Weight regain after bariatric surgery is a reality. The numbers aren’t conclusive, but one study found that excess weight loss is at approximately 77% within the first year but drops to 56% after five years. Another study found that only 40% of gastric bypass patients maintained a 30% or more loss after 12 years. Obviously, no one wants to experience weight regain, but it is important to keep in mind that this is common. If you have experienced weight regain, you are not alone. And it doesn’t at all mean that you’ve done something wrong.
..it’s extremely important to discuss the impact of our physiology on weight. Body weight is not merely a case of calories in, calories out.
In this article, we’ll look at some of the common psychological contributors to weight regain after bariatric surgery. But before we get to that, it’s extremely important to discuss the impact of our physiology on weight. Body weight is not merely a case of calories in, calories out. There are a multitude of bodily systems that regulate weight—and we don’t have total control over them.
Physiological Contributor to Weight Regain after Bariatric Surgery
For example, there is plenty of research supporting the theory that all of our bodies have a set point that they like. Although our set points are flexible, our bodies tend to work to stay within a certain range. And unfortunately, it’s easier to go above our set point than it is to go below. Set point theory explains why some individuals can lead extremely healthy lives and have difficulty with weight loss. Their bodies are just happier at a higher weight.
Set point theory can also help explain weight regain after bariatric surgery. Indeed, if you’ve fallen far below your set point range, your body will work to gain weight. In addition to this, studies have suggested that bariatric surgery can actually reset a person’s set point to a lower set point. This may make it even more difficult to maintain weight loss. I know that this is not good news! But, if you are someone who is doing everything “right” and are still not where you thought you’d be in terms of weight, this could very well be why. Your body is just doing its thing. You aren’t doing anything wrong!
Common Psychological Contributors to Weight Regain after Bariatric Surgery
Getting back to psychology, the following are factors that I have seen contribute to weight regain after bariatric surgery:
1. An unchanged relationship with food. It is vitally important that surgery patients work on changing their relationship with food prior to and following surgery. What does that mean? It means that you must be aware of how and why you are using food for reasons other than nourishment. Are you eating when you’re stressed? Angry? Sad? Is food your only reward? Is it your best friend? If any of these are true for you, you will very likely continue using food in the same way following surgery. But let me just say that most people eat in response to emotions at least sometimes. No one expects you to never do this again! But if you are/were someone who’s main coping skill is eating, you will likely struggle with this same issue following surgery unless you work to change it.
2. Loss of identity following surgery. I’ve worked with bariatric surgery patients who have felt like they have no idea who they are anymore since they’ve lost weight. If you’re used to seeing yourself in a certain way, looking very different can be extremely disconcerting. We all need to have a consistent idea of who were are, what we believe in, and how we look. Losing some of those identifying factors can be difficult.
3. Unhappiness with excess skin. Some bariatric surgery patients experience significant excess skin that can lead to physical challenges, including difficulty with exercise. Excess skin can also lead to negative body image, which can also contribute to depression and anxiety.
4. Fear of success. Believe it or not, some patients have difficulty with the “success” of weight loss. They either feel that they don’t deserve it, or they feel incredibly uncomfortable with the positive attention they are getting from others.
5. Feelings of vulnerability. For some patients, weight can be a protective boundary. This can be especially true for women with histories of abuse. Significant weight loss can lead to feeling vulnerable both physically and emotionally.
6. Lack of overall self-care. Whether you’ve had surgery or not, it’s vitally important to maintain positive sleep habits, engage regularly in movement, and connect with a support system. A lack in some or all of these areas can lead to weight regain after bariatric surgery.
The Bottom Line
All of the above can lead to a conscious decision to regain weight, or a subconscious process of self-sabotage. If you notice that you are having difficulty engaging in eating habits, movement, and self-care in the way that serves you well, one or more of these issues may be at play. It may be helpful to find a therapist who is knowledgeable of bariatric surgery and/or eating disorders in order to gain insight and awareness into what’s going on.
Wishing you freedom from food,
Kim Daniels, PsyD
“Ask the Psychologist” is a monthly column by Kim Daniels, PsyD. Content is the opinion of the author and does not constitute or is a replacement for medical advice.