Obesity Weight Management

Potential Causes of Weight Regain After Bariatric Surgery

Weight loss surgery is a tool to help individuals with significant weight to lose (generally at least 100 lbs) to do so faster than through diet and exercise alone. However, weight loss surgery doesn’t guarantee permanent weight loss. In fact, there’s a large percentage of patients who likely will regain the weight they lose.

Among all the weight loss surgery procedures offered, the expected weight loss is an average of 65% of excess body weight. Combination procedures that are both malabsorptive and restrictive generally will result in greater weight loss than solely restrictive procedures. In the weight loss surgery community, we expect approximately a 10% weight regain two years or more after weight loss surgery.

According to the American Society for Metabolic and Bariatric Surgery, successful weight loss after surgery is equal to or greater than 50% of excess body weight. Some patients may achieve a better outcome, while others don’t. Many patients have weight loss goals that are higher than the generally expected weight loss. For this reason, patients determine their success with regard to their own goals and improved quality of life.

Presurgery patients often inquire about weight regain in the hopes of preventing it. There doesn’t appear to be one single cause for weight regain. In practice, I see a variety of behaviors that return postsurgery that contribute to increased caloric intake and therefore weight regain.

Behaviors Leading to Weight Regain

  • Time management. Time management appears to be a contributor to weight gain. Many patients have busy schedules, juggling work and family commitments. Before surgery, patients often reached for convenience foods and meals because they lacked the knowledge to plan and prepare meals. Surgery only changes a patient’s anatomy. They still have the same job and same family obligations.
  • Limited cooking skills. Reliance on convenience foods can be related to limited cooking knowledge and skill. Often, patients tell me they don’t cook either because they just don’t want to or their skills are limited to microwaving or boiling water.
  • Little knowledge of basic nutrition. Many patients come to surgery with only a basic understanding of nutrition. Often they simply don’t know what to eat or what foods are healthful choices. Added to this issue is the confusion caused by the wealth of nutrition information now shared online and in the media, which, as we all know, isn’t always accurate.
  • Emotional eating. Before surgery, all patients must receive a psychological evaluation. This evaluation helps identify those who struggle with emotional eating, stress eating, and/or binge eating behaviors. These issues don’t disqualify patients from surgery; however, programs need to make sure these patients learn proper coping strategies to deal with triggers after surgery.
  • Lack of physical activity. Regular physical activity is important in weight management and, of course, in a healthful lifestyle overall. Before surgery, it’s common for patients to not be physically active. This may be due to physical limitations, time constraints, or lack of desire to exercise for various reasons. After surgery, patients still may continue to struggle with physical limitations; however, those who are physically able should be encouraged to participate in some form of physical activity.
  • Lack of support. Finally, patients often fall back into less desirable habits because they lack support from family and friends. They may be compelled to eat out often because it’s what their spouse or friends desire. Patients may feel overwhelmed trying to manage meal planning and preparation without the support and assistance from others in their household.

Many patients deal with these issues before surgery so it’s important to help them learn new skills and behaviors. Yet, despite our best efforts patients still may struggle with these challenges and behaviors after surgery. We need to encourage them to follow up regularly with their surgical team and bariatric dietitian, seek psychological treatment if needed, and join patient support groups.

— Jennifer Pullman, MA, RDN, LDN, has been a practicing dietitian since 2001. Since 2007 she has worked solely with patients undergoing a variety of weight loss procedures, including Roux-En-Y gastric bypass, lap-band, and sleeve gastrectomy. In addition to her work as a bariatric dietitian, she publishes two blogs: Nourished Simply, a general nutrition and recipe blog, and Bariatric Bits, a website dedicated to providing nutrition information for weight loss surgery patients.

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