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Weight Recidivism Post-Bariatric Surgery: A Systematic Review

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Abstract

Obesity is considered a worldwide health problem of epidemic proportions. Bariatric surgery remains the most effective treatment for patients with severe obesity, resulting in improved obesity-related co-morbidities and increased overall life expectancy. However, weight recidivism has been observed in a subset of patients post-bariatric surgery. Weight recidivism has significant medical, societal and economic ramifications. Unfortunately, there is a very limited understanding of how to predict which bariatric surgical patients are more likely to regain weight following surgery and how to appropriately treat patients who have regained weight. The objective of this paper is to systematically review the existing literature to assess the incidence and causative factors associated with weight regain following bariatric surgery. An electronic literature search was performed of the Medline, Embase and Cochrane library databases along with the PubMed US national library from January 1950 to December 2012 to identify relevant articles. Following an initial screen of 2,204 titles, 1,437 abstracts were reviewed and 1,421 met exclusion criteria. Sixteen studies were included in this analysis: seven case series, five surveys and four non-randomized controlled trials, with a total of 4,864 patients for analysis. Weight regain in these patients appeared to be multi-factorial and overlapping. Aetiologies were categorized as patient specific (psychiatric, physical inactivity, endocrinopathies/metabolic and dietary non-compliance) and operation specific. Weight regain following bariatric surgery varies according to duration of follow-up and the bariatric surgical procedure performed. The underlying causes leading to weight regain are multi-factorial and related to patient- and procedure-specific factors. Addressing post-surgical weight regain requires a systematic approach to patient assessment focusing on contributory dietary, psychologic, medical and surgical factors.

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Conflicts of interest

Shahzeer Karmali, Balpreet Brar, Christopher de Gara, Arya M Sharma and Daniel Birch have no conflicts of interest to report in respect to the drafting, review and final editing of this manuscript. Shahzeer Karmali and Daniel Birch serve as consultants for Ethicon Endosurgery, Covidien and BARD. These associations did not interfere with this manuscript.

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  1. Center for the Advancement of Minimally Invasive Surgery (CAMIS), Royal Alexandra Hospital, Room 405 CSC, 10240 Kingsway Ave, Edmonton, AB, T5H 3 V9, Canada

    Shahzeer Karmali, Balpreet Brar, Xinzhe Shi, Arya M. Sharma, Christopher de Gara & Daniel W. Birch

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  1. Shahzeer Karmali
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  2. Balpreet Brar
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Correspondence to Shahzeer Karmali.

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Karmali, S., Brar, B., Shi, X. et al. Weight Recidivism Post-Bariatric Surgery: A Systematic Review. OBES SURG 23, 1922–1933 (2013). https://doi.org/10.1007/s11695-013-1070-4

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