Bariatric surgery is a procedure for long term weight loss. It should be accompanied lifestyle modification to ensure that the results stay for a long time. Many people, however, are concerned that they might regain weight which they have initially lost after their surgery. This can happen in 5-10 % of individuals who may regain upto 50 % of the weight which they lost initially. Weight regain usually happens after the second or third year of surgery and is related to a number of factors.
The most important factor is poor lifestyle choices and lack of discipline in diet. Bariatric surgery restricts the amount of food which a person can take but the food choices that we take are determined by our own conscious decisions. Taking a lot of high calorie processed food leads to fat deposition causing weight gain. Lack of dietary fibre and poor protein intake also predispose to this problem. Also, improper meal timings, late night snacking and liquid calories in the diet bypass the regulation imposed by bariatric surgery and can cause weight regain.
Bariatric surgery is a metabolic procedure which accelerates the basal metabolic rate by promoting the release of fat burning hormones. However, with time, these hormonal effects wane of and the BMR may again become sluggish if the person doesn’t follow a proper active lifestyle. It is recommended that every adult should walk 8000-10000 steps a day and indulge in 20 minutes of active exercise to maintain a healthy BMR. Sedentary lifestyle, stress and lack of proper sleep all tend to slow down the BMR which cause weight regain.
The third important factor for weight regain is mechanical dilatation of the gastric pouch or sleeve with time. This is a natural process which occurs in all individuals as the stomach tissues are elastic and can stretch. It becomes more problematic for people who indulge in overeating and taking carbonated drinks which can cause rapid stretching of the pouch. This in turn increases the capacity to take food and when the caloric intake increases, it causes weight regain. It can again be avoided by a proper disciplined diet.
Besides diet and lifestyle, an important surgical method of preventing weight regain is to perform banded bariatric procedures. This involves placing a loosely fitting non adjustable band or ring around the gastric sleeve/ pouch at the time of surgery. This band/ring though initially is loose fitting, becomes snug around the pouch once the latter starts dilating. This gives the patient a renewed sense of satiety and restricts food intake. It also prevents rapid dilation of the pouch and promotes proper food discipline. The added cost of the band/ring is compensated by the added advantage of preventing weight regain in the long run. Many scientific studies have established the efficacy of banded sleeve and banded gastric bypass in long term weight management and preventing weight regain.