October 2018 #obsm chat. Is Weight Regain Inevitable?

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October 2018 #obsm chat.  Is Weight Regain Inevitable?
Like it or not, the brain and body are wired for survival.  This impacts many functions, and one of the most important yet frustrating examples of this involves weight loss and subsequent weight regain.  Since most people have dieted at some point, if not chronically, nearly all are familiar with the dreaded boomerang properties of body weight. A study several years ago showed that while most people will lose weight with diet and exercise within the first year, nearly all of them will put back all but 2 lbs. in the next two to five years.  An exception to this rule seems to be those who have had bariatric surgery. The majority of these people tend to keep most of the weight off. However, some weight regain is expected even after surgical intervention.
There are many reasons why weight regain is the norm rather than the exception.  Hormones, which exert great control over emotions and eating behavior, are altered following weight loss.  The famous study by Kevin Hall with The Biggest Loser participants following their return home showed that the majority experienced weight regain.  A significant influence in that case proved to be lower levels of leptin, a hormone stored in fat, which signals that we’ve had enough to eat.  Other evidence suggests that people who lose weight have increased levels of ghrelin, a key hunger hormone,. These and other constitutional factors strive for homeostasis, getting the body back to where it was before one started losing weight.  In addition, life events, such as having a hysterectomy with removal of the ovaries, childbirth, or thyroid problems can add to the problem of weight regain.
For many trying to lose weight, mindful eating tends to decline over time, meaning eating more rapidly, not chewing as thoroughly, spending less time meal planning, and being more likely to eat while distracted. With bariatric patients, it becomes easier to eat a wider variety and larger portions of foods after a period of months, and the feeling of hunger returns. Unfortunately, there are a significant number of common medications which promote weight gain and this can be detrimental to one's ability to keep weight off. In a study published last month, sleeve gastrectomy patients taking these obesogenic medications had significantly less weight loss after a year than their peers who weren’t taking them.
Social pressures can be an influence too. People around the individual trying to keep weight off may feel uncomfortable with the change in their spouse, partner, sibling, or friend.  Similarly, those who socialize with the person who has lost weight may put subtle or not so subtle pressure on that person to loosen up and enjoy eating more the way he or she used to do.  Jealousy and perceived threats of loss of a relationship can lead to sabotaging the efforts of the person with weight loss. Even issues such as cooking for a family whose eating habits haven’t changed can erode the ability to stick to a specific diet.
Emotional issues can be a significant piece of weight regain.  A return to or genesis of disordered eating patterns can play a role in putting back what was taken off before.  Grazing, or picking at food over extended periods of time, is particularly common, but there can also be binge eating behaviors, or eating larger quantities at night when it is harder to burn the calories.  Some individuals who have experienced trauma may lose the sense of safety they had at a higher weight and may start regaining as a result. In certain cases, especially after a gastric bypass or sleeve gastrectomy, there is also an increased risk of alcohol use issues, leading to taking in large quantities of liquid calories.
A specific issue for bariatric patients can be unexpected physiological problems.  Whether a prolapse after gastric band; acid reflux after a procedure leading to taking in soft, highly palatable foods; gastric fistulas; or enlargement of the bypass pouch or gastric sleeve, anatomical issues may lead to weight regain.
There are a myriad of reasons why weight regain is so common, and our goal in this #obsm chat is to discuss these and see how they relate to individuals.
Q1.  What has been your personal experience or your patients’ experience with weight regain following weight loss?
Q2.  Is weight regain inevitable?  What does it take to prevent this from becoming a significant issue?
Q3.  What behavioral strategies can you employ to minimize or reverse weight regain?
Q4.  What biological strategies can you utilize to minimize or reverse weight regain?
Q5.  How can you put weight regain in perspective so as to stay committed to ongoing weight loss?
Tomiyama, A. J., Ahlstrom, B., & Mann, T. (2013). Long-term effects of dieting: Is weight loss related to health? Social and Personality Psychology Compass, 7(12), 861–877. https://doi.org/10.1111/spc3.12076
Fothergill E, Guo J, Howard L, et al. Persistent metabolic adaptation 6 years after The Biggest Loser competition. Obesity (Silver Spring, Md). 2016;24(8):1612-1619. doi:10.1002/oby.21538.
Leggett C, Athanasios P Desalermos, S. Danielle Brown, E Lyn Lee, James A. Proudfoot, Santiago Horgan, Samir Gupta, Eduardo L Grunvald, Samuel B. Ho, Amir Zarrinpar. The effects of provider-prescribed obesogenic drugs on post-laparoscopic sleeve gastrectomy outcomes: a retrospective cohort study. International Journal of Obesity(London). 2018: Sept 21. Epublished ahead of print.

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