Abstract
Achieving optimal weight outcomes for patients with obesity is important to the management of their chronic disease. All interventions present risks for weight regain. Bariatric surgery is the most efficacious treatment, producing greater weight losses that are sustained over more time compared to lifestyle interventions. However, approximately 20–30% of patients do not achieve successful weight outcomes, and patients may experience a regain of 20–25% of their lost weight. This paper reviews several factors that influence weight regain after bariatric surgery, including type of surgery, food tolerance, energy requirements, drivers to eat, errors in estimating intake, adherence, food and beverage choices, and patient knowledge. A comprehensive multidisciplinary approach can provide the best care for patients with weight regain. Nutrition care by a registered dietitian is recommended for all bariatric surgery patients. Nutrition diagnoses and interventions are discussed. Regular monitoring of weight status and early intervention may help prevent significant weight regain.
Highlights
Obesity is a chronic disease that presents significant challenges for treatment long term
Interventions and strategies for weight regain that have been found effective in the nonsurgical literature include self monitoring, continued patient-provider contact, and increased physical activity [3]
The outcomes from this study indicated that laparoscopic adjustable gastric band (LAGB) had a higher failure rate compared to roux-en-Y gastric bypass (RYGB)
Summary
Obesity is a chronic disease that presents significant challenges for treatment long term. In one study RYGB patients (>18 months post op) with weight regain reported a return of problematic presurgical eating behaviours, such as increased hunger, difficulty coping with the return of food cravings, and grazing on energy dense foods [30]. In the study by Stewart et al [30], RYGB patients with weight regain were able to identify a number of behaviour change strategies that worked initially after surgery, but overtime relaxed their use of these strategies, including self monitoring (i.e., journaling, measuring weight) and attending follow-up appointments. A greater percentage of surgical participants (compared to nonsurgical) reported night eating at least one time per week at both National Weight Control Registry entry and 1 year followup, and this may contribute to weight regain [5]. Patients presenting with weight regain likely had their surgery a few years ago, and it is important to assess and update them with current evidence-based information
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