Bariatric Surgery & The Dreaded Weight Loss Stalls

Blog By: Mind, Mouth and Movement: Connecting the Missing Links

By Nancy Lum, RDN and Dawn O’Meally LCSW-C, P.A.

Why do stalls happen? During the first few weeks of losing weight, a rapid drop in weight is typical. In part, this is because when you initially cut calories, the body gets needed energy by releasing its stores of glycogen. Glycogen is the stored form of carbohydrate found in the muscles and the liver. Glycogen is partly made of water. When glycogen is burned for energy, it releases water, resulting in weight loss that’s mostly water. But this effect is temporary. As you lose weight, you lose some muscle along with fat. Muscle helps keep up the rate at which you burn calories (metabolism). This is why it is imperative that your metabolic need for protein is met to decrease the loss of muscle mass. If you lose a lot of muscle, the calorie total you burn daily i.e. (metabolism) decreases, causing you to burn fewer calories than you did at your heavier weight. A slower metabolism will ultimately slow your weight loss, even if you eat the same number of calories that helped you lose weight. When the calories you burn equal the calories you eat, you reach a plateau. To lose more weight, you need to either increase your physical activity or decrease the calories you eat.

There are many other reasons for plateaus in weight loss such as not being on an appropriately dosed bariatric formulated vitamin regimen for your surgery type. When the vitamins deplete in the liver stores over time, your body slows down the metabolism to conserve energy and nutrients. This eventually causes deficiencies and symptoms of deficiency. Many serum levels in lab work will form false positives but the stored levels will drop primarily Ferritin iron stores, B12, prealbumin and vitamin D. Unfortunately, we see this in our practice all the time.

Once bariatric patients start increasing the starch/whole grain servings per day beyond two servings, the weight loss will stall and eventually weight gain will ensue much like someone coming off a high protein low carb type diet. Another reason for weight loss stalls and eventual weight gain is patients start skipping meals and forget to eat as their lives get back to being busy again. To make the metabolism burn efficiently it is necessary to eat every 3-4 hours (4-5 times a day max) and have a source of lean protein at every meal. The protein at meals will slow down digestion and prevent insulin spikes. Adding the fiber at each mealtime whether it is a fruit serving, whole grain high fiber starch serving, and non-starch vegetables utilizing the bariatric eating pattern will also slowdown the digestion and reduce insulin spikes and drops. Metabolic adaptation leads to stalls. This is where the body adapts to the decreased calorie intake during weight loss, and thus burns fewer calories at rest.

The body adapts to physical activity and may become more efficient at performing physical activities, leading to a decrease in calorie burn during exercise. Shaking up workouts, doing various forms of exercise, utilizing a trainer, increasing time, duration, and intensity of exercise will also help. Building more muscle with weight training and core work will also increase metabolism and calorie burning. Over training with not enough calories to support your efforts can also cause stalls. Living on protein shakes and bars more than 1-2 times a day, lack of whole foods, and lack of calories, can also lead to stalls as well as eating the same foods every day.

Lack of stress management will cause an increase in Cortisol levels which will increase cravings for simple carbohydrates and quick sugar energy as well as increases the storage of calories for the fight or flight mode. Making bad food choices often will increase calories normally eaten. It is important to keep treat foods at a serving 1 or 2 times a week max. The chronic stress and lack of sleep disrupts hormonal balance leading to stalls.

Keeping Hydrated helps weight loss. Cold water helps you burn calories more efficiently as per research. Water removes waste from the body, is a natural appetite suppressant, and is necessary for fat and carbohydrate metabolism or breakdown. Water also helps workouts by helping muscles, connective tissues, and joints. It also helps lungs, heart and other organs work efficiently and helps prevent fatigue.

Primary things to focus on for re-igniting weight loss:

1. Eat the metabolic amount of protein you need for your height and metabolic weight daily.
2. Eat every 3-4 hours and set a timer system up to remind yourself not to skip meals.
3. Increase time, intensity, and duration of exercise.
4. Switch up the forms of exercise.
5. Have a varied food plan so you are not eating the same things every day.
6. Make sure you’re getting in the bariatric eating pattern at 6 months on out of surgery.
7. Do not live on protein drinks and supplements and exclude whole foods.  Having 1-2 supplements daily in addition to whole foods depending on your protein needs is fine.
8. Hydration 64+ ounces a day.
9. Keep whole grain starch servings to 2 servings per day.  One serving at two of your meals.
10. See a therapist for stress management tools to prevent Cortisol hikes.
11. Sleep 7-9 hours a night and create a good sleep routine.
12. Take appropriate USP GMP bariatric formulated vitamin regimens for life.
13. Follow up with your Dietitian at least one to two times a year or more as needed.
14. Keep deep fat fried foods, eating out, and sweets to no more than 1-2 treats a week.