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

Weight gain after gastric bypass surgery is not guaranteed, but there’s a good chance that it will occur to some extent.

Find out how likely you are to experience it and how to reduce your chances below…

Average Weight Gain After Gastric Bypass Surgery

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

"Most patients keep at least 50% of their excess weight off after 10 years."

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

As many as 80% of patients eventually gain a little weight back after hitting their nadir.1 In addition, the more time that passes following surgery, the more likely patients are to gain some weight back.2

On average, patients who gain weight back see about 8% of their old weight return within 5 years of surgery.3 So if a patient is one of the 80% 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.2

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Predictors of Weight Gain After Gastric Bypass Surgery

YOUR Weight Loss Journey

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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…

  • 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.
  • 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.
  • 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.
  • 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.1

    Note that these issues are relatively uncommon. For most, food urges and feelings of well being are either partially or completely resolved after surgery.
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9 ways to avoid or reverse weight gain after gastric bypass surgery

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...

"The percentage of patients who keep off at least half of their excess weight is 15% higher for those [with a lower body mass index]."

Avoiding Weight Regain

  1. 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.5
  2. 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).2
  3. 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.
  4. 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.
  5. 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.
  6. "Patients who actively participate in support groups have about a 10% lower body mass index than patients who go it alone."

  1. Continue to get nutritional counseling – patients who continue to monitor their diet with the help of a professional have better long-term results.6  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…
  1. Join and participate in a good bariatric surgery support group – patients who actively participate in support groups have about a 10% lower body mass index than patients who do go it alone.7

    Participation in an online weight loss support groups or forums is helpful, but it doesn't replace the need for the kind of one-on-one or in-person group support mechanism which every bariatric surgery patient will need for the rest of his or her life to maintain and maximize the benefits of the surgery. If your doctor or hospital doesn't provide a support group, START ONE. (However, in choosing a bariatric surgeon, it is preferable to choose one who is affiliated with a bariatric surgery program or support group.)

Reversing Weight Gain After Gastric Bypass Surgery

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...

Finding a Surgeon

Not all bariatric surgeons perform these corrective procedures.

If your surgeon does not and recommends surgical intervention, ask for a referral to a bariatric surgeon who has experience with these specific procedures.

You can also click here to access our directory of qualified surgeons in your area. Give the surgeon(s) in your area a call to find out if they perform any of these procedures. If they do, schedule a free one-on-one consultation to discuss.

  1. Pouch connection 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.8 The ROSE technique and endoscopic injection of a sclerosant options discussed below appear to be the emerging "best options" for this procedure.
  2. Talk about having your pouch resized/tightened – if your pouch has stretched over time, having it reduced can also improve weight loss.9  Two techniques have shown good results:
    • 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.10

      Another study revealed that out of 231 patients who underwent 575 sclerotherapy sessions:13
      • 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.
    • ROSE technique - also performed endoscopically, the ROSE procedure places tissue anchors to shrink the size of your stomach. Several studies have shown it to cause weight loss in gastric bypass patients.11

      One meta analysis (study combining the results of several other studies) showed that on average 88% of patients stopped regaining weight and that 96% of patients had lost 18% of their excess weight six months after the procedure.12

      See our ROSE Procedure section for more information.
    • StomaphyX - this endoscopic procedure is similar to the ROSE technique but uses a special device to create permanent folds by suctioning and fastening the lining of the pouch. Unlike the ROSE technique, StomaphyX is unable reduce the size of the stoma.

      See our StomaphyX Procedure page for more information.

For more information about each of these options and for one additional alternative, see our Gastric Bypass Revision Surgery page.

Patient Experiences

Click here to read about many patients' experiences with weight gain after bariatric surgery. While you're there, please share your own experiences as well!

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References for Weight Gain After Gastric Bypass Surgery

  1. Odom J, et al.  Behavioral Predictors of Weight Regain after Bariatric Surgery. Obesity Surgery DOI 10.1007/s11695-009-9895-6.
  2. Nicolas V. Christou, MD, PhD, Didier Look, MD, and Lloyd D. MacLean, MD, PhD. 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.
  3. Magro DO, et al.  Long-term Weight Regain after Gastric Bypass: A 5-year Prospective Study. Obesity Surgery Volume 18, Number 6 / June, 2008 pgs 648-651.
  4. Averbukh Y, et al.  Depression Score Predicts Weight Loss following Roux-en-Y Gastric Bypass. Obesity Surgery Volume 13, Number 6 / December, 2003 pgs 833-836.
  5. Sallet PC, et al.  Eating Behavior as a Prognostic Factor for Weight Loss after Gastric Bypass. Obesity Surgery Volume 17, Number 4 / April, 2007 pgs 445-451.
  6. Faria SL, et al.  Nutritional Management of Weight Regain After Bariatric Surgery. Obesity Surgery. DOI 10.1007/s11695-008-9610-z
  7. 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.
  8. 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)
  9. Muller MK, et al.  Laparoscopic Pouch Resizing and Redo of Gastro-jejunal Anastomosis for Pouch Dilatation following Gastric Bypass. Obesity Surgery Volume 15, Number 8 / September, 2005 pgs 1089-1095.
  10. 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)
  11. 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)
  12. 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.
  13. Helwick, Caroline. Sclerotherapy Stabilizes Weight Regain After Gastric Bypass. Gastroenterology & Endoscopy News. Dec 2011, Volume 62:12.

[Last editorial review/modification of this page: 2/26/2011]

Disclaimer: The information contained in this web site is provided for general informational purposes only. It is not intended as nor should be relied upon as medical advice. Rather, it is designed to support, not replace, the relationship that exists between a patient/site visitor and his/her existing physician(s). Before you use any of the information provided in the site, you should seek the advice of a qualified medical, dietary, fitness or other appropriate professional. Read More