Expert: Cathy Wilson, ACC-ICF, CLC - 8/18/2008

Question
once you have the RNY surgery , does the pouch expand/ enlarge?  If you have this surgery and gain most of the weight back , what is the alternative? I have thought about this often . I get a little frightened when thinking of having the surgery and failing . Your time is greatly appreciated.

Answer
You are right, it is frightening to think of having the surgery and not achieving your weight loss goals.  It is understandable because, if you're like me, I tried every diet out there multiple times, and failed.  It is hard to believe that there is an option that would actually work and you could succeed.

That being said, surgery isn't the magic answer.  You have the surgery and then the work really begins.  You learn to eat healthy, incorporate activity, and exchange the unhealthy habits that made you heavy for new healthy habits that will allow you to lose weight and maintain the loss.  

I think if you have a healthy amount of fear, it can work for you.  It will make you take the surgical step seriously and not as a quick fix that doesn't require anything from you.  

As far as your pouch, it is created to be very small at first.  It will stretch as the swelling from the initial procedure goes down and will expand slightly.  Some stretching is common and desired as you don't want to eat just a few cc's of food at a time.  It won't stretch out to the point that your stomach is now.  You can minimize by not over-filling your pouch.  Don't eat past what feels like "full" for you after your surgery.  If you take care by eating according to your surgeon's protocol and not over-filling your pouch, you'll be fine.  

It is a possibility to regain your weight.  However, it isn't extremely common.  If you follow the guidelines of a healthy RNY nutrition program, you won't regain all of your weight back.  It is common to get to your goal and experience a bounce-back regain of 10% to 15% of your excess weight.  The great news is that you can always relose weight you gain.  It will be more difficult the second time around to relose weight because your malabsorption rate is at the highest it ever will be immediately after having your surgery.  That is why you lose so quickly and easily the first year or so after having your RNY surgery.  

I would suggest the best way to guard against weight regain is to work with a therapist, weight loss surgery life coach, or counselor to develop ways to live without emotionally eating or grazing all day.  Most weight regain is returning to unhealthy habits out of emotional eating or head hunger.

I hope this answers your questions and concerns.  If you have additional questions, please let me know.

Best regards,
Cathy, CLC
Certified Life Coach, Weight Loss Surgery Coach