Is weight loss surgery really a permanent solution?


Carnie Wilson after 150 pound loss from gastric bypass and within 5 years of the bypass.  (She elected  a second weight loss surgery and still struggles with weight)


I belong to an online group for Registered Dietitians.  The following is a serious plea asked by an RD to other RD’s.  She has a morbidly obese patient (this means a person with medical conditions caused by weight) on a 1400 calorie well-balanced diet.  The woman exercises (weights and cardio) two hours/day! She is conscientious with her food intake and Spartan exercise regimen and is not losing weight.  The RD mentions that the patient’s insulin level is high.

Still, the RD  remains flummoxed by the fact that her patient is not losing weight.  Sadly…. RD’s who commented suggested bariatric surgery for this patient.

Here is the actual post by the RD…and my response.

THE QUESTION:  Does anyone have a case of a morbidly obese patient with a basic metabolism of 1400Cal who is not losing weight despite all the efforts. Any suggestions that might help? (PS: she never cheats on food)….signed:  Dietitian / Nutrition Consultant

I have a morbidly obese patient BMI 42, who has been on a well balanced diet for over 8 months. She barely lost 6kg of fat. Her BMR = 1400 Cal.
She is committed to 1.5 hours of body building and 30 min of cardio per day.
She has a prolactin level on the highest normal range, same goes for the insuline.
For the past couple of consultations she was either the same weight or she would gain few grams of fat.
Does anyone have the same case?
Can anyone give me an idea about a successful approach?
Thank you


Diane Kress‘ RESPONSE:

Top 10 RD, CDE, NY Times Bestselling author, Diabetes Expert, administrator for

Many RD’s have come to believe that for patients with obesity or morbid obesity; bariatric surgery is the answer. After all, these patients have not been successful with multiple weight reduction attempts over their lifetimes. They’ve tried low calorie, low fat, VLCD’s, weight loss drugs, stimulants, counting carbs, counting points, eating processed/packaged diet foods….you name it….they have tried it….and without long term results.

Years of yo yo dieting have left them beyond frustrated, depressed, and cynical.

On the surface, the results of bariatric surgery look appealing. To lose over 100# in a year or so is major “progress.” But here’s the rub:

Over 60% of patients who subject their bodies to major surgery in an attempt to finally lose weight and get healthy will regain most or all of their weight in less than 5 years. We need to be honest with these patients.

When the stomach is surgically decreased to the size of a 2 ounce pouch and the part of the small intestine that is responsible for absorbing vital nutrients and calories is bypassed….it follows that major amounts of weight will be lost.

But…over the first year post op, the stomach’s capacity increases to over 1 cup in size. At this time, the patient can begin to fill the expanded stomach pouch with “easy to digest foods” like rice, pasta, cooked cereal, potatoes, etc. Sure we taught them to use protein first, then veggies….but when time passes and it’s possible to fit more food into the stomach, easy to digest carb foods are increased. These foods stimulate the over-release of the fat gain hormone; insulin.

After bypass or sleeve…the pancreas is still functioning. For over 60% of the adult population…genetically mediated stressor induced insulin imbalance is a fact of life. These people over-release insulin in response to a rise in blood sugar (from carbohydrate foods and the liver’s natural release of glycogen).

So, about 2 years after surgery (or even sooner), weight loss stops. And not long after, gradual weight regain begins. And that’s not all…fat increases around the middle (belly fat) and hypertension, elevated blood lipids, liver fat deposits, and blood sugar return. The medications that were D/C’d after the initial weight loss are re-prescribed.

I feel that it is essential to make bariatric patients aware that the surgery is merely a tool. If they do not work with their “newly designed” GI tract, there is an excellent chance they will regain lost weight and the medical conditions that go along with it.

This patient has morbid obesity….I am sure she is dealing with obesity, hypertension, high cholesterol and triglycerides, high blood sugar, low Vitamin D and more.  I know this because she has a high insulin level.

Because she is among the 60% of overweight people with insulin imbalance, she will initially succeed from the surgery as her carb intake will be drastically decreased.  But…in time…the regain will begin.  She will once again feel like a failure.  After her surgeon determines that the surgery component is fine….she will be told to go back to low calorie dieting and exercising.  And just like it did not work before, it will not work for her post surgery.

As RD’s we must routinely screen our obese and morbidly obese patients for insulin imbalance.  It’s easy to do.  Look at fasting glucose, total cholesterol, LDL cholesterol, triglycerides, blood pressure, Vitamin D levels, and fasting insulin.  Then, instead of recommending major surgery, recommend the one diet program designed to work with this metabolic challenge:  The Metabolism Miracle. 

They will lose weight and fat and will experience marked improvements in glucose, insulin, lipids, liver fat, Vitamin D, and fasting insulin.  Then, they can decide whether to continue losing weight and improving their health with a lifestyle program, or undergo major surgery and follow The Metabolism Miracle afterward.

In either case…our patients with insulin imbalance need to understand that their body does not process carbohydrate foods normally, and the RIGHT adjustments must be made in diet and exercise to match their body.  Only then will they have long term success….


Love Diane Kress’ work?  Here are links to her books and support site!

 The Metabolism Miracle:

The Metabolism Miracle Cookbook:

The Metabolism Miracle Update:  (Brand new!)

The Diabetes Miracle:

The Interactive Support Group for Followers of The Metabolism Miracle and The Diabetes Miracle:





About Diane Kress

Author of The New York Times Bestseller; The Metabolism Miracle, The Metabolism Miracle Cookbook, and The Diabetes Miracle. and The Metabolism Miracle, Revised Edition. Owner, developer, and administrator of The Metabolism Miracle's support site: Registered Dietitian, Certified Diabetes Educator, Email:
This entry was posted in ADA, AMA, asthma, Atkins diet, breast cancer, carb blocker, Diane Kress, Diet, dLife, Dr. Oz, Energy Drink, excess insulin, fat burner, insulin resistance, LADA, low carb, low carbohydrate, Met B, Metabolic syndrome, Metabolism B,, monitoring blood glucose, obesity, overweight, PCOS, pre diabetes, prediabetes, stress, The Diabetes Miracle, The Metabolism Miracle, The Metabolism Miracle Cookbook, The Metabolism Miracle Update, type 1.5 diabetes, type 2 diabetes, weigh in and tagged , , , , , . Bookmark the permalink.

Leave a Reply

Fill in your details below or click an icon to log in: Logo

You are commenting using your account. Log Out / Change )

Twitter picture

You are commenting using your Twitter account. Log Out / Change )

Facebook photo

You are commenting using your Facebook account. Log Out / Change )

Google+ photo

You are commenting using your Google+ account. Log Out / Change )

Connecting to %s