Gastric bypass is a weight-loss surgery that “shrinks” the stomach, resulting in rapid weight loss. However, an estimated 10-20% of gastric bypass patients can gain a significant amount of the weight back[*]. If this has happened to you or someone you care about, there is a simple and effective way to restart the weight loss journey — you just need the right tools and guidelines. Read on for some science-backed ways to sustainably keep weight gain at bay after gastric bypass.
Gastric bypass is a weight loss surgery (also known as bariatric surgery) where the surgeon creates a small pouch in the stomach and connects it directly to the small intestine. This allows your food to bypass the majority of your stomach and the first part of your small intestine. The result is a tube-like structure, also known as a gastric sleeve, which is why some people refer to this surgery as a gastric sleeve surgery. Gastric bypass is usually performed in people who are overweight or struggle with obesity when diet and exercise are not enough for weight loss[*].
It’s not uncommon to rapidly lose weight after gastric bypass surgery as the changes in your stomach and intestine don’t allow you to consume or absorb very much food. However, many people find that they eventually start regaining weight once their stomachs have healed. This is typically due to the fact that your stomach has the capacity to stretch and grow. Right after surgery, the inflammation and scarring in your stomach limit its ability to expand, but once the stomach has healed, it may once again stretch to accommodate more food (and therefore more calories)[*]. If this happens to you, you have two choices:
- Have a revision surgery to reset your stomach
- Do a pouch reset (shrink your stomach by reducing the amount of food you eat)
Most people opt for a pouch reset because it is much less expensive and invasive than a second surgery.
What Is a Bariatric Pouch Reset?
When your stomach is empty, it’s about the size of your first. However, when you eat food, your stomach has the capacity to expand to hold as much as one quart. Even after bariatric surgery, your stomach still has the ability to stretch significantly as the folds within your stomach, known as rugae, expand and contract in response to food. A pouch reset is a way to shrink your stomach back down to size by drastically restricting your food intake. The diet for a pouch reset mimics your post-op diet plan, although instead of lasting a couple of months, the diet only needs to be followed for about 8 to 10 days at a time.
When doing a pouch reset, it’s advised to work with a bariatric specialist or dietician to guide you. Many pouch reset meal plans include applesauce, sweet potatoes, and grains like oatmeal. Of course, for a keto dieter, you’ll stick to low-carb veggies, soft proteins, and protein powders. A typical low-carb pouch reset diet looks like:
- Don’t drink liquids for least 30 minutes before and after your meals
- Keep your portions small, about ½ cup to one cup maximum.
- Eat slowly and mindfully, paying attention to each bite
- Drink plenty of water throughout the day (but not with meals)
- Herbal teas
- Sugar-free drinks that are not carbonated
Day 2 and 3
- Protein shakes
- Cottage cheese
- Chia seed pudding
Day 4 to 6
- Pureed soup
- Cottage cheese
- Scrambled eggs
- Chia seed pudding
- (no meat yet)
Day 7 to 9
- Steamed vegetables
- Soft cheese
- Ground chicken or beef
- Canned salmon or tuna
- Steamed fish
- Scrambled eggs
Day 10 and Beyond
Focus on healthy foods (this is your chance to restart weight loss in a lasting way, so you’ll want to be sure to take care of your diet and maintain moderate portion sizes)
- Reintroduce foods slowly, with meals about the size of your fist (this will slowly increase over time, but start here as your stomach is much smaller now).
- Eat slowly, allowing 20 to 30 minutes per meal
- Consult with your bariatric surgeon or dietitian, but most meals should focus on protein and veggies
- Don’t drink liquids for at least 30 minutes before and after your meals
Shrinking the size of your pouch can help you feel satisfied with less food, but it’s not the answer to weight loss as your pouch can always re-expand. The majority of weight gain after gastric bypass is due to the types of food you’re eating when you’re eating them and your overall calorie intake. For this reason, doing a pouch reset is really only the first step in your weight loss journey. Once the reset diet is complete, it’s up to you to stick to healthy foods in moderate amounts if you want to experience lasting weight loss. Working with a dietician can be very helpful for making changes to your mindset around food and understanding what to eat and when. It’s not that you can never treat yourself — in fact, research shows that having some flexibility in your diet is crucial for long-term commitment and healthy weight loss[*][*]. With that being said, having some guidelines that can help you get into healthy eating habits is crucial for success. During the pouch reset, you’ll need to muster some willpower as you’ll be drastically reducing calories. This is another reason that working with a healthcare professional can be very helpful.
Many gastric bypass patients experience weight gain due to the stomach’s ability to expand after a period of time. While this can be very disconcerting for weight loss surgery patients, it’s incredibly common and, with a bit of willpower, pretty easy to come back from. Along with a pouch reset, lifestyle changes play a significant role in your ability to lose weight and keep it off. If you continue overeating, you’ll only find yourself right back where you started. For this reason, working with a dietitian is highly recommended for continuing weight loss after gastric bypass.