Reasons Why You Regain After Surgery

Breaking the Drinking Rule


Most patients off track after weight loss surgery tend to always think that they have sabotaged their tool.  Many will come in saying “I have stretched out my pouch” “I can eat as much as I want”.  This thinking is ultimately so far from the truth. It comes down to their actions and behaviors that make them feel like they have ruined their tool and it will not work.  Over and over I have worked with 100s of patients just like this and once I show them why what they are doing make them feel this way, they are able to make small changes and get back to that feeling of fullness and satisfaction with smaller portion.  There are important rules to follow after surgery.  These are rules that are specific to people who have had surgery and don’t really apply to those that don’t.  The rules are important to follow in order to get the most out of your tool!  Breaking these rules is why patients feel they have sabotaged their tools.

One important rule after surgery is the drinking rule.  The drinking rule states that you should not drink while you eat and you should not drink for one hour after you eat.  This goes for meals and snacks.  It has to do with the significant change in your anatomy of your stomach after surgery.   You have to think of your pouch or sleeve has a funnel after surgery.  The goal is to put the right foods in the pouch or sleeve therefore clogging up the funnel allowing you to feel full on small amounts.  Now if you drink at the same time as you eat, you are constantly washing the funnel out and refilling it.  You eat you fill it up, you drink, you wash it out, you eat you fill it up , you drink you wash it out.  This pattern is why you feel you can eat so much because you are washing the food out quickly.  The goal is to fill the pouch or sleeve once at each meal, not 4-5 times at each meal.  Now the rule also states no drinking for one hour after a meal.  The reason for this is that in order for you to get and keep that full feeling there must be a small amount of stretch on the pouch or sleeve to stimulate the nerve to send the full signal to the brain.  Therefore if you eat and fill the pouch up, but then 10 minutes later drink and wash all the food out, there is no more stretch on the pouch and the signal is no longer sent and you will be hunger in an hour.  However, if you eat and fill your pouch up and then wait an hour to drink, the signal is being sent the whole time helping to keep you full and satisfied for a much longer period between meals.

So drinking with your meals makes you feel like you have stretched your pouch or sleeve because you can eat more.  It allows you to fill your pouch multiple times at each meal therefore causing you to overeating.    It also makes you feel more hunger between meals therefore leading to the need and want to nibble and graze between meals.  

So one step to getting back on track and getting the most out of your surgical tool is to get back to the drinking rule.  Start with not drinking while you eat.  Work to get very hydrated before your meal and once you start a meal put the drink far far away.  Then start with 15-30 minutes after a meal.  Some is better than none.  Aim for at least not drinking for 30 minutes after a meal and then slowly work your way up to an hour.  Progress not perfection!

If you are interested in learning about the other rules of the pouch and why breaking them leads to weight regain and plateaus consider joining the Bariatric back on track program. This 6 week online comprehensive program will provide you with the knowledge to finally lose the weight and more importantly keep it off!



The birth of the back on track program

Hello and welcome to my very first blog post on my sparkly new website!  My name is Amanda Nighbert and I am a registered dietitian specializing in Bariatric and non surgical weight loss nutrition.  I have spent the last 15 years working with the most amazing Bariatric team helping thousands of patients reach their wellness goals.  There is nothing more rewarding than watching a person work hard to regain their health back!

Every year thousands of people have surgical weight loss procedures and their results are a testament to their effort and hard work!  The misconception about weight loss surgery is that it is the easy way out and unless you have had surgery or worked with surgical patients you will never truly understand just how hard these patients work to be successful!

It's a lot of work and over time it is very normal for some patients to struggle.  The further one gets from surgery the easier it is for some of those old habits to return. I have seen first hand how frustrated and disappointed a patient can feel when they find themselves not losing or gaining the weight back. It is almost a feeling of hopelessness, like they have been down this road before and this will turn out just like all the other diets they tried in the past, with failure.  Which is why the back on track program was born.  I know that bariatric patients have the most successful weight loss tool in their arsenal, I just saw that they forgot how to use it, how it worked, and how to get the most out it.  I have been using a back on track program for years in my current practice and over and over again patients attend the sessions and leave with relief and hope that they can turn this around.  They can get back to losing again and more importantly finally keep the weight off for good.

So recently I made the decision to branch out and develop a more comprehensive back on track program that is accessible to any surgical weight loss patient in need.  I did some research and found that there really wasn't such a program out there to help patients like this.  I know that even in my own practice patients are hesitant to come back when they are struggling because they are embarrassed and hate the feeling of failing.  My hope is that by providing this comprehensive program online it will help those wanting it but reluctant to seek it out in their own program.

As of February 2017 I launched my first online group with 17 eager clients and it has been amazing.  They are clients of all ages, all physical capabilities and of all surgical procedures.  Some had surgery a year ago and have hit a plateau and some had surgery 10 years ago and are slowly gaining it back.  They are enthusiastic, motivated and ready to get on track. They are soaking up all the education and putting it to work in their own lives.  We are interacting on a daily basis, setting daily goals, and support each other in the process.  I am truly honored to work with them and even more excited to see their progress and results as the 6 week program progresses!  

Here is what my clients are saying:


Becky C. Gastric Bypass 2011

"I had lost 165 pounds from my gastric bypass 6 years ago but over the last few years had steadily gained weight back until I found that I had gained back 74 pounds. I had to do something but had not been successful with diets. Just when I was beginning to give up, I received an email about the Back on Track Program. It has only been two weeks and I have already lost 12 pounds! I went back to waiting an hour after a meal to drink, which helped a lot. I also think the morning coffee with the MCT oil and the 16 hour fasting has really helped me to lose quickly. This is something I can stick with. The alternating low and regular carb days also makes it easier for me to follow. I'm excited that my clothes are fitting me looser and I have hope now that I can stick with this and get this extra weight back off! Thanks Amanda!"

Angie F. Gastric Sleeve 2014

"I have found the program very beneficial to getting me back on track. The carb cycling & intermittent fasting has been easy to follow. I can already see a difference in just week 2. My clothes are looser & I feel better overall. Also, find the helpful hints for food prep & recipes and the information shared has been very beneficial to my getting back on track as far as my weight loss & overall health. Would highly recommend it anyone wanting to improve their health & wellness."

Pam S. Gastric Bypass 2003

"I have lost 6.2 pounds and 2-4 inches in just the 1st 2 weeks. I am thrilled to death with this program. I am so happy that this is being offered to all of past patients. Thanks to Amanda for being so helpful!"


The next session begins with prep week on April 3rd and the 6 week program on April 10th.  See below for more info about getting registered!  So stay tuned!  You are going to be seeing a lot more of me in the future! So much more to come!  My goal will be to provide relevant nutritional and wellness information and not just for Bariatric patients, but for friends and family too!  We can all benefit from living a healthier life.