Four Truths About Weight Regain After Weight Loss Surgery

I was born with the disease obesity and by the time I was out of college it had advanced to morbid obesity. At age 33 my disease was treated with gastric bypass surgery which affected a loss of weight that put my disease, morbid obesity, in remission. Three years later I suffered a relapse of my disease with a weight gain of 20 pounds. Through dietary and lifestyle compliance, much like a person with heart disease who suffers a relapse, I was able to put my disease, obesity, back in remission. I will always have the disease of morbid obesity and am fortunate that I was able, at a young age, to be treated with the best medically available option.

The Facts:

• Obesity is a disease.
• Weight loss puts the disease in remission.
• Weight gain puts the disease in relapse.
• Like most diseases, victims of obesity are responsible to make dietary and lifestyle changes that work with medical treatment to keep our disease in remission.
• Like most diseases, relapses occur, obesity manifests relapse in weight gain.
• We are not the disease, we have the disease.

My Four Truths:
Regain Is Likely: It is generally believed that 80% of people who undergo weight loss surgery (WLS) will experience weight gain (relapse) of 10-30 pounds depending upon initial weight loss. It is further believed that 20% of those will relapse to their former weight and possibly gain more as the disease of morbid obesity advances. This relapse can be the result of failed gastric surgery (the surgery was improperly performed or medical device failure); a non-compliant patient who does not evolve their eating and exercise habits; the active intestine becoming more efficient at absorbing calories; and potential stomach pouch stretch. Dr. Anita Courcoulas, chief of minimally invasive bariatric and general surgery at the University of Pittsburgh Medical Center said, "Regaining weight down the road is a common phenomenon for weight loss patients. These patients need to be educated and prepared for it if it happens."

100% Conviction: It is my experience that 100% of patients who take to the operating table for the treatment of their disease say, "I'm not going to be one of those people  who gain weight after surgery." You can bet the farm I said that - and imagine my embarrassment and shame when I did in fact become one of those people. At the time I didn't understand my disease had relapsed, in part because I had relaxed my newly evolved eating and exercise habits, but also because my body has a disease that wants to store excess fat. I thought I gained weight because I was a failure at surgery.

I failed AGAIN! I am not alone in my feelings of failure over weight regain. Dr. Courcoulas said, "These are people who feel that they have failed at everything they tried in their lives. If they feel that they are failing surgery, they're embarrassed and they don't want to come back for help." How sad for us. When a cancer patient suffers a relapse do they take it as a personal failure? I sure hope not. Popular media perpetuates the belief that weight gain equals failure. WLS celebrities are splashed across mainstream media and tabloids alike for weight regain. But the celebrity with cancer who suffers relapse? Charity benefits are hosted bearing their name and their bravery is lauded. With a relapse in obesity the celebrity becomes the brunt of jokes for late night comedians. No wonder we don't want to become one of those people but statistics are not on our side

I Am Not Obese. Since kindergarten the word "fat" defined me and I actually thought that was who I was because "You are fat" and "I am fat" were constant phrases in my world. By about age 40 I finally figured out that I am not fat. I have obesity, a disease. Have you heard a heart attack patient say, "I am heart disease" or a leukemia patient say, "I am cancer"? We are not the disease! We have a disease that is part of the whole person that makes us the wonderfully unique and powerful person we are.
Relapse to Remission: Just like other diseases, obesity relapse can be put into remission. There is hope! As noted above there are (at least) four reasons for relapse including: failed gastric surgery; a non-compliant patient who does not evolve their eating and exercise habits; the active intestine becoming more efficient at absorbing calories; and potential stomach pouch stretch. Keeping in mind that statistically weight regain is likely, that you are not a failure, and that you are not the disease, you can pragmatically go about mapping a plan to fight your relapse.

• Seek medical help and treatment: you are fighting a killer disease
• Assess your eating and exercise evolution and return to the lifestyle prescribed at the time of surgery
• Educate yourself on nutrition, physical and spiritual health so they may work in harmony to heal your body
• Seek support, family, friends, community, and fellow patients to help maintain your personal motivation
• Educate others to stop the ignorance and blame and promote the understanding of this illness we are fighting.

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