How Much Weight Should I Be Losing…?

Aside from improved health, more energy, increased mobility, and a better quality of life, choosing bariatric surgery is often tied to the desire to well, lose weight (obviously). Then comes the question of HOW MUCH weight is expected to come off and WHEN…?

Bariatric surgeons talk about weight loss “success” in terms of excess weight loss and percent excess weight loss or % EWL. Excess weight is the extra weight a person is carrying above what is healthy. So if you currently weigh 275 lbs, but a healthy weight at a body mass index of 24.9 for your height is 175 lbs, then your excess weight is 100 lbs. If you have a sleeve gastrectomy and get down to 200 lbs, then you have lost 75 of 100 lbs = 75% EWL.

Remember, that even 50% EWL is considered a successful bariatric surgery. That means that in the example above, going from 275 lbs to 225 lbs (-50 lbs weight loss) is considered SUCCESSFUL without reaching the ideal weight of 175 lbs or even 199 lbs (aka entering “onederland”). Now, as we collect more data over time on surgery outcomes, we see that sleeve gastrectomy and gastric bypass patients tend to achieve an average of 60-70% EWL by 12 months after surgery, although individual results vary. So, barring any significant obstacles to weight loss like uncontrolled hypothyroidism or a major injury that keeps you from moving, aiming to get down to ~210 lbs is a realistic goal in the example above.

As far as timing, certainly the fastest weight loss is in the first month. Many patients retain fluid weight from IV hydration while hospitalized, so the first few days may actually show weight gain. Those who lose a lot of weight quickly at first, may then encounter a drastic slow down by the second month. At some point, everyone hits a plateau in weight loss that may last a week or two, or even for several weeks. Before assuming it’s from taking in too many calories, consider that in the early phases, calorie intake is solely from protein shakes, other full liquids, and tiny amounts of soft food. Patients could be under consuming calories - especially if they are increasing exercise but still consuming only 400-600 calories a day.

So, if you observe incredible weight loss at over 5 lbs per week initially, but then only see 1 lb per week or less, you are still doing great! It is normal and expected to see the rate of weight loss slow down. In fact, losing slowly helps preserve lean muscle mass. It also helps the skin to preserve a little more elasticity so there’s less excess hanging skin overall. Rest assured that weight loss is a journey that takes at least a year or longer.

If you feel stuck in a weight plateau, but still observe yourself losing inches with clothes fitting looser, then you are still on the right track.

If you feel stuck in a weight plateau, but you are eating sufficient protein and following your surgeon/dietitian’s nutrition guidelines, then you are still on the right track.

If you feel stuck in a weight plateau at six months or more after surgery and feel the restriction or satiety decreasing, share your concerns with your surgeon and bariatric dietitian. Obesity is a chronic disease and its treatment is a continuum that does not end with bariatric surgery.

You are probably doing better than you think you are! Keep sticking to what you have learned and trust the process. Connect with your bariatric tribe - support group members and bariatric professionals to get through these times!