Weight Regain Following Bariatric Surgery – Weight Loss Medication

In Australia there are over 22,000 people each year undergoing bariatric surgery, helping those living with obesity move towards a healthier body and lifestyle. Many people view bariatric surgery as their final and best chance to lose weight. Following bariatric surgery (depending on the procedure and how their body responds to the procedure), a person can often expect to achieve a weight loss of between 25-35% percent of their starting weight. This weight loss will transform someone’s life, but it won’t transform their eating habits – that part of the post-surgical care needs to be gotten right to reduce the amount of weight regain in the future.

Weight gain following bariatric surgery

Although bariatric surgery is a fantastic tool used to aid in weight loss, it requires important, lifelong commitments to a change in diet and activity levels (exercise) to be effective in the long term. Even with consistent healthy lifestyle changes, some weight regain can and does recur. Typically, weight regain can be expected to occur after 12-24 months, and while in some the weight gain is minor, in others it is progressive which can be very disheartening. From our clinical experience, patients who attend regular follow-up with their clinic, tend to regain less weight than those who don’t come back for follow-up.

What causes weight gain after bariatric surgery

The reasons why a person may gain weight following bariatric surgery can be categorised into four main factors, bearing in mind that any/all of the below might apply to an individual. 

Physiological – bariatric surgery can alter fat metabolism, resulting in easy fat storage and limited fat burning. Body fat is subject to metabolic pressure to regain lost weight. This means that everyone who has lost weight needs to restrict their intake to be less than their friends/family/colleagues. Typically, people who have lost >20 kg who wish to keep their weight off need to keep their daily intake under 1200-1500 kCal. We also see a change in so many hormones in the body that govern hunger and cravings, which are not under our voluntary control and encourage the body to regain weight.

Anatomical – over time, the stomach will soften and stretch. While the stomach after the sleeve and gastric bypass procedures will always remain small compared to how it was pre-op, people find over time that they can eat more food per sitting if they choose to. The amount of stomach stretching is the same in patients who have gained weight and those who haven’t gained weight. Patients with weight gain after bariatric surgery generally don’t eat larger meals than people without weight gain, they just eat more frequently (snacking and calorific liquids) and consume more addictive, hunger generating foods/drinks such as alcohol, milky or sweet drinks, salty/fatty snacks and processed foods. The narrative that stomach stretching leads to weight gain is a false narrative that’s popular on the internet, but it diverts people from focusing on the real underlying cause of weight regain which is addiction/grazing/comfort eating. While it’s true that the person’s softer stomach now allows them to eat more of the wrong thing for the wrong reason, it’s the choice/habit of doing the wrong thing that’s the underlying problem.

Psychological – obesity is a chronic condition and requires significant life changes following bariatric surgery in order to effectively manage weight. Psychological reasons for weight gain can be observed in many ways such as – a person slipping back into ‘old habits’ of an unhealthy relationship with food, especially the addictive foods and drinks we consume to make us feel better; they may feel a loss of identity following weight loss, or even become depressed due to factors they may not have considered such as excess skin, or because their relationships with friends/colleagues/partners have not improved even though they have lost weight. 

Behavioural – as mentioned above, lifelong commitments to behaviour are required to manage weight long-term. Despite the inability to consume large amounts of food, behaviours such as grazing in between meals or eating the wrong foods (such as processed or fast foods, consuming alcohol) can have a negative impact on diet. Another aspect of a person’s behaviour is levels of daily activity (or inactivity). 

Sadly we live in an obesogenic environment (an environment that promotes obesity), and this combined with an individual’s own challenges to change their thinking and behaviour can lead to weight gain being quite common following bariatric surgery. 

Non-Surgical Weight Loss Treatments for Weight Regain

The most important thing to do when you recognise that you have regained weight is to acknowledge it early by regularly weighing yourself and thinking about whether or not you are happy with how your weight is tracking. Many people when they are gaining weight stop weighing themselves, stop exercising, stop taking their multivitamins and stop thinking about their food choices.

In fact,  when a person regains 3-5kg this is the perfect time to ask for help, rather than waiting until they have gained 10-20-30 or more kg in weight. Seeking advice from your GP, dietitian and bariatric specialist team is critically important when you feel that things are not going the way you want them to. On-going support is available and vital for long-term weight management, and we are happy to provide it at any time along your journey. 

If someone is struggling to lose weight they have regained through diet and exercise alone, there are plenty of non-surgical weight loss treatments, such as weight loss medication, that can help them get back on track and lose the regained kg’s. At Upper GI Surgery our bariatric specialists can offer a large range of powerful medications to help with hunger and weight loss while you work on some of the “triggers’ that have led to weight gain.

If you have experienced weight gain following bariatric surgery and are interested in learning more about weight management medications and if they would be suitable for you, please contact our practice on (02) 9553 1120 who will be able to arrange an appointment with one of our Bariatric Specialists.