Gastric Sleeve Surgery (VSG) is a game-changer in your weight loss journey. It limits the amount of food you can eat and curbs your hunger. People opt for metabolic bariatric surgery when all the other choices, like diet, exercise, and medications, are not maintaining long-term results.

While gastric sleeve can lead to lasting weight loss for most, less than 30% of patients face challenges like not losing enough weight, regaining weight later on or developing severe upper GI issues.

Not reaching your target weight could be due to mental health, eating habits, hormonal changes, increased ghrelin levels, metabolic rate, genetics, lifestyle, or follow-up support. If you’ve found yourself experiencing weight regain and aren’t sure what to do, don’t worry! Here, we will go through EXACTLY what could be causing weight gain after gastric sleeve and how to reverse it!

Why am I Gaining Weight After Gastric Sleeve?

Some patients may regain weight after Laparoscopic Sleeve Gastrectomy (LSG), usually starting around 18 months to 6 years later. This can range from a fraction of excess weight to returning to nearly all the weight lost.

To reach and maintain your ideal weight after a sleeve operation, it’s crucial to plan ahead and avoid overeating, as your appetite can gradually return. Remember, you’re not alone in this experience. Just know that your weight loss will eventually stop, and weight gain can happen after gastric sleeve surgery.

Top 10 Causes of Weight Gain After Gastric Sleeve

Top 5 Causes of Weight Gain After Sleeve -Mexico Bariatric Center

1. Not Following Post-Op Diet Guidelines

Adhering to the pre-op and post-operative diet plan is crucial for successful weight loss after gastric sleeve surgery. Noncompliance with a proper diet makes it easy to fall into the trap of yo-yo dieting—a toxic cycle of losing and regaining weight. To maintain progress, prioritize nutrient-rich foods and avoid ultra-processed foods, artificial sweeteners, and liquid calories like soda.

2. Lack of Physical Activity

Weight loss happens when your body burns more calories than you eat, often by staying active. Aim for 150 minutes of cardio and 2-3 days of strength training each week. A great way to start is walking, running, dancing or using free weights. If gym anxiety is a concern, consider less crowded times like early mornings or late nights. Getting personal training or bringing a friend along can keep you motivated!

3. Emotional Hunger

Stress, depression, and anxiety often trigger emotional eating, leading to unhealthy food choices. This includes stress eating, where food is sought for comfort during tough times, and binge eating, consuming large amounts of food uncontrollably. To combat head hunger, seek support from a psychological therapist and practice self-awareness to break free from these patterns.

4. Genetics

Your genes can affect how likely you are to gain weight and how well you respond to weight loss treatments like surgery. Some people have genes that make it harder for them to keep weight off, even if they follow all the advice after surgery.

5. Hormonal Imbalance

After surgery, certain hormones in our body change, such as GLP-1, GIP, and PYY. Elevated postprandial GLP-1 (Glucagon-Like Peptide) levels help rapid weight loss and control of blood sugar. However, GLP-1 concentration might decrease because of genetics or lifestyle as it progresses. Weight gain can also happen because of hormonal shifts like ghrelin and leptin, which manage our feeling of fullness.[2]

Also, hormones like growth hormone and reactive hypoglycemia can mess with how we manage our weight. For women, going through menopause might make bariatric surgery less effective. This is because hormones like estrogen, which help control our appetite and how we burn calories, change during menopause.

6. Metabolic Adaptation

The body does a remarkable job of adapting to changes in calorie intake and energy expenditure post-surgery. In the bariatric population, resting expenditure (known as metabolic adaptation) decreases initially to promote rapid weight loss. This adjustment makes the body more efficient, burning fewer calories for the same level of physical activity.  However, the metabolic adaptation changes over time, and weight maintenance becomes more difficult.

7. Surgical and Anatomical Factors

After a gastric sleeve, problems like an increase in the stomach’s capacity for food, acid reflux, or blockages can happen. Another possible scenario is the surgeon’s technical errors, such as incorrect calibration with a bougie or incomplete dissection of the gastric fundus.

8. Medications

Some medications can affect weight by influencing appetite, metabolism, or fluid retention.

9. Lack of Sleep

Scientific research (National Library of Medicine) suggests poor sleep can disrupt hormones regulating appetite and metabolism, leading to increased food intake and decreased energy.

10. Chronic Disease

Chronic diseases, such as diabetes, heart disease, and hypertension, can impact weight management after sleeve gastrectomy. Managing these conditions is essential, as they can affect metabolism and complicate weight loss efforts.

Can Your Stomach Stretch?

It is a common misconception that the smaller stomach can stretch back to its original size. However, this is false. Rather than your pouch “stretching,” patients can see increased capacity for food. Overeating causes a loss of restriction, resulting in weight gain or increased capacity for food.

After gastric sleeve surgery, the stomach size holds roughly 2-3 ounces of food as opposed to the average 40 ounces. All patients progressively increase their capacity for food.
Patient’s appetites tend to increase, as shown below:

  • 1 month: 2 to 3 bites per meal
  • 6 months: 3-4 ounces of food per meal
  • 1 year: 6 ounces per meal
  • 3 years: 8 ounces per meal
  • 5+ year: 8+ ounces per meal

As your body adapts to the new stomach size, neurohormonal changes occur and will adjust after gastric sleeve surgery. Patients may encounter slight dilation with bad eating habits for long periods. The goal is to avoid increasing your stomach’s capacity more than it will naturally.

Does hunger hormone grow after gastric sleeve?

After gastric sleeve surgery, levels of the hunger hormone ghrelin typically decrease significantly. During a gastric sleeve surgery, a portion of the stomach is removed, including the area where ghrelin is produced. As a result, the production of ghrelin is significantly reduced, which can lead to decreased feelings of hunger.

However, over time, ghrelin levels can gradually increase, though they often remain lower than pre-surgery levels. This means you may still experience reduced hunger compared to before the surgery, but some hunger sensations might return. Patients should focus on eating lean proteins, healthy fats, and drinking sugar free beverages. Nuts and seeds can also help curb cravings (after 8 weeks post-op).

How to Restart Weight Loss After Gastric Sleeve?

Gastric sleeve surgery is not a perfect “fix-all” solution. It’s more like a tool you can use to help you lose weight. Some people might find it easier to lose weight after surgery, while others might struggle more. If you’re having trouble, here are some options to help you lose weight again:

  • Speak with your nutritionist
  • Cut out all added sugar from your diet
  • Increase water intake to a minimum of 64 ounces
  • Find a healthy meal plan
  • Try out the 5-day pouch reset diet or the 10-day pouch reset diet
  • Join our Facebook support group to get advice from past patients
  • Start a food journal to understand your eating habits and what types of food are causing weight reganance
  • Revision surgery is the best method to get back on track when all else fails

Gastric Sleeve Revision

Gastric Sleeve Revision Options -Mexico Bariatric Center

If you fail to get to your goal weight or feel less restricted, many revision options are available for the gastric sleeve. Our top bariatric surgeons specialize in these adjustments for better results. Popular revision procedures include:

Patients who had sleeve revision surgery saw a decrease in body mass index (BMI) from 55.4 to an average of 35, and average loss of 68.9% excess body weight (ScienceDaily)

See if you qualify for sleeve revision!


Insufficient weight loss after gastric sleeve surgery may be frustrating, but with the right strategy, you can get back on track to weight loss. At Mexico Bariatric Center®, we’re dedicated to giving our patients the education, resources, and encouragement needed to maintain their success. Our expert healthcare team provides tailored counseling and nutritional advice to help you achieve your goals. We empathize with the obstacles you might encounter and are ready to guide you through every stage of your journey.

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