Many patients state that “I know a person who had weight loss surgery
and years later they are just as big as they were before due to significant
weight regain.” The problem with this statement is that nobody truly
knows the circumstances behind the weight regain. Statistics demonstrate
that as many as 50% of patients may regain a minimal amount of weight
(5%) back after two to three years. However, they remain successful in
their long term weight loss efforts. “Successful” weight loss
is defined as greater than or equal to 50% of a person’s excess
body weight. Therefore, in order to calculate that number, an individual
must take their height and weight to calculate their BMI and compare it
to a normal BMI. Half, or 50%, of that difference is the amount of weight
that is expected from bariatric surgery. The majority of patients achieve
much higher percentages of weight loss. So regaining 50% of their excess
weight that was lost is very rare, in which case the surgery was not successful.
There are many reasons for which patients regain weight. Most of these
reasons are behavioral. The biology does not change other than hunger
hormones and metabolic set points stabilizing. The majority of patients
who suffer from significant weight regain can pinpoint reasons for their
weight gain. Examples reasons may include stress, loss of a loved one,
loss of employment, or economic hardship. In these cases, individuals
may turn back to bad eating habits as a coping mechanism.
Unfortunately, no surgical weight loss procedure is immune to liquid calories.
Those who consume ice-cream, milkshakes, and sugary alcoholic beverages
as coping mechanisms can easily regain weight. In addition, resorting
to bad eating habits with high calorie, sugary, or fatty foods including
sweets, even in small amounts throughout the day, can lead to weight regain
in the long run. It is thus extremely important to curb these habits and
the reasons for embarking on a surgical weight loss journey are to eradicate
bad eating behaviors.
Unfortunately, economic instability and medical tourism have led many patients
to undergo procedures from non-qualified healthcare practitioners. Patients
considering the surgery should only go to board certified fellowship trained
bariatric surgeons who practice at comprehensive bariatric centers.
Patient who have had the procedure done incorrectly all have the same story.
Weight loss surgery is performed, the patient feels good and initially
loses weight because they are on a post-surgical restrictive diet while
undergoing the healing process. Months later the patient starts feeling
hungry again, as they used to prior to surgery. They can no longer fight
their hunger and start to regain weight. Time goes by and unfortunately
patients regain a substantial amount, if not reaching their preoperative
weight again. The patients feel terrible because they have “failed”
surgery and it can take them years to again seek help.
In some cases, when patients go back to their original surgeons, they are
told that “your stomach stretched out,” when in fact, the
procedure was not done correctly the first time. I have unfortunately
treated many patients with the same story and had to revise many bariatric
procedures in order to provide patients with the long term weight loss
tools they were initially seeking.