The goal of any bariatric surgery is long term weight loss and many patients perceive that the changes induced by bariatric surgery are permanent. However, we need to understand that obesity is a chronic relapsing condition that is very difficult to eradicate completely. Hence the risk of weight regain is very real if the dietary and lifestyle modifications are not adhered to properly.
Weight regain is a long term complication which is seen in 5-15% of patients who undergo bariatric surgery. It is defined as regain of more than 20% of the nadir weight which was achieved after weight loss surgery. The regain of weight usually starts 2-3 years after undergoing the initial bariatric surgery operation and is sometimes accompanied by return of the co-morbidities which were associated with obesity.
The risk factors associated with weight regain can be divided into anatomical/physiological, behavioural/lifestyle and medical factors. After the phase of weight loss is over and weight gradually stabilises over 12-18 months, the appetite and capacity to take food at one time starts increasing gradually. This is related to gradual stretching of the remnant stomach/gastric pouch and/or widening of the anastomosis with the intestine. Moreover, the secretion of hunger hormone which was suppressed initially to very low levels also increases slowly and the body adapts itself to consuming more food at one time. This is the time when adherence to the correct diet as well as proper food choices plays a vital role. A high protein nutritious diet with plenty of fibre and unprocessed foods prevents the intake of excess calories at this stage. Excess of alcohol as well as intake of liquid calories should be avoided at all costs as they can cause the weight to rise steeply. Maintaining a proper routine and sticking to meal times as well as noting the food intake in a food diary will minimise gross errors in diet.
Regular exercise also plays a vital role in long term weight loss and preventing regain. The exercise routine should be started early, followed religiously with frequent modifications or innovations to avoid boredom as well adaptation. A combination of aerobic exercises and weight training is ideal because it accelerates the heart rate for fat burning as well preservation of the lean body mass for a higher BMR. This also prevents weight bouncing back when the capacity for food intake has increased.
Bariatric surgery patients should attend the support group meetings and programmes regularly and try to engage themselves in recreation involving physical activity. Participation in group sporting activities is often a great way to burn calories along with the enjoyment of social interaction. Also, a number of hobbies can be cultivated which involve physical activity and hence prevent weight regain.
Last but not the least, medical conditions can contribute to weight regain in some people. These may be the pre-existing medical conditions which were present before surgery or new diseases which have developed with time. Many drugs can contribute to weight gain and they should be taken only after proper prescription by the concerned physician and dose should be optimised to minimise the side effects. Sometimes, accidents and injuries can lead to long term physical impairment and can contribute to weight regain.
Above all, patients undergoing bariatric surgery should always remember that obesity is a recalcitrant medical condition and never let down their guard regarding recurrence of this condition.