Bariatric surgery includes a series of surgical weight loss procedures designed to help obese or morbidly obese patients who have failed to lose weight using other methods. Despite the fact that there are proven non-surgical, medically supervised weight loss programs, for some patients, losing weight is an almost impossible task. However, there are specific reasons for not losing weight after bariatric surgery, and understanding these reasons can help patients avoid them.

There are currently four types of bariatric surgery performed in the United States, which are adjustable gastric banding, Roux-en-Y gastric bypass, sleeve gastrectomy, and biliopancreatic diversion with duodenal switch. All of them are performed and work differently, which is why physicians evaluate the patient prior to deciding which one is more appropriate. Despite the fact that bariatric surgical procedures have been meticulously studied and are proven to beboth safe and effective, patients can not always lose the amount of weight expected after weight loss surgery, due to several

Lack of Compliance That Avoids Weight Loss

None of the types of bariatric surgery cause weight loss directly, and the entire treatment process involves a high level of commitment and compliance from the patient. Even before, but particularly after the surgery, patients need to follow a strict diet, which is designed by their medical healthcare team to increase weight loss, help the stomach continue healing, and decrease the possibility of side-effects. Immediately after the surgery, patients initiate a liquid diet, slowly transition to solid foods, and three or four months following the procedure may return to a normal diet.

In addition, best practices can help keep a patient’s weight-loss goals on track, including eating and drinking slowly, keeping meals small, drinking plenty of liquids between meals, chewing food thoroughly, favoring high-protein foods, avoiding foods that are high in fat and sugar, trying each new food alone to evaluate tolerability, and taking recommended vitamin and mineral supplements. When patients fail to follow physicians’ recommendations regarding diet and exercise, not only can weight loss be compromised, but they are also at higher risk of suffering side-effects.

Diabetes As Cause to Not Lose Weight After Bariatric Surgery

Obese and morbidly obese patients commonly develop comorbidities, which are other medical conditions associated with obesity. Bariatric surgery is expected to help them lose weight, which can also result in improvements in overall health, including these conditions. However, there are other problems related to the existence of comorbidities, which occur when patients need to take medication that can influence weight loss. Among these conditions is diabetes, one of the most common obesity comorbidities.

According to the study “Factors associated with suboptimal weight loss after gastric bypass surgery,” patients with diabetes may need to take insulin or other drugs that stimulate the production of fat and cholesterol, making it more difficult for them to lose weight. “Other factors that may lead to weight gain in patients with diabetes include a ‘protective’ increase in caloric intake to treat episodes of hypoglycemia [low blood sugar], reduction of urinary glucose losses and sodium and water retention that are a direct effect of insulin on the distal tubule in the kidney,” explained the authors.

Bariatric Surgery Complications That Inhibit Weight Loss

In addition to problems that already exist prior to surgery, patients can also be prevented from losing weight due to complications that occur after the surgery. The same study demonstrated that diabetes and having a larger size stomach pouch were independently associated with poor weight loss. The size of the stomach pouch created during a bariatric surgery is determined using anatomical landmarks, but the researchers “believe it is critical to stress the importance of and to teach the creation of the small gastric pouch and to better standardize the technique used for pouch creation,” in order to improve outcomes.

Similarly, in the case of the use of the gastric band, surgeons place a rubber ring around the patients’ stomach, reducing its size. However, one of the complications that can occur is gastric band erosion, which consists of the band growing into the stomach. Due to this malfunction, the band will stop restricting the organ and patients will not only feel hungry again, but also they will start gaining or regaining weight as well. Fistulas between the gastric pouch and remnant can also cause problems with weight loss, and both physicians and patients need to be attentive to signs of potential problems that may unable weight loss and compromise the patients’ health.

Inability to Lose Weight in the Long-Term

Bariatric surgery, just like any type of medically supervised weight loss program, does not work miracles and won’t directly cause weight loss for the rest of patients’ lives. Even when patients are able to lose weight right after the surgery, continuing to visit a physician regularly and follow a healthy life-style is key to ensuring long-term results. According to the study “Long-term Management of Patients After Weight Loss Surgery,” the main factors that contribute to successful weight loss after bariatric surgery are the patient’s ability to make lifestyle changes and maintain those changes years after the procedure.

“Maintenance of weight loss is obtained by following a healthy balanced diet with regular exercise every week. Weight regain is a warning sign. It is best for patients to return to the bariatric team at the earliest signs of weight regain. If weight regain is caught in its early stages, it is easier for patients to get back on track. Regain of weight can be due to changes in operative anatomy and requires workup, but the most common causes are changes in diet, lack of exercise, or psychological issues,” state the authors.

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