Gastric Bypass | Upper GI Surgery | Bariatric Surgery

Weight Regain After Bariatric Surgery: What Actually Causes It?

purpleeffect — Fri, 27 Mar 2026 03:16:42 +0000

Bariatric surgery is one of the most effective long-term treatments for obesity. Most patients achieve significant weight loss in the first 12-18 months, however for some individuals, weight regain can occur in the years that follow. This can feel discouraging, particularly after the effort involved in surgery and recovery.

It is important to understand that weight regain is rarely about willpower. In most cases, it reflects biological adaptation, behavioural patterns and life circumstances.

What is normal weight regain?

A small amount of regain after reaching your lowest weight is common. The body often stabilises slightly above the lowest number on the scale. More significant regain, usually defined as more than 10-15% of the weight lost, or at our clinic, anything over 3 kg, we would recommend coming to chat to us about your options and getting back on track.

What causes weight regain after bariatric surgery?

Metabolic and Hormonal Adaptation

The body is designed to defend against weight loss. After significant weight reduction, resting metabolic rate can decrease and hunger hormones can increase. This is a normal physiological response and not a personal failure.

Procedures such as sleeve gastrectomy and gastric bypass alter gut hormones in ways that reduce appetite and improve blood sugar control, while reducing the amount of food a person can consume in one sitting. Over time, some of these effects can soften, leading to a gradual increase in hunger.

Eating Patterns Over Time

Certain behaviours can reduce the effectiveness of bariatric surgery. Grazing/snacking throughout the day can increase total calorie intake even when portions remain small. High-calorie liquids and frequent snacking on energy-dense foods bypass new restrictions and accumulate gradually. These patterns and ‘bad habits’ often develop slowly over time and may not be immediately obvious.

Lifestyle and Psychological Factors

Stress, poor sleep, emotional eating and major life transitions can all influence weight gain and weight management. Hormonal changes such as perimenopause can also affect appetite and fat distribution. Long-term follow-up is important because weight management is not only surgical. It is behavioural and metabolic.

Anatomical or Medical Factors

In some cases, the stomach pouch or sleeve may stretch slightly over time. If weight regain is significant, an assessment can determine whether dietary adjustment, medication or revision surgery may be appropriate.

Weight regain after bariatric surgery is multifactorial. It is rarely due to lack of effort alone. Obesity is a chronic condition. Bariatric surgery is a powerful tool, but long-term success depends on ongoing support, monitoring and early intervention when changes occur.

If you are concerned about weight regain, early review with your team allows practical strategies to be implemented before the situation progresses further.

Bariatric Surgery in 2026: Where Does It Fit in the Age of Weight Loss Injections?

purpleeffect — Wed, 11 Mar 2026 06:10:26 +0000

Weight loss injections have transformed public awareness of obesity treatment. Many patients now ask whether surgery is still necessary. Bariatric surgery still remains the most effective treatment for severe obesity.

The Rise of GLP-1 Medications

Weight loss medications such as semaglutide and tirzepatide reduce appetite and improve blood sugar control. For many patients they provide meaningful weight loss, however weight loss medications can require long-term use. When a person stops using these medications, appetite typically increases and they regain the weight, unless they are committed to diet and lifestyle changes.

Bariatric surgery alters gut hormones, insulin sensitivity and appetite signalling in a sustained way, along with reducing the volume of food a person is able to consume in one sitting. Long-term studies continue to demonstrate durable weight loss and improvement in type 2 diabetes, sleep apnoea and hypertension amongst other chronic conditions.

When Bariatric Surgery May Be More Appropriate

For people living with obesity, especially those with type 2 diabetes, high BMI or repeated cycles of weight regain, bariatric surgery continues to offer the most reliable long-term results. It is currently the only intervention with decades of data demonstrating sustained weight loss.

When Weight Loss Medication May Be Suitable

For some people, particularly those earlier in their weight journey or not ready to consider surgery, medication can be a reasonable starting point.

Why Hunger Comes Back After Stopping Weight Loss Medication

One of the most common concerns patients express is weight regain after stopping weight loss medication. To understand this, we need to understand how these medications work.

Appetite Regulation – GLP-1 receptor agonists act on the brain to reduce appetite and slow gastric emptying. While the medication is active, hunger is suppressed.

Biological Set Point – The body defends its highest sustained weight. When weight decreases, hormonal signals such as ghrelin can increase and metabolic rate can decrease. This creates biological and psychological pressure to regain weight.

What Happens When Medication Stops

When a person stops taking weight loss medication, appetite signalling doesn’t return to baseline; in fact, a person often finds themselves hungrier than ever before. Without strong lifestyle strategies, increased hunger can lead to gradual weight regain and you end up back where you started or worse.

How Bariatric Surgery Is Different

Procedures such as sleeve gastrectomy and gastric bypass alter gut hormone release and reduce ghrelin production, while reducing your stomach capacity. Weight management is not about willpower. It is about understanding physiology and choosing the approach that aligns with long-term health goals.

Choosing the Right Milk After Bariatric Surgery

purpleeffect — Mon, 08 Dec 2025 23:00:05 +0000

After bariatric surgery, every sip and bite counts. Your new stomach capacity is smaller, so the foods and drinks you choose need to be packed with nutrition, not empty calories. Milk can be a great source of protein and calcium, but not all milk is created equal. Understanding the differences can help you make choices that support your recovery and long-term health.

Why milk matters

In the early months after bariatric surgery, protein is essential for healing, maintaining muscle mass, and keeping you feeling satisfied. Milk can be an easy, gentle source of protein and calcium, especially when your portions are small. But many types of milk, especially plant-based ones, vary widely in their protein, sugar and calorie content.

Comparing your options

Cow’s milk

Regular cow’s milk naturally contains protein, calcium and some natural milk sugars (lactose). Choose reduced-fat or skim milk to lower overall calories while still getting around 8 grams of protein per cup. It’s often fortified with vitamin D, which supports calcium absorption. For most bariatric patients, this remains the gold standard unless lactose intolerance or dietary preference suggests otherwise.

Lactose-free cow’s milk

If you experience bloating or discomfort from lactose, lactose-free milk can be a good alternative. It has the same nutrients and protein as regular milk, just with the lactose broken down for easier digestion.

Soy milk

Of the plant-based milks, unsweetened soy milk is the closest nutritionally to cow’s milk, offering around 7–8 grams of protein per cup. Make sure you choose one that’s unsweetened and calcium-fortified, as some flavoured or sweetened versions can contain up to 10 grams of added sugar per cup.

Almond, oat, coconut and other plant milks

These tend to be much lower in protein (often less than 1 gram per cup) and can contain added sugars to improve taste. Oat milk, for instance, is naturally higher in carbohydrates and often sweetened, making it a poor choice if you’re managing your sugar intake. Coconut milk is higher in fat and calories, with little protein benefit. If you prefer these milks, look for unsweetened and fortified versions and use them occasionally rather than as your main source of protein.

Protein-enriched or high-protein milks

Several brands now offer high-protein or “ultra-filtered” milk options. These can contain up to twice the protein of regular milk with less sugar, making them a smart choice for bariatric patients who struggle to meet daily protein goals.

What to look for on the label

When comparing milk options, check the nutrition label carefully:

Protein: Aim for at least 7–8 grams per 250 mL serve
Sugar: Choose milks with 0–3 grams of added sugar per serve
Calcium: Look for at least 100 mg per 100 mL (fortified if plant-based)
Fat: Reduced-fat or low-fat options help reduce unnecessary calories

A few final tips

Always opt for unsweetened varieties – “original” or “barista” blends are often sweetened.
Avoid milks marketed as “light” or “diet” unless you’ve checked the protein content. Some sacrifice protein for fewer calories.
If you enjoy flavoured milk, treat it as an occasional indulgence – some contain as much sugar as a soft drink.
If you’re struggling to meet protein goals, consider adding a spoonful of your approved protein powder to milk or a smoothie for an extra boost.

After bariatric surgery, your nutrition choices matter more than ever. Milk can be a valuable part of your diet, but it’s important to choose wisely. Go for options that are high in protein, low in added sugars, and enriched with calcium. Read labels carefully, and when in doubt, check with your dietitian about which milk best supports your stage of recovery.

Talking About Weight With Someone You Care About: A Compassionate Guide

purpleeffect — Tue, 11 Nov 2025 23:07:44 +0000

Health, body and weight are deeply personal topics. Many people avoid talking about them – even health professionals struggle to do so well. But when someone you love is struggling with their weight, you might feel torn: you want to help, but fear causing shame, hurting the relationship, or being misunderstood. This guide is designed to help you approach the subject gently, respectfully, and in a way that builds connection rather than conflict.

Why is this conversation so difficult?

Weight is more than a number on a scale – it’s tied to identity, self-worth, and years of social conditioning. Research shows that weight stigma remains widespread, not only in society but also in healthcare settings. Studies published in the BMJ Open Diabetes Research & Care have found that stigma contributes to poorer mental health, discourages people from seeking medical help, and increases stress-related eating behaviours.

Even GP’s and allied health professionals report finding this conversation challenging. A UNSW study found that when doctors used supportive, non-judgmental language, patients were far more open to change and felt greater trust, whereas critical or shaming language immediately reduced motivation. Understanding this context helps you approach your loved one with empathy rather than frustration.

Ask permission before you begin

One of the most respectful things you can do is to ask permission before raising the topic. You might say:

“Can I share something I’ve been worried about?”

“Would it be okay if I mentioned something I’ve noticed about your health?”

This simple act gives your loved one control. It signals that you respect their boundaries and it reduces the chance of defensiveness.

Focus on health, not appearance

Frame the conversation around wellbeing, energy or quality of life, not looks or body size. Instead of saying, “You’ve gained weight,” you could say, “I’ve noticed you seem more tired lately, are you okay?”. Research consistently shows that people respond better when discussions focus on how they feel and function, rather than how they look. This keeps the tone supportive and avoids reinforcing social beauty ideals that have nothing to do with health.

Use kind, person-centred language

Language matters more than many realise. The British Dietetic Association and other professional bodies recommend avoiding words like “fat” or “obese” unless the person themselves uses those terms comfortably. Instead, use phrases like “weight,” “body size,” or “health changes.” Avoid saying things like “You need to lose weight” or “You should start exercising.” Try instead, “I care about you and want to see you feeling your best,” or “Would you like to do something together to feel healthier?” This shifts the focus from criticism to collaboration.

Share observations, not judgements

When you talk about what you’ve noticed rather than what you assume, it helps your loved one feel seen rather than attacked. For example:

“I’ve noticed you’ve been avoiding walks lately, and I wondered if your joints have been sore?”

That’s very different from: “You’ve gotten too heavy; you need to exercise.”

Describing behaviour rather than assigning blame creates space for honesty.

Listen more than you talk

Once you’ve opened the conversation, pause and give them space. You might discover things you didn’t know, such as underlying medical issues, emotional challenges, or past failed attempts at weight loss that left them disheartened. Listening shows respect and builds trust. It also helps you understand whether they want your help right now or whether they simply need to feel heard.

Offer to support, not to fix

Your role isn’t to prescribe or correct, it’s to support. You could offer to make small changes together, like cooking healthier meals, walking after dinner, or researching dietitians or support programs if they’re open to that. Statements like “We can figure this out together” or “Would you like me to help find someone you can talk to?” are far more effective than “You should…” Even if they’re not ready, knowing you’re there and non-judgmental makes a difference.

Acknowledge that change takes time

Behavioural change is rarely linear. There will be starts, stops, and moments of frustration. Be patient, especially if you’ve seen your loved one try before. The goal is not to rush them but to stay beside them.

Common fears (and how to manage them)

“They’ll feel judged or ashamed.” That’s a valid worry. This is why tone and timing are everything. Keep the conversation private, gentle and loving.

“What if they don’t want to talk?” If they say “not now,” respect that boundary. You’ve opened the door; they know they can come to you when they’re ready.

“I don’t want to make things worse.” You may stumble, but if your intent is genuine and you’re open to apologising if something lands wrong, your care will come through.

What not to do

Don’t bring it up in public or during conflict.
Don’t use guilt or ultimatums (“If you don’t change, you’ll regret it”).
Don’t make assumptions about willpower or effort. Weight is complex, influenced by genetics, metabolism, medication, sleep, mental health and environment.
Don’t compare them to others or yourself.
Don’t make it a one-time “intervention.” The best conversations are ongoing and adaptive.

Why talking about weight the right way can help

When handled compassionately, these conversations can strengthen trust and connection, reduce feelings of isolation, encourage professional support (GP, psychologist, dietitian, or bariatric specialist), and reframe weight in terms of overall wellbeing rather than shame. Even if nothing changes straight away, showing that you care enough to have the conversation and that you’re a safe person to talk to can be life-changing.

Weight is a deeply personal subject surrounded by stigma and misunderstanding. But silence can also be isolating. When you approach the conversation with permission, empathy and respect, you send a powerful message: “I care about you, and I’m here to support your health, not to judge you.” You don’t need the perfect words; you just need kindness, patience and a willingness to listen. Over time, that can do far more than any single piece of advice.

Protein After Bariatric Surgery – Why Real Food Matters

purpleeffect — Tue, 16 Sep 2025 23:30:07 +0000

After bariatric surgery, your body needs protein to heal, maintain muscle mass and support weight loss. Many patients start with shakes and supplements in the early weeks, but over time, these shouldn’t be your main source of protein.

Why shakes and supplements aren’t enough

Protein shakes and powders can be helpful right after surgery when your stomach is still healing. But they often lack the variety of nutrients found in whole foods, and they don’t train your body (or your taste buds) to enjoy a balanced diet. Relying on them too much can mean missing out on other essential vitamins, minerals and fibre.

Protein + fibre = a powerful duo

Protein helps you feel full and preserve muscle, while fibre supports gut health, regulates digestion and keeps blood sugar steady. Combining both in your meals, for example, chicken with roasted vegetables or lentils with leafy greens, gives your body long-lasting energy and supports your recovery.

Ways to add more protein naturally:

Include eggs, lean meats, poultry, or fish in every meal
Choose dairy or dairy alternatives with higher protein content (e.g. Greek yoghurt)
Add legumes such as lentils, chickpeas or beans to soups, salads, or stews
Sprinkle nuts or seeds over salads, porridge or smoothies
Use wholegrain bread or crackers with cottage cheese, tuna or boiled eggs

Protein-enriched foods

Some everyday foods now come in high-protein versions – bread, pasta, yoghurt and even snacks. These can help you reach your daily protein target, especially when combined with other whole food sources.

Supplements can be a useful tool after surgery, but your long-term goal should be to get most of your protein from real food. Pairing protein with fibre-rich foods will help you stay fuller for longer, support your health and make your weight loss results sustainable.

Gallbladder Removal After Bariatric Surgery: What You Need to Know

purpleeffect — Wed, 27 Aug 2025 03:48:29 +0000

If you’ve had bariatric surgery, you’re already making big changes to your health. But rapid weight loss can also trigger side effects, and gallstones are one of the more common ones. While not every patient will have problems, some may need their gallbladder removed in the months or years that follow. Understanding why it happens, what to look out for, and how it’s treated could be useful for the future.

What does the gallbladder do?

The gallbladder is a small organ located under the liver. Its main job is to store bile, a fluid that helps digest fats. While there is always bile trickling out of the liver and into the small intestine, some is diverted into the gallbladder. When you eat, the gallbladder releases bile to mix with your food. If bile becomes too concentrated, it can form hard deposits known as gallstones. While gallstones can be present in people for some time without causing problems, in around 5% of people per year they can start to damage the gallbladder or surrounding organs, causing pain and other symptoms.

Why can gallstones develop after bariatric surgery?

Rapid weight loss after surgery changes the balance of cholesterol and bile salts in the gallbladder, making gallstones more likely to form. Eating smaller portions also means the gallbladder empties less often, giving bile more time to crystallise. In some procedures, like gastric bypass, there can also be changes to the nerve signals that control gallbladder contractions, which may further increase the risk.

How common is gallbladder removal?

While 10-20% of patients develop gallstones in the first year after bariatric surgery, only around 8% experience symptoms, and roughly 4% require gallbladder removal. The highest risk period is the first 6 – 18 months after surgery, when weight loss is at its fastest.

When surgery might be needed

Not all gallstones cause problems. “Silent” gallstones can be left alone, but if they cause symptoms such as sudden right-side upper abdominal pain (often after eating), nausea, vomiting or fever, then removal of the gallbladder – known as a cholecystectomy – may be recommended. If gallstones are found to be causing problems before bariatric surgery, the gallbladder can sometimes be removed during the same operation, although this does involve extra risks. Patients who have had gastric bypass surgery are usually counseled to consider having gallbladder surgery if they develop gallstones, because of the higher risks of gallstone complications after bypass surgery.

Recovery after gallbladder removal

Most gallbladder surgeries are performed laparoscopically, which means small incisions and a fast recovery. Patients are usually back to light activities within a week and fully recovered in two to four weeks. While the body can digest food without a gallbladder, some people may experience temporary changes in digestion. Eating smaller, more frequent meals and avoiding very high-fat foods in the early weeks can help.

Can gallstones be prevented?

Not all gallstones can be avoided, but following your bariatric team’s nutrition guidelines and staying hydrated may help. If patients are particularly worried about developing gallstones after bariatric surgery, they can ask to be prescribed a medication called ursodeoxycholic acid. This medication, which isn’t PBS subsidised, helps prevent the formation of gallstones but must be taken for 12 months or more following surgery.

Gallbladder removal after bariatric surgery is not inevitable, but it’s worth knowing about, especially during the rapid weight loss phase. By understanding the risks, recognising symptoms early and seeking prompt medical advice, you can stay proactive in protecting your health.

Interview with Dr Daniel Chan – Upper GI Surgeon Sydney

purpleeffect — Tue, 12 Aug 2025 04:42:54 +0000

We would like to give our followers the opportunity to get to know the medical team here at Upper GI Surgery a little bit better. We recently asked one of the bariatric surgeons, Dr Daniel Chan, to participate in a quick interview to get to know him a little better. From why he became involved in upper gastrointestinal surgery in the first place, to what his favourite film is, we hope today’s blog gives you a deeper insight into the life of one of the team.

Let’s start at the beginning Dan, how long have you been doing this?

I completed my training in General Surgery and attained my FRACS in 2019. Since then, I have been undertaking subspecialty training in upper GI surgery and have been practising in the field since then. My experience includes working in both public and private hospitals across Australia and overseas.

What is your role and how do you contribute to part of the team?

I am a Consultant Surgeon at St George Hospital, St George Private, and East Sydney Private Hospitals, specialising in upper gastrointestinal, bariatric, and hernia surgery. I work closely with multidisciplinary teams to provide personalised, evidence-based care, while also mentoring junior staff and contributing to clinical governance.

Why did you get into the upper gastrointestinal field?

It was the last year of my fellowship at St George Hospital, and we were doing a lot of bariatric work. It seemed to be a fertile field with many improvements to be made and plenty of unknowns. Knowledge was far from complete, and there was a real curiosity about how the obesity epidemic had come about. I figured that if I stayed in the field long enough, I might be able to help work it out.

What excites you about the future of upper GI surgery?

Advances in surgical technology, including robotics and AI integration, are transforming the way we approach complex procedures. I’m particularly excited about the increasing role of precision diagnostics and personalised care pathways in improving long-term outcomes.

Do you do anything outside of work towards UGIS care? Conferences? Research?

Yes – I’m an active researcher and am currently completing my PhD, focusing on the objective assessment of oesophageal hiatus pathology. I regularly present at national and international conferences, supervise research projects, and peer-review for several surgical journals.

Other than bariatric UGIS, what other types of surgery do you perform?

In addition to bariatric procedures, I perform anti-reflux, hiatus hernia, and benign and malignant gastric and oesophageal surgery, as well as complex abdominal wall hernia repairs. My military surgical experience has also included emergency trauma and general surgery in austere environments.

We understand you speak multiple languages, tell us more.

Born and raised in Sydney to parents from Hong Kong, I speak English, Cantonese and Mandarin. This has helped bridge communication with patients and colleagues in multicultural settings both locally and abroad.

What’s it like working at UGIS?

It’s a dynamic, supportive environment with a strong focus on collaboration and patient-centred care. There’s a real culture of research and excellence that makes it rewarding to be part of the team.

What’s your favourite part of the day?

The early morning theatre brief and first cases of the day – when the team is focused and energised. It’s also a moment to teach, troubleshoot and align for the day ahead.

What do you do when you’re not being a surgeon?

I serve as an Army Reservist and am involved in veteran and community organisations. When time allows, I recharge by running, listening to audiobooks and exploring new culinary spots.

Where’s your favourite place to travel?

Asia – I love the blend of tradition and innovation, the food, and the calmness of nature in various places across China and Japan in particular.

Favourite movie?

It’s hard to pick a favourite, but if I had to, then probably The Lord of the Rings: The Two Towers, and that whole trilogy really.

What sort of music do you like?

A bit of everything – from chilled classics to pop, and I tend to listen in music in both English and Chinese (Cantonese/ Mandarin).

The Future of the Sleeve Gastrectomy

purpleeffect — Wed, 21 May 2025 00:59:00 +0000

Gastric sleeve surgery is now the most commonly performed weight loss procedure around the world. It’s effective, but not perfect. Around 5 – 6% of patients need another surgery within five years, often due to weight regain or reflux. In this video, we look at what might help bring that number down.

In this video:

00:00 – 00:10 Introduction from A/Prof Michael Talbot: New Developments in Sleeve Gastrectomy

00:10 – 01:18 Gastric Sleeve Evolution: What Started as a Step Became the Standard

01:18 – 01:50 Why is the sleeve so popular?

01:50 – 02:19 Weight loss after a gastric sleeve

02:19 – 02:50 Common challenges after gastric sleeve surgery

02:50 – 04:15 How the new one-line stapler is shaping the future of sleeve surgery

04:15 – 04:26 Start your journey today

A/Prof Talbot has been performing bariatric surgery in Australia since 2003. Gastric sleeve surgery was once considered a stepping stone to the gastric bypass, but it proved so effective that it became the most commonly performed weight loss procedure worldwide.

Still, up to 5 – 6% of patients need revisional surgery within five years, often due to weight regain or reflux.

Research has shown (Lin, L. 2025) that patients who had a sleeve with a single-fire stapler experienced:

• A 73% lower rate of reflux after surgery – 7.1% with the single-fire stapler vs. 26.4% using a multi-fire stapler.
• Decreased incidence of new reflux symptoms (that weren’t there before surgery) – 1.8% with the single-fire stapler vs 10.9% using a multi-fire stapler.

If you’re considering gastric sleeve surgery and would like to discuss whether this new technique is right for you, contact our practice on (02) 9553 1120 to make an appointment.

Ying L, Rutledge R, Butensky S, Lugo DF, Morton J, Ringold F. Does Stapling Platform Influence Robotic Sleeve Gastrectomy Postoperative Outcomes? Obes Surg. 2025 May;35(5):1838-1844. doi: 10.1007/s11695-025-07855-z. Epub 2025 Apr 14. PMID: 40227538; PMCID: PMC12065732.

Titan SGS™ Stapler – standardbariatrics.com/titansgs

Weight Regain After Bariatric Surgery Q&A Recap

purpleeffect — Thu, 10 Apr 2025 04:39:11 +0000

A/Prof Michael Talbot hosted our latest webinar on the topic of weight regain after gastric sleeve or bariatric surgery. Here are some of the questions that he answered during the live Q&A that followed the short presentation.

What would be the revision surgery for a gastric bypass?

The type of revision surgery needed depends on several factors, including the type of bypass performed, the size of the stomach, and whether it has stretched over time.

If a patient’s stomach has stretched significantly after a bypass, it can often be trimmed and tightened. In these cases, a surgeon may also consider placing a ring around the stomach to prevent future stretching. However if the stomach has not stretched, a different procedure may be required. A bypass distalisation is also an option.

Before determining the best approach, a thorough assessment is needed. This typically includes a couple of scans and a dietary evaluation. If the patient has a small stomach but is engaging in frequent eating, surgery may not be the most effective solution.

Is there more risk in undergoing a different surgery after a sleeve?

Yes, any revision surgery after a sleeve gastrectomy is at least three times riskier than the initial sleeve procedure. This is primarily because the surgery may involve re-stapling along the existing staple line, which is technically more challenging and increases potential complications.

The risk of infection, for example, rises from approximately 1 in 500 for the first sleeve surgery, to around 1 in 50 – 1 in 100 for a revision procedure. The specific approach taken depends on the patient’s individual issues and needs.

If we notice weight gain coming on, what’s the first course of action?

The first step is to go back to basics. Focus on increasing your protein intake and incorporating more exercise into your routine. Consider using meal replacements like Optifast for around five meals a week.

It’s also important to book an appointment with the team for support and guidance. If you’ve already made these adjustments and they aren’t working, we often recommend a weight loss medication program. A structured 3 – 6 month course can help patients get back on track, and many can stop the medication once they regain control without the weight returning.

If the weight gain is significant and these simpler strategies aren’t effective, we may explore other therapies, including assessing the size of the stomach to determine if further intervention is needed.

Do you require health insurance for a revision (re-do) surgery?

Health insurance is required for nearly all weight loss surgeries, including revision procedures. While some bariatric surgeries are performed in the public system, access is extremely limited. At St George Hospital, we perform around 20 cases per year in the public system, compared to approx 1,200 in the private hospital.

In NSW, only about 2.5% of bariatric surgeries are done in public hospitals, meaning most patients will need either private health insurance or to self-fund their procedure. Health insurance is generally the more cost-effective option.

Is there a higher chance of ulcers and hernias with a gastric bypass?

Yes, ulcers are more common after a gastric bypass compared to other procedures like the sleeve or SADI. They are usually caused by factors such as aspirin, anti-inflammatory medications, smoking, or alcohol consumption. So if you’re a smoker, a bypass might not be the right option for you. However, ulcers can also develop due to bad luck, high stress, or following another operation.

As for hernias, anyone who loses a significant amount of weight is at a higher risk of developing symptomatic hernias. This is because hernias are often plugged with fatty tissue, and when that fat is lost, the hernia can loosen and become problematic. Additionally, in about 3% of cases the small bowel can twist around itself, which requires surgery to correct.

Is stomach stretching as big of an issue as once thought?

For most people, stomach stretching isn’t a major issue. However in a small number of cases it can be. When comparing stomach sizes between those who have lost weight and those who haven’t, the size is generally similar.

That said, if a patient reports feeling a lack of restriction, their stomach may have stretched slightly over time. In these cases, tightening the stomach can help restore that feeling of restriction, which can be beneficial.

Assessing stomach size is just one of many tools available when considering treatment options. Some stomachs naturally stretch more than others, though the reasons for this aren’t fully understood. This is why evaluating stomach size can be useful, especially if a patient is experiencing significant issues.

Why can individuals who have undergone bariatric surgery successfully discontinue weight loss medications without regaining weight, while those without surgery are more likely to experience weight relapse?

After bariatric surgery, the stomach can no longer produce the same range of appetite-stimulating hormones as it did before. This means that the surgical effect remains permanent, helping to regulate appetite long-term.

However, some patients go through difficult periods where they experience sudden weight regain over six months or so. This isn’t usually due to changes in their stomach but rather life events that impact their behaviour and eating habits. In these cases, using WLM (Weight Loss Medication) can help patients lose the regained weight and return to their previous habits, allowing them to maintain their results.

For people without surgery, weight loss often leads to increasing hunger over time. Once they stop WLM, their hunger returns, making it much harder to maintain weight loss. This is where bariatric surgery provides an advantage – it helps regulate hunger, making long-term weight management more achievable.

What if you’ve lost 20% with surgery but can’t lose any more weight, even with exercise?

In this case, it might be related to your metabolism. A metabolic rate analysis can help determine how much energy your body uses at rest. This information can give insights into how your metabolism is functioning and whether it’s impacting your ability to lose more weight.

If you’ve lost a significant amount of weight and still need to lose more, considering Weight Loss Medication (WLM) could be a good option. It can help speed up the process and might help you lose an additional 10-12%. Typically, people tend to lose 8-10% of their body weight within 6-9 months, and that’s often all they need to get back on track.

Start with WLM to see if it works for you. If it doesn’t, or if it’s not the right fit, we can then look into further tests to understand what’s going on.

How long can you use Weight Loss Medications (WLM)?

Weight loss medications can be used long-term, with many studies showing that they are safe and effective for use over extended periods, including 2 years or more. However, the challenge with long-term use is the cost, as they can become relatively expensive.

It’s worth testing de-escalation strategies, such as reducing the dose or using intermittent dosing to lower the cost. Increasing exercise can also help boost your metabolic rate and complement the medication. Medically, it’s safe to use these medications long-term, but it’s helpful to explore ways to manage the financial burden while still achieving effective results.

If a GP says the drugs won’t work if you don’t have any appetite, is that true?

This is often the case. If you don’t have much of an appetite and are still struggling to lose weight, it could indicate other factors at play, such as unacknowledged snacking or a metabolic rate issue. However even in these situations, it’s still worth trying the medications because they do more than just suppress appetite.

They can help reduce your overall interest in food, which allows you to unconsciously eat less. Additionally, they alter the way your body uses glucose, which can further support weight loss.

How soon post-surgery would you recommend weight loss medications?

The timing of introducing weight loss medications (WLM) post-surgery depends on several factors including the type of surgery, the amount of weight lost, and individual progress. A key concept in weight loss surgery and in weight loss treatment in general, is that you can predict how much weight someone will lose based on their initial progress in the first 3 to 4 months.

For example, with sleeve gastrectomy, the goal is usually for patients to lose about 30% of their total body weight. A target of 15% weight loss should occur in the first 3 to 4 months. If the patient has not reached 15% by that point, it may suggest they may not achieve their full weight loss goal, and WLM could be considered at that time.

For most patients, the first 12 to 18 months post-surgery is the key window for weight loss. If progress slows down significantly or a plateau persists, introducing medications may be appropriate to support further weight loss.

In cases of revision surgery such as switching from sleeve to bypass, weight loss may take longer to achieve so it might be reasonable to consider starting WLM earlier, once the patient is on normal food.

Should I go to my GP for weight loss medication (WLM) or UGIS?

It depends on your GP. Dr Jenny Matthei is a General Practitioner (GP) with a specialist interest who has retrained as a weight loss physician and focuses solely on weight loss management. She is happy to supervise patients through the process.

However, many GP’s are generalists and may feel less confident managing patients who are using weight loss medications. It’s often a good idea to start by consulting your GP, but if they are not comfortable with or interested in this approach, you can always make an appointment with Jenny.

A common pitfall when using WLM with your GP is that without the proper diet and lifestyle plan, you may not reach your weight loss goals for several reasons. First, if you use WLM without a high-quality diet, you may lose protein and muscle mass along with fat. This can contribute to increased fatigue, which can be even worse if you’re not eating the right vitamins and nutrients. Losing muscle mass also lowers your metabolic rate.

For the best results, it’s crucial to combine WLM with the right diet and exercise plan to maximise your success. GP’s often don’t have the resources to provide all of these components, but at UGIS we offer everything in one place, with Jenny providing the necessary prescriptions as well as guidance on diet and exercise.

Can the stomach “bounce back”?

The size of your stomach doesn’t change if you don’t eat. Resetting your stomach size, going on a diet, or taking weight loss medications (WLM) won’t change how much your stomach can hold. However, what you eat can change how much you eat.

When patients experience weight regain after bariatric surgery, they often report being able to eat large portions of certain foods, like macaroni and cheese, but feeling full quickly with healthier options like salad or vegetables. The key is changing what you eat, rather than focusing on the stomach size itself.

By introducing meal replacements or using WLM, you can modify your food choices. High-protein, low-sugar foods can help suppress appetite, while sugary, high-energy foods can stimulate hunger. GLP-1 agonists, a type of WLM, help reduce cravings for sugar and carbs, which are often the foods that trigger hunger. This approach can help re-establish healthier eating habits and better appetite control.

When will the price of weight loss medication (WLM) come down?

The price of WLM is unlikely to decrease significantly for at least five years. Currently there seems to be a bit of a double standard, as diabetics can access GLP 1 agonists for free and the “wholesale price” is low, while those seeking it for weight loss must pay more.

It will likely take around five years before GLP-1 agonists come off patent and become available for generic production, which could help reduce prices. Additionally, with only two options currently available on the market and the demand being so high, the companies have little incentive to lower prices. However as we’ve seen with other expensive medications in the past, once more companies enter the market, the prices will eventually come down in order to capture a share of the market. Still, it will likely take a minimum of five years for prices to drop.

How do you increase metabolism in someone who physically can’t exercise?

Increasing metabolism without exercise is quite challenging, but it can be done by making dietary adjustments. The key is to switch from foods that drive insulin production to those that don’t. Foods that require more effort to metabolise can help increase energy burn.

It’s also worthwhile to assess the individual’s metabolic rate, which can be measured to understand how many calories they burn while at rest. Once you know the baseline, you can tailor their diet to suit their metabolism, ensuring that they are consuming foods that support their more efficient metabolism.

Weight Loss Medication – Your Questions Answered

purpleeffect — Thu, 03 Apr 2025 04:19:20 +0000

In this blog, we answer your top questions about weight loss medication.

Are weight loss medications safe?

All medications have side effects and risks but most people tolerate weight loss medications well. Side effects become more of an issue if the dose of weight loss medication is increased too quickly. Common side effects such as nausea and constipation will mostly settle in the first month or two of treatment when managed under the care of our doctors.

If you experience nausea, we advise that you eat smaller meals, avoid fatty foods and take your time to eat more slowly. There are medications our doctors can also prescribe to help with nausea. If you experience constipation, increase your fluid intake, eat more vegetables, consider using a fibre supplement such as Metamucil and if you still have constipation you can use a laxative such as lactulose or movicol.

You shouldn’t increase your dose of weight loss medications until your side effects are under control. More serious and troublesome side effects and complications occur in about 1 in 200 patients which is a similar rate to a wide range of commonly prescribed medications for other health conditions. You can visit the website of your prescribed weight loss medication, to learn about the risks in more detail.

How long do I need to take weight loss medication?

Weight loss medications are effective in helping patients to lose weight and keep the weight off in the long-term, when used alongside lifestyle changes including healthy eating patterns and regular exercise. If these medications are stopped and patients go back to their previous unhealthy eating habits and stop exercising, their weight will increase again.

Some patients are able to stop weight loss medication and keep weight off if they continue to work on lifestyle management strategies. Other people do better with continuing on medication, often at a lower dose or with intermittent dosing, alongside lifestyle management in the longer term. It is important to monitor your weight regularly as you may need to restart your medication if your weight increases more than 3kg after stopping.

What are the long-term effects of weight loss medication?

Obesity is a chronic disease that affects every system in the body. Losing 10-20% of your starting weight will result in improvements in a wide range of other conditions including joint pain, high blood pressure, high cholesterol, heart disease, kidney disease, diabetes, sleep apnoea and mental health conditions. Losing weight can also prevent you from developing some of these diseases especially if you receive treatment before these diseases are established.

If you use weight loss medications and don’t eat a proper diet (including eating adequate amounts of protein and a wide range of fruit and vegetables), don’t drink adequate fluids or exercise (including resistance exercises), you will be at risk of muscle and bone loss or vitamin and mineral deficiencies.

How much weight can I expect to lose with medication?

There are a range of weight loss medications and the expected weight loss varies between 8-20% off the starting weight.

Is weight loss medication covered by insurance?

Some funds do pay a benefit for weight loss medications under ‘extras’ cover. We recommend you check with your insurer.

Can I take weight loss medication if I have diabetes?

Some of the weight loss medications available in Australia are also used for diabetes management and so can help with both weight loss and blood sugar control. Some of the agents are available to patients with diabetes on the PBS when certain criteria are met.

Are weight loss medications suitable for older adults?

Weight loss medications can be suitable and effective for older adults, however there is limited research data for patients over 75 years of age. Weight loss can be associated with a loss of muscle mass and so older patients who need to lose weight to improve their health will need to take these medications under good medical supervision.