Weight Loss 5 years post op

Question
It has been almost exactly 5 years since I had my weight loss surgery, the duodenal switch. I had relatively little complications, just anemia and I need to take high dose vitamin d, and of course multi-vitamins, etc. I started at 352lbs and dropped down to a lowest of 215 a few years ago. I had a baby 19 months ago and my weight has been creeping back on. I got back up to 267, which really freaked me out. I admit I was eating badly and sedentary. I decided to start a diet and exercise regimen. I have been following a "regular" diet on sparkpeople.com but trying to keep my protein up more than what they recommend. I am worried about malnutrition possibly because of malabsorbsion and I am not even quite sure what % of the food I am now absorbing, 5 years post op. It seems to me based on my weight gain (which about 35 of that was gained during pregnancy) that I must be absorbing a fair amount of what I eat now. Does the surgery "reverse" itself in a way in that your body adapts and you absorb more of what you eat over time? I also am not quite sure how to tailor my diet but my results have been very good. I lost 24lbs in the first month. I'm just a little confused as I've never (except immediately post op) followed a strict balanced diet. Since my surgery I've kept sugars in check, didn't drink pop, tried to get my fruits and veggies in, etc.. but still made bad food choices, my surgery kept things in check. It seems like I may have reached the end of that or.. I'm not sure? I'm hoping you can help me :) thank you!

Answer
Brianna,

Sorry for the delayed reply - seems that not all my questions in this category were showing up properly.  

Malnutrition is always a risk with the Duodenal Switch.  Because you have such a long intestinal bypass, you are at risk for deficiency of protein, iron, zinc, calcium, magnesium, all the fat-soluble vitamins and more.

Your surgery will never reverse itself, but there can be multiple reasons for weight regain over time.  Some of the reasons are the ones you already know - you still have to have some control over your calories and you should exercise.  Your surgery makes it easier to lose weight and keep it off (even more so than a gastric bypass) especially in the first few years, but you still absorb calories, so you still have to watch them.

The digestive system does adapt over time.  We do know that starting after about 2 years, the non-bypassed part of your intestines will get smarter and more able to absorb more nutrients and calories.  It does still appear, however, that there is sort of a permanent deficit with DS of about 30% (especially for protein) which needs to be compensated for life-long.

Other reasons for weight regain can be more complicated.  You had a baby, which changes your hormones and your metabolism.  There can be new problems that develop over time that have nothing to do with your weight loss surgery - such as thyroid disease.

I generally think the best place to start is by making an appointment with your doctor.  I usually think it's ideal with weight regain to have at least one visit with your bariatric surgeon if you can - it's very likely that he/she has helped many people with weight regain over the years.  Your surgeon's office may even offer a support group specifically to help longer-term patients like yourself work on this issue.  If not, there are on line groups such as the ones that Barbara Thompson (WLS Center) or Colleen Cook (BSCI) offer.  Also go and see you regular doctor.  Get a good health check up to make sure that your protein levels are good, your thyroid is healthy, etc - so that you rule out other health issues that could contribute.

Most importantly, stick with your goals.  Weight regain is scary, but it is also pretty common and there are a a lot of people who will support you in getting back to where you want to be.

Please let me know if you need more information.

In Health,

Dr. Jacques

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