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How to address weight regain after bariatric surgery in an individualized way

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Abstract

Bariatric surgery is the most effective obesity treatment. As a chronic and progressive disease, weight loss response to surgery will vary individually. Thus, insufficient weight loss or regain can happen after surgery, but they lack a standard definition. There are different mechanisms underlying weight regain and/or insufficient weight loss, such as genetics, maladaptive eating behaviors, and the inadequate choice of index operations, among others. Patients with weight regain or insufficient weight loss should be submitted to an individualized and comprehensive evaluation by a multidisciplinary team. This may help identify the causes and direct the appropriate treatment individually. Options for patients with insufficient weight loss and/or weight regain following bariatric surgery include repair of postoperative complications, conversion into another operation, endoscopic therapies with inconsistent outcomes, and dietary/behavioral counseling. Revision and conversion surgeries have higher complication rates than primary operations. Although there is no standard pharmacological regimen for that indication, the new agents seem efficient and safe to promote the loss of the regained weight and even be adjunctive to selected patients before they reach the plateau. This review aims to summarize the knowledge of the best approach for patients with weight regain/insufficient weight loss and suggests an algorithm to customize the approach and therapeutic options after bariatric surgery.

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Abbreviations

MBS:

Metabolic/bariatric surgery

WL:

Weight loss

IWL:

Insufficient weight loss

TBWL:

Total body weight loss

WR:

Weight regain

BMI:

Body mass index

GI:

Gastrointestinal

GLP1RA:

Glucagon-like receptor 1 analog

SG:

Sleeve gastrectomy

BPD-DS:

Biliopancreatic diversion with duodenal switch

SADI-S:

Single anastomosis duodenal ileostomy and sleeve gastrectomy version

OAGB:

One-anastomosis gastric bypass

RYGB:

Roux-en -Y gastric bypass

AOM:

Anti-obesity medication

FU:

Follow-up

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Cohen, R.V., Petry, T.B. How to address weight regain after bariatric surgery in an individualized way. Rev Endocr Metab Disord 24, 993–1002 (2023). https://doi.org/10.1007/s11154-023-09806-4

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