Possible Weight Regain Managements after Bariatric Surgery

Abstract

Obesity is an uprising trend across the world resulting in huge costs for healthcare systems and declines in the quality of life in patients. Bariatric surgery is one of the most effective approaches to weight loss. Although bariatric surgery can be considered as a minimally invasive approach it has a series of complications such as weight regain 1 to 4 years after surgery. Nonetheless, most patients achieve sufficient weight loss, but the other subjects with supervised strategies would be able to manage food intake and change problematic lifestyles to continue the weight loss process. In this review article, we aim to gather valuable interventions performed and reported by researchers to manage weight regain in bariatric patients. Weight regain is a multi-factorial condition owing to hormonal imbalances, nutritional deficiencies, physical inactivity, mental health disorders, problematic dietary behaviors, medical issues such as thyroid, adrenal, kidney, or heart problems, taking new medications, diabetes relapse, and pregnancy, as well as anatomic and surgical factors. Therefore, its remission needs interdisciplinary approaches.

What About My Weight? Insufficient Weight Loss or Weight Regain After Bariatric Metabolic Surgery

“…These RFs include preoperative BMI, male gender, psychiatric conditions, comorbidities, age, and genetic predisposition-epigenetic factors ( 3 , 35 ). Some modifiable RFs, including unhealthy dietary habits, food intolerance, eating disorders, poor long-term follow-ups, insufficient patient knowledge, and lack of sufficient physical activity, are significantly associated with WR ( 48 ) due to their potential effects on loss of appetite control and increased eating frequency ( 49 ). Consequently, WR could refer to the metabolic overfeeding process, defined as nutrient excess and positive energy balance, along with diminished energy expenditure and resting metabolic rate.…”

“…Reduced metabolic rate results from adaptive thermogenesis following post-bariatric weight loss and alterations in fat mass and lean body mass in the first six months ( 17 , 36 ). As mentioned earlier, WR might also be a result of changes and imbalances in the gut and adipocyte hormones, which comprise rising ghrelin, neuropeptide Y (NPY), insulin sensitivity, and dropped peptide YY (PYY), cholecystokinin (CCK), glucagon-like peptide 1 (GLP-1), serotonin, and leptin and eventually hypoglycemic, and even insulin resistance ( 17 , 36 , 49 , 50 ). Finally, abnormal estrogen levels among women have been implicated in WR ( 49 ).…”

“…In addition, limitations intake in terms of sweetened drinks, including fruit juices, sports (energic) drinks, sweetened waters, regular soda (not sugar-free ones), coffee and tea beverages, along with added sugars and high-fructose corn syrup, because following such foods-eating impaired proper ghrelin response, have been advised to reduce ghrelin, which can act as the hunger hormone ( 49 ). It has been well recognized in the literature that the balance of estrogen in women can be made by having fiber-rich sources, flax seeds, and cruciferous vegetables, such as arugula, bok choy, broccoli, brussels sprouts, and cabbage ( 49 ). As a result, a registered dietitian should recommend and plan a high-protein, low-glycemic index, lower caloric-density foods (raw fruits and vegetables), and low-fat content diet for patients who experience WR or avoid weight gain ( 17 ).…”

The role of serotonin hormone on weight loss maintenance after sleeve gastrectomy: a systematic review

“…Diet plays a significant role in regulating serotonin levels. High-fat and high-sugar diets can decrease serotonin transporter (SERT) binding, potentially lowering serotonin levels [ 48 ]. For instance, the ketogenic diet (KD), characterized by low carbohydrates and high fats, can influence norepinephrine, dopamine, and serotonin concentrations [ 49 ].…”