Weight Gain After Bariatric Surgery &
How to Avoid or Reverse
It
Are you likely to experience weight gain after bariatric surgery? It depends on factors both in and out of your control.
- How much do patients gain back on average?
- 7 ways to minimize weight regain after bariatric surgery
- Surgical options to reverse weight gain after weight loss surgery
How much weight gain after bariatric surgery should you expect?
The procedure you choose will play a large part in determining how much weight you will gain back after you hit your low point.
"Malabsorptive procedures have been shown to result in greater excess weight loss over the long-term, despite the weight regain."
Patients who undergo malabsorptive procedures (i.e. duodenal switch, laparoscopic gastric bypass surgery or mini gastric bypass surgery) usually gain around 8 to 10% of their weight back. Patients who chose restrictive procedures (i.e. lap band surgery or vertical banded gastroplasty) usually gain back less weight.
However, malabsorptive procedures have been shown to result in greater excess weight loss over the long-term, despite the weight regain. After any weight regain, patients who undergo malabsorptive procedures experience at least 10% to 15% greater excess weight loss than restrictive procedures.
The one exception may be gastric sleeve surgery, which is a primarily restrictive procedure. Short-term studies have shown it to have similar weight loss to some of the malabsorptive procedures, although additional long-term research is needed to confirm that these results will last.
Regardless of which procedure you choose (or chose), the possibility for weight gain after a bariatric procedure will remain present throughout your life.
Remember… bariatric surgery is only a tool. You’ll need to continue doing the right things and making the right choices for the surgery to be effective over the long run…
7 Ways to minimize weight gain after bariatric surgery
YOUR Weight Loss Journey
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The key to preventing long term weight regain and reducing your risk of baratric surgery complications is to learn and address potential pitfalls early on.
Seven behaviors have been proven to reduce the chance of weight gain after bariatric surgery:
- Stop binge eating well before surgery – Patients with binge eating disorder (BED) tend to lose less weight after surgery. Receiving treatment for BED prior to surgery will lead to less weight gain after bariatric surgery.1
- Lose as much weight as possible prior to surgery - Your body mass index (BMI) prior to surgery directly relates to how much weight you'll lose and keep off. For example, one study showed that morbidly obese patients (BMI between 35 and 39.9) were 15% more likely than super obese patients (BMI of 40 or more) to keep off at least half of their excess weight 10 years after surgery.2
- Address alcohol and drug abuse problems as they will cause weight gain after bariatric surgery and potentially lead to bariatric surgery complications. Your surgeon and bariatric surgery insurance company will both require a psychological evaluation before they approve surgery and the evaluation will include this topic. Be prepared to be honest with your psychologist and work with them to get any problems under control.
- Follow your bariatric doctors’ advice to the letter – this may sound obvious, but you’d be surprised how many patients follow their doctors’ orders for the first year or two and then slowly begin to slip back into their old habits. The best bariatric doctors are not only good in the operating room but are also trained and experienced in helping patients keep the weight off long-term.
- Join and participate in a good weight loss surgery support group – weight loss surgery patients who actively participate in support groups have roughly a 10% lower body mass index than patients who do not.3
- Address food urges and lack of well being if you start to experience them after surgery - If you begin to experience increased food urges, depression or other emotional problems following surgery, talk with your bariatric doctors right away and bring these issues out in the open with your family and support group. Patients who experience these feelings and don’t address them usually gain more weight back.
- Continue to get nutritional counseling – patients who continue to monitor their diet with the help of a professional (your surgeon-referred dietician or nutritionist) have better long-term results.4 Good bariatric doctors partner with or will refer you to a nutritionist or dietician, so you should not need to find one on your own. The key is to never stop seeing them. Review the following pages for more about proper diet and eating habits…
- Bariatric Diet - learn the proper diet before and after surgery and tips to stay on track
- Bariatric eating – how you eat vs what you eat
In addition to the above, the following pages will set you up for success, both reducing your risk of complications and minimizing your weight gain after bariatric surgery…
- Bariatric Doctors – how to find, interview and choose the best surgeon
- Life After Weight Loss Surgery – what to expect in every area of your life
- Bariatric Exercise Programs (coming soon)
- In-person weight loss surgery support groups and online weight loss support – finding and participating in the right support groups has been proven to lead to better weight loss
Surgical Options to Reverse Weight Gain After Bariatric Surgery
The first path your doctor will have you take to reverse weight gain after bariatric surgery is good old-fashioned diet and exercise.
If these are not effective towards keeping the weight off after surgery, it may be because your new stomach (and possibly the digestive openings made during surgery) has stretched which allows you to eat more before getting full.
Talk with your surgeon about whether one of the following options could be right for you…
- Endoscopic injection of a “sclerosant” (sodium morrhuate) to shrink the stomach. Your bariatric surgeon may administer the injections 2 to 3 times before determining whether the process was a success. One study showed that 64% of patients lost at least 75% of their weight regain. The only complication that occurred was symptoms of stomal stenosis that required the stomach to be stretched back out with the use of a special balloon.5
- Restorative Obesity Surgery, Endolumenal (ROSE technique) – also performed endoscopically, the ROSE procedure places tissue anchors to get your stomach size back down. Several studies have shown it to be effective in reducing the stomach size and causing weight loss in gastric bypass patients.6 One meta analysis showed that 88% of patients stopped regaining weight and that 96% of patients had lost 18% of their excess weight six months after the procedure.7
- Pouch connection size - The connection made between your new stomach and small intestines during certain bariatric surgery procedures (also called the “gastrojejunal anastomoses”) can grow following surgery. If your surgeon determines that this has happened to you, going back in to tighten it can get you back on the right track.8
- The non-adjustable silicone ring - If less invasive therapies don’t work, also talk with your doctor about the placement of a non-adjustable silicone ring loosely fitted around your gastric pouch. It has been shown to increase the percentage of excess weight loss by around 23%.9
Did YOU experience weight gain after bariatric surgery?
- How much weight did you lose before the weight regain started?
- How long after surgery did it begin?
- Which type of weight loss surgery did you have?
- What diet, exercise or other factors caused your weight regain?
- What did you do to stop or reverse it?
- If you haven't experienced weight regain, give us your advice about how you've been able to avoid it.
Please share your experiences to help other bariatric surgery patients avoid pitfalls, keep their weight off and reverse weight regain if necessary...
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Weight Regain 20 Years After Surgery - Help!
At age 32, I had a stomach stapling done about 20 years ago, and went from 335lbs (5 foot 2) to 175lbs. I got fit and healthy and life was great.
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References
- Sallet PC, et al. Eating Behavior as a Prognostic Factor for Weight Loss after Gastric Bypass. Obesity Surgery Volume 17, Number 4 / April, 2007 Pages 445-451.
- Christou NV, et al. Weight Gain After Short- and Long-Limb
Gastric Bypass in Patients Followed for Longer Than 10 Years. Ann Surg.
2006 November; 244(5): 734–740.
doi: 10.1097/01.sla.0000217592.04061.d5. - Orth WS, et al. Support Group Meeting Attendance is Associated with Better Weight Loss. Obesity Surgery Volume 18, Number 4 / April, 2008 pgs 391-394.
- Faria SL, et al. Nutritional Management of Weight
Regain After Bariatric Surgery
Obesity Surgery. Available at: http://www.springerlink.com/content/w716724l2u68l31u/
?p=6d029e9052c048d9beab73c0b56c2ce0&pi=3 - Weight gain after bariatric surgery as a result of a large
gastric stoma: endotherapy with sodium morrhuate may prevent the need
for surgical revision
Marc F. Catalano, Goran Rudic, Alfred J. Anderson, Thomas Y. Chua
Gastrointestinal Endoscopy - August 2007 (Vol. 66, Issue 2, Pages 240-245, DOI: 10.1016/j.gie.2006.06.061) - Treatment of weight regain after gastric bypass surgery
when using a new endoscopic platform: initial experience and early
outcomes (with video)
Daniel K. Mullady, David B. Lautz, Christopher C. Thompson
Gastrointestinal Endoscopy - September 2009 (Vol. 70, Issue 3, Pages 440-444, DOI: 10.1016/j.gie.2009.01.042) - UC San Diego Medical Center Press Release: Data Shows Incision-free Procedure Reverses Weight Regain after Gastric Bypass Surgery. June 2009. Available at: http://health.ucsd.edu/news/2009/6-29-rose-procedure.htm.
- Thompson, C.1; Slattery, J.; Bundga, M.; Lautz, D. Peroral endoscopic reduction of dilated gastrojejunal anastomosis after Roux-en-Y gastric bypass: a possible new option for patients with weight regain. Surgical Endoscopy, Volume 20, Number 11, November 2006 , pp. 1744-1748(5)
- Dapri G, et al. Laparoscopic Placement of Non-Adjustable Silicone Ring for Weight Regain After Roux-en-Y Gastric Bypass. Obesity Surgery Volume 19, Number 5 / May, 2009 Pages 650-654.
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