Food indiscretion also contributed to WR. For instance, the follow up of patients for 85 months after surgery revealed that poor dietary habits including consumption of excessive calories, snacks, sweets oils and fatty foods were statistically higher in WR patients [ 6 ].
This highlightes the importance of appropriate nutritional counselling for long-term weight maintenance. Lack of appropriate nutritional follow-up was also significantly associated with WR post BS [ 6 ].
Inadequate physical activity contributes to WR. A meta-analysis of 14 studies and a literature review of 19 studies concluded that post-BS physical activity was significantly associated with greater WL [ 40 ]. Amongst obese patients post-RYGB, those who performed physical activity had the lowest incidence of WR compared to those who were relatively inactive [ 6 ]. Such findings highlight the importance of measuring and documenting physical activity levels after BS [ 35 ].
The represents a risk factor for WR Sedentary behavior is associated with increased risk of obesity and related comorbidities [ 40 ]. Research have found that severely obese BS candidates are at high risk for SB [ 41 ]. Mental health status prior to surgery is linked to WL following BS. Therefore, pre-operative psychological evaluation is important. Psychological factors might interfere with successful WL by undermining motivation, diet and exercise compliance, and other health behaviors critical to maintaining WL [ 42 ].
Evidence supports the association between post-operative depressive disorders and poorer WL; however, the directionality of the relationship remains unknown [ 44 ].
More research is required to assess the long-term associations and directionality of depression and weight loss post BS. Maladaptive eating patterns after BS have impact on weight and psychological outcomes [ 45 ]. Despite the physical limitations of BS on stomach capacity, BE is not always abolished and many of those who had BE before BS still had feelings of loss of control when eating even small amounts of food post BS [ 37 , 47 ]. Likewise, among LAGB patients, the prevalence of eating disorder increased from LAGB success is correlated with appropriate follow-up, as saline adjustment of the band is essential for proper restriction and WL.
Moreover, after 14 years, the reoperation rate was as high as The main reason for LAGB removal was intolerance secondary to increased reflux type symptoms [ 52 ]. The gastric sleeve may dilate over time leading to reduced restrictive effect and increase in gastric capacity, both associated with reduced satiety response and increased food intake resulting in WR [ 23 ]. For instance, among the Several theories have been proposed as to the relationship of increased gastric volume and WR.
One theory is that the physiologic dilation of the remnant stomach over time and the size of the gastric sleeve are linearly correlated with post-operative BMI [ 53 , 54 ].
Another theory is the incomplete removal of the gastric fundus [ 55 , 56 ], where in many cases, the dissection over the fundus, especially on the posterior aspect, may be difficult and technically demanding, notably in patients with the extreme obesity.
Dilatation of the gastric pouch or gastrojejunostomy GJ stoma outlet have been associated with loss of satiety with subsequent increase in food intake and WR [ 57 , 58 ]. This is thought to develop as a result of the breakdown of the surgical staple line.
Although gastro-gastric fistulas are uncommon, with a 1. Gastro-gastric fistulas have potentially significant effects as a complication after RYGB [ 60 ] as they may diminish the restrictive and malabsorptive components of RYGB leading WR [ 61 ].
The bariatric team can then offer such patients appropriate resources and counseling. Figure 1 depicts the predictors of WR. Age seems to be a predictor of WR, however, findings are inconsistent.
Some smaller studies identified older age as a potential preoperative predictor of WR [ 62 , 63 ]. Among post RYGB patients, male sex was associated with a worse weight trajectory [ 22 ] and suboptimal WL at 1 year after surgery [ 64 ].
Others found no effect of gender on weight loss outcomes [ 62 ]. Longer duration after BS predicted WR [ 24 ]. One study reported significant longer time since RYGB surgery in patients with WR 6 years compared with patients who sustained their weight loss 3.
Longer durations after surgery are probably associated with resolution of food intolerances, return to preoperative eating and other lifestyle patterns, anatomic surgical failure, or poor attendance of postoperative appointments [ 7 , 65 ]. A meta-analysis found that preoperative BMI and super-obesity were negatively associated with WL, where super-obese patients had For example, studies found that among post-RYGB patients with An assessment of bariatric participants in the Longitudinal Assessment of Bariatric Surgery LABS Study found that low HDL cholesterol and hypertension were also associated with an inferior weight trajectory [ 22 ].
WR has important health consequences including recurrence of obesity related co-morbidities such as T2DM and deterioration in quality of life QoL , thus contributing to socioeconomic and direct health care costs.
This range of implications of WR is highlighted below. Patients with no WR had no relapse of their diabetes [70]. WR is significantly associated with deterioration in QoL [ 3 , 9 ]. Others reported declines of physical and mental health—related QoL among Moreover, satisfaction with surgery also declined among This decline was observed when the rate of WR was the highest, supporting a dose—response relationship i.
Figure 1 summarizes the prevention strategies of WR. The foundation of prevention of WR after BS is aggressive behavioral interventions, similar to those utilized for medical weight management patients [ 33 ]. Behavioral modification components include commitment to regular structured physical activity, dietary control, nutritional optimization with substantive changes in eating practices and lifestyle habits [ 33 , 71 ].
Other modulators include stress management, realistic goal setting, environmental control strategies, support systems, and cognitive restructuring [ 33 , 71 ]. Close regular follow-up should start shortly after BS to reinforce nutritional and lifestyle instructions provided at discharge. Monitoring, education, and support should continue on the long term as the effectiveness of behavioral changes diminishes with time [ 33 ].
Self-monitoring with regular weight measurement, food records, and exercise diaries are essential tools for avoiding WR. In-person dietary counseling by a registered dietitian has an important role in prevention of WR post BS [ 73 ]. Structured physical activity is vital for weight prevention. Only patients with at least 2 years of surgery were included. The percentage of excess body mass index BMI loss at 24, 36, 48, and 60 months postsurgery was compared to the measurements obtained at 18 months after surgery.
Surgical therapeutic failure was also evaluated. There are numerous reasons why this might happen or factors that might contribute:. Prior Weight : Gastric bypass surgery patients are usually encouraged to lose some weight before the surgery in order to reduce the chance of surgical complications and to begin to make the kind of lifestyle adjustments that are necessary for sustained weight loss.
Those with binge eating disorder BED are especially vulnerable to experiencing weight regain. In addition to having a poor diet and low physical activity, some patients also turn to alcohol or drug abuse; besides the potential for associated negative eating habits, alcohol and drug abuse can cause significant complications in terms of the actual surgery.
Mental Health : An issue often closely related to lifestyle and behavior issues is mental health. Beyond the well understood physical health concerns associated with obesity, it also has many psychological and emotional components. These factors, combined with a possible lack of a social support group, can make weight regain more likely in the years following surgery.
Old habits and food addiction may return and create a spiraling effect that leads to more weight gain and more depression. Some common issues that may come up include:. True You is pleased to offer this procedure for motivated individuals who previously had gastric bypass and are now experiencing weight regain.
Even though the original gastric bypass was done surgically, True You can perform a revision endoscopically and without the need for any incisions. The most common reasons for a revision is either an enlarged gastric pouch or an enlarged opening between the gastric pouch and the small intestine known as gastrojejunal anastomosis.
To resolve the problem, we use an endoscope to reduce the size of the pouch or the opening through carefully placed sutures. With the reduced pouch size, it allows the gastric bypass to function the same way it did when the surgery was first completed. But as potentially beneficial as the surgery can be, there are always risks associated with surgery; this is especially true for obese adults who may already have underlying health issues.
At True You, we understand how challenging it can be to lose weight. In a world where fad dieting and unsustainable exercise regimens are often put forward as the only ways to lose weight, we offer state-of-the-art, non-surgical solutions that can give you comparable results to bariatric surgery without the risks and complexities of actual surgery.
Contact us today to request a consultation. Freedom is waiting!
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