Expert Q&A -- How can I lose regained weight after bariatric surgery?

[MsJacquiiC]

Asked by Joan Ashmun, Portland, Oregon

I had gastric bypass six year ago and lost 150 pounds and had kept it off. A year ago, I began a desk job for the first time in my life. I have gradually gained about 35 pounds. I have what some consider an alcohol problem since the weight loss.

What can I do to lose the weight again and stop gaining?

Could I have changed addictions? Could the weight gain be from a liver or kidney problem? Or just the change in activity and such, with added calories from the alcohol? What can I do to lose the weight again and stop gaining?



Answer by Dr. Melina Jampolis
Physician Nutrition Specialist

Hi Joan -- This is an important question as people mistakenly assume that their weight struggles are completely over after gastric bypass surgery. As you and many others can attest, this is not the case.

Replacing food addiction with another addiction, alcohol being a popular choice, happens sometimes. It's one of the reasons that it's important to have adequate counseling before and after gastric bypass surgery for optimal results.

With regards to your weight gain, it is very unlikely that it is due to fluid retention caused by liver or kidney problems, but this should be ruled out by a physician. In my practice, I frequently see weight gain when people begin more sedentary jobs such as you describe.

Most people think of calories burned during exercise as being the most critical to maintaining your weight, but what you do the remainder of the day is just as important, if not more so. This is why most experts emphasize increasing lifestyle-based activity in addition to getting regular exercise.

Consider that you burn considerably more calories just standing versus sitting (up to 50 percent more) and you can see how sitting for long periods of time could lead to slow and steady weight gain. This is one of the reasons that television watching is significantly associated with weight gain.

Combine this with the extra calories you are probably consuming from alcohol, which can add up very quickly considering that the average serving of alcohol ranges from 100 to 200 calories, and your weight gain is easily explained.

To lose weight or at least stop gaining, I recommend that you see a trained counselor or therapist to tackle the alcohol addiction. To increase calories burned throughout the day, you have to make an effort to build in activity whenever possible.

Try taking a five to 10 minute break every hour, if possible, to walk around or even to stand up and stretch at your desk. Going up and down stairs if they are available at work burns even more calories.

A Swiss study showed that employees encouraged to use the stairs for three months lost weight, including belly fat, and lowered their cholesterol and blood pressure.

Walk to lunch whenever possible and get up to ask colleagues questions instead of e-mailing. You might even consider wearing a pedometer (step counter) to make sure that you are moving enough throughout the day. Many experts recommend getting 10,000 steps per day, but this can be challenging and time consuming so I suggest seeing how much you walk at baseline and challenging yourself to walk a little more every week.

In addition, you can try waking up 30 minutes earlier and doing a short workout video before (or after) work to offset your sedentary desk job. And try planning more active activities when you aren't at work.

Suggest going for a walk with a friend instead of meeting for a drink or take up an active hobby in your free time. The weight loss may not be dramatic as a result of these changes. but it should help prevent further weight gain and might slowly help you lose weight as well.

Dr. Melina Jampolis Dr. Melina Jampolis is a San Francisco, California, physician nutrition specialist - a specialty practiced by only about 200 physicians in the United States. She focuses exclusively on nutrition for weight loss and disease prevention and treatment. Jampolis believes wholeheartedly in the role of nutrition in preventive medicine and achieving optimal health. She teaches a realistic, balanced and manageable lifestyle-based eating and exercise program and has helped thousands of clients improve their health and well-being over the past several years. Her real passion is to bridge the gap between the experts who talk about the latest nutrition and diet research and the "real-life" food and exercise choices that people face daily. In her free time, Dr. Jampolis enjoys hiking with her dogs, mountain biking, tennis, golf, and Pilates. Visit her Web page: DrMelina.com

Expert Q&A - CNN Health
Source

Roux-en-Y Gastric Bypass A type of gastric bypass procedure which combines restrictive and malabsorption techniques - meaning, it reduces the amount of food a patient can comfortably eat (restriction), and also reduces the amount of calories that can be digested in the small intestine (malabsorption). This combination of bariatric methods leads to greater weight loss and the roux-en-y procedure is seen as one of the best ways to treat clinically severe obesity. See WLS Videos for animated surgery technique.

Cholesterol A fat-like substance that is made by the body and is found naturally in animal foods such as meat, fish, poultry, eggs, and dairy products. Foods high in cholesterol include organ meats, egg yolks, and dairy fats. Cholesterol is needed to carry out functions such as hormone and vitamin production. When cholesterol levels are too high, some of the cholesterol is deposited on the walls of the blood vessels. Over time, the deposits can build up and cause the blood vessels to narrow and blood flow to decrease. Total blood cholesterol levels above 240 mg/dl are considered high. Levels between 200 and 239 mg/dl are considered borderline high. Levels under 200 mg/dl are considered desirable.