Challenges After Weight Loss Surgery

Weight Gain After Gastric Sleeve & How to Reverse It

John Rabkin, MD, FACS

Last Updated:  

Weight gain after gastric sleeve surgery:

  • Happens for as many as 30% of patients
  • Starts anywhere from 18 months to 6 years after surgery
  • Ranges from a regaining a small amount of weight to all of the excess weight lost
  • Is usually caused by the stomach stretching back out as the result of poor diet choices

Read below for more information.

TABLE OF CONTENTS

Click on any of the topics below to jump directly to that section

  1. Weight Regain
  2. Reverse Weight Gain
  3. Patient Community & Expert Advice
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01.

Reason for Weight Regain After Gastric Sleeve Surgery

SECTION SUMMARY:

  • The most common cause of weight regain is your stomach stretching as a result of poor diet choices, which allows you to eat more and, as a result, gain weight

Gastric sleeve surgery works by making the patient feel full sooner while eating and by reducing the amount of hunger-causing hormones secreted by the stomach. As a result, patients lose up to 70% of their excess body weight within 18 months to 2 years.

However, up to 3 out of 10 gastric sleeve patients gain weight after reaching their low weight (1)(2). The amount varies widely by patient, ranging from only a small amount of weight to all of it (3)(4).

Can a gastric sleeve stretch?

Yes. If you lost weight initially and then gained some back, it was most likely caused by your smaller sleeve stomach stretching out as a result of poor diet choices or lifestyle habits, including (5):

  • Eating or drinking the wrong things
  • Not exercising enough
  • Overeating during meals
  • Drinking within 30 minutes of your meals (before or after)

However, the sleeve stomach may also stretch for patients with perfect diets and eating habits.

Gastric sleeve stretching causes weight regain by allowing patients to eat more during meals and by increasing the amount of hunger-causing hormones secreted by your stomach.

02.

How to Reverse Weight Gain

SECTION SUMMARY:

  • You'll need change your diet & lifestyle back to the good habits you formed just after surgery
  • You can for more support online or in-person
  • Talk to your doctor about medication
  • You can investigate a revision surgery
  • You should address food addiction

There are 5 options for reversing weight gain after gastric sleeve surgery:

  • Change your diet & lifestyle
  • Ask for more support
  • Ask about medication
  • Have a gastric sleeve revision surgery (last resort)
  • If food addiction is present, seek treatment

Click below for more information about each option.

Change your diet & lifestyle

Two of the most common reasons for gastric sleeve weight gain are (6)(7):

  • Consuming the wrong foods/liquids or too much foods/liquids
  • Not exercising enough

Review our Gastric Sleeve Diet Guidelines and Exercise Guidelines and compare them to your current habits. If you’ve let yourself slip, make a concerted effort to get back on track before considering surgery.

Talk with your surgeon and dietitian about helping you get on a strict dietary regimen to get back on track.

Start & Maintain a Diet Journal

Diet journals are directly associated with more weight loss (8). If you reach your low point then gain weight after gastric sleeve, a well-kept journal will help you to:

  • Set goals and record progress
  • Plan your meals ahead of time
  • Prevent “cheating” on your meal plans
  • Shop smartly – take your journal with you to the grocery store and only buy the foods that you have planned

If you haven’t been journaling, give it a try before exploring more aggressive options like revision surgery.

Ask for more support

It’s so much more difficult to succeed on your own. If haven’t done so already, talk with your surgeon about specialists and local support groups.

Talk with a Specialist

Your surgeon should have several gastric sleeve specialists either in-house or nearby who are experts at helping patients experiencing weight gain after gastric sleeve surgery, including:

  • Dietitian
  • Psychologist
  • Personal Trainer

Set up an appointment with your surgeon to discuss your options.

Join a Gastric Sleeve Support Group

If you’re having a tough time sticking to your diet and exercise goals on your own, join a local support group of other gastric sleeve patients. Odds are, at least a few people in the group will have struggled with gastric sleeve weight gain.

Your surgeon’s office should be able to refer you to a good group.

In addition to the invaluable encouragement and support you’ll receive from others who know your challenges, support groups also result in more weight loss. Several studies have shown that regular weight loss support group attendees lose as much as 12% more excess weight than patients who do not attend (9).

See our Weight Loss Surgery Support Group page for more information.

Ask about medication

Medication is usually not effective for weight regain after gastric sleeve surgery, but it’s worth discussing with your surgeon.

For example, one study of gastric bypass and gastric sleeve patients undergoing revision surgery for weight regain or inadequate weight loss found that the medication Topiramate made patients more likely to lose weight (10).

Have a gastric sleeve revision surgery

Revision surgery should only be considered as a last resort for addressing weight gain after gastric sleeve surgery. Just like your initial surgery, it’s time consuming, costs money, carries risk, and isn’t guaranteed to work long-term.

Following are the 4 gastric sleeve revision surgery options in order of the most long-term weight loss:

  1. Convert to duodenal switch
  2. Convert to gastric bypass
  3. Re-sleeve (having another gastric sleeve surgery)
  4. Convert to Lap-Band (“band over sleeve”)

See our Gastric Sleeve Revision Surgery Guide for more information about each option, including expected weight loss, risks, and cost.

Address Food Addiction

Gastric sleeve patients with food addiction are at high risk of weight regain after surgery. If you think you may have a food addiction, you are strongly encouraged to meet with a therapist and discuss this further. Food addiction symptoms include:

  • Eating due to stress
  • Food cravings despite being full
  • Feeling guilty about what or how much you ate
  • Prioritizing food over work, friends, family
  • Justifying unhealthy food choices (making excuses)

Meeting with a therapist to address food addiction can lead to weight loss. Therapist are trained to uncover the root cause of your eating, and working with one might be the missing link to lose the weight you gained back.

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03.

Patient Community & Expert Advice

SECTION SUMMARY:

  • You can read about the experiences of other patients who gained weight
  • You can "Ask the Expert"

Have you experienced weight gain after gastric sleeve surgery? Have you been successful at reversing your weight regain?

Please use the form below to share your experiences or submit your questions.

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Questions From Other Visitors*

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Weight Gain Due to Poor Diet Choices 8 Years After Gastric Sleeve*

So I always told myself that if I gained weight back it would be my ultimate failure in life, and yes, I have gained. I had gastric sleeve surgery 8…

Food & Bowel Problems Advice One Month After Gastric Sleeve*

I had a bariatric sleeve done June 24, 2015. So far I have lost 31 pounds. I am having a hard time finding things to eat. Baby food tastes nasty…

Breast Cancer After Gastric Sleeve Followed By Weight Regain*

I had WLS in July 2013.....I went with the gastric sleeve. I lost 80 pounds and got down to 135 pounds. I was in a solid size 6. Last June,…

Weight Regain One Year After Gastric Sleeve Surgery*

About a year and a half ago I had gastric sleeve surgery and lost about 30 kgs (66 lbs) which is perfect. However, my stomach stretched and I started to…

Patient Experience: Weight Regain After Gastric Sleeve Surgery*

I had Gastric Sleeve done 1 year and 7 months ago and for about 5 months I have been gaining weight... about 23 pounds total. I think it is because…

I thought it was over my struggle with food*

Before going for my gastric sleeve operation my weight was 29 stones and 8 pounds. Six months later I was almost 17 stones lighter. I totally embraced my after-op program:…

Patient Experience: Gastric Sleeve Weight Regain*

I went into surgery at 330 lbs - when I went under for surgery I thought I was having gastric bypass. During surgery it came to be known that my…

Gained Back 40 Pounds in 8 Years Since Gastric Sleeve Surgery*

I had a gastric sleeve procedure in 2005. I went from 275 to 120 pounds and felt fantastic. It was effortless as I had to remind myself to eat, was…

Are My Bad Habits Leading to Weight Regain After Gastric Sleeve?*

Hello there, My name is Anne, I am 4 years out from my Gastric Sleeve. The day of the surgery I was 5'4, and 254, BMI of 44 or so.…

How Do I Get Past My Weight Loss Plateau?*

Hello, I am a couple months post-op with the gastric sleeve and have a problem: the dreaded weight loss plateau. I was doin' great, losin' weight at a steady pace,…

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Do You Qualify for a Bariatric Procedure?

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Do You Qualify for a Bariatric Procedure?

Patients who qualify for bariatric surgery usually:

  • Are at least 80 lbs (36 kg) overweight
  • Are between 18 and 75 years old
  • Have a history of failed weight loss attempts (e.g., failed diets)
  • Thoroughly understand that the procedure is just a tool; long-term success requires significant diet and lifestyle changes

The minimum bariatric surgery qualifications include:

  • A body mass index (BMI) of 40 or more
  • OR a BMI between 30 and 39.9 with a serious obesity-related health problem like diabetes, high blood pressure, sleep apnea, high cholesterol, joint problems, or others
  • OR a BMI of 30 to 40 with or without health issues for the gastric balloon procedure

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Bariatric surgery insurance coverage varies by insurance policy:

Individual/Family Plans & Small Group Plans – Coverage varies by state; coverage is required by the Affordable Care Act in some states

Large Group Plans – Coverage depends on whether your employer has chosen to add it to your policy

Medicare and Medicaid – Bariatric surgery is covered

If your policy covers it and you meet the qualification requirements, your plan will likely include 4 procedures:

  • Gastric sleeve
  • Gastric bypass
  • LAP-BAND®
  • Duodenal switch

Your surgeon may be able to get partial coverage for the other procedures.

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You will start losing weight fast after any bariatric surgery procedure, but the total amount lost varies based on:

  • The procedure you choose
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Enter your information into the tool to get an idea about how much weight you’ll lose after each procedure.

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Your out-of-pocket bariatric surgery cost can range anywhere from $0 to $20,000 or more depending on several factors, including:

Whether your insurance covers it – many insurances (including Medicare, Medicaid, and many individual/family and employer-provided policies) cover the majority of costs for gastric sleeve, gastric bypass, LAP-BAND®, and duodenal switch. The other types of bariatric surgery are less likely to be covered, although you may be able to get insurance to pay for some of the costs. Tap the “With Insurance” button in the tool to see average out-of-pocket costs per procedure after insurance pays. See our Insurance Tool to find out if your plan covers it.

Which procedure you choose – if insurance won’t pay, costs range anywhere from $8,000 to $20,000+, depending on the procedure. Tap the “Without Insurance” button in the tool to compare the national average self-pay costs for each procedure. (NOTE: Some surgeons offer each procedure for as low as half of the national average).

How competitive your surgeon and hospital fees are – there is often a substantial difference in costs between different doctors and hospitals, even within the same town.

Whether you qualify for tax write-offs – Bariatric surgery is tax deductible, which can have a big impact on the total cost of surgery. You can deduct medical expenses if your out-of-pocket costs are more than 10% of your adjusted gross income. See our Tax Tool to find out if your bariatric procedure will be tax deductible.

How you choose to pay for your procedure – If insurance covers it, you’ll only be responsible for any copays, deductibles, and coinsurance required by your specific plan. If you pay for the procedure without insurance, total costs will depend on how you pay. For example, your surgeon may offer a discount if you pay the full amount up front, and you can make the costs more affordable by applying for bariatric surgery financing.

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Bariatric Surgery Tax Write-Off Calculator

Weight loss surgery is tax deductible, which can have a big impact on the total cost of surgery. You can deduct medical expenses if the costs are more than 10% of your adjusted gross income.

Use the tool to find out if you qualify for a tax deduction.

To receive the deductions, you’ll need to complete Schedule A of the IRS Form 1040. You’ll also need to save your medical bills and payment statements as proof. Money in one of the following special savings accounts (or even your IRA) may also be a way to pay for part of surgery tax-free:

  • Health Savings Account (HSA)
  • Archer Medical Savings Account (Archer MSA)
  • Health Reimbursement Account (HRA)
  • Flexible Spending Account (FSA)
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Weight loss surgery is tax deductible, which can have a big impact on the total cost of surgery. You can deduct medical expenses if the costs are more than 10% of your adjusted gross income.

Use the tool to find out if you qualify for a tax deduction

To receive the deductions, you’ll need to complete Schedule A of the IRS Form 1040. You’ll also need to save your medical bills and payment statements as proof.

Money in one of the following special savings accounts (or even your IRA) may also be a way to pay for part of surgery tax-free:

  • Health Savings Account (HSA)
  • Archer Medical Savings Account (Archer MSA)
  • Health Reimbursement Account (HRA)
  • Flexible Spending Account (FSA)
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Bariatric surgery recovery varies by procedure. Here are the ranges:

  • Timeline Range: from 3 days to 6 weeks to full recovery
    • Hospital Stay: from outpatient (return home same-day) to 3 days
    • Back to Work: from 3 days to 3 weeks
  • Pain Range: from mild discomfort to manageable with medication
  • Diet Range: from no restrictions to slow transition from clear liquids to solid foods
  • Activity Range: from no restrictions to slow transition back to regular activity and exercise

Use the tool to learn more about each stage of recovery.

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Bariatric Procedure Summaries

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Below is a brief explanation of how each bariatric surgery procedure works. Tap the icons for more information.

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Below is a brief explanation of how each bariatric surgery procedure works. Tap the icons for more information.

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There are 6 types of bariatric surgery (also called “weight loss surgery”) available, including:

  • Gastric Sleeve – feel less hungry & full sooner while eating
  • Gastric Bypass – feel full sooner while eating & absorb fewer minerals
  • Duodenal Switch – feel less hungry & full sooner while eating, absorb fewer calories and minerals
  • LAP-BAND® – feel full sooner while eating
  • Gastric Balloon – temporarily feel full sooner while eating (balloon removed after 6 months)
  • AspireAssist – drain a portion of stomach contents after eating

Use the tool to compare each procedure.

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The best weight loss surgery options for you depend on:

  • How much weight you want to lose
  • Your current age, weight, health issues, habits, and lifestyle
  • Your expectations for life after surgery
  • Whether you want a reversible procedure
  • What “trade-offs” you are willing to make

Take the quiz to find out which two procedures are best for you and why.

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Bariatric surgery “cures” or significantly improves many obesity-related health conditions, including:

  • Diabetes
  • Sleep apnea
  • Hypertension
  • Joint issues
  • … and many others

Select your health conditions in the tool, then click the Submit button to find out the impact a procedure like gastric sleeve can have.

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