—What is a plateau

Every patient stops losing weight after bariatric surgery and wonders why.Often they think their stomach has stretched. Often they just don’t know why they stop losing. But first let us define a true plateau. A plateau is when you have maintained your weight and your measurements for four weeks. If you are still losing inches, you are not on a plateau; you are simply redistributing the pounds.

The first six weeks after weight loss surgery

You will reach the plateau during the first few weeks after weight loss surgery.Some people find they weigh more when they come back from the hospital than when they went in. This is usually because a lot of the fluid we pumped in you is still in your tissues, so the first few pounds you lose are typically water. The first six weeks after weight loss surgery is a fun time, and it is common for patients to lose 10 percent of their extra pounds during this time. This means that if you weigh 300 pounds you will lose 30 pounds or more. More isn’t bad. Some patients don’t have a scale or they are looking forward to the time when their scale can weigh them. You will sometimes lose inches before you lose pounds, as your body is changing where it is putting things. It is important to know where you are losing the pounds. That is why you should take your measurements—as well as your photograph—prior to going to the hospital. So, measure your neck, chest, waist, thighs, and arms before going to weight loss surgery, and keep watching those at least once a month.

One of my patients didn’t have a lot of spending money and didn’t want to buy too many clothes until she had a more stable body form. She changed her mind after her underwear fell off as she was purchasing food at the checkout counter in the grocery store. Taking measurements not only helps you chart your progress, it can prevent an embarrassing moment.

Sometime during this first six weeks, the reduction will stop for a while. Your body is readjusting—that is all. If your weight loss surgeon has placed you on a liquid diet, you will also notice that you can drink a lot more than you thought you could. No, you didn’t stretch it. It is just that liquids are able to flow passively through the stoma or the pylorus (if you had a duodenal switch). Sometimes you are left with a lot of hunger. In the beginning fluids will fill your pouch or stomach, and you will not have much of an appetite, but as you move forward, you will re-discover your appetite—not a bad thing. This is just one sign that it is time to move to more solid foods.

A readjustment period for the body is necessary. During the postoperative time, you not only lose pounds from fat cells, but also from what we call “lean body mass.” That is, you lose pounds also from muscles. You need this muscle mass for walking, moving around, breathing, and assorted other body functions. That muscle mass needs to be rebuilt, therefore we want you to start a walking program. The more you walk, the more lean body mass you will keep. If you don’t use muscle, you will lose it—so start walking.

The carbohydrate trap

Weight loss surgeons have their own version of a postoperative diet. Some weight loss surgeons do not want you eating any sugar-filled foods after weight loss surgery, and some weight loss surgeons do not mind for the first few weeks. Essentially, the first goal is to get your stomach working again and your body used to its new anatomy. Some items “go down” well, and a lot of things do not. If your weight loss surgeon is liberal the first few weeks after bariatric surgery, do not assume this is license to continue consuming these types of carbohydrates later on.

This is the carbohydrate trap: you begin to consume juices, yogurt, mashed potatoes—all items that have nutritional value, but also contain a fair bit of calories in the form of carbohydrates. As you transition out of your first few weeks and into “normal” eating, some of those foods should be put aside in favor of low fat, high quality protein foods. There is nothing wrong with yogurt, fruit juices, or even mashed potatoes. The trouble is that it is possible to consume them in large quantities, even with a small stomach. If your weight loss surgeon is liberal in the first few weeks after weight loss surgery, remember, these are just transitional “soft” foods; you should not consume them after the “soft” food phase of your diet.

The best example of this is the clear liquid diet. Even patients with diabetes are allowed a hospital clear liquid diet. Many of the approved liquids contain sugar. Immediately after bariatric surgery, patients with diabetes are allowed any clear liquid—as the affect of the sugar on their blood sugar will be minimal. However, when their stomach has fully regained function and they can consume larger quantities of liquids, the types of clear liquids are restricted. That is because if you consume enough of those sugar-filled liquids, you can raise your blood sugar. Again—small quantities of almost any food or liquid is fine. However, some patients find that they can consume vast quantities of these “soft” foods and it becomes a trap.

So, beware—as you transition from early post op period (the first 6-12 weeks) to the later period, you need to limit the “soft” high carbohydrate foods and move to a higher protein food.