Weight Regain After Bariatric Surgery: Scope of the Problem, Causes, Prevention, and Treatment

Abstract

Purpose of Review Although bariatric surgery is the most effective treatment of severe obesity, a proportion of patients experience clinically significant weight regain (WR) with further out from surgery. The purpose of this review is to summarize the prevalence, predictors, and causes of weight regain. Recent Findings Estimating the prevalence of WR is limited by a lack of consensus on its definition. While anatomic failures such as dilated gastric fundus after sleeve gastrectomy and gastro-gastric fistula after Roux-en-Y gastric bypass can lead to WR, the most common causes appear to be dysregulated/maladaptive eating behaviors, lifestyle factors, and physiological compensatory mechanisms. To date, dietary, supportive, behavioral, and exercise interventions have not demonstrated a clinically meaningful impact on WR, and there is limited evidence for pharmacotherapy. Summary Future studies should be aimed at better defining WR to begin to understand the etiologies. Additionally, there is a need for non-surgical interventions with demonstrated efficacy in rigorous randomized controlled trials for the prevention and reversal of WR after bariatric surgery.

Efficacy of Telephone-Based Cognitive Behavioral Therapy for Weight Loss, Disordered Eating, and Psychological Distress After Bariatric Surgery

“…4,5 However, 11% to 22% of patients experienced suboptimal weight loss within the first 2 years after surgery, and 10% or greater weight regain was reported by 23% and 72% of patients at 1 year and 5 years after surgery, respectively. 6 Weight regain is a major challenge facing bariatric teams. A systematic review identified 5 categories of risk factors associated with weight regain: temporal, anatomical, genetic, dietary, and psychiatric factors.…”

“…7 Furthermore, an additional review suggested that the most common factors associated with weight regain were dysregulated or maladaptive eating behaviors, lifestyle factors, life stresses, and depressive symptoms. 6 Data from systematic reviews and meta-analyses concluded that post-bariatric surgery eating psychopathology was associated with weight regain 8 and showed an association between depression and disordered eating, lower mental quality of life, and weight regain. 9 Given that weight regain has been associated with recurrence of medical comorbidities and deterioration in quality of life, 6,10,11 developing efficacious psychosocial interventions that target risk factors and prevent or reverse weight regain is imperative.…”

“…6 Data from systematic reviews and meta-analyses concluded that post-bariatric surgery eating psychopathology was associated with weight regain 8 and showed an association between depression and disordered eating, lower mental quality of life, and weight regain. 9 Given that weight regain has been associated with recurrence of medical comorbidities and deterioration in quality of life, 6,10,11 developing efficacious psychosocial interventions that target risk factors and prevent or reverse weight regain is imperative. 6 Several studies have examined the effectiveness of psychosocial interventions for improving disordered eating and psychological distress before and after bariatric surgery.…”

“…9 Given that weight regain has been associated with recurrence of medical comorbidities and deterioration in quality of life, 6,10,11 developing efficacious psychosocial interventions that target risk factors and prevent or reverse weight regain is imperative. 6 Several studies have examined the effectiveness of psychosocial interventions for improving disordered eating and psychological distress before and after bariatric surgery. Concerning timing of psychosocial interventions, those delivered before bariatric surgery did not yield sustained benefits in improved disordered eating, psychological distress, or weight loss after bariatric surgery compared with surgery alone.…”

“…In addition to reducing metabolic disease, it reduces mortality in patients with severe obesity . However, 11% to 22% of patients experienced suboptimal weight loss within the first 2 years after surgery, and 10% or greater weight regain was reported by 23% and 72% of patients at 1 year and 5 years after surgery, respectively …”