Skip to main content

Advertisement

SpringerLink
Log in

Understanding Weight Regain and the Need for Life-Long Follow-up After Bariatric Surgery

  • Bariatric Surgery (A. Ghaferi, Section Editor)
  • Published:
Current Surgery Reports Aims and scope Submit manuscript

Abstract

Purpose of Review

Currently, 15.4% of the population has severe obesity. For adults with severe obesity, bariatric surgery is the most effective and cost-effective treatment available for mortality reduction, weight loss, and comorbidity resolution. Although most surgical patients experience significant weight loss in the year following surgery, a subset of patients experience weight regain thereafter. Weight regain can result in recurrence of comorbidities and reduction in the long-term cost-effectiveness of surgery. Weight regain prompts providers to consider additional interventions.

Recent Findings

We summarize illustrative studies from the past 5 years on the effectiveness of bariatric surgery; the prevalence of weight regain following surgery; anatomic and behavioral factors contributing to weight regain; and behavioral, surgical, and pharmacological interventions to reduce weight regain.

Summary

We conclude with recommendations for increasing the evidence base regarding effective methods for maximizing long-term weight loss and associated health and economic outcomes.

This is a preview of subscription content, log in via an institution to check access.

Access this article

Log in via an institution

Price excludes VAT (USA)
Tax calculation will be finalised during checkout.

Instant access to the full article PDF.

Institutional subscriptions

Similar content being viewed by others

References

Papers of particular interest, published recently, have been highlighted as: • Of importance •• Of major importance

  1. Flegal KM, Carroll MD, Kit BK, Ogden CL. Prevalence of obesity and trends in the distribution of body mass index among US adults, 1999-2010. J Am Med Assoc. 2012;307(5):491–7.

    Article  Google Scholar 

  2. Kleinman NL, Melkonian A, Borden ST, Rohrbacker N, Lynch WD, Gardner HH. The impact of morbid obesity and bariatric surgery on comorbid conditions: a comprehensive examination of comorbidities in an employed population. J Occup Environ Med. 2009;51(2):170–9.

    Article  PubMed  Google Scholar 

  3. Masters RK, Reither EN, Powers DA, Yang YC, Burger AE, Link BG. The impact of obesity on US mortality levels: the importance of age and cohort factors in population estimates. Am J Public Health. 2013;103(10):1895–901.

    Article  PubMed  PubMed Central  Google Scholar 

  4. Cawley J, Meyerhoefer C, Biener A, Hammer M, Wintfeld N. Savings in medical expenditures associated with reductions in body mass index among US adults with obesity, by diabetes status. PharmacoEconomics. 2015;33(7):707–22.

    Article  PubMed  Google Scholar 

  5. Brunton SA. Management of obesity in adults: introduction. J Fam Pract. 2014;63(7 Suppl):S1–2.

    PubMed  Google Scholar 

  6. Chang SH, Stoll CR, Song J, Varela JE, Eagon CJ, Colditz GA. The effectiveness and risks of bariatric surgery: an updated systematic review and meta-analysis, 2003-2012. JAMA Surgery. 2013;149:275–87.

    Article  Google Scholar 

  7. Golzarand M, Toolabi K, Farid R. The bariatric surgery and weight losing: a meta-analysis in the long- and very long-term effects of laparoscopic adjustable gastric banding, laparoscopic Roux-en-Y gastric bypass and laparoscopic sleeve gastrectomy on weight loss in adults. Surg Endosc. 2017;. doi:10.1007/s00464-017-5505-1.

    PubMed  Google Scholar 

  8. Kolotkin RL, Andersen JR. A systematic review of reviews: exploring the relationship between obesity, weight loss and health-related quality of life. Clin Obes. 2017;. doi:10.1111/cob.12203.

    Google Scholar 

  9. Efferdinger C, Konig D, Klaus A, Jagsch R. Emotion regulation and mental well-being before and six months after bariatric surgery. Eat Weight Disord. 2017;22(2):353–60.

    Article  PubMed  PubMed Central  Google Scholar 

  10. Wang BC, Furnback W. Modelling the long-term outcomes of bariatric surgery: a review of cost-effectiveness studies. Best Pract Res Clin Gastroenterol. 2013;27(6):987–95.

    Article  PubMed  Google Scholar 

  11. Cooper TC, Simmons EB, Webb K, Burns JL, Kushner RF. Trends in weight regain following Roux-en-Y Gastric Bypass (RYGB) bariatric surgery. Obes Surg. 2015;25(8):1474–81.

    Article  PubMed  Google Scholar 

  12. •• Courcoulas AP, Christian NJ, Belle SH, et al. Weight change and health outcomes at 3 years after bariatric surgery among individuals with severe obesity. J Am Med Assoc. 2013;310(22):2416–25. In this observational study, five groups of patients were identified that experienced distinct weight trajectories following gastric bypass and sleeve gastrectomy.

  13. Sjostrom L. Review of the key results from the Swedish Obese Subjects (SOS) trial—a prospective controlled intervention study of bariatric surgery. J Intern Med. 2013;273(3):219–34.

    Article  CAS  PubMed  Google Scholar 

  14. Lauti M, Kularatna M, Hill AG, MacCormick AD. Weight regain following sleeve gastrectomy-A systematic review. Obes Surg. 2016;26(6):1326–34.

    Article  PubMed  Google Scholar 

  15. Golomb I, Ben David M, Glass A, Kolitz T, Keidar A. Long-term metabolic effects of laparoscopic sleeve gastrectomy. JAMA Surg. 2015;150(11):1051–7.

    Article  PubMed  Google Scholar 

  16. Sundbom M, Hedberg J, Marsk R, et al. Substantial decrease in comorbidity 5 years after gastric bypass: a population-based study from the Scandinavian Obesity Surgery Registry. Ann Surg. 2017;265(6):1166–71.

    Article  PubMed  Google Scholar 

  17. Kim HJ, Madan A, Fenton-Lee D. Does patient compliance with follow-up influence weight loss after gastric bypass surgery? A systematic review and meta-analysis. Obes Surg. 2014;24(4):647–51.

    Article  PubMed  Google Scholar 

  18. • Freire RH, Borges MC, Alvarez-Leite JI, Toulson Davisson Correia MI. Food quality, physical activity, and nutritional follow-up as determinant of weight regain after Roux-en-Y gastric bypass. Nutrition (Burbank, Los Angeles County, Calif). 2012;28(1):53–8. This observational study showed that weight regain following gastric bypass increased with time after surgery, poor diet quality, sedentary lifestyle, and lack of nutritional counseling follow-up.

  19. Conceicao E, Mitchell JE, Vaz AR, et al. The presence of maladaptive eating behaviors after bariatric surgery in a cross sectional study: importance of picking or nibbling on weight regain. Eat Behav. 2014;15(4):558–62.

    Article  PubMed  Google Scholar 

  20. Herman KM, Carver TE, Christou NV, Andersen RE. Keeping the weight off: physical activity, sitting time, and weight loss maintenance in bariatric surgery patients 2 to 16 years postsurgery. Obes Surg. 2014;24(7):1064–72.

    Article  PubMed  Google Scholar 

  21. Jones L, Cleator J, Yorke J. Maintaining weight loss after bariatric surgery: when the spectator role is no longer enough. Clin Obes. 2016;6(4):249–58.

    Article  CAS  PubMed  Google Scholar 

  22. Natvik E, Gjengedal E, Raheim M. Totally changed, yet still the same: patients’ lived experiences 5 years beyond bariatric surgery. Qual Health Res. 2013;23(9):1202–14.

    Article  PubMed  Google Scholar 

  23. Wood KV, Ogden J. Patients’ long-term experiences following obesity surgery with a focus on eating behaviour: a qualitative study. J Health Psychol. 2015;21(11):2447–56.

    Article  Google Scholar 

  24. Benson-Davies S, Davies ML, Kattelmann K. Understanding eating and exercise behaviors in post Roux-en-Y gastric bypass patients: a quantitative and qualitative study. Bariatr Surg Pract Patient Care. 2013;8(2):61–8.

    Article  PubMed  PubMed Central  Google Scholar 

  25. •• Stewart F, Avenell A. Behavioural interventions for severe obesity before and/or after bariatric surgery: A systematic review and meta-analysis. Obes Surg. 2016;26(6):1203–14. This systematic review examined behavioral interventions delivered pre- and post-operatively to reduce weight regain following bariatric surgery. Various outcomes were measured, and methodological quality of the studies was low. There was some indication that behavioral interventions improved 12-month weight loss following surgery.

  26. •• Rudolph A, Hilbert A. Post-operative behavioural management in bariatric surgery: A systematic review and meta-analysis of randomized controlled trials. Obes Rev. 2013;14(4):292–302. This systematic review examined post-operative behavioral interventions to reduce weight regain following bariatric surgery. Studies were heterogeneous and had small sample sizes but supported the potential for behavioral interventions to reduce weight regain 12 months following surgery.

  27. Parikh M, Dasari M, McMacken M, Ren C, Fielding G, Ogedegbe G. Does a preoperative medically supervised weight loss program improve bariatric surgery outcomes? A pilot randomized study. Surg Endosc. 2012;26(3):853–61.

    Article  PubMed  Google Scholar 

  28. Solomon H, Liu GY, Alami R, Morton J, Curet MJ. Benefits to patients choosing preoperative weight Loss in gastric bypass surgery: new results of a randomized trial. J Am Coll Surg. 2009;208(2):241–5.

    Article  PubMed  Google Scholar 

  29. Ogden J, Hollywood A, Pring C. The impact of psychological support on weight loss post weight loss surgery: a randomised control trial. Obes Surg. 2015;25(3):500–5.

    Article  PubMed  Google Scholar 

  30. Lier HO, Biringer E, Stubhaug B, Tangen T. The impact of preoperative counseling on postoperative treatment adherence in bariatric surgery patients: a randomized controlled trial. Patient Educ Couns. 2012;87(3):336–42.

    Article  PubMed  Google Scholar 

  31. Swenson BR, Saalwachter Schulman A, Edwards MJ, et al. The effect of a low-carbohydrate, high-protein diet on post laparoscopic gastric bypass weight loss: a prospective randomized trial. J Surg Res. 2007;142(2):308–13.

    Article  CAS  PubMed  Google Scholar 

  32. Sarwer DB, Moore RH, Spitzer JC, Wadden TA, Raper SE, Williams NN. A pilot study investigating the efficacy of postoperative dietary counseling to improve outcomes after bariatric surgery. Surg Obes Relat Dis. 2012;8(5):561–8.

    Article  PubMed  Google Scholar 

  33. Nijamkin MP, Campa A, Sosa J, Baum M, Himburg S, Johnson P. Comprehensive nutrition and lifestyle education improves weight loss and physical activity in Hispanic Americans following gastric bypass surgery: a randomized controlled trial. J Acad Nutr Diet. 2012;112(3):382–90.

    Article  PubMed  Google Scholar 

  34. Papalazarou A, Yannakoulia M, Kavouras SA, et al. Lifestyle intervention favorably affects weight loss and maintenance following obesity surgery. Obesity. 2010;18(7):1348–53.

    Article  CAS  PubMed  Google Scholar 

  35. Tucker JA, Samo JA, Rand CS, Woodward ER. Behavioral interventions to promote adaptive eating behavior and lifestyle changes following surgery for obesity: results of a two-year outcome evaluation. Int J Eat Disord. 1991;10(6):689–98.

    Article  Google Scholar 

  36. Kalarchian MA, Marcus MD, Courcoulas AP, Cheng Y, Levine MD, Josbeno D. Optimizing long-term weight control after bariatric surgery: a pilot study. Surg Obes Relat Dis. 2012;8(6):710–5.

    Article  PubMed  Google Scholar 

  37. Voils CI, Olsen MK, Gierisch JM, et al. Maintenance of weight loss after initiation of nutrition training: a randomized trial. Ann Intern Med. 2017;166(7):463–71.

    Article  PubMed  PubMed Central  Google Scholar 

  38. Sherwood NE, Crain AL, Martinson BC, et al. Enhancing long-term weight loss maintenance: 2 year results from the Keep It Off randomized controlled trial. Prev Med. 2013;56(3–4):171–7.

    Article  PubMed  Google Scholar 

  39. Svetkey LP, Stevens VJ, Brantley PJ, et al. Comparison of strategies for sustaining weight loss: the weight loss maintenance randomized controlled trial. J Am Med Assoc. 2008;299(10):1139–48.

    Article  CAS  Google Scholar 

  40. Jeffery RW, Levy RL, Langer SL, et al. A comparison of maintenance-tailored therapy (MTT) and standard behavior therapy (SBT) for the treatment of obesity. Prev Med. 2009;49(5):384–9.

    Article  PubMed  PubMed Central  Google Scholar 

  41. West DS, Gorin AA, Subak LL, et al. A motivation-focused weight loss maintenance program is an effective alternative to a skill-based approach. Int J Obes. 2010;35(2):259.

    Article  Google Scholar 

  42. Wing RR, Tate DF, Gorin AA, Raynor HA, Fava JL. A self-regulation program for maintenance of weight loss. N Engl J Med. 2006;355(15):1563–71.

    Article  CAS  PubMed  Google Scholar 

  43. Perri MG, Limacher MC, Durning PE, et al. Extended-care programs for weight management in rural communities: the treatment of obesity in underserved rural settings (TOURS) randomized trial. Arch Intern Med. 2008;168(21):2347–54.

    Article  PubMed  PubMed Central  Google Scholar 

  44. Perri MG, McAdoo WG, McAlister DA, et al. Effects of peer support and therapist contact on long-term weight loss. J Consult Clin Psychol. 1987;55(4):615–7.

    Article  PubMed  Google Scholar 

  45. Voils CI, King HA, Maciejewski ML, Allen KD, Yancy WS Jr, Shaffer JA. Approaches for informing optimal dose of behavioral interventions. Ann Behav Med. 2014;48(3):392–401.

    Article  PubMed  PubMed Central  Google Scholar 

  46. Funk LM, Gunnar W, Dominitz JA, et al. A health services research agenda for bariatric surgery within the Veterans Health Administration. J Gen Intern Med. 2017;32(Suppl 1):65–9.

    Article  CAS  PubMed  Google Scholar 

  47. Rothman AJ. Toward a theory-based analysis of behavioral maintenance. Health Psychol. 2000;19(1Suppl):64–9.

    Article  CAS  PubMed  Google Scholar 

  48. Voils CI, Gierisch JM, Yancy WS Jr, et al. Differentiating behavior initiation and maintenance: theoretical framework and proof of concept. Health Educ Behav. 2014;41(3):325–36.

    Article  PubMed  Google Scholar 

  49. Perri MG, Nezu AM, McKelvey WF, Shermer RL, Renjilian DA, Viegener BJ. Relapse prevention training and problem-solving therapy in the long-term management of obesity. J Clin Consult Psychol. 2001;69(4):722–6.

    Article  CAS  Google Scholar 

  50. Estimate of bariatric surgery numbers, 2011–2015. https://asmbs.org/resources/estimate-of-bariatric-surgery-numbers. Accessed 5 May 2017.

  51. Carmeli I, Golomb I, Sadot E, Kashtan H, Keidar A. Laparoscopic conversion of sleeve gastrectomy to a biliopancreatic diversion with duodenal switch or a Roux-en-Y gastric bypass due to weight loss failure: our algorithm. Surg Obes Relat Dis. 2015;11(1):79–85.

    Article  PubMed  Google Scholar 

  52. AlSabah S, Alsharqawi N, Almulla A, et al. Approach to poor weight loss after laparoscopic sleeve gastrectomy: re-sleeve vs. gastric bypass. Obes Surg. 2016;26(10):2302–7.

    Article  PubMed  Google Scholar 

  53. Silecchia G, De Angelis F, Rizzello M, Albanese A, Longo F, Foletto M. Residual fundus or neofundus after laparoscopic sleeve gastrectomy: is fundectomy safe and effective as revision surgery? Surg Endosc. 2015;29(10):2899–903.

    Article  PubMed  Google Scholar 

  54. Parmar CD, Mahawar KK, Boyle M, Schroeder N, Balupuri S, Small PK. Conversion of sleeve gastrectomy to Roux-en-Y gastric bypass is effective for gastro-oesophageal reflux disease but not for further weight loss. Obes Surg. 2017;27(7):1651–8.

    Article  PubMed  Google Scholar 

  55. Santo MA, Riccioppo D, Pajecki D, et al. Weight regain after gastric bypass: influence of gut hormones. Obes Surg. 2016;26(5):919–25.

    Article  PubMed  Google Scholar 

  56. Roslin M, Damani T, Oren J, Andrews R, Yatco E, Shah P. Abnormal glucose tolerance testing following gastric bypass demonstrates reactive hypoglycemia. Surg Endosc. 2011;25(6):1926–32.

    Article  PubMed  Google Scholar 

  57. Heneghan HM, Yimcharoen P, Brethauer SA, Kroh M, Chand B. Influence of pouch and stoma size on weight loss after gastric bypass. Surg Obes Relat Dis. 2012;8(4):408–15.

    Article  PubMed  Google Scholar 

  58. Topart P, Becouarn G, Ritz P. Pouch size after gastric bypass does not correlate with weight loss outcome. Obes Surg. 2011;21(9):1350–4.

    Article  PubMed  Google Scholar 

  59. • Gallo AS, DuCoin CG, Berducci MA, et al. Endoscopic revision of gastric bypass: Holy Grail or Epic fail? Surg Endosc. 2016;30(9):3922–7. This study showed that endoscopic plication reduced pouch and stoma diameter at 3 months but that the they approached pre-operative diameter by 12 months and that this was associated with weight regain.

  60. Maleckas A, Gudaityte R, Petereit R, Venclauskas L, Velickiene D. Weight regain after gastric bypass: etiology and treatment options. Gland Surg. 2016;5(6):617–24.

    Article  PubMed  PubMed Central  Google Scholar 

  61. Stefanidis D, Kuwada TS, Gersin KS. The importance of the length of the limbs for gastric bypass patients—An evidence-based review. Obes Surg. 2011;21(1):119–24.

    Article  PubMed  Google Scholar 

  62. Carandina S, Genser L, Bossi M, Polliand C, Tabbara M, Barrat C. Laparoscopic sleeve gastrectomy after failed gastric banding: is it really effective? Six years of follow-up. Surg Obes Relat Dis. 2017;13(7):1165–73.

    Article  PubMed  Google Scholar 

  63. • Chansaenroj P, Aung L, Lee WJ, Chen SC, Chen JC, Ser KH. Revision procedures after failed adjustable gastric banding: Comparison of efficacy and safety. Obes Surg. 2017. https://doi.org/10.1007/s11695-017-2716-42017. This observational study showed that revision surgery following larapscopic adjustable gastric banding is safe and results in excess weight loss > 50% at two-year follow-up.

  64. Heber D, Greenway FL, Kaplan LM, Livingston E, Salvador J, Still C. Endocrine and nutritional management of the post-bariatric surgery patient: an Endocrine Society Clinical Practice Guideline. J Clin Endocrinol Metab. 2010;95(11):4823–43.

    Article  CAS  PubMed  Google Scholar 

  65. Schwartz J, Chaudhry UI, Suzo A, et al. Pharmacotherapy in conjunction with a diet and exercise program for the treatment of weight recidivism or weight loss plateau post-bariatric surgery: a retrospective review. Obes Surg. 2016;26(2):452–8.

    Article  PubMed  Google Scholar 

  66. Dombrowski SU, Knittle K, Avenell A, Araujo-Soares V, Sniehotta FF. Long term maintenance of weight loss with non-surgical interventions in obese adults: systematic review and meta-analyses of randomised controlled trials. BMJ. 2014;348:g2646.

    Article  CAS  PubMed  PubMed Central  Google Scholar 

Download references

Acknowledgements

Effort on this manuscript was made possible by a Research Career Scientist award (RCS 14-443) to Dr. Voils and a Career Development Award (CDA 15-060) to Dr. Funk from the Department of Veterans Affairs Health Services Research & Development service. The contents of this manuscript do not represent the views of the Department of Veterans Affairs or the United States Government.

Author information

Authors and Affiliations

  1. William S. Middleton Memorial Veterans Hospital, Madison, WI, USA

    Corrine I. Voils & Luke M. Funk

  2. Department of Surgery, Wisconsin Surgical Outcomes Research Program, University of Wisconsin School of Medicine and Public Health, 600 Highland Ave, K6/100 CSC, Madison, WI, 53792-1690, USA

    Corrine I. Voils, Rachel Adler, Natalie Liu & Luke M. Funk

Authors
  1. Corrine I. Voils
    View author publications

    You can also search for this author in PubMed Google Scholar

  2. Rachel Adler
    View author publications

    You can also search for this author in PubMed Google Scholar

  3. Natalie Liu
    View author publications

    You can also search for this author in PubMed Google Scholar

  4. Luke M. Funk
    View author publications

    You can also search for this author in PubMed Google Scholar

Corresponding author

Correspondence to Corrine I. Voils.

Ethics declarations

Conflict of interest

Dr. Voils and Dr. Funk report grants from Department of Veterans Affairs. Drs. Adler and Liu declare no conflicts of interest relevant to this manuscript.

Human and Animal Rights and Informed Consent

This article does not contain any studies with human or animal subjects performed by any of the authors.

Additional information

This article is part of the Topical collection on Bariatric Surgery.

Rights and permissions

Reprints and permissions

About this article

Check for updates. Verify currency and authenticity via CrossMark

Cite this article

Voils, C.I., Adler, R., Liu, N. et al. Understanding Weight Regain and the Need for Life-Long Follow-up After Bariatric Surgery. Curr Surg Rep 5, 33 (2017). https://doi.org/10.1007/s40137-017-0196-z

Download citation

  • Published:

  • DOI: https://doi.org/10.1007/s40137-017-0196-z

Keywords

Search

Navigation