Why Do Some People Regain Weight After Bariatric Surgery?

Although bariatric surgery is by far the most effective treatment for severe obesity, it is not a magic bullet and there are a significant number of patients, who either fail to lose a significant amount of weight or ultimately regain most of their weight.

In a paper published in Obesity Surgery, we conducted an in-depth review on the issue of post-surgical weight regain.

Following an initial screen of 2,204 titles and review of 1,437 abstracts, we found only 16 studies with meaningful information on this issue.

These studies included seven case series, five surveys and four non-randomized controlled trials, with a total of 4,864 patients for analysis.

There were a number of methodological issues with these studies as they varied widely in terms of duration and quality of follow-up, definitions of surgical failure or weight recidivism, as well as the actual surgical procedures, all of which had important implications for the interpretation of the data.

Thus, for example, inconsistent definitions of exactly what constitutes “excessive” weight regain or “insufficient” weight loss makes it virtually impossible to determine even exactly how often this treatment can be considered to have “failed”. (Remember, it is always the treatment that fails the patient and never the patient who fails the treatment!).

Nevertheless, it is clear that post-surgical weight regain is highly multi-factorial (like obesity itself), involving both patient and surgery related factors.

Overall, we identified five principle aetiologies representing nutritional indiscretion, mental health issues, endocrine/metabolic alterations, physical inactivity and anatomic surgical failure, each of which I will discuss in upcoming posts.

There is no doubt that the issue of post-surgical weight regain requires a systematic approach to patient assessment focusing on contributory dietary, psychologic, medical and surgical factors.

@DrSharma
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

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