May 5, 2016 – Weight Loss Process & Expectations

Bariatric Support Group Date: May 5, 2016 

The presentation began with a discussion about what happens in the body when you lose weight and reviewing what we know about energy.  Energy is measured in calories, and calories are composed of Proteins, Fats, Carbohydrates and Alcohol.  The energy you burn, or Total Energy Expenditure (TEE) is made up of several components:

  • Basal metabolic rate (BMR) – accounts for a about 60% of daily energy out
  • Thermic Effect of Food (TEF) – this is the energy you use to digest food when you eat, and accounts for about 10-15% of energy output
  • Non-Exercise Activity Thermogensis (NEAT) – this is the energy your burn throughout the day that isn’t the result of exercise or sleeping, and accounts for about 15% of output – you can control this and improve it by just becoming more active and sitting less
  • Adaptive Thermogenesis – the energy you burn when you exercise, which changes as you lose weight and your body begins to adapt to the new weight and your body works more efficiently – you can also control this

After surgery, your intake is dramatically reduced, to about 400 – 600 calories a day, and then gradually to 800 calories a day.  That’s why you begin losing weight right away.   As you begin to get more active and then exercise more, you can gradually increase your activity to maximize the energy burned and lose the most weight in that first year.

A lot of the medications we take either cause increased weight gain or prevent weight loss, such as insulin and some of the antidepressants.  It is important to review every medication you are on with your primary care doctor and switch those that sabotage weight loss to a different drug that doesn’t.

We then discussed weight loss expectations.  We viewed a chart with 2 patients, one who had sleeve gastrectomy and one that had gastric bypass.  It showed that initially their weight loss was close to the same, but by 8 weeks, the patient with the gastric bypass began to have more weight loss during the course of the first 12 months.  They both started at 350 lbs., and the patient with the sleeve lost about 120 lbs. in a year, and the patient with the bypass lost about 170 lbs., which is as expected.

The sleeve patient lost 34% of their total body weight and the bypass patient lost 48%.

We discussed that ideal body weight varies from person to person, and that when you lose even 10% of your body weight, you improve your health dramatically.  After 6 – 12 months, the Ghrelin, your hunger hormone, can begin to come back and make people hungry again.  There are medications that can be used to help with that in order to main the weight loss long term.