Almost everyone who has weight loss (bariatric) surgery will have previously attempted to diet, probably many, many times. You may have been able to lose weight, but not always. For those who are able to lose weight following a diet, keeping it off is an entirely different story. The repeated experience of feeling like you have somehow failed at dieting gets logged into our psyche. It is the baggage we carry with us going into surgery and so it is not at all surprising that it hangs around for a long while afterwards.
I frequently tell people that it takes about 2 years to psychologically adjust after surgery. This doesn’t mean that you will struggle throughout, rather it suggests that there are many different parts to recovery. Sometimes it’s quicker for people and sometimes it takes more time. But for almost everyone, there is a fear of weight regain.
The fear of weight regain
Even when people are navigating all of the aspects of their surgical recovery, and everything is going as expected, worry about weight regain is never very far away. In the early stages after surgery it may feel like it has disappeared, the relief from which is liberating. But many people notice it like a niggling thought in the back of their mind:
‘’What if the surgery doesn’t work for me?’’,
‘’Am I going to regain all my weight’?’
And of course, it makes sense that we have these thoughts because weight regain is likely to have been our experience with weight loss attempts before.
Responding to times when eating does not go to plan
Inevitably there will be times when we don’t eat ‘perfectly’. How we respond to those occasions is actually more important than the food we have just eaten.
People respond in different ways:
- Panic - this is the start of a slippery slope to weight gain
- Restrict the amount or type of food later on that day or the next
- Increase the frequency of using the scales to keep track of weight
- Hopelessness - feeling there’s nothing that can be done, weight regain is inevitable
- Failure - this is something that I have done wrong
- Eat more of the food that I had been avoiding
- Feel calm - it’s all about balance
- Not give it a second thought.
The more we worry about it, the worse it can feel, and if left to fester it can snowball into panic. This is something that is useful to discuss with your dietitian and psychologist who will be able to help you to make sense of your response, and explore strategies to cope.
The reality of weight regain after surgery
It is important to set realistic expectations. It is very unlikely that you will remain at the lowest weight you reach after surgery. Most people will regain a small amount of weight after about 18 months. Despite always telling people about this before surgery, when it occurs, people feel a sense of dread and disappointment. I have had so many conversations with people in which they question what they have done wrong.
You haven’t done anything wrong!
Believing that you have failed in some way is when old dieting habits can kick in, specifically avoiding certain food, reducing calories or stopping planned snacks. But as you will know from dieting in the past, as soon as we start to restrict our intake in this way, we increase the risk of becoming more preoccupied with food and our mood lowers. Furthermore, after surgery, restrictions have an increased risk of causing nutritional deficiencies.
It takes time to adjust
This is one of the hardest parts of life after weight loss surgery. We may have a fantasy that the within the first few months after surgery our relationship with food and with our body image will be on track, that the surgery will be the answer to healing the years of difficulty we have experienced. This is however, not an automatic process.
You do not have to be hyper-vigilant and aware of every food decision, but you do need to tune in to some of what is driving your eating habits. If you are critical of your food choice then it makes it harder to be curious about what is triggering your decisions.
You may not see the change to your body that others are noticing. Often people know that the number on the scales is reducing, but they don't feel that they look very different.
Both of these aspects take time and can feel hard to trust that you will slowly start to heal of the way you see your body and also manage your eating habits.
Learning from when things don’t go to plan is just as important as celebrating when things go smoothly.
Go back to the information you were given at the start of your surgery about helpful habits. Think about what has changed: what you are doing or not doing now? What might be getting in the way of returning to this? Most importantly, catch the wonky thoughts that you have about regaining all of your weight; It is not inevitable so don’t jump to the worst scenario.
This is the first time that you will have focused on weight maintenance since you have had surgery (and maybe it is the first time you have ever thought about weight maintenance!).
Be gentle with yourself. Your recovery will take time.
And don’t forget to focus on your non-scale victories.
Have a look at out information about coping after surgery and if you need any additional support, one of our specialist dietitians or clinical psychologists, will be happy to work with you. You can read more about our specialist clinicians here.
Or send us a message