Guest Blog by: Dr. Lillian Craggs-Dino, DHA, RDN, LDN\nMetabolic and bariatric surgery (MBS) is a proven and durable remedy for obesity. However, it is not unusual for patients to regain some excess weight over time. Why does this happen? \nThis issue confirms that obesity is a chronic, genetic, and complex disease that may require different avenues of intervention, including eating habits, physical activity, follow-up bariatric procedures, and weight loss medications if needed. \nThe good news? Action can always be taken when it comes to weight regain, whether it's lifestyle changes or accountability. It’s unlikely that you will gain all of the weight back after MBS. \nThis blog explores the contributing factors to weight gain and how to support weight management after MBS.\nLong-Term Weight Loss \nWhen it comes to meeting personal goals after surgery, more often than not, metabolic and bariatric patients keep excess weight off, gain control of their health, and are happier with their quality of life.\nSo, what are the statistics for weight regain? According to Elhag \u0026amp; El Ansari, at two years post-surgery, 5.7% weight regain can be seen in patients with sleeve gastrectomy and 17.1% with gastric bypass. (1) \nThose aren’t great numbers, but fortunately, utilizing the right tools and support should bury old habits that cause weight fluctuations. \nWeight Gain Contributing Factors\nThere are many contributing factors to weight gain after MBS. Body weight can be influenced by medical, surgical, dietary, lifestyle, and psychosocial reasons. \nFor example, weight regain may result from a new medical diagnosis or medication. Another issue could be that your bariatric stomach pouch has become abnormally dilated or the surgery is not providing effective restriction or satiety control. Some of these reasons may be beyond our control, so it’s essential to focus on what can be managed. \nSo, what can be controlled? It’s your choice to follow bariatric nutrition guidelines recommended by your dietitian and other healthcare practitioners. This includes incorporating physical activity and healthy eating behaviors.\nIf you have lost weight and started to regain it back, take a moment to acknowledge if you have revisited old habits, like snacking or binge eating. Weight management and maintenance require daily self-monitoring, assessing, adjusting, and changing. Once you have taken those steps, you should reevaluate to ensure that your changes are meaningful based on your goals. \n\nWeight Management and Dietary Support \nYou are never alone in your journey! You can access a bariatric team for a complete medical, nutritional, and emotional follow-up. \nGet labs done to evaluate vitamin and mineral deficiencies that might contribute to weight regain. Discuss with your surgeon if any surgical or physical changes to your stomach pouch or sleeve may affect your weight loss efforts.\nIf you need to catch up with your dietary habits, revisit bariatric basics. Now, let’s review those basics!\nProtein Intake\nIt is critical to consume an adequate amount of lean protein daily. This nutrient is needed to maintain muscle mass and satiety while supporting healing after MBS. Generally, it is recommended that women start with 60-80 grams per day and men with 80-100 grams per day. Protein supplements can help you reach daily protein goals and support muscle mass if you have difficulty getting enough protein through dietary sources.*\nFluids\nIn a recent study, 3.5% of every 141,748 bariatric cases required intervention for dehydration. (2) For proper hydration, drinking 64 ounces of sugar-free, low-calorie, alcohol-free, and carbonation-free beverages is recommended daily after MBS. \nRemember, do not eat and drink together to avoid false signs of satiety.\nNutrients\nLifelong bariatric-specific vitamin and mineral supplements are recommended post-surgery. Patients with metabolic and bariatric surgery need a daily multivitamin\/multimineral (bariatric-specific preferred). Some may also require vitamin B12, additional B1, calcium with vitamin D, and extra iron.* \nRefer to your bariatric program’s guidelines for proper dosages and follow up with labs to determine if you require more or less.\nPhysical Activity \nExercise is a significant contributing factor to weight loss. Including variety, such as resistance training and aerobic exercise, is essential in your routine. \nIf you already have a consistent workout routine but are still gaining weight, increase the duration and intensity of your exercise. The body can adapt to a workout regimen and may need that extra push. \nEating Behaviors\nBreaking old habits can be challenging. Eating slowly, chewing food well, and stopping when you feel full is a good start.\nMonitor\nSelf-monitoring increases awareness of nutritional intake and highlights areas of improvement. What exactly should you monitor? \n\nBody weight\nBody composition \nDietary intake\nFluid intake\nVitamin and mineral intake\nPhysical activity\nEmotional state \n\nSupport\nThis can include your bariatric team's medical, surgical, and dietary support. Friends and family can offer emotional support as well. \nSupport groups are also widely available in person and online to get advice from medical professionals and hear the viewpoint of fellow patients. \nSummary\nWeight regain is normal and natural after weight loss, whether induced through surgery or non-surgical. The key is to keep weight gain minimal and maintain healthy weight management. \nMetabolic and bariatric surgery (MBS) can provide a weight loss jumpstart and help keep you ahead of the curve, but it’s your responsibility to maintain lifestyle changes. The most successful people make small, smart steps toward their goals. Making small, consistent, and meaningful changes is ultimately your key to lasting weight loss and management. \nReferences\n\nObes Surg. 2021; 31(4): 1755-1766 [PMID: 33555451]\nObes Surg. 2021; 31(2): 838-846 [PMID: 33051789]\n\n\n*These statements have not been evaluated by the Food \u0026amp; Drug Administration (FDA). These products are not intended to diagnose, treat, cure or prevent any disease.\nThis blog is for information and education purposes only. This information is not intended to substitute professional medical advice, diagnosis, or treatment. Please consult with your bariatric surgeon or another qualified healthcare provider with any questions in regards to a medical condition. A qualified healthcare professional can best assist you in deciding whether a dietary supplement is suitable based on your individual needs.\nDr. Lillian Craggs-Dino is a retained consultant for Bariatric Fusion.