Weight Regain After Bariatric Surgery: Scope of the Problem, Causes, Prevention, and Treatment

Purpose of ReviewAlthough bariatric surgery is the mosteffective treatment of severe obesity, a proportion of patients experience clinically significant weight regain (WR) with further out from surgery. The purpose of this review is to summarize the prevalence, predictors, and causes of weight regain. Recent FindingsEstimating the prevalence of WR is limited by a lack of consensus on its definition. While anatomic failures such as dilated gastric fundus after sleeve gastrectomy and gastro-gastric fistula after Roux-en-Y gastric bypass can lead to WR, the most common causes appear to be dysregulated/maladaptive eating behaviors, lifestyle factors, and physiological compensatory mechanisms. To date, dietary, supportive, behavioral, and exercise interventions have not demonstrated a clinically meaningful impact on WR, and there is limited evidence for pharmacotherapy. Summary Future studies should be aimed at better defining WR to begin to understand the etiologies. Additionally, there is a need for non-surgical interventions with demonstrated efficacy in rigorous randomized controlled trials for the prevention and reversal of WR after bariatric surgery.

Automated summary

Although bariatric surgery is the most effective treatment for severe obesity, a proportion of patients experience weight regain after surgery. The causes of weight regain are not well-defined, but dysregulated/maladaptive eating behaviors, lifestyle factors, and physiological compensatory mechanisms are believed to contribute. Current interventions, including dietary, supportive, behavioral, and exercise approaches, have not shown significant impact on weight regain. Future studies should aim to better understand the etiologies of weight regain and develop non-surgical interventions with demonstrated efficacy in rigorous trials.