Patients’ Experiences of Weight Regain After Bariatric Surgery

Abstract

Purpose Bariatric surgery is a successful obesity treatment; however, an estimated 1/5 of patients have regained more than 15% of their body weight 5 years post-surgery. To increase the understanding of patients who experienced weight regain after bariatric surgery, we conducted a qualitative study. Materials and Methods We recruited 16 adult participants (4 men, 12 women) at an obesity clinic in Stockholm, Sweden, 2018 to 2019, and performed semi-structured individual interviews. The transcribed recorded interview data was analyzed with thematic analysis. Results Participants had undergone gastric bypass surgery on average 10 years prior to study and regained 36% (range 12 to 71%) of their weight from their nadir. Participants experienced challenges such as eating in social settings, loneliness, family difficulties, increases in appetite, and physical and mental health problems, which distracted them from weight management. Participants responded to weight regain with emotional distress, particularly with hopelessness, discouragement, shame, and frustration (theme: loss of control and focus). Nonetheless, participants experienced remaining benefits from the surgery, despite weight regain. Social support, self-care, and behavioral strategies were perceived as facilitators for weight management (theme: reducing the burden of weight management). Conclusions Weight regain after bariatric surgery was perceived to be an unexpected and difficult experience that induced hopelessness, discouragement, shame, and frustration. Results indicate that internal and external circumstances such as psychosocial factors, changes in appetite, and physical and mental health problems may contribute to loss of control over weight. Social support, self-care, and behavioral strategies might facilitate long-term post-surgical weight management. Graphical abstract

Behavioral Interventions to Attenuate Driven Overeating and Weight Regain After Bariatric Surgery

“…While emotion-based eating generally leads people to consume highly palatable foods, patients typically avoid these foods due to care team recommendations and/or due to negative physiological responses to ingestion of high-sugar, high-fat foods (e.g., dumping syndrome) in the months following bariatric surgery. Over time, these physiological responses may diminish, leading to increased poor-quality food consumption ( 13 , 42 ). A final mechanism in a patient’s return to emotion-based eating after having bariatric surgery may be related to improved emotional states over the short term, leading to less desire or need to use food to cope with negative emotions.…”

“…Maintaining weight loss requires substantial effort as patients experience biological and environmental pressures to regain weight ( 74 ). That is, after having achieved nadir weight loss, patients may be unprepared to experience increased hunger, desire for highly palatable foods, increased portion sizes, and driven overeating ( 13 , 75 , 76 ). Standard behavior modification strategies for weight loss have consistently included goal setting, self-monitoring, stimulus control, contingency management, problem solving, thought restructuring, social support, and stress management ( 77 ).…”

“…Because of the metabolic changes induced by bariatric surgery combined with behavioral effort, patients are typically rewarded with large weight loss and substantial improvements in health within the first year. However, when weight loss diminishes and stops, the powerful effects of reduced appetite and physical restriction induced by bariatric surgery are attenuated ( 13 , 75 , 76 ). Some postbariatric surgery patients may perceive these experiences as unexpected, distressing, and harbingers that their surgical weight loss tool is not working anymore, leaving them vulnerable to weight regain.…”

“…Destabilizing events that result in loss of control and focus on health behaviors are often unexpected and perhaps not immediately perceived as risk factors for weight gain. These events may include life challenges (e.g., prioritizing caregiving responsibilities over personal health, financial problems, housing insecurity, loss of employment and healthcare benefits), increased appetite, and changes in physical and mental health (e.g., prescribed weight-promoting medication) ( 13 ). The experience of weight regain after bariatric surgery is likely to induce feelings of disappointment, frustration, fear of regaining back to their heaviest weight, and shame ( 13 , 75 ).…”

“…In the first year after surgery, patients may experience reduced cravings, changes in preference for highly palatable foods, and altered responses to environmental food cues ( 12 ). Beyond the first year, however, some patients report experiencing increased hunger, food cravings, portion sizes, and tolerance for highly palatable foods ( 13 ). Problematic eating behaviors are described in the literature in different, ways including hedonic eating, loss of control eating, food addiction, compulsive eating, binge eating episodes, reward-based eating, emotion-based eating, grazing, and other terms ( 14 ).…”