A common question that we get when consulting with patients considering bariatric surgery is, “Can I lose too much weight after weight loss surgery?” The operation we’re referring to in this blog is the sleeve gastrectomy, after which we typically see gradual, healthy weight loss.
The Mechanisms for Weight Loss After a Sleeve
The gastric sleeve is the most popular bariatric surgery in the United States. It is worth understanding more about the anatomical changes to realize how weight loss works. The gastric sleeve began life as the first part of a duodenal switch. The DS, at the time, was usually reserved for patients with an extremely high BMI. However, it became clear that the gastric sleeve as a standalone procedure was highly effective, and patients were doing just fine without the secondary malabsorptive procedure.
Interestingly, we also realized over the years that the gastric sleeve did not simply confer a mechanical benefit but a hormonal one. By removing the outer portion of the stomach along the greater curvature, we also remove the primary production center for the hunger hormone known as ghrelin. During the hunger cycle, ghrelin secretions tell the brain that the body needs food. Once we eat enough, leptin takes over and makes us feel full. This balance can be disrupted by obesity and poor lifestyle choices.
Most of the weight loss you experience with the sleeve will come within the first year. After this time, you will likely hit a plateau, at around 60% excess body weight loss. If you were 100 pounds overweight, you would have lost about 60 pounds. This level of excess weight loss is considered very successful by many patients and is objectively an excellent place to be. However, with dedication and focus, there’s no reason why patients cannot continue their weight loss and eliminate even more excess body weight.
What Do We Mean by Losing Too Much Weight?
There are two scenarios where we consider a patient losing too much weight. The first is if they lose weight too quickly. We are looking for somewhere between two and three pounds of weight loss per week. This means that patients are stabilized in their diet and are likely getting all their nutrients. If patients lose too much weight, they may be at greater risk of vitamin or protein deficiency and muscle wasting, and they may not be able to maintain their goal weight when they reach it.
Further, hanging skin becomes more of an issue. While taking advantage of the weight loss excitement and pushing even harder on your dietary plan is tempting, it rarely ends the way you expect. Instead, you often regain weight because the diet isn’t sustainable. Putting yourself into starvation mode triggers your body’s natural reaction to store extra fat. You may slow your calorie burn and weight loss despite consuming fewer calories.
The other concern is dropping below a healthy body weight level. Remember that overeating and obesity often come with addiction to food which can co-occur with underlying psychological factors. These mental health care issues do not go away as the weight does. Some patients suffer from body dysmorphia, believing they look overweight or unhealthy even when they’ve lost plenty of weight and can see that clearly in the mirror. There is also the possibility of anorexia. Most patients know this before surgery and have a support system to help them identify its onset.
In the end, losing too much weight is unlikely, but patients must be well informed before their surgery to understand the potential psychological pitfalls. Maintaining all your post-op visits is essential as these are the opportunities for us to see your progress and determine if recovery and weight loss are on track. During these visits, we can also determine if you are lacking in minerals or vitamins that are crucial for long-term health.
If you are interested in more information about weight loss surgery options, risks, and benefits, please view our online weight loss surgery webinar.