Weight [Re]Gain Post Bariatric Surgery

North West CoastMetabolic and Endocrine
Start Date: 16 Feb 2016

Weight [Re]Gain Post Bariatric Surgery

Introduction & Aim

Following weight loss surgery, some people struggle to maintain their new lower weight, and regain some or all of their lost weight ¹,². The main aim of the research study was to find out what factors seem to influence whether or not someone regains weight following bariatric surgery.

Participants and Study Design

Seven participants were recruited by their usual care team. Inclusion criteria:

  • Patients who consider themselves to have weight regained
  • Had a bypass or sleeve within the previous 20 years Exclusion criteria
  • Patients with an overt eating disorder
  • Patients receiving psychological intervention for their weight
  • Patients who are unable to converse fluently in English
  • Patients who are unable to provide informed consent

Results

Analysis identified themes that might indicate risk of weight regain. Pre-operative behaviours included:

  • A history of ‘yo-yo’ dieting
  • A lack of weight loss before surgery (despite engagement with specialist services). Behaviours present before and after surgery included
  • Eating habits and behaviours inconsistent with weight management
  • Comfort eating or drinking post-operatively
  • The diminishing effects of surgery
  • Inadvertent sabotage
  • Lack of self monitoring
  • Lack of post operative support

Conclusion

Identifying patients likely to struggle following bariatric surgery should be a priority for health care professionals. These people should not be denied surgery for their severe obesity, but identification of new strategies or care pathways should be considered to help identify these individuals before surgery, so that adequate support can be provided to help them achieve and maintain their weight loss goals for as long as possible.

Direction for further work

There will be a cohort for patients who have undergone bariatric surgery and failed to maintain their new weight despite surgical success. The participants in this study proactively engaged with specialist follow up - but not every patient will do this. It is not inappropriate to suggest that some patients who weight regain, will be in worse overall health than before surgery, with unchanged cardiorespiratory fitness with the potential for vitamin and mineral insufficiency secondary to malabsorption. For these patients, further surgery provided by the NHS is very unlikely and the only management option will be conservative. Future research should give greater consideration to physical activity, dietetic and psychological intervention following surgery.

Contact 
Professor John Wilding
j.p.h.wilding@liverpool.ac.uk