"I am scheduled to have weight loss surgery in three weeks, but I am afraid that I will regain my weight. Someone I work with had that happen to her. Does that happen to everyone?"

This is typical of questions I am asked more than any other. Patients really want to know how to deal with weight regain that sometimes happens a few years after weight loss surgery.

I know when I had my surgery nearly 12 years ago, the thinking was that you would never regain your weight. Unfortunately many people took for granted that they were safe, and that weight regain would never again be a problem. They didn't worry about what they were eating, and are now struggling to lose those 20, 30, or more pounds. So if weight regain happens, how do you attack those pounds?

How about diet and exercise? If there is one thing that we should have learned, it is that diet and exercise do not work. At least our statistics, as weight loss surgery patients, are far better than the national averages. We may regain those 20 to 40 pounds, but few regain all of the weight plus more, which is what happens with diet and exercise.

So how bad are the national statistics on dieting? Some estimate that 80% of dieters regain their weight by the 2 year mark, and 2/3rds of dieters regain more than what they lost after 4 or 5 years. If we lose 10% of our weight, you would think that our metabolism would decrease by 10%, but that's not what happens. Our metabolism decreases by 12% to 15% making it harder and harder to lose weight, until we become so frustrated that we give up. With a lower metabolism, we regain weight easily.

Research reported in the journal Obesity shows that people who are on a very strict diet, regain more weight than those who are on a more forgiving diet. So what does this mean for us? Try losing weight without dieting.  This is actually what I recommend in my Back on Track with Barbara Program. But this is such a hard thing to do. We are so impatient, and want to lose weight right away - and that just does not work. 

What has a much better chance of working is employing life style changes. Take a really hard look at what you normally eat. Do you eat at night? Well, don't stop eating at night, just find something to eat at night that you enjoy that has fewer calories, such as cut up fruit with some Cool Whip Free and yogurt, rather than eating chips.

If you normally eat regular yogurt, switch to low fat. In fact, look closely at where you can cut down on fat in all of your foods. But don't eliminate fat altogether, because it is important for a balanced diet and important for your ability to feel satisfied.

The real problem is not that people go back to poor eating habits.  The problem is really that they rarely deal with why we have poor eating habits to begin with, despite the fact that we know very well what a nutritionally sound meal looks like. What is the underlying problem?

Something else that is extremely important to success is counseling. How important is it? A study was reported in the Journal of Psychosomatic Research.  A group of 200 dieters were put into 2 groups. One group had an hour of low-intensity exercise once a week while the other group had an hour of counseling about changing eating habits once a week. The group that were counseled maintained their weight loss while the exercise group did not.

So some tips to follow for those pounds you may have added:
1. Don't diet
2. Work on life-style changes
3. Be patient - lose weight very slowly
4. Find a counselor who will help you change your eating

You may also want to try my Back on Track with Barbara Program:

Back on Track with Barbara Internet Mentoring Program The Back on Track with Barbara Internet Mentoring Program really concentrates on lifestyle changes. Join our group and receive lessons via the internet and the support of others who are struggling just like you are.

Are you suffering from emotional eating and can’t stop? Are you grazing on carbohydrates and can’t control it? Are you lacking inspiration to lose the weight you have regained? Do you feel that you don’t know what to do now that you have had surgery? Are you dying to be in better shape? My Back on Track Internet Mentoring Program will give you the support you need to get your weight under control. Watch My Back On Track Video View a FREE Lesson and Listen to a FREE Telephone Seminar by clicking here and scrolling down to the bottom of the page.

That is the title of a speech that I just made at the Obesity Society Annual Meeting in Orlando, FL. In my speech, I talked about how physicians need to take a more active role in addressing the weight of their patients. However, physicians have not done a very good job so far. Physicians tend to avoid that conversation, having it in only 20% of patient visits, even though professional associations urge doctors to engage in these discussions.

It is well documented that healthcare providers have the same prejudices as anyone else against those who are affected by obesity. Even those who specialize in working with the obese are prejudiced.

There currently is a Medicare proposal that would cover patients when discussing their weight. However, doctors need to do a much better job with their overweight patients, especially if the role of physicians might be increasing.

There was a very interesting study that showed how patient perceive their doctor's attempt to counsel them on their weight. Some very interesting comments were made that I shared at the Obesity Society, and I want to share those comments with you. You may recognize and agree with the comments here.

1. Patients hate the use of the term "obese," finding it insulting even though it is clinical term. They much preferred "heavy," or even "fat" to the word "obese."

2. Attitude counts! It is as important how something is said, as what is said.

3. Doctors need to be respectful, non-judgmental, and encouraging. If you have lost 2 pounds, they want doctors to notice, and be pleased.

4. Everything isn't weight related. Patients reported that even if they go in for a sprained wrist or a skin rash, doctors want to relate it to their weight.

5. Timing and assessment are important. Patients need to be ready to deal with their weight, and doctors need to determine if that appointment is the time.

6. Advice needs to be appropriate to the individual's needs. If someone has a very bad back, don't talk about joining a gym.

7. Patients want specific strategies and goals. They don't want to be told they need to lose weight. They want to know how much weight, and how they can lose it.

8. Connect weight to their individual health. Patients want to know specifically how their weight can cause type II diabetes, respiratory problems, or cardiac problems. They want it to be realistic, and explained in common language.

9. Scare tactics don't always work.  If you are told, "If you don't lose weight, I'm going to put you in the hospital," this will only lead to people staying away from their doctors.

This study was reported in the May 2009 issue of The Journal of General Internal Medicine and is one of the few studies that looks at how patients feel when talking to their doctor about their weight. Doctors have a long way to go in understanding obesity and dealing with it. I'm sure all of us hope that this will improve.

“Reprinted from Barbara Thompson’s free newsletter featuring helpful information and research material to help patients succeed following weight loss surgery.
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