In 2018, Juana Navarro decided to go under the knife. At 36, the logistics manager had battled obesity all of her adult life.
At 297 pounds, she decided to have a gastric bypass and lost almost 130 pounds over 18 months. Afraid of getting sick, she was militant about sticking to the post-surgery diet.
Eating two eggs instead of one was enough to make her feel terrible. When she was furloughed in 2020, she started working out three times a day. "It was the best shape of my life," she says.
But over time, life got busy again. Her habits slipped and her stomach adapted so that she could eat more food. "Now I can eat anything," she says. Her weight started creeping up again until she’d regained 60 pounds.
It wasn’t the first time. In 2012, when Navarro first moved to Queens, she managed to lose 70 pounds with diet and exercise. But once she made friends and started socializing, all of the weight came right back. It was disheartening to say the least.
"I was like, 'Damn! After all that hard work – here we go again.'"
This boomerang effect is a common theme in obesity treatment, says Fatima Cody Stanford, MD, MPH, an obesity medicine physician-scientist at Massachusetts General Hospital.
In the U.S., 42% of adults have obesity. And many of them struggle repeatedly to lose weight. Even those, like Navarro, who succeed for a time often gain it back.
So how do you get back on track?
Where Do You Start?
The basics are a good place to start, Stanford says.
Reexamine your diet. Are there places where you have slipped or could improve? Are you eating between meals? Could you cut added sugar? Quit sugary drinks or fast food? Add more vegetables, lean protein, and whole grains?
What about a shorter eating window? There’s some data showing intermittent fasting, where you only eat within an 8- to 10-hour window and fast the rest of the day, can help with weight loss. Consult your doctor or nutritionist if you’re unsure of the best diet for you or before making drastic changes to your eating habits. And whatever changes you make, try to make them reasonable so they’ll be sustainable over the long term.
Exercise is also important. But note that it often works best to help prevent further weight gain rather than to help you lose weight that you already have, Stanford says.
A healthy sleep routine can also help with weight loss, she says. Good sleep hygiene can include waking at the same time every day, shutting down digital devices before bedtime, and maintaining a calming and consistent pre-bedtime routine.
Still, if you’ve tried adjusting lifestyle factors and struggle to stick to them, you’re not alone, says Melanie Jay, MD, an obesity medicine expert at NYU Langone. An examination of multiple studies found that on average, a person will regain half the weight they’ve lost within 2 years and 80% of it within 5 years.
"That’s part of the condition. Don’t beat yourself up," Jay says.
Look for others to lean on, Jay says. Consider signing up for a lifestyle intensive, a group at your local YMCA, or the Move program at the VA, she says. Or if you struggle with emotional eating or binge eating, seek out a behavioral health professional who can help you deal with those challenges as they could hinder your obesity treatment.
When Lifestyle Changes Aren’t Enough
Healthy habits and psychological support are good foundations, but for many patients they don’t lead to meaningful weight loss, says Stanford at MGU.
It’s not uncommon for her patients to cut out fast food, increase lean protein, and add more vegetables only to lose 2 pounds, Stanford says.
One reason for this, says Stanford, may be because their brain is defending a higher weight set point – a theory that the brain adjusts hunger signals and fat storage to keep the body at a certain weight. Though more research is needed, the theory states that in some people, the brain fights to keep them at a leaner weight, while in others, it does the opposite – resisting lifestyle interventions by promoting appetite and fat storage to keep them at a higher weight.
Whatever the reason, when lifestyle and behavioral interventions fail repeatedly, it may be time to consider other things like surgery or medication.
Gastric sleeve or gastric bypass surgeries reduce the size of the stomach and length of the small intestine so patients feel fuller sooner and absorb less of the food they eat. There’s evidence that these procedures also directly impact the brain by altering hormonal and neural appetite signaling. Still, like Navarro, many people regain significant weight after these surgeries, especially without careful and consistent lifestyle changes.
Medications for weight loss have a variety of different targets. Some reduce fat absorption and others suppress appetite. A newer class of weight loss medications, which includes Mounjaro, Wegovy, and Zepbound, mimic a hormone called GLP-1 that regulates appetite and food intake in the brain.
Some patients with obesity have seen significant weight loss with GLP-1s. Clinical trials report up to a 20% reduction in body fat and improvements in blood pressure, lipid levels, fasting insulin, physical function, and waist circumference. But studies show people gain two-thirds of the weight back when they stop these medications. And many people don’t want to stay on GLP-1s long term, either because of the cost, access, or side effects.
Beware of getting GLP-1s from wellness clinics advertising lower-cost medications (sometimes found to be counterfeit) without the help of a doctor, says Jay. Seek out a provider specializing in obesity who can offer you individualized and holistic care, not just a prescription for an injection, she says.
There are no guaranteed one-time fixes for obesity, says Jay. Weight regain is common even for the most effective interventions. That’s why – as with high blood pressure, diabetes, and other chronic illnesses – it’s critical to take a long-term view of the condition and its treatment.
Finally, says Stanford of Massachusetts General Hospital, remember that no two people have the same disease. Some patients have battled obesity since childhood and tried many different approaches. Others developed obesity in midlife or later life or as a result of illness or injury. So their treatment strategies and progression won’t be the same either, she says.
"The key thing in this journey is to compare ourselves to none other than ourselves."
‘A Commitment You Make to Yourself’
Juana Navarro has not given in to her obesity.
"One hundred percent, I know the way I’m eating has changed and that’s why I’m gaining weight," she says. But she’s determined to get help before she regains more.
She plans to ask about GLP-1s at her doctor’s appointment in September. Her surgeon suggested a follow-up surgery is one way to see more results, but she wants to know all her options before choosing surgery for a second time.
Medical help and good nutrition helped her lose weight before, and she’s confident it can work again. "It's a commitment you have to make to yourself," she says. "I don’t want to get to 300 pounds again."
