Solutions to Weight Regain After WLS

February 17, 2020

Typically, within the first 12-18 months of having WLS is when most of the excess body weight is metabolized throughout the body resulting in weight loss. After this period, maintaining a nutritious diet, a healthy lifestyle, and post-WLS medical follow-up compliance is crucial. Close follow-up care can help to facilitate a routine to continue losing excess body fat percentage and reduce the risk of weight regain after WLS.

Adhering to a recommended regimen will help to keep the risk of weight regain to a minimum. If there is an underlying medical issue, then this can also pose a threat, thus making weight regain a higher possibility. Understanding the risks before and after WLS is beneficial in being able to follow, adapt, and plan for the appropriate medical follow-up care that is recommended within the crucial 18 months post-operative and beyond.

Weight Regain After WLS

Once a person has achieved their weight-loss goal, it can become easy to slip back into old habits. The patient might not realize that things may be changing, which may affect overall long-term success. Just small changes can lead to more significant problems later on.

Things like skipping meals, not meal prepping, starting to snack more often or graze, drinking sweet drinks, and alcohol intake may seem like nothing in the beginning. Over several months, a few pounds of weight gain will start to be noticeable. Periodic weighing is encouraged.

We see people coming in between three and ten years after their weight loss procedures wanting help for weight regain.

What’s my approach?

• Pouch reset
  • Revisit the diet
  • Portion control-decrease size
• Physical activity regimen
• Nutritional counseling
  • Individualized diet Plan
• Revision surgery options

Behavioral, functional, and also unrelated diseases can play a significant role for patients before and after WLS regarding weight regain. Weight gain and regain should be assessed and supported by a bariatric specialist and medical support team. Pinpointing the potential causes of weight regain will help to diagnose the cause and select a more favorable option towards the health goal. Medical follow-up care, along with attending bariatric support group meetings and laboratory testing (blood work, UGI, etc.), can also help eliminate and address underlying issues.

Pouch Reset

When we talk about a pouch reset, we are really trying to address the portion control issues.

Diets involving a pouch reset will include going back to the liquid phase of the bariatric diet and supplementation with meal replacement protein shakes. Using meal replacements is a good way to control your caloric intake as we know that one shake, when made correctly, will deliver a certain number of calories, on average, about 150 calories and protein between 15 to 30 grams. Make sure to read the labels to look out for brands that have high amounts of sugar in the shake. Diets and individualized protocols can help to eliminate many issues to help lose weight more effectively.

Physical Activity

Implementing a physical activity regimen to help the body’s metabolism and circulation is a benefit that many overlook due to time constraints, immobility or lack of preparation.

Exercise therapy, in conjunction with a calorie-restricted diet, has been clinically proven to promote significant weight loss. We know that societies and cultures that are more active tend to have lower obesity rates. At first, move a bit on a regular basis. For individuals who have mobility issues, try and focus on low impact activities like aqua aerobics and the like.

Nutritional Counseling

It is important to adhere to a medically supervised diet and a bariatric maintenance regimen given by a nutritionist and or physician.

Knowing your daily caloric intake or at least having some idea of what you are consuming can help tremendously with gauging and monitoring weight loss. A good way to keep track is to journal. Having a food log or diary can be very helpful because it allows one to go back and see what they were doing correctly or incorrectly given the results and success of the weight loss program. As an example, at Las Vegas Bariatrics, we offer clients the opportunity to log into our health app to track everything, such as food, calories, water intake, and activity, etc.

Revision Bariatric Surgery

Lastly, consulting with a bariatric specialist to see if revision surgery is appropriate can be ideal when all other options have been exhausted.

Many clients are coming to us now with failed procedures for many reasons. Revision surgery is rapidly rising, especially with the Lap-Band. We are seeing individuals with issues such as inadequate weight loss and the inability to eat certain foods that get stuck, which leads to abnormal eating behavior.

Lap-Band to the Sleeve Gastrectomy has shown outstanding results. Countless patients are now seeing better weight loss and improved health with the Lap-Band to Sleeve Gastrectomy revision. Older procedures such as the Vertical Banded Gastroplasty are also showing failed results, and weight regain. We also see that Gastric Bypass patients are having weight regain and wanting revisional procedures.

When a new patient comes to me for revision surgery, my approach is:

1. Behavior evaluation: Rule out bad eating habits.
2. Anatomical evaluation: Upper GI studies and endoscopy studies to evaluate the anatomy of the stomach.
3. Assessment: Assess what revisional procedure is appropriate.

With any revision surgery, the risk is usually higher than the original surgery. There is always the possibility of encountering scar tissue. This adds technical risk to the procedure.

Overall, your lifestyle is the key to success. I teach my patients that a healthy lifestyle and making good healthy choices daily is what one needs to do to succeed and maintain their weight loss goals. Going back to old habits has a negative impact on success. Once a patient learns how to do it the right way in the beginning; hopefully, they will continue on the right path forever.

Remember that weight loss is a journey. One should think about why you’re doing this. And the answer should be "Health."

We all have this one chance of making this life awesome. So stay focused and do it the right way.

ABOUT THE AUTHOR Bernie Hanna, MD, FACS is an internationally recognized bariatric surgeon, and the founder and Medical Director of Las Vegas Bariatrics. He is the Medical Director of North Vista Hospital, a Metabolic and Bariatric Surgery Accreditation and Quality Improvement Program (MBSAQIP) accredited for excellence in patient care & safety. Dr. Hanna has practiced medicine in the Las Vegas Valley since 2000. Read more articles from Dr. Hanna!

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