#obsm July 14, 2019: How to approach weight regain? Let’s chat!
By Nate Sann, FNP-BC
Obesity affects over two thirds of Americans and is one of the most prevalent chronic diseases in the United States. It is associated with other significant disease processes such as diabetes, hypertension, obstructive sleep apnea, nonalcoholic fatty liver disease, and multiple types of cancer to name a few. To date, bariatric surgery has been the most effective treatment for persons with moderate to severe obesity. Even so, only a small fraction of people with obesity proceed with surgery. Many others lose weight with lifestyle change.
After weight loss through bariatric surgery or other methods, people often experience improvement or complete resolution of these obesity related conditions. Unfortunately, some people do not see these results because they either have inadequate weight loss or experience weight regain. Patients and health care professionals alike need to focus on addressing these issues. Weight regain is multifactorial. Contributing factors may include dietary, physiological issues, psychological issues, medication changes, metabolic imbalances, behavior changes, sedentary lifestyle, or lack of physical activity. In the bariatric surgery context, additional factors such as mechanical issues with a primary bariatric surgery and postoperative complications may also play a role. Some people may not achieve their goal weight loss after surgery.
When evaluating weight regain, it is important to be sure that all relevant lifestyle factors (e.g., diet quality, physical activity, sleep, and stress level) have been optimized and that any medical conditions negatively impacting weight are considered and ruled out (or treated). In addition, for those who have had bariatric surgery, the doctor and patient should ascertain whether there is any anatomic reason for weight regain with a thorough history and physical as well as diagnostic studies. If a mechanical problem is found, re-operation to fix the issue may be an option.
The health care professional and patient may also want to consider other treatments, including medications. In past decades pharmacotherapy had been aimed at short-term intervention. But advances in medications in the past decade now offer intermediate and long-term treatment options. Having these pharmacotherapy options available, tailored to the patient's needs, can suppress hunger and cravings, helping the patient with additional weight loss. For those who have had surgery, revisional bariatric surgery may be an additional option.
In this month’s #obsm chat, we will be discussing treatment options for weight regain.
1. What are the options for someone who has weight regain or inadequate weight loss? Are there different options for patients who have had bariatric surgery?
2. There can be a negative perception around inadequate weight loss or weight regain that may create feelings of shame for patients. How do we address this bias and determine a treatment plan?
3. From the healthcare professional’s perspective, determining the appropriate medication for weight management can be difficult. When is medication indicated, and how do you select the appropriate one for each patient?
4. From a patient perspective, taking medication may be a difficult choice. What hinders people from taking medications to treat obesity?
5. In what circumstances do you recommend (or as a patient, consider) revisional bariatric surgery?
6. What are realistic expectations with results from taking medications or having revisional surgery? Any other thoughts related to weight regain?