Weight regain occurs regardless what type of bariatric procedure is performed [1,2]. And so it is becoming a part of the private practice of all bariatric surgeons to encounter patients that are experiencing poor weight loss results after undergoing bariatric surgery and these patients are seeking for advice on what to do.
We can divide weight loss surgery outcomes in three different types: Success, Failure And Regain.
There are different ways of assessing weight loss after bariatric surgery, and currently the ASMBS (American Society for Metabolic and Bariatric Surgery) recommends the use of %EWL and BMI to do so. To correctly assess our patient we must know what Percentage Excess Weight Loss (%EWL) is, since that is the measurement considered to determine success or failure of a weight loss surgical procedure.
Percentage Excess Weight Loss (%EWL): Preoperative Weight – Followup Weight
——————–————————————————— X 100
Ideal Weight*
* Ideal Weight is usually taken from the Metropolitan Life Insurance tables.
Weight Loss Success: Loss of more than 50 %EWL in the first 18 months.
Weight Loss Failure: Loss of less than 50 %EWL in the first 18 months.
Weight Regain: Progressive weight regain after achievement of an initial successful weight loss:
And weight regain defined as [3,5]:
Weight regain of 10kg after nadir (lowest point achieved).
Regain of >5kg/m2
Weight regain to reach 35 BMI.
Increase of 25%EWL after nadir.
Among the causes of weight regain it has been established that is probably multifactorial, some of these factors identified in a systematic review are:
Bougie size used in the calibration of sleeve/pouch, remnant antrum size, high gherlin levels, maladaptive lifestyle behaviors, and lack of followup [3]. Another study stated that weight regain outcomes after sleeve gastrectomy ranged from 6% at 2 years to 76% at 6 years depending on the definition used to establish weight regain [4].
It is also important to mention that some of the patients seeking for advice to get back on track on their weight loss process through nutritional counseling or even seeking revision or conversion surgery do not know or meet the criteria to consider their case as experiencing weight regain or to be a surgical failure (taking into account the criteria listed above). On the other hand, there is another subset of patients that do meet the criteria for considering them to have a weight loss failure or even weight regain, but the fact that the surgery improved their obesity related diseases, helped to stop or decrease medication intake and improved quality of life in personal and work related interactions make them feel satisfied and happy about their weight loss surgical procedure and results.
So, even that we do have criteria for diagnosing patients with weight regain or weight loss failure, there is a lot personal perception involved in individual desire to seek for a revision or conversion surgery and to considere themselves to have success or failure, this highlights the necessity of the patients and healthcare providers to adhere to a proper followup with a multidisciplinary team that guides the patient on his/her weight loss process, taking into account well established medical, surgical, nutritional, and psychological followup and criteria.
Angrisani L, Santonicola A, Iovino P, Formisano G, Buchwald H, Scopinaro N. Bariatric surgery worldwide 2013. Obes Surg 2015;25 (10):1822–32.
Colquitt JL, Pickett K, Loveman E, Frampton GK. Surgery for weight loss in adults. Cochrane Database Syst Rev 2014;8 (8):CD003641.
Lauti M, Hill AG, MacCormik AD, Weight regain following sleeve gastrectomy- a systematic review. Obes Sure 2016;26(6):1326-34.
M Lauti et al. Surgery for Obesity and Related Diseases 2017;13:1123-1129.
Marius Nedelcu,Haris A. Khwaja, D.Phil, Weight Regain After bariatric Surgery, Surgery for Obesity and related Diseases, 2016;12: 1129–1130.