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Weight loss can be tricky. We can become victims of our own success. When you are able to lower your calorie intake on a consistent basis and lose weight, you will most likely reach a plateau. That plateau where the scale just seems to be stubborn and stuck at the same number for weeks at a time. Our body does this when calories are restricted because the metabolism begins to slow down to match the calorie intake. When you hit a plateau it is easy to become psychologically demoralized and begin to question the diet, hard work and sacrifice. Do not panic.This is a normal phenomena with losing weight and is a natural part of the weight loss process.
Following weight loss surgery, patients may lose weight fairly rapidly at first and then as time passes the weight loss becomes more gradual. Commonly, weight will stabilize at about 18 months after Roux en Y gastric bypass and duodenal switch. During these 18 months weight loss does not follow a predictable trend, but can be erratic with alternating periods of significant weight loss followed by no weight loss. Charting this weight loss may give the appearance of a stairway. It is not uncommon for patients to question why their weight loss has stalled at times and wonder if they are doing something wrong or if the surgery has not worked for them. This same trend can be seen after LAGB, however the weight loss will be more gradual and steady, averaging 5-10 lbs per month but continuing upto 3 yrs. Plateaus may occur if the band is not tightened, and therefore if this happens, the patient should consult with their surgeon for possibly a band adjustment.
Day to day or even week to week, fluctuations in weight loss occur due to many factors beyond just loss of fat mass. Water weight is probably the most common cause of this variability. This depends upon one's hydration status. Other factors besides fat mass that may result in inaccurate weights are current contents of the GI tract, gaining muscle mass and menstrual cycle in females. It is , thus recommended that patients should not weigh themselves too frequently. Exercise frequency and intensity may result in weight loss plateaus. An increase in meal frequency to high grazing or a decrease in frequency by starving during day and binge eating at night may also reduce one's ability to lose weight.
For surgeries that have malabsorptive component, the GI tract will adapt overtime to its new anatomic change. This adaptation may allow for better absorption of the consumed food, especially fats, reducing the benefits of surgery. Unfortunately nothing short of a further surgery can avert the adaptation effect. However, adhering to small meals high in protein may limit this effect. Anatomic factors exist which may limit one's ability to lose weight. With the RYGB, the size of the gastric pouch may change overtime. If it enlarges, it will accomodate larger meals. In addition, anastomotic dilation between stomach pouch may allow quicker emptying of the pouch reducing its effect on satiety and potential weight loss. Once dilation occurs, they cannot be reversed, and correction can only be obtained through surgical revision. With gastric band, the stoma may widen due to weight loss , at which point the band should be tightened with an adjustment. Weight loss can be resumed after this. For the same reason, after GB ,a patient should not drink during meals. This activity will result in more rapid transition of solid food from the gastric pouch eliminating the sensation of fullness and resulting in ingestion of larger portions.
In general it is normal to have periods of plateaus through all phases of weight loss after surgery. Recognize this plateaus as being normal. Don't focus on the scales too often. Adhering to the basic rules of eating correctly and exercising regularly may shorten the duration of a plateau and lead ultimately to greater longterm weight loss, improved balance, improved self confidence, and overall improved sense of well being.

Collectively known as inflammatory bowel disease, Crohns and ulcerative colitis produce chronic, uncontrolled inflammation of the intestinal mucosa. The underlying cause of IBD isnt clearly understood but research clearly suggests that bacteria and viruses or proteins ( antibodies) cause the immune system to overreact and produce inflammation in the GI tract. Two known antibodies that are sometimes found in the serum of patients with IBD are antineutrophil cytoplasmic antibodies( ANCA) and antisaccharomyces cerevisiae antibodies( ASCA). Infact ASCA are diagnostic markers for crohn's disease whereas ANCA are more likely to be identified in the serum of patients with ulcerative colitis. There are other antibodies associated with IBD as well
Crohns disease is seen in young and older adults. Its an inflammatory disorder affecting mostly the distal ileum and colon. The intestinal lining ulcerates and scar tissue develops. Generally seperated by normal tissue, fistulas, fissures, and abscesses form. The wall of the bowel thickens and becomes fibrotic which causes a narrowing of the bowel lumen. Formation of granulomas, inflammatory masses that result from a collection of immune cells called macrophages also occur in many patients. Sometimes the lesions have a cobblestone appearance. A fibrotic bowel with abscesses and granulomas can lead to perforation. Crohns disease results in malabsorption of water and nutrients, which may lead to fluid and electrolyte imbalances. Patients experience abdominal pain and cramping in the right lower quadrant of abdomen, especially after a meal. Inflammation of the bowel mucosa prevents water absorption, and the patient may experience more than 10 bloody diarrhea episode each day. Anorexia, weight loss, cachexia, weakness and fatigue are common. Fever may be present from the inflammatory process or due to infection. Anemia results due to poor dietary intake or poor absorption of vitamins and nutrients. Lesion that bleed may also lead to anemia. Bright red blood may be observed in the stool because of bleeding lesions or excoriation of anal mucosa due to frequency and amount of diarrhea.
Diagnostic endoscopy confirms the presence of intestinal lesions. A barium study of the upper GI tract wil commonly show a constriction of the terminal ileum in the patient with Crohns disease. This constriction is known as the string sign. There are "skip areas" seen unlike what is seen in ulcerative colitis where the lesion is continuous. IBD can mpact other areas of the body in addition to the GI system, including the eyes, liver, joints and skin. Systemic complications that occur in IBD include nephrolithiasis, cholelithiasis and pyelonephritis.

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