Weight Regain After A Successful Bariatric Procedure

The stomach is an exceptionally versatile organ. It’s high level of adaptability is both a blessing, as we can perform successful surgical procedures to reduce its size, but also a curse because it can easily stretch to accommodate overeating. Before we delve into the causes of unacceptable weight regain, we should discuss when weight gain after surgery is perfectly normal:

• Most patients, regardless of the procedure they undergo will regain some weight between the first and third years after surgery. This often comes after a prolonged period of consistent and significant weight loss. The reason is simply due to the normalization of the diet. Once additional calories are consumed, it stands to reason that some weight would be regained.
• Further, just like an elastic band, over time the stomach begins to stretch naturally. We are typically not concerned by minor weight regain of up to 5-10% of the excess body weight lost previously. We also remain unconcerned by small fluctuations over short periods of time. These are often due to hormonal changes, menstrual cycles in women and life’s ups and downs.
• Lastly, patients may begin to gain weight if they start a significant muscle building / weightlifting regimen. Muscle tissue is denser than fat and as they begin to work out more, they may gain weight. This is a temporary occurrence but can last a few weeks after beginning the exercise regimen. Further, as muscles are stressed during exercise, they tend to tear and retain water, also adding weight.

When Weight Regain Becomes A Concern

There are several situations when weight regain may become concerning, some of which follow

• Extreme fluctuations in weight – both up and down – Have to be evaluated. Some patients may develop an eating disorder including bulimia or anorexia. Others may allow themselves to overeat and then crash diet. First, we will evaluate a patient’s lifestyle and eating habits to try to determine what may be wrong. This is a time to be very open and honest with your surgeon so he or she can offer the most appropriate course of action. Do not be embarrassed by faltering – every bariatric patient has failed at some point. It is how you pick yourself up and get back on the program that counts.
• In other cases, specifically with the gastric bypass, the stoma, or the opening between the stomach and the small intestine created during surgery, may begin to stretch. This is again, often due to poor lifestyle habits after surgery. Stretching of the stoma allows the patient to eat more but will also increase the risk of a very rapid gastric emptying / dumping syndrome after meals. If the weight regain is due to dilation of the stoma, various endoscopic procedures including Transoral Outlet Reduction or TORe are available to correct it.
• While rare, the procedure itself may fail, even if the patient has followed their post bariatric diet. This is especially true of the gastric band / Lap-Band® which has shown a higher risk of weight-regain-related complications after surgery, versus stapled procedures. We usually begin testing for the failure of the procedure only after all lifestyle related problems are ruled out.
• A note on balloons: Remember, this is a temporary weight loss system. Once the balloon has been removed from the stomach – after approximately 6 months – it is up to the patient to maintain their new and improved diet and exercise regimen. If they do not, they may regain weight – sometimes rapidly. It is therefore important to stick to the post-procedure lifestyle and take full advantage of the 1 year of supervised weight loss.
• At times, weight regain can occur due to medications, genetic, or hormonal reasons. These are usually found during testing when other causes of weight regain have been ruled out. In cases where the underlying condition can be treated or managed, patients often shed some excess weight.

Resolution of Weight Regain

Resolving weight regain and allowing the patient to begin losing again is possible and hope should not be lost. In cases where lifestyle issues are at fault, patients work with our dietitians, nurses and their surgeon to develop a ”Get Back on Track” plan. While it can be frustrating and upsetting to regain weight, following this plan helps patients refocus their attention on their health. If the weight regain was caused by disease, hormones or medication, we work in conjunction with primary care physicians and appropriate specialists to adjust care.

If the procedure has failed or if irreparable changes have occurred to the stomach or stomatal opening, revision surgery may be necessary. This is a secondary bariatric procedure that carries additional risk but offers the patient a second chance of losing weight.

While the potential for weight regain is a real and frustrating part of any weight loss program, surgical or not, remember you have a team of professionals at our office, a group of people with similar experiences at your support group and, and with luck, supportive family and friends around you. Utilizing your support system is one of the best ways to stay on track. It is also a great way to get back on track when you hit a hurdle. As with any other post-operative concerns, we encourage you to contact our office for more information.