Post-Surgery Weight Regain: Nutritional Factors

diet journalOne of the key reasons why bariatric surgery is so much more effective for treating severe obesity than non-surgical approaches, is because of its profound effect on food intake.

Thus, bariatric surgery significantly affects hunger and satiety and may even have important effects on “wanting” and “liking” of high-caloric foods.

However, this effect on ingestive behaviour is neither “guaranteed” not are these effects consistent between individuals.

As I tell my patients, “The surgeons operate on your gut, not your brain”.

Thus, it can only be expected that a certain proportion of patients will struggle to control their food intake despite surgery, thereby either losing less weight than expected or putting the weight back on.

In an article, published in Obesity Surgery, we systematically reviewed the published evidence on the role of dietary factors in this issue.

As may be expected, patients reporting “loss of control” of eating behaviour post-surgery lost less weight or had a higher risk of gaining back any weight they may have initially lost. Thus, individuals with self-reported “high-adherence” scores tended to lose and sustain greater weight loss than those who did not.

Given that bariatric surgery may limit the amount of food that can be eaten at a single meal, some patients resorted to grazing behaviours (defined as consumption of smaller amounts of foods over extended periods of time) leading to subsequent weight regain. In addition, it was reported that poor diet quality, characterized by an excessive intake of calories, snacks and sweets, as well as oils and fatty foods, was statistically higher in patients experiencing weight regain.

Interestingly, even short-term dietary “indiscretion” (or falling off) can result in very rapid weight regain. This is not surprising as, in this regard there is little difference between someone who has lost weight through surgery or simply through diet and exercise. Irrespective of how the weight is lost, the body appears to retain its ability to rapidly regain lost weight if allowed to do so.

Thus, as we discuss in our article,

“The existing literature strongly suggests that nutritional and lifestyle compliance is crucial to weight management post- bariatric surgery.”

“Comprehensive weight management programs must therefore provide improved patient education and promote adherence to post-bariatric surgery diets in order to ensure success. These programs must take action to support patients towards a long-term goal of healthy and appropriate dietary choices with active monitoring (journaling) and reinforcement (review of food records) strategies provided by a multidisciplinary health care team.”

As I have discussed previously, although bariatric surgery increases the chances of success, it is no magic bullet or easy way out – all patients have to work hard at learning to use their surgery as a tool to help them better control their food intake and will likely do better, the more they understand and comply with the post-surgical nutrition recommendations.

On the other hand, there may be very good reasons why certain individuals, despite best efforts, struggle to meet these recommendations.

I will discuss how neurohormanal and metabolic factors can make dietary compliance difficult in my next post.

Edmonton, Alberta
Karmali S, Brar B, Shi X, Sharma AM, de Gara C, & Birch DW (2013). Weight Recidivism Post-Bariatric Surgery: A Systematic Review. Obesity surgery PMID: 23996349