After years of struggling with “yo-yo” dieting, many patients understandably worry about weight gain after weight loss surgery. It is important to remember that obesity is a chronic disease and surgery, while a powerful tool, is not a cure. Bariatric surgery results in greater weight loss, resolution of associated diseases, quality of life improvement, and extended lifespan compared to nonsurgical treatments. However, up to 50% of patients regain some weight after maximal weight loss (also called their “nadir). The impact of the regain varies by patient and may result in recurrence of obesity-related medical problems.
Understanding factors contributing to weight regain can help patients and providers maximize the long-term health benefits of bariatric surgery. However, research on weight regain, its prevention, and treatment is still in its infancy. Studies show that beginning one year after bariatric surgery, many patients begin to regain weight. The relative contribution of behavioral changes (i.e. adherence to recommended diet and exercise) versus hormonal or genetic changes is unclear.
Many methods have been used to prevent and treat postoperative weight regain, including diet, exercise, weight loss medications, support groups, virtual support groups, online health discussions, and even revisional bariatric surgery. Some studies suggest addressing behavioral issues that contribute to overeating and sedentary lifestyles can limit weight regain. Despite many limitations in these studies, they demonstrate the potential efficacy of weight maintenance interventions. While no single method has been shown to prevent regain in all patients, it is clear that successful weight loss surgery necessitates permanent lifestyle changes. Patients must be committed to eating differently and changing their behavior to maintain their weight loss and its health benefits. Lifelong follow up with healthcare professionals is necessary to monitor for weight regain as well as nutritional deficiencies.
Our understanding of the science and management of obesity continues to evolve. There is significant room for improvement in the longitudinal management of severe obesity treated with surgery and behavioral interventions. The varying degree of weight loss and regain among patients undergoing the same surgical treatments suggests a complex relationship of biology and behavior best treated with a multi-faceted approach.
Please join us in the #obsm chat to discuss ways that all of us--health practitioners, patients, and advocates--can support patients in addressing challenges with post-surgical weight regain.
Sunday, April 9, 2017