Weight Regain after Gastric Bypass

Gastric bypass performed by an experienced surgeon will often result in lifetime restriction and malabsorption leading to sustained weight loss over the long-term. There is the possibility, however, that after several years patients may begin to regain weight. There are several possible reasons for this weight gain, we will explore below.

It is not uncommon for patients to regain 10 to 15% of their excess body weight lost after a few years of consistent weight loss and plateauing. This occurs in virtually every patient and is usually the result of the stomach adapting to dietary and exercise fluctuations. This is your so called “set weight”.which

If a patient is regaining a significant amount of weight, it warrants a closer evaluation.

First and most importantly, we will be looking at the patient’s lifestyle and specifically their diet and exercise regimen. If the patient’s diet and exercise plan is no longer working to their advantage, a change in routine may be what is needed to ensure limited weight regain or additional weight loss. After months of consistent weight loss and the constant environmental pressures to consume foods that are not beneficial to weight loss, it becomes easier to stray from our diets. In addition, our bodies are very adaptable, repetitive exercise often becomes less effective over time, making changing routines or cross training more important. .
In some cases, the patient will not have been able to maintain their post bariatric diet and will be consuming significantly more food than is prescribed. It is possible that a patient has redeveloped poor eating habits or consuming large volumes of liquid calories. The newly created stomach in the form of a pouch for a gastric bypass and the sleeve do not stretch readily. However, the opening of a bypass, the stoma, and the outlet of the sleeve, the pylorus, may allow food to pass through more readily and functionally allow greater intake. There are surgical options for correction with a stoma repair and/or the addition of medications to reestablish weight loss. See Overstitch
If the procedure is performed by another surgeon at an outside institution, further investigation is warranted. Sleeve sizes have not been standardized across the United States. Bypassed stomachs can fistulize into the old stomach or be created too large. Therefore a combination of tests such as a CT scan of the abdomen, an UGI, or an EGD may be warranted.