Bariatric Surgery – How to maintain weight when the “Honeymoon” Wears off

Mariam Lakdawala, Bariatric nutritionist; Dr. Aparna Govil Bhasker, Bariatric Surgeon

Honeymoon period is basically the golden period in the first year post bariatric surgery wherein the patient experiences drastic weight loss. Obesity surgery leads to weight loss through a combination of various mechanisms such as restriction of food intake, a decrease in hunger sensation, mal-absorption of calories, action of gut microbes and hormonal activity in the gut.

An interesting fact about the “post-bariatric surgery honeymoon phase” is that it is relatively longer than the “post-marriage honeymoon phase”. However, like the other one, this too is a temporary phase which sadly comes to an end after 6-9 months of surgery. After about 6 months or so, weight loss starts slowing down, but continues to happen until 1 year-18 months. Most patients reach the nadir of weight loss between 18 to 24 months.

By the end of 12 to 18 months, there is a considerable increase in food intake and hunger. Bariatric surgery is a tool that must be used for pushing one into a lifestyle change. Patients who embrace a healthy diet and an exercise regime, tend to do better in the long term. Varying degrees of weight regain is seen after obesity surgery in the long term. Regular follow up is the key to maintenance of weight loss in the long term.

In the first 6 to 9 months after the surgery, the main focus must be on conditioning the mind to, adopt a low calorie well balanced diet:

• Your diet is important not only during the honeymoon phase but is even more important after 12 to 18 months to prevent weight from coming back
• Restricting outside eating & intake of fried food, ice-cream, chocolates, processed foods, sugary foods etc.
• Fat gives double the amount of energy as compared to carbohydrates and proteins, hence it should be restricted in the diet.
• The body spends more energy to digest protein; thus, a high protein diet is very important for weight loss and maintenance. It is wise to distribute protein rich foods in all the meals in order to ensure better absorption.
• Avoid keeping long gaps between meals, eat every 3-4 hours to prevent overeating in the subsequent meal
• Maintaining a food diary is the best method to be aware of the food choices you make.
• Grazing which is a repetitive eating behaviour, in an unplanned manner not associated with hunger or satiety sensations, could develop post the surgery. It might lead to poor weight loss if not corrected. A simple way to deal with it is to eat the entire meal at a go and keep a decided gap consciously between the meals.

Mindful eating

The story doesn’t end on what to eat, how to eat? how much to eat? When to eat? Is equally important. Given below is the cycle of mindful eating created to make you more mindful about your eating habits.

Mindful eating basically involves the practise of eating food slowly, in a relaxed environment by limiting other distractions so that you can focus well on your meals. As a result, you will be more conscious of portions and food intake.

Make exercise a way of life – Engage in any form of physical activity daily for at least 40-45 minutes. Make exercising fun by engaging in the activities you like so that you don’t leave it in between.

In addition to a focused exercise, increase the nonspecific exercise activities like usinga stairs instead of taking elevators or escalators, park your vehicle a little away from the intended destination, avoid using vehicle for short distances, etc

Stay away from lifestyle stressors like alcohol, smoking, erratic sleeping, sedentary lifestyle, work stress, etc.

Engage in meditation/ yoga/ breathing techniques or spend 30-40 minutes of your time daily in any activity that keeps you away from negative thoughts.

Dr. Aparna Govil Bhasker is one of the best bariatric surgeons in India and is associated as a consultant bariatric surgeon in Mumbai with many renowned hospitals.