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Weight Regain after Bariatric Surgery

Before and After BMI

October 12, 2021

Weight Regain after Bariatric Surgery

Every year, over 200,000 Americans opt for bariatric surgery, particularly gastric sleeve surgery, in pursuit of their weight loss and health goals. This procedure’s popularity is due in part to its effectiveness, as most patients will lose a significant amount of excess body weight with an average decrease of 60-75% in excess body weight after two years post-operation.

For the millions suffering from severe obesity or obesity-related health issues who are struggling to lose weight via conventional methods alone (diet and exercise), weight loss surgeries are typically a safe intervention that can be life-changing. In addition to significant weight loss, patients typically experience measurable improvements in co-occurring disorders such as high cholesterol, sleep apnea, hypertension, and type 2 diabetes, as well as decreases in cardiovascular risk (heart disease, stroke) and even risk of cancer. 

While broadly considered the most effective intervention for weight loss — as well as delivering some of the best long-term weight maintenance — bariatric surgery is not a silver bullet for permanent change. Unfortunately, no such single solution exists. It is, therefore, highly common for patients to experience some degree of weight regain in the years following the procedure.

While most patients regain a modest amount of weight — anywhere from 20% to 50% of lost excess body weight — some will regain more and, in some cases, patients may regain all of their excess body weight. For some prospective patients — many of whom have already dealt with “yo-yo dieting” — the mere fear of weight regain might be enough to discourage them from the procedure altogether, depriving them of a powerful and generally effective intervention.

In this article, we’ll take an in-depth look at the phenomena of weight recurrence so that prospective patients can go into the process with eyes wide open, while post-op patients can calibrate more realistic expectations and determine their best next steps.

How Common is Weight Regain After Bariatric Surgery? What Studies Show

To better understand the real risks of weight regain after bariatric surgery, let’s take a look at some of the data on postoperative results.

Unsurprisingly, there is no single, uniform postoperative experience, particularly when measured over the ensuing decade

According to UCLA, bariatric patients on average regain about 30% of their excess body weight within 10 years. However, in some cases, up to 25% of patients will regain all of their excess body weight within 10 years. That number may seem daunting — one in four — until we remember this also means that a full 75% of patients avoid this scenario a full decade later.

Causes of Weight Regain After Bariatric Surgery

Of course, no patient commits the time, energy, and finances toward bariatric surgery with the aim of eventually regaining all of their lost weight. But many patients may be dissatisfied with any gained weight that they’ve worked so hard to lose. So why does this happen? 

Although there are circumstances in which anatomical or surgical factors contribute to weight recurrence, in the vast majority of cases, the major factor is behavioral. Specifically, it is exceedingly common for patients to struggle to maintain a healthy diet and lifestyle over the long term.

None of this should surprise us, as any behavioral scientist will tell you that humans find new habits very difficult to make and maintain. “Regression to the mean”, “behavioral drift”, or, plainly put, relapse, is highly common over time. Often, a bariatric patient has already struggled to commit to consistent, healthy habits prior to surgery. As helpful and motivating as the surgery can be, it cannot completely rewrite entrenched, counterproductive habits. 

Dietary Factors in Weight Regain After Bariatric Surgery

In the months and even years post-surgery, most patients remain diligent with exercise habits and healthy eating after bariatric surgery. They eat controlled portions while cutting out fast food, high-calorie drinks, and a “grazing” approach to eating. They stay active and build muscle mass, avoiding the trap of a sedentary lifestyle. 

Over time, however, many will gradually and unconsciously relax the rigor with which they practice good habits. They adapt to their new normal, disconnecting from the motivation to change that used to accompany looking in the mirror, getting on the scale, or seeing a doctor. Weight regain often reflects this gradual relaxation of healthy habits — slowly, even imperceptibly, they will add back the excess body weight they worked so hard to lose.

Unfortunately, the stomach will respond in kind over time to this behavior, literally stretching and expanding over the ensuing years, enabling more food consumption before feelings of satiation kick in.

If a medically significant trait such as binge eating disorder was previously present, the risk of weight recurrence inevitably goes up. Drug and alcohol abuse can also present major complicating factors, threatening the patient’s commitment to healthy habits.

Psychological Factors in Weight Regain After Bariatric Surgery

To whatever degree a patient is struggling with weight regain, the role of mental health is hard to underestimate.

For some patients, it can feel discouraging in the extreme to see their hard-fought results — results that literally transformed their sense of self — erode over time. They may feel as though they have already explored their last option, losing hope in achieving their weight loss goals. 

Anxiety, depression, and other mood disorders can be both a cause and consequence of weight regain, creating a dangerous feedback loop that must be faced head-on. 

As discouraging as this scenario can feel, the good news is that we know what makes the biggest difference in improving or avoiding significant weight regain altogether: accountability

Accountability can take numerous forms. For some patients, a simple meal journal may be enough. Others may be drawn to the countless apps enabling dietary, physical activity, and weight tracking. Many, however, will benefit from actual, interpersonal accountability, whether 1:1 with a mentor or counselor, or with a group of individuals with shared goals. This form of accountability, as early on and as continuously as possible, yields the best results in terms of long-term weight maintenance.

Preventing or Reversing Weight Regain After Bariatric Surgery: A Summary

Set realistic expectations from the start. Correct the belief that “weight regain is a sign of my failure” to “weight regain is expected, and there are practical steps I can take to manage it.” 

Recognize that some weight recurrence is not just common, but typical. Accept that it is likely you will regain some weight, unlikely you will regain all of it, and that where you land in between comes down to practical, measurable choices. Define success for yourself — ideally with your doctor or support group — in a reasonable way. Don’t set an unattainably high bar for yourself in gauging your treatment and weight loss journey as a success. 

Identify your “why”. Weight regain is almost always multifactorial, with certain factors playing larger roles than others. For you specifically, is diet primarily the problem? Is it physical activity? How specific can you get? There’s a big difference between setting the goal of “eating less” versus realizing that on Thursday nights, you tend to stop for fast food on your way home from work, and can take a different route.

Go back to basics. Are you controlling portions? Avoiding snacks and grazing? Exercising as advised? Staying accountable to someone? Frequently, the principal problem is simple and obvious and, while fixing it is rarely easy, identifying it is necessary for improvement.

Reconnect with your doctor. We work with bariatric patients every single workday, and we very much want each of them to succeed on their weight loss journey. We are happy to help connect you with the support system you need to achieve persistent, long-term success.

Find a social support group in which you are comfortable processing and exploring these issues. Many patients benefit from one-on-one counseling or connecting with a mentor who has succeeded in maintaining their weight loss over time. Talk to your bariatric team for help in finding what’s right for you.

Consider revision surgery. For committed individuals who follow best practices and still experience weight gain after bariatric surgery, revision surgery is often recommended by bariatric surgeons. This approach effectively resets your original surgery, putting your body back into an ideal state to resume healthy weight loss. If you’ve been following the behavioral guidelines to a T while steadily regaining weight, this might be your best option. Many revision surgeries, such as Transoral Outlet Reduction after Gastric Bypass Surgery, are minimally invasive.

Don’t give up hope. There is no such thing as a “last option”. There is always another support group to join, mentor to work with, workout to try, and potentially even weight loss medications and endoscopic interventions to give you an additional helping boost. Even if you feel you’ve truly tried everything, remember your motivation for undergoing the surgery in the first place and simply try again, knowing you’re a wiser, more experienced version of yourself than you’ve ever been.

Weight Regain after Bariatric Surgery: Conclusion

As effective as bariatric surgery can be, there is no magic, permanent solution to prevent weight recurrence over time. Weight regain is not only common but expected over the ensuing years in one’s postoperative life. Solutions are typically simple, but rarely easy, and accountability is the number one key to sustaining healthy habits over time.