How to Manage Your Fear of Weight Regain

Article By: Maria Tucker, MPH, RDN, LDN, CDCES

Maria Tucker is a Registered Dietitian and Certified Diabetes Educator with over 20 years of experience assisting patients with diabetes, obesity, and nutrition-related conditions.

Obesity is a disease that can be associated with major chronic co-morbidities such as type 2 diabetes, heart disease, and some cancers. According to the Centers for Disease Control’s Division of Nutrition, Physical Activity, and Obesity, 1 in 3 children and 1 in 5 adults struggle with obesity. Bariatric surgery is considered to be one of the most effective treatments for obesity; however, many patients do experience a significant amount of weight regain after surgery. The fear of regaining some or all of the weight lost after bariatric surgery is REAL and can cause anxiety, distress, frustration, and a feeling of being a “failure” at weight loss.

How does one conquer this very real fear of regaining weight? First, let’s examine the reasons why weight regain may occur. A dilated gastric fundus (post-sleeve gastrectomy) or gastro-gastric fistulas can lead to post-surgical weight regain but are not the most common causes of weight regain.

Research has shown that pre-operative BMI (or your starting weight pre-surgery), maladaptive eating and lifestyle behaviors, and stress are the most common contributors to weight regain. Dealing with the fear of regaining the weight lost can be related to several factors such as previous weight history, internal bias towards weight, and one’s own fear of failure.

• Weight loss/gain/loss history — most, if not all, bariatric surgery patients have experienced “yo-yo” dieting, weight loss, and weight regain leading to mistrust of one’s ability to lose the weight permanently after surgery.

• Those who have experienced body/weight shaming by family members or friends may develop an intense fear of experiencing this all over again after bariatric surgery.

• Someone who has experienced gaining weight back after losing a large amount of weight can have a fear of the very real pain and the roller coaster of emotions that come with losing weight and gaining it back.

How does one manage this fear of weight regain and prevent gaining weight back after bariatric surgery?

Do a daily check-in with yourself at the end of the day... Ask yourself if you have implemented the most important daily habits to help you stay on track:

• Did I eat timely and include protein with all my meals and snacks today? Did I meet but not exceed my calorie goals? Did I eat enough protein?

• Did I take my bariatric multivitamin with minerals and my calcium supplements?

• Did I drink enough water and other hydrating fluids today?

• Did I meet my physical activity goal today?

If you answered no to one or more of these questions, think about what barriers kept you from being able to answer yes. Create an action plan to help you overcome those barriers.

1) Access your “wise mind”. According to an article from Dr. Paul Greene, research and health psychologist in New York City and Director of the Manhattan Center for Cognitive-Behavioral Therapy, “Wise mind is a concept from DBT (dialectical behavior therapy) that refers to times when you’re able to make choices based on your inner wisdom, your emotions, and the facts of the situation”. There are several exercises you can look up online and try to help you access your wise mind.

2) Implement strategies to help you stay on track. These strategies may include recording food intake, tracking physical activity, and using apps to remind you when to eat and take your bariatric vitamins.

3) Plan to implement at least one positive behavior daily that supports your weight goal. It could be taking a healthy protein-containing lunch to work instead of ordering out, walking five minutes longer than usual, or drinking 8 more ounces of water — something that is easy to achieve and can eventually become part of your daily routine.

4) Focus on the here and now. Do your best to not dwell on failures you’ve had with weight loss. Remind yourself of your accomplishments both with the weight you’ve lost and the “non-scale” victories you’ve had. Avoid comparing yourself to others who may have had the same bariatric surgery or who started their weight loss surgery journey at the same time you did.

Focus on your own journey and celebrate you! Avoid dwelling on the "what ifs" — "What if I gain the weight back?" "What if I don’t lose the weight I want to lose?" Dwelling on these scenarios can lead to self-defeating thoughts and behaviors.

5) Surround yourself with positive people who will support you. It's important to have family members and friends nearby who will encourage you when you are experiencing setbacks. Reach out to your bariatric surgery team often, especially when you feel something is not right, whether it be noticing weight stalling for at least 4 weeks, your weight increasing or suddenly experiencing gastrointestinal symptoms you had not experienced before. Your bariatric surgery team cannot help you address your concerns if they do not know what is going on with you.

6) Keep in mind that there are interventions available to help reverse weight regain. Your surgical team may suggest behavior therapy and lifestyle interventions, medications to help control appetite/cravings, and revisional surgery. Your medical providers can help you decide the best option for you.

BariMelts provides general recommendations, not to be construed as medical advice. Please consult your doctor.