"When the honeymoon is over, the real work begins:" Gastric bypass patients' weight loss trajectories and dietary change experiences.

To understand gastric bypass patients' experiences with managing food and eating for long-term weight management, this study examined patients' self-reported dietary changes and weight loss patterns. Thirteen women and three men between 15 months and 10 years post-gastric bypass surgery were recruited in Upstate New York. They completed two qualitative, in-depth interviews about their weight loss and dietary experiences. Using verbatim transcripts, researchers created timelines for each participant that summarized weight changes and the associated dietary behaviors. Constant comparative analysis of the timelines and transcripts identified a common, initial rapid weight loss period followed by weight stabilization, after which participants' weight loss patterns diverged into three possible long-term trajectories (Maintaining, Regained/Losing, and Regained) and one short-term trajectory (Losing). Dietary management over the periods of weight loss involved six components: physical needs, hunger and fullness, relationship with food, strategy use, habit formation, and awareness of eating. In the "honeymoon period" weight loss was "easy" because "surgery does the work" in limiting appetite, portion sizes, and interest in foods. As weight stabilized, "the work begins" as participants became capable of eating a greater quantity and a wider variety of foods. Differences in weight loss trajectories were associated with participants' abilities to maintain changes in relationship with food, dietary strategies and habits, and awareness of eating behaviors. Viewing weight loss outcomes of gastric bypass surgery as trajectories that develop as the result of dietary transitions and changes in dietary management suggests that patients need to be counseled on a variety of cognitive and behavioral strategies.