Myth or Fact: If you’re having trouble with weight regain after metabolic surgery, you can do a “pouch (or sleeve) reset.”

Daniel Cronk, MD

Welcome to the New Year! As one year ends and another is ushered in many take time to reflect and plan. If, like researchers say, you are one of the 60% of people making a new year’s resolution and you joined the average American adults that gained one to two pounds over the last six weeks, you might have a goal of weight loss or getting back on track in the new year.

First of all, we should start off with the understanding that some weight regain is inevitable following the weight loss that occurs after metabolic surgery such as the Roux-en-Y gastric bypass or the gastric sleeve resection; whether or not it is a holiday season. It’s going to happen; the weight loss curves that we show at our seminars shows this trend. There’s a steady, and often steep, weight loss over the first year or two after surgery followed by a period of weight regain. After the period of weight regain, a leveling off of the weight occurs. The amount of weight lost or regained depends upon many factors, the least important of which seems to be the size of the pouch or sleeve.

There is a concept out there that is represented in many blogs, articles, and even books called the “pouch reset.” This usually consists of a period of time, usually between 2 days and 2 weeks, in which a patient returns to the diet originally prescribed after the surgery (“pouch” refers to the gastric pouch in a gastric bypass but the concept is also applied to the sleeve.) This train of thought is rooted in part by the idea that the pouch or sleeve may have stretched since surgery, allowing a patient to eat more. It is thought by some that this “resetting” of the pouch or sleeve may return it to the original size. While that all seems pretty intuitive, the science show it’s wrong. Most regain of weight following surgery has nothing to do with stretch of the pouch (or sleeve) or enlargement of the opening from pouch to the bowel rather it is mainly the development of poor eating habits. These habits are probably driven by the underlying physiology of obesity or inattention to exercise needs. The physiology is altered by surgery, it is weakened, but is likely still present. Following through on a “pouch reset” or a “back on track” program doesn’t really make any changes to the pouch or sleeve. That’s not to say that it’s a useless idea to use such a program. It just means you have to be realistic with your expectations and understand what’s really going on. When you follow a “pouch reset’ or similar program, you are not recreating the conditions that immediately followed your surgery but you are giving yourself some structure to encourage mindful eating and to make some other behavioral changes that favor weight loss or maintenance.

So the answer is: Myth. You can’t really reset the pouch or sleeve, but you can use one of the “reset” programs to help you reset eating and exercise habits.

Ready to learn more? Call our office at 423-778-2906 to sign up for a free seminar.