoring allows us to have accountability and awareness of our daily choices. It’s important to face what you eat. You can review smart choices, learn from struggles, and lose more weight. Studies suggest that patients can lose more weight and maintain weight loss when they track food intake. Instead of wasting 15-minutes on social media, why not redirect that time toward a productive, healthy habit that will improve success?
5) Attending support groups. As I lead my program’s monthly support groups, I get to see how they help patients become more successful. Having an extra network of people who understand your struggles also means they will help celebrate your success. Beyond my personal bias to their benefit, studies suggest that those who attend bariatric support groups achieve greater weight loss. Patients get validation, education, motivation, and most important dedication to their bariatric lifestyle.
6) Exercising. After bariatric surgery, patients will often have a short-term restriction on exercise during the initial post-op period. Despite the restriction, walking is critical and will help improve recovery. Over time, exercise intensity will increase as energy and healing increase. Physical activity is highly studied when it comes to weight loss maintenance. It will help maximize fat loss while reducing muscle loss. To maintain weight loss success, patients will be instructed to work up to 150 minutes of moderate-intensity aerobic activity.
BariMelts provides general recommendations, not to be construed as medical advice. Please consult your doctor.