Weight loss surgery or medication marks a significant step toward better health. Sustaining that progress depends heavily on your diet and establishing lifelong healthy habits for continued success.
“Diet implies any changes made are temporary. To reach your goal and keep excess weight off is a lifelong journey,” says Dr. Fernando E. Miranda, MD, a general and bariatric surgeon with Memorial Hermann NewStart Medical Weight Management Program®.
Otherwise, he says, you risk regaining the weight—and more.
Why can weight gain reoccur? Each time you limit food intake through dieting, your body slows your metabolism and clings to calories—progressively more with each short-term weight loss, becoming a vicious cycle.
Dr. Miranda discusses the best dietary tactics to lose weight permanently, depending on your individual weight loss goals.
THE TOOL: CALORIC DEFICIT
Who: Those who would like to lose 30 or fewer pounds.
How: Choose nutritious ingredients and shrink your portions.
You’re better off filling up on vegetables, fruits and lean protein rather than carbs and sugars. But that doesn’t mean you’ve got to forsake fast food and fries for broccoli on week one—or even month one, Dr. Miranda says. “Weight loss doesn’t have to be traumatic.” It should be a sustainable routine.
He recommends targeting one highly caloric element each month. Maybe you target full calorie drinks, paring down your consumption of them over the month and finding a healthy alternative you enjoy. “The next month you might make cutting fries a goal,” he says.
If you or your family find fruits and veggies unappetizing at first, registered dietitians can share recipes and tips for portion control and grocery shopping.
Take advantage of movement to burn calories. Boost your cardiovascular exercise, working up to 150 minutes weekly of walking, dancing or swimming.
The slow and steady approach helps make healthy habits stick, he says.
The TOOL: MEDICINE
Who: If your goal is to lose 40 to 60 pounds, you may need more assistance.
Most weight management patients have a body-mass index (BMI) greater than 30 or a BMI greater than 27 with an obesity-linked health condition. These include sleep apnea, high blood pressure, type 2 diabetes (T2D), prediabetes or insulin resistance.
How: Weight loss medications make you feel fuller while slowing your digestion. They do so by mimicking glucagon-like peptide-1 (GLP-1), a chemical that targets gut hormone receptors in the small intestine, Dr. Miranda says.
But just as you could harm yourself by running a marathon without training for it, you also can endanger yourself by ramping up the amount you take of a GLP-1 medication too quickly, he says.
That’s where a weight management specialist enters. They can determine which weight loss medication will work best for you. And your doctor can adjust your weekly dosage to help prevent side effects, such as nausea, bloating, cramps and vomiting. Too much medication, too soon could land you in the ER, he says.
“These drugs can work, but it depends on how you take them and how long you take them,” Dr. Miranda says.
“We want to suppress appetite, not remove it entirely,” Dr. Miranda says. “If you cannot tolerate the dose, you could become averse to all foods—and that’s not the goal.”
You’ll have better results if you adopt a lasting healthy lifestyle. That may involve additional health care providers; sometimes a sleep specialist or psychologist can help you overcome barriers such as sleep apnea, depression or anxiety about regaining weight.
THE TOOL: SURGERY
Who: If you need to lose 100 pounds or more, you may consider bariatric surgery to reach your goal weight.
How: Weight loss surgery reduces the stomach to one-fifth of its original size through tiny cuts in the abdomen.
With a gastric bypass, surgeons sew a small pouch from the stomach and reroute the small intestines to that area.
With a gastric sleeve, or vertical sleeve gastrectomy, doctors remove all but a banana-sized sliver of the stomach. The entrance and exit to the stomach remain, so the small intestines are untouched.
The shrunken stomach fits little food—or liquid. “The surgeries reduce food intake considerably.”
After surgery, you’ll start with liquids, then soft foods before graduating to a full diet in a month.
Once you’ve healed, “certain foods may not agree with you,” Dr. Miranda says. “Some people have no problems. But some people cannot tolerate scrambled eggs, red meat, tuna fish or bread,” he says. “It’s unique to every individual. I recommend patients avoid these foods for a few months before reintroducing them.”
Otherwise, portion size and timing are key. A fist-sized portion of food followed with liquid a half hour later.
While you may eventually be able to eat a wider variety of foods, achieving a healthy BMI is the priority following bariatric surgery. Reaching this goal is crucial for long-term weight maintenance.
Furthermore, increased mobility and sustained lifestyle changes, including dietary adjustments, are essential for continued well-being, even after significant weight loss.
Weight loss surgery patients often find that a lower BMI alleviates issues such as knee and ankle pain, making it easier to maintain their weight in the long run. “Your body will thank you,” he says.
