Most patients lose all the weight they desire after bariatric surgery and keep it off for good. However, a small percentage of patients experience weight regain and are understandably upset and confused about why this is happening and what they can do about it.
Some patients seek information from their bariatric surgeon, but others feel like they have failed and are embarrassed to seek help.
The reality is there are many reasons why someone might regain weight after surgery:
1. Poor follow-up. Commonly, this is the fault of the surgeon. Many surgeons don’t encourage or even offer long-term follow-up for their bariatric patients even though it has been proven in numerous studies that patients who follow-up regularly lose more weight. These visits include meeting with a dietician when necessary and detailed analysis of vitamin and protein levels. They are helpful because mild weight gain can be halted with dietary adjustments and medications when necessary and significant weight re-gain can be avoided.
2. Anatomical problems. If the surgery was not performed correctly in the first-place food restriction can be inadequate and hunger hormone levels can increase causing weight regain. Typically, this weight gain occurs one or more years following surgery.
3. Genetics. Unfortunately, not all patients respond well to the initial surgery. While weight loss surgery is safe for almost everyone, rare patients don’t lose all they weight they desire or regain weight simply because their hormone levels do not respond to surgery in the typical fashion.
Fortunately, there are excellent treatments for most patients who regain weight after surgery.
For the patient who has not been following up with their surgeon, the solution is simple. He or she is returned to the program (patients can also enroll in our post-op program if their surgery was performed somewhere else). A thorough assessment is performed, including lab studies and endoscopy when necessary. Once the problem is identified it can be corrected and the patient can go on to continue losing weight or at least stop gaining weight.
For the remainder of patients, it’s important to thoroughly study the anatomy and function of their weight loss procedure in order to determine what additional/revisional surgery can correct the problem. This can be done easily with UGI x-rays, endoscopy and or CT scans. The most common revision procedure is known as the duodenal switch. This operation is very safe and effective for patients who have regained weight following sleeve gastrectomy due either to a poorly performed surgery or genetics that are resistant to losing weight.