Weight Gain After Gastric Bypass Surgery & 9 Ways to Avoid or Reverse It

Weight Gain After Gastric Bypass Surgery: 8% On Average Gained Back After Achieving Weight Loss Low

The average excess weight lost following laparoscopic gastric bypass surgery is about 65% (in other words, at 100 pounds overweight the average patient loses almost 70 pounds). And many patients have seen results of well over 80%.

But once you reach your low point (called your “nadir”), will you start heading in the opposite direction? Unfortunately, it’s very likely.

About 50% of patients eventually gain a little weight back after hitting their nadir.³ In addition, the more time that passes following surgery, the more likely patients are to gain some weight back.⁴

On average, patients who gain weight back see about 8% of their old weight return within 5 years of surgery.⁵ So if a patient is one of the 50% who gains weight back, was 100 pounds overweight and lost 70 pounds from surgery, on average she can expect to gain back about 8 pounds.

The good news is that most patients (about 80% of morbidly obese and 65% of super obese) keep at least 50% of their excess weight off after 10 years.⁶

Reasons for Weight Regain: 4 Most Likely Causes

Several factors make you more likely to lose less weight or gain weight back following gastric bypass surgery. Addressing and preparing for these factors ahead of time can make all the difference…

1. Your weight prior to surgery – losing weight before gastric bypass surgery sounds pointless… after all, isn’t that what the surgery is for?
   
   The fact is that shedding some extra pounds before surgery can have a significant impact. Not only will it reduce the risk of gastric bypass complications, but the lower your body mass index (BMI) prior to surgery the more weight you are likely to lose and the less likely you will be to experience weight gain after gastric bypass surgery.
2. Alcohol or drug abuse – not surprisingly, substance abusers are more likely to revert back to their old habits following surgery. Plus, some patients begin to abuse alcohol and drugs after bariatric surgery, in effect, replacing one addition with another. In addition, drinking alcohol and taking certain drugs can lead to significant bariatric surgery complications.
3. Lack of a support system among family, friends and a weight loss surgery support group and lack of ongoing lifestyle counseling through a hospital or doctor based support group.
4. Psychological state following surgery – Increased food urges and decreased feelings of well-being following surgery are directly correlated with weight gain after gastric bypass surgery (7). Food addiction is also a big (and under-reported) reason for gastric bypass weight regain. See our Food Addiction Treatment page to learn more.

Avoiding or Reversing Weight Regain: 9 Top Tips

While a little bit of weight gain after gastric bypass surgery is likely to occur after hitting your nadir (lowest weight), there are many things you can do to keep the weight regain to a minimum…

1. 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.⁸
2. Stop binge eating well before surgery – Research suggests that patients with binge eating disorder (BED) tend to lose less weight after surgery. Seeking treatment for BED prior to surgery will make you less likely to experience weight gain after gastric bypass surgery.⁹
3. Lose as much weight as possible prior to surgery – The percentage of patients who keep off at least half of their excess weight 10 years after surgery is almost 15% higher for the morbidly obese (BMI between 40 and 49.9) than for the super obese (BMI of 50 or more).¹⁰
4. Address alcohol and drug abuse problems to prevent weight gain after gastric bypass surgery and avoid gastric bypass complications. The topic of alcohol and drug use will come up in your psychological evaluation prior to surgery approval, so be prepared to be honest with your psychologist and work with him or her to get any problems under control.
5. 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 then slowly start to falter. Effective surgeons are not only good in the operating room but are also trained and experienced in helping patients keep the weight off long-term.
6. Address food urges and lack of well being if you start to experience them after surgery – If you begin to experience increased food urges or your mental state becomes unstable following surgery, talk with your bariatric doctors immediately. Patients who experience these feelings and don’t address them usually gain more weight back. Between meetings with your surgeon and psychologist along with regular discussions with your weight loss surgery support group, you will overcome these issues.

“Patients who actively participate in support groups have about a 10% lower body mass index than patients who go it alone.”

7. Continue to get nutritional counseling – patients who continue to monitor their diet with the help of a professional have better long-term results.¹¹  Good bariatric doctors partner with or will refer you to a nutritionist or dietitian, so you should not need to find one on your own. The key is to never stop seeing them. The importance of this cannot be understated and needs to be repeated: the key is to never stop seeing them.
   
   Review the following pages for more about proper diet and eating habits…

• Diet after gastric bypass surgery (during recovery)
• Long term diet for gastric bypass
• Bariatric eating – how you eat vs what you eat

Revision Surgery: Reduce ‘stoma’ size, Resize or tighten stomach pouch

Even if you stay on top of the points above, there’s still a chance that you could experience weight gain after gastric bypass surgery. Discuss the following two options with your surgeon if you’re doing all the right things and the pounds continue to come back…

1. Reduce “stoma” size – The connection between your pouch and small intestines (also called the “gastrojejunal anastomoses” or "stoma") gets bigger following surgery for some patients.
   
   If your surgeon determines that this has happened to you, having the connection tightened can get you back on the right track.¹²
2. Resize or tighten stomach pouch – if your pouch has stretched over time, having it reduced can also improve weight loss.¹³ For example:
• Endoscopic injection of a “sclerosant” (sodium morrhuate) to shrink the stomach. Your surgeon may need to 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 after their injections. 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.¹⁴
  
  Another study revealed that out of 231 patients who underwent 575 sclerotherapy sessions:¹⁵
  • 12 months from the last sclerotherapy session, weight regain stabilized in 78% of the patients
  • Patients who underwent two or three sclerotherapy sessions had much higher rates of weight regain stabilization than those who underwent a single session
  • The average sclerotherapy patient lost 10 pounds in six months
  • There were ‘high responders’ who lost an average of 26 pounds, which was 61% of the weight regain
  • Those who had higher regain after bariatric surgery responded better to sclerotherapy
  The procedure does carry a low risk of minor complications including bleeding (2.5% of patients), abdominal pain (0.5%) and small ulcers (1%) along with a relatively high risk of blood pressure elevation (11%). Due to the risk of blood pressure elevation, patients with cardiac risk factors should most likely stay away from this procedure.

For more information, see our Gastric Bypass Revision Surgery page.