Recently I have seen a good number of patients who had successful gastric bypass surgery several years ago and now are gaining weight back. Erin, for example, has lost 90 pounds after her bypass surgery and has managed to maintain the weight loss. For nine years, Erin has enjoyed her new life; free of medications for hypertension and diabetes, she traveled all over the world, hiked the Appalachian trail, enjoy her daily swimming and many other activities she was not able to do before her weight loss surgery.

Suddenly, Erin started gaining weight (20 pounds over the past 8 months). She still has excellent restriction and appetite control. Erin, however, admits to “munching on peanut butter and cheese crackers throughout the day”. She reports that she has recently developed this new habit and started buying boxes of cheese crackers to stock her pantry!

I have always been intrigued by this behavior. Why do bariatric patients revert to old habits? Habits they have overcome longtime ago and as a result they have enjoyed years of healthy happy living.

The answer is STRESS. The majority of patients that I have encountered in my practice, who regain weight many years after gastric bypass surgery report new onset anxiety and stress.

Chronic stress is one of the main reasons for weight gain in the 21st century. Whether you had bariatric surgery or not, chronic stress increases body cortisol level, which in turn leads to increased insulin resistance. High insulin resistance prevents the movement of sugar from the blood stream into muscles to be metabolized. Instead, excess sugar moves into fat stores favoring weight gain.

Furthermore, in addition to disrupting the metabolic machinery that burns excess calories and fat, chronic stress prevents an individual from exercising. Most people these days respond to stress by stewing in frustration and anger. Instead of moving, eating becomes the activity of choice to relieve stress. They stock their homes with an endless array of junk food items (crackers, pretzels, chips, ice cream, candy bars…) for munching on day and night. Grazing on junk food is the worst thing you can do to your gastric bypass. In addition to the hundreds of calories added per day, the efficacy of gastric bypass in dealing with processed food is very limited. Our intestines are not made to handle junk food. The end result of junk food consumption is invariably weight gain, diabetes, depression, hypertension, and sleep apnea…

In my next blog, I will go over techniques and solutions for coping with stress. Until then, try to relax, exercise and eat healthy.