Why Can’t I Lose Weight?

The Cycle of Extra Weight

“If you want to lose weight, just follow this diet.”

We’ve all heard this before. From regimens espoused by the latest reality TV show to headlines read in the checkout line, promises that your ‘ideal body’ is within reach abound. But what if you do everything right and you still can’t lose weight? Or what if you lose it only to gain it back months later?

If you’ve diligently been trying to shed pounds but feel like you’ve come to the end of your rope, be encouraged: new research is offering more insight into obesity and weight loss than ever before. There’s a good reason why you may feel stuck in a rut, and today’s surgical treatments are designed to nip the underlying issues in the bud.

Weight Loss Struggles

Over the past 35 years, obesity rates have more than doubled in the U.S. Today more than 1 in 3 adults over the age of 20 in the United States are obese.

We know sedentary lifestyles and diets high in sugar and fat have much to blame for expanding waistlines. And yet, for many people, particularly those who are severely obese, consecutive attempts to diet and exercise only lead to increased weight gain.

What gives?

The answer lies in a basic understanding of the body’s set point, researchers say. Our bodies regulate appetite, digestion, metabolism, and fat storage via an intricate system of signals.

These signals work to keep the body at its perceived set point – a place where weight and fat levels remain steady – and they adapt in response to any potential threat to this “normal” weight. So even if you restrict caloric intake and exercise, your body may resist shedding pounds thanks to its hardwired physiological defense against starvation. Your metabolic rate—or the rate at which you burn calories for energy—may actually slow down to maintain your set point.

For those who are severely obese, this is why drastic weight loss can be so difficult to achieve with diet and exercise alone. According to the National Institute of Health Experts Panel, it is nearly impossible for severely obese individuals to maintain long-term weight loss without surgical intervention due to the way their metabolism functions.

How Metabolic Surgery Works

For those whose set point presents a serious obstacle to long-term weight loss, metabolic surgery can stimulate biochemical changes to drastically reduce risk of disease and help keep weight off for good.

“Metabolic surgery is the most effective treatment for severe obesity and the best therapy for patients with obesity and type 2 diabetes,” says Dr. Jaime Ponce, bariatric surgeon with Chattanooga Bariatrics.

By changing the way your body consumes and digests food, metabolic surgery initiates hormonal changes that alter metabolism and energy balance. It actually increases the production of hormones in the stomach and digestive tract, telling the brain to lower appetite and increase the feeling of being full.

The most common types of metabolic surgery are the gastric bypass and vertical sleeve gastrectomy. During a gastric bypass, a surgeon creates a small pouch in the upper part of your stomach and connects that pouch to your small intestine. Food then “bypasses” the larger portion of your stomach and goes right into your intestinal track.

In contrast, a vertical sleeve gastrectomy removes about 80% of a person’s original stomach. The portion remaining is a narrow-shaped tube resembling a banana.

“Most people think these operations work by mechanically restricting food intake,” says Dr. Jack Rutledge, bariatric surgeon with CHI Memorial Metabolic and Bariatric Care. In other words, smaller stomach = less food ingested = weight loss. “This is false, and if it were true it would be a complication of the operation and not a benefit.

“Restriction in any form is not effective to maintain long-term fat loss because it doesn’t address the primary problem of metabolic and energy dysregulation,” he continues. “The bypass and sleeve are both effective at biological correction, which is why we call them metabolic operations.”

How It Affects Blood Sugar

Being overweight or obese is, by far, the number one risk factor for insulin resistance – when the body’s cells don’t respond well to the production of insulin. Over time, unchecked insulin resistance can lead to the development of type 2 diabetes. Today, about 80% of people with type 2 diabetes are obese.

Metabolic surgery has an immediate effect on diabetes and insulin and can improve blood sugar control within days, even before weight loss begins. A disease once thought to be incurable and progressive, diabetes is now put into remission in more than 3 out of 4 metabolic surgeries.

According to Drs. Rutledge and Ponce, there are two ways metabolic surgery works to improve diabetes. The first way is by altering the body’s set point, allowing the patient to maintain substantial, long-term weight loss. “Weight loss decreases the need for insulin, as the target body mass is less,” says Dr. Ponce.

“Weight loss coupled with a healthy lifestyle leads to dramatic improvement if not remission of diabetes,” says Dr. Rutledge.

The second way, which applies primarily to gastric bypass, is that it appears to have a biological correcting influence independent of the fat loss mentioned above. “After surgery, cells from the bowel are stimulated to produce substances that stimulate the pancreas, allowing the patient to have more insulin available to handle the blood sugar,” says Dr. Ponce. This is why severe diabetics gravitate toward the gastric bypass procedure, according to Dr. Rutledge.

Who Is Eligible

Because of its risk profile, metabolic surgery is considered a last resort for obese patients stuck in a cycle of dieting attempts and weight gain. Potential candidates are screened by a team of medical professionals including a physician, dietician, psychologist, and surgeon for specific criteria, including:

– A BMI of 40 or higher or a BMI of 35 to 39.9 accompanied by a weight-related health issue like type 2 diabetes, sleep apnea, or high blood pressure

– Significant, yet unsuccessful efforts to lose weight with diet and exercise

– Whether or not the health benefits of surgery outweigh the risks

– No conditions – mental or physical – that will compromise maintaining the benefits of surgery

– Motivation and commitment to change diet and exercise habits

Before and After the Procedure

Patients approved for a gastric bypass or vertical sleeve procedure begin prepping for surgery weeks—or even months—in advance. Studies show the more weight you can shed in the months leading up to the procedure, the greater your chance of long-term weight loss success. Pre-op weight loss can also lead to less time on the operating table—meaning a lower risk of complications.

Depending on the patient, metabolic surgery can last between 45 minutes to 5 hours. Most patients will go home in 1 to 3 days after surgery depending on the type of procedure. However, the surgeon will decide how long your hospital stay should be based on how you are tolerating water and progressing to a clear, liquid diet.

Once back at home, it is crucial that patients follow take-home instructions for medications, movement, and diet. Follow-up is key to successfully maintaining results in the long run.

“Patients must participate in bariatric support from their surgeon’s office, establish good food choices, and learn to eat slowly, chew well, and gradually add in exercise,” says Dr. Ponce.

Metabolic surgery patients can be helped greatly in these endeavors by looking to others who have been on a similar journey. Research shows patients who attend support groups—whether in person or online—lose more weight than patients who do not attend support groups. They also have a lower BMI. According to the National Institute of Health Experts Panel, it is nearly impossible for severely obese individuals to maintain long-term weight loss without surgical intervention.

Learn More!

If you’re exploring your options for weight loss, don’t wait to educate yourself on the ins and outs of metabolic surgery. For more details on how metabolic surgery can combat disease and help keep weight off for good, visit the American Society for Metabolic and Bariatric Surgery at asmbs.org.

Get access to the next issue before it hits the stands!