Weight Regain After Bariatric Surgery: Prevalence, Etiology, and Treatment

Abstract

Given the high percentage of patients with weight regain after surgery, significant effort has been placed on developing treatment options in the last few years. Tremendous work has taken place in the realm of cognitive behavior therapy, appetite suppressants, and endoscopic procedures with the hope of reducing the need for revision surgery which can be associated with significant complications. Weight regain is unfortunately a common phenomenon associated with all weight loss modalities including bariatric surgery. We now have a number of treatment options that can reverse the weight loss trend.

Preoperative and post‐operative psychosocial interventions for bariatric surgery patients: A systematic review

“…For this reason, adjunctive psychosocial interventions are increasingly being recommended for bariatric patients, and the number of studies examining the impact of psychosocial interventions has blossomed in recent years. Liu conducted a systematic review of eight studies examining the impact of preoperative behavioural interventions on weight loss.…”

“…6 Weight regain has been attributed, in part, to a number of potentially modifiable factors including eating pathology, nonadherence to dietary and physical activity guidelines, and certain concurrent psychological disorders. [7][8][9][10] For this reason, adjunctive psychosocial interventions are increasingly being recommended for bariatric patients, 9,[11][12][13][14] Although weight loss and improvement in medical comorbidities tend to be the key metrics for determining the efficacy of bariatric surgery, a number of authors have advocated that psychosocial outcomes are of equal importance. Quality of life is a multidimensional construct composed of physical and mental components, yet bariatric surgery has a much greater impact on physical than mental quality of life.…”

Evolution of NAFLD and Its Management

“…Over the last few years, endoscopic therapeutic procedures have emerged as a weight loss option for individuals who have been unsuccessful in losing and sustaining weight loss with lifestyle interventions or medications and also do not wish to undergo bariatric surgery . Currently, similar to bariatric surgery, there are 2 major approaches to endoscopic bariatric therapies: restrictive and malabsorptive (Figure ).…”

Biobehavioural approaches to prevention and treatment: A call for implementation science in obesity research

“…3 Bariatric surgery, which to date results in the highest average percentage of total weight loss, is another biobehavioural treatment that alters fundamental aspects of digestive and hormonal physiology; however, behaviour change remains critical for long-term success, [29][30][31] as weight regain within 5 to 10 years is common. 5 Both bariatric surgery and pharmacotherapy are commonly used in conjunction with behavioural therapy in treating T2D or hypertension but are less often used in cases of obesity that have not manifested comorbid conditions. Biobehavioural convergence as an approach to weight loss and obesity management may have the greatest impact on long-term obesity outcomes and thus prevents T2D and hypertension in many patients.…”

“…Two years prior to this IOM report, the use of the term “biobehavioural” as related to obesity can be found . Decades of previous work have gone deeply into discovering detailed mechanisms to understand the contributing factors driving obesity and its complications, and by leveraging these discoveries from recent decades, scientists in our community can develop new and creative approaches using the biobehavioural framework. This mechanistic research has resulted in a broad but fragmented literature base that needs to be more fully integrated into a systems approach.…”