Weight Regain and Insufficient Weight Loss After Bariatric Surgery: Definitions, Prevalence, Mechanisms, Predictors, Prevention and Management Strategies, and Knowledge Gaps—a Scoping Review

Abstract

Some patients experience weight regain (WR) or insufficient weight loss (IWL) after bariatric surgery (BS). We undertook a scoping review of WR and IWL after BS. We searched electronic databases for studies addressing the definitions, prevalence, mechanisms, clinical significance, preoperative predictors, and preventive and treatment approaches including behavioral, pharmacological, and surgical management strategies of WR and IWL. Many definitions exist for WR, less so for IWL, resulting in inconsistencies in the reported prevalence of these two conditions. Mechanisms and preoperative predictors contributing to WR are complex and multifactorial. A range of the current knowledge gaps are identified and questions that need to be addressed are outlined. Therefore, there is an urgent need to address these knowledge gaps for a better evidence base that would guide patient counseling, selection, and lead to improved outcomes.

Understanding Uncontrolled Eating after Bariatric Surgery: The Role of Excessive Skin and Body Image Shame

“…Bariatric surgery is currently the most effective and durable treatment for severe obesity, resulting in significant weight loss and substantial improvements in obesity-related comorbidities [1] and patients' psychosocial function [2]. With a variability of weight loss outcomes being observed particularly in the long-term, the mechanisms underlying individual weight-loss trajectories after bariatric surgery are not fully understood but are likely due to a complex interplay between surgery-and patient-related factors [3].…”

Impact of Bariatric Surgery on the Healthy Eating Index, Binge Eating Behavior and Food Craving in a Middle Eastern Population: A Lebanese Experience

“…This contradicts a retrospective study by Da Silva et al, which found that HEI predicted weight regain [11]. These differences may be explained by discrepancies in the definitions used to define weight regain, as well as baseline characteristics such as gender and type of BS [35,54,55]. Even though 'time since surgery' has been more evident in the literature as a predictor of weight regain [11,54] this latter variable lost its significance, in our analysis, after adjusting for binge-eating traits.…”

“…Assessment included the collection of information on demographics, surgery type and date, as well as the administration of dietary recalls to calculate HEI scores; the Binge Eating Scale (BES) and the Food Craving Inventory (FCI) were administered as described below. Weight regain was defined as any weight regain after the patient reached their lowest postoperative weight [34,35].…”

Bariatric Surgery and Liver Disease: General Considerations and Role of the Gut–Liver Axis

“…However, studies have shown that various parameters can affect the good outcomes of bariatric surgery, with some patients experiencing insufficient weight loss (around 50%, with a difference between the procedures) or weight regain (around 20–25%)[ 34 ]. The mechanisms involved in these suboptimal responses are not completely understood, but the causes are probably multi-factorial [ 35 ].…”

“…The mechanisms involved in these suboptimal responses are not completely understood, but the causes are probably multi-factorial [ 35 ]. They include sedentary lifestyle and low aerobic fitness [ 36 ], non-compliance to dietary programs (including grazing, sweet consumption, emotional eating, binge eating and maladaptive eating) [ 37 ], hormonal activity (for example, a reduction in the alteration of ghrelin, leptin, and incretins levels) [ 38 ], mental health causes and surgical procedure-related factors, such as the volume of the gastric pouch, gastro-gastric fistula or gastro-jejunostomy stoma dilatation [ 34 ]. A recent study outlined some preoperative factors related to weight regain after BS, emphasizing the importance of preoperative body mass index (BMI) and type of surgery [ 39 ].…”