Weight Regain after Bariatric Surgery

What is it?

Weight regain is known as one of the most impacting long-term complications post bariatric surgery, though there is currently no clear definition to what exactly weight regain means. A recent poll from the International Bariatric Club, a group of experts in the field of bariatrics, determined that the two most favorable definitions of weight regain are regaining weight to achieve a BMI above 35", and/or "an increase in weight of above 10 kg (22 lbs.) from the patients lowest post-operative weight", respectively. No matter your definition, if you are a post bariatric surgery patient who is experiencing weight regain there is no denying it is frustrating, and can sometimes lead to feelings of defeat, anger, or even depression.

Why does it happen?

It is nearly impossible to pinpoint exactly what causes weight regain. Mechanisms behind weight regain stem from lifestyle, mental health, hormonal changes, surgical factors, or combinations of any of the previous mentioned.2 Behavioral drift, the slow movement away from a behavior or skill, is also common among patients experiencing post-surgical weight regain.3

What can you do?

If this is happening to you, your first thought might be "I failed". Rest assured, this is far from the truth. According to the American Society for Metabolic and Bariatric Surgery, "As many as 50 percent of patients may regain a small amount of weight (approximately 5 percent) two years or more following their surgery."4 While some weight regain may be tolerable, if you are feeling that your weight regain is getting out of control, here are 5 recommendations to help get back on track.

• Go back to the basics
  • Follow a balanced meal plan focusing on protein, and an adequate intake of vegetables, fruits, and healthy fats.
  • Drink at least 48 oz of fluids each day, avoiding high calorie fluids.
  • Increase movement throughout your day, and incorporate a weekly exercise regimen including some resistance training and aerobic exercise.
• Take your vitamins
  • Adhere to the vitamin/mineral regimen set by your bariatric team
  • Have your nutrition related laboratory values checked annually 
• Control life stressors
  • Stress plays a huge role in our hormone balance and eating patterns, and can therefore lead to weight regain
  • Find healthy ways to deal with stress; seek out a counselor, keep a journal, go for a walk, read a book, console in a trusted family member or friend, etc
• Set small, attainable goals
  • Trying to take on too much at once can be overwhelming
  • Identify behaviors or skills that helped you lose weight in the beginning (some examples might be food tracking, meal prepping, step counting, journaling, etc). Reincorporate those skills one or two at a time so that it’s manageable 
• Go back to your bariatric clinic!
  • Weight regain is common, and your bariatric team is there to help you, for life.  Attending support groups is a great way to stay involved in the community.
  • If you cannot go back to your original clinic, do not hesitate to find a new clinic. Other practices will be more than happy to continue your care! 

Before making any changes, it is important to consult with your doctor and bariatric team to ensure they are appropriate for you. 

Resources:

1. Nedelcu, Marius, et al. “Weight Regain after Bariatric Surgery—How Should It Be Defined?” Surgery for Obesity and Related Diseases, vol. 12, no. 5, 2016, pp. 1129–1130., doi:10.1016/j.soard.2016.04.028.
2. Maleckas, Almantas, et al. “Weight Regain after Gastric Bypass: Etiology and Treatment Options.” Gland Surgery, vol. 5, no. 6, 2016, pp. 617–624., doi:10.21037/gs.2016.12.02.
3. “Endocrinology: Weight Regain after Bariatric Surgery.” Mayo Clinic, Mayo Foundation for Medical Education and Research, 13 June 2018, www.mayoclinic.org/medical-professionals/endocrinology/news/weight-regain-after-bariatric-surgery/mac-20431467.
4. “Bariatric Surgery Misconceptions: ASMBS.” American Society for Metabolic and Bariatric Surgery, https://asmbs.org/patients/faqs-of-bariatric-surgery?/patients/bariatric-surgery-misconception.