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Salazar J, Duran P, Garrido B, Parra H, Hernández M, Cano C, Añez R, García-Pacheco H, Cubillos G, Vasquez N, Chacin M, Bermúdez V. Weight Regain after Metabolic Surgery: Beyond the Surgical Failure. J Clin Med 2024; 13:1143. [PMID: 38398456 PMCID: PMC10888585 DOI: 10.3390/jcm13041143] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/11/2023] [Revised: 01/20/2024] [Accepted: 02/02/2024] [Indexed: 02/25/2024] Open
Abstract
Patients undergoing metabolic surgery have factors ranging from anatomo-surgical, endocrine metabolic, eating patterns and physical activity, mental health and psychological factors. Some of the latter can explain the possible pathophysiological neuroendocrine, metabolic, and adaptive mechanisms that cause the high prevalence of weight regain in postbariatric patients. Even metabolic surgery has proven to be effective in reducing excess weight in patients with obesity; some of them regain weight after this intervention. In this vein, several studies have been conducted to search factors and mechanisms involved in weight regain, to stablish strategies to manage this complication by combining metabolic surgery with either lifestyle changes, behavioral therapies, pharmacotherapy, endoscopic interventions, or finally, surgical revision. The aim of this revision is to describe certain aspects and mechanisms behind weight regain after metabolic surgery, along with preventive and therapeutic strategies for this complication.
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Affiliation(s)
- Juan Salazar
- Endocrine and Metabolic Diseases Research Center, School of Medicine, University of Zulia, Maracaibo 4004, Venezuela
| | - Pablo Duran
- Endocrine and Metabolic Diseases Research Center, School of Medicine, University of Zulia, Maracaibo 4004, Venezuela
| | - Bermary Garrido
- Endocrine and Metabolic Diseases Research Center, School of Medicine, University of Zulia, Maracaibo 4004, Venezuela
| | - Heliana Parra
- Endocrine and Metabolic Diseases Research Center, School of Medicine, University of Zulia, Maracaibo 4004, Venezuela
| | - Marlon Hernández
- Endocrine and Metabolic Diseases Research Center, School of Medicine, University of Zulia, Maracaibo 4004, Venezuela
| | - Clímaco Cano
- Endocrine and Metabolic Diseases Research Center, School of Medicine, University of Zulia, Maracaibo 4004, Venezuela
| | - Roberto Añez
- Departamento de Endocrinología y Nutrición, Hospital Quirónsalud, 28009 Madrid, Spain
| | - Henry García-Pacheco
- Facultad de Medicina, Departamento de Cirugía, Universidad del Zulia, Hospital General del Sur, Dr. Pedro Iturbe, Maracaibo 4004, Venezuela
- Unidad de Cirugía para Obesidad y Metabolismo (UCOM), Maracaibo 4004, Venezuela
| | | | | | - Maricarmen Chacin
- Facultad de Ciencias de la Salud, Universidad Simón Bolívar, Barranquilla 080001, Colombia
- Centro de Investigaciones en Ciencias de la Vida, Universidad Simón Bolívar, Barranquilla 080001, Colombia
| | - Valmore Bermúdez
- Facultad de Ciencias de la Salud, Universidad Simón Bolívar, Barranquilla 080001, Colombia
- Centro de Investigaciones en Ciencias de la Vida, Universidad Simón Bolívar, Barranquilla 080001, Colombia
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Tabesh MR, Eghtesadi M, Abolhasani M, Maleklou F, Ejtehadi F, Alizadeh Z. Nutrition, Physical Activity, and Prescription of Supplements in Pre- and Post-bariatric Surgery Patients: An Updated Comprehensive Practical Guideline. Obes Surg 2023; 33:2557-2572. [PMID: 37389806 DOI: 10.1007/s11695-023-06703-2] [Citation(s) in RCA: 7] [Impact Index Per Article: 7.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/26/2023] [Revised: 06/18/2023] [Accepted: 06/23/2023] [Indexed: 07/01/2023]
Abstract
Only in the USA, 315 billion dollars are spent annually on the medical cost of obesity in adult patients. Till now, bariatric surgery is the most effective method for treating obesity and can play an essential role in reducing the direct and indirect costs of obesity treatment. Nonetheless, there are few comprehensive guidelines which include nutrition, physical activity, and supplements, before and after surgery. The purpose of the present narrative review is to provide an updated and comprehensive practical guideline to help multidisciplinary teams. The core keywords include nutrition, diet, physical activity, exercise, supplements, macronutrients, micronutrients, weight reduction, bariatric surgery, Roux-en-Y Gastric Bypass, Sleeve Gastrostomy, Laparoscopic Adjustable Gastric Banding, and Biliopancreatic diversion with duodenal switch which were searched in databases including PubMed/Medline, Cochrane, and some other sources such as Google Scholar. We answered questions in five important areas: (a) nutritional strategies before bariatric surgery, (b) nutrition after bariatric surgery, (c) physical activity before and after bariatric surgery, (d) weight regain after bariatric surgery, and (e) micronutrient assessments and recommendations before and after bariatric surgery. Some new items were added in this updated guideline including "weight regain" and "pregnancy after bariatric surgery." Other fields were updated based on new evidence and guidelines.
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Affiliation(s)
| | - Maryam Eghtesadi
- Sports and Exercise Medicine Department, Tehran University of Medical Sciences, No. 7, Ale-ahmad Highway, Tehran, 14395-578, Iran
| | - Maryam Abolhasani
- Cardiac Primary Prevention Research Center, Cardiovascular Diseases Research Centre, Tehran University of Medical Sciences, Tehran, Iran
| | - Faezeh Maleklou
- Sports Medicine Research Center, Tehran University of Medical Sciences, Tehran, Iran
| | - Fatemeh Ejtehadi
- Sports Medicine Research Center, Tehran University of Medical Sciences, Tehran, Iran
| | - Zahra Alizadeh
- Sports and Exercise Medicine Department, Tehran University of Medical Sciences, No. 7, Ale-ahmad Highway, Tehran, 14395-578, Iran.
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Nonino CB, Barato M, Ferreira FC, Delfino HBP, Noronha NY, Nicoletti CF, Junior WS, Welendorf CR, Souza DRS, Ferreira-Julio MA, Watanabe LM, de Souza Pinhel MA. DRD2 and BDNF polymorphisms are associated with binge eating disorder in patients with weight regain after bariatric surgery. Eat Weight Disord 2022; 27:1505-1512. [PMID: 34478125 DOI: 10.1007/s40519-021-01290-6] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/13/2021] [Accepted: 08/06/2021] [Indexed: 12/23/2022] Open
Abstract
AIM The aim of this study was to analyze the association and susceptibility of Single Nucleotide Polymorphisms (SNPs) in the DRD2 and BDNF genes with BED in patients with weight regain in the postoperative period of bariatric surgery. METHODS One hundred and seventy-seven individuals who underwent bariatric surgery with weight regain were evaluated and divided into two groups according to the BED diagnostic. The individuals were submitted to an anthropometric evaluation, analysis of the presence of BED using a validated questionnaire, and blood collection for genotyping of the polymorphisms rs6265 (BDNF) and rs1800497 (DRD2) by real-time polymerase chain reaction (RT-PCR). RESULTS The presence of wild-type alleles for rs1800497 (CC) and rs6265 (GG) was more frequent in patients without BED. Nevertheless, the presence of one or two variant alleles for rs1800497 (CT + TT) and rs6265 (GA + AA) was more frequent in patients with BED. The combination of the two studied SNPs prevailed in patients with BED. CONCLUSIONS The presence of allele frequency of rs1800497 SNP in the DRD2 gene and rs6265 SNP in the BDNF gene, isolated and/or combined, indicated an additional risk for the development of BED in patients with obesity, especially in the context of weight regain. LEVEL OF EVIDENCE III (evidence obtained from the case-control analytic study).
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Affiliation(s)
- Carla Barbosa Nonino
- Laboratory of Nutrigenomic Studies, FMRP/USP, Department of Health Sciences, Ribeirao Preto Medical School, University of Sao Paulo, Av Bandeirantes, 3900, Monte Alegre, Ribeirão Preto, SP, 14049-900, Brazil.
| | - Mariana Barato
- Department of Molecular Biology, Sao Jose Do Rio Preto Medical School, São José Do Rio Preto, SP, Brazil
| | - Flávia Campos Ferreira
- Laboratory of Nutrigenomic Studies, FMRP/USP, Department of Health Sciences, Ribeirao Preto Medical School, University of Sao Paulo, Av Bandeirantes, 3900, Monte Alegre, Ribeirão Preto, SP, 14049-900, Brazil
| | - Heitor Bernardes Pereira Delfino
- Laboratory of Nutrigenomic Studies, FMRP/USP, Department of Health Sciences, Ribeirao Preto Medical School, University of Sao Paulo, Av Bandeirantes, 3900, Monte Alegre, Ribeirão Preto, SP, 14049-900, Brazil
| | - Natalia Yumi Noronha
- Laboratory of Nutrigenomic Studies, FMRP/USP, Department of Health Sciences, Ribeirao Preto Medical School, University of Sao Paulo, Av Bandeirantes, 3900, Monte Alegre, Ribeirão Preto, SP, 14049-900, Brazil
| | - Carolina Ferreira Nicoletti
- Laboratory of Nutrigenomic Studies, FMRP/USP, Department of Health Sciences, Ribeirao Preto Medical School, University of Sao Paulo, Av Bandeirantes, 3900, Monte Alegre, Ribeirão Preto, SP, 14049-900, Brazil
| | - Wilson Salgado Junior
- Department of Surgery and Anatomy, Ribeirao Preto Medical School, Ribeirão Preto, SP, Brazil
| | - Caroline Rossi Welendorf
- Laboratory of Nutrigenomic Studies, FMRP/USP, Department of Health Sciences, Ribeirao Preto Medical School, University of Sao Paulo, Av Bandeirantes, 3900, Monte Alegre, Ribeirão Preto, SP, 14049-900, Brazil
| | - Doroteia Rossi Silva Souza
- Department of Molecular Biology, Sao Jose Do Rio Preto Medical School, São José Do Rio Preto, SP, Brazil
| | | | - Ligia Moriguchi Watanabe
- Laboratory of Nutrigenomic Studies, FMRP/USP, Department of Health Sciences, Ribeirao Preto Medical School, University of Sao Paulo, Av Bandeirantes, 3900, Monte Alegre, Ribeirão Preto, SP, 14049-900, Brazil
| | - Marcela Augusta de Souza Pinhel
- Laboratory of Nutrigenomic Studies, FMRP/USP, Department of Health Sciences, Ribeirao Preto Medical School, University of Sao Paulo, Av Bandeirantes, 3900, Monte Alegre, Ribeirão Preto, SP, 14049-900, Brazil
- Department of Molecular Biology, Sao Jose Do Rio Preto Medical School, São José Do Rio Preto, SP, Brazil
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The effect of stoma size on the mid-term weight loss outcome of one anastomosis gastric bypass (OAGB): a single-blinded prospective randomized trial. Surg Endosc 2020; 35:1691-1695. [PMID: 32277357 DOI: 10.1007/s00464-020-07553-0] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/09/2020] [Accepted: 04/04/2020] [Indexed: 10/24/2022]
Abstract
BACKGROUND One anastomosis gastric bypass (OAGB) is gaining wide spread acceptance among bariatric surgeons all over the world because of its technical simplicity and documented efficacy. However, the relation between stoma size in OAGB and magnitude of weight loss has not been addressed. OBJECTIVES To evaluate the effect of stoma size on the mid-term weight loss outcome for patients with obesity after OAGB. SETTING University Hospital. MATERIALS AND METHODS This is a single-blinded prospectively randomized trial. From March 2014 to September 2016, 83 patients, eligible for bariatric surgery, were included in the study. OAGB was carried out with the same technical steps, except for the size of the gastrojejunostomy (GJ). Patients were randomly allocated into two equal groups; narrow GJ group (30 mm) and wide GJ group (45 mm). The percentage of total weight loss (%TWL) and the percentage of excess weight loss (%EWL) were recorded at 6, 12 and 24 months after procedure. RESULTS At 6 months follow-up, patients with 30 mm GJ had better %EWL (53.3) and %TWL (23.4) than other patients with 45 mm GJ (42.6 and 18.2 respectively). However, at 12 and 24 months the %TWL and %EWL difference between the two groups have disappeared. CONCLUSION Patients with narrower stoma size (30 mm) of OAGB tend initially to lose more weight than patients with wider stoma (45 mm). However, this difference disappears at mid-term follow-up after 2 years.
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Endoscopic Argon Plasma Coagulation vs. Multidisciplinary Evaluation in the Management of Weight Regain After Gastric Bypass Surgery: a Randomized Controlled Trial with SHAM Group. Obes Surg 2020; 30:1904-1916. [DOI: 10.1007/s11695-020-04414-6] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/13/2022]
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Kortchmar E, Merighi MAB, Conz CA, Jesus MCPD, Oliveira DMD. Reganho de peso após a cirurgia bariátrica: um enfoque da fenomenologia social. ACTA PAUL ENFERM 2018. [DOI: 10.1590/1982-0194201800058] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/21/2022] Open
Abstract
Resumo Objetivo Compreender a experiência de reganho de peso após a cirurgia bariátrica. Métodos Pesquisa qualitativa realizada em um Hospital Público da cidade de São Paulo. A coleta de dados foi realizada entre março a maio de 2017, por meio de entrevistas com dezessete participantes e encerrada quando o conteúdo dos depoimentos responderam ao objetivo do estudo. A análise dos significados foi norteada pelo referencial teórico-filosófico de Alfred Schütz e estudiosos da fenomenologia social. Resultados O referencial adotado possibilitou desvelar quatro categorias que traduzem os motivos existenciais do agir de pessoas com reganho de peso após cirurgia bariátrica: “sentimento de fracasso frente ao reganho de peso; “aspectos emocionais que contribuem para o reganho de peso”, “impacto do reganho de peso na saúde física e mental” e “expectativas frente ao reganho de peso”. Conclusão Os resultados deste estudo permitem ressaltar a importância da escuta qualificada e o acolhimento das questões subjetivas que levam em conta a relação que cada paciente estabelece com a obesidade e com a cirurgia bariátrica. Os aspectos da experiência de reganho de peso destacados no grupo social estudado podem subsidiar a melhoria das práticas profissionais, o incremento do ensino, pesquisa e do conhecimento em saúde.
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Chou JJ, Lee WJ, Almalki O, Chen JC, Tsai PL, Yang SH. Dietary Intake and Weight Changes 5 Years After Laparoscopic Sleeve Gastrectomy. Obes Surg 2018; 27:3240-3246. [PMID: 28589529 DOI: 10.1007/s11695-017-2765-8] [Citation(s) in RCA: 42] [Impact Index Per Article: 7.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/19/2022]
Abstract
BACKGROUND Laparoscopic sleeve gastrectomy (LSG) is becoming a leading primary bariatric surgery but long-term outcome remains unclear. The amount of food eaten is drastically reduced after LSG and may lead to nutritional deficiencies potentially. The aim of this study is to investigate long-term dietary intake and weight status after LSG. METHODS Forty patients underwent LSG had more than 5-year follow-up with complete clinical data and food frequency questionnaires were analyzed. RESULTS The mean age of subjects is 33.5 years old with mean body mass index (BMI) 37.9 kg/m2. Mean BMI loss at 5 years after LSG is 10.6 kg/m2. Weight regain appeared in 20% of patients. Dietary composition analysis at 5 years showed mean calorie intake of 1230 kcal/day, protein 70 g/day (22.5% of calorie), fat 50 g/day (36.1%), carbohydrate 126 g (41.4%), iron 7.5 mg/day, calcium 536.2 mg/day, and fiber 11.7 g/day. Calorie intake at 5 years after LSG is correlated with weight loss but weight regain is not related to a higher calorie intake. All comorbidities were significantly improved after LSG but hemoglobin and parathyroid hormone significantly changed. Incidence of iron deficiency anemia increased from 7.5% at pre-operation to 41.2% after LSG. Incidence of secondary hyperparathyroidism increased from 17.5 to 60.7%. CONCLUSION LSG is an effective and durable bariatric procedure but with significant changes in nutritional status. Dietary instruction for LSG should include foods rich in protein, iron, calcium, and fiber.
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Affiliation(s)
- Ju-Jun Chou
- School of Nutrition and Health Sciences, Taipei Medical University, No 250, Wuxing St, Xinyi District, Taipei, 110, Taiwan.,Central Clinic and Hospital, Taipei, Taiwan
| | - Wei-Jei Lee
- Central Clinic and Hospital, Taipei, Taiwan.,Min-Sheng General Hospital, Taoyuan City, Taiwan
| | - Owaid Almalki
- School of Nutrition and Health Sciences, Taipei Medical University, No 250, Wuxing St, Xinyi District, Taipei, 110, Taiwan.,Department of Surgery, College of Medicine, Taif University, Taif, Saudi Arabia
| | | | | | - Shwu-Huey Yang
- School of Nutrition and Health Sciences, Taipei Medical University, No 250, Wuxing St, Xinyi District, Taipei, 110, Taiwan. .,Nutrition Research Center, Taipei Medical University Hospital, Taipei, Taiwan.
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Abstract
OBJECTIVE This study aims to investigate weight regain and the associated variables 10 years after Roux-en-Y gastric bypass. METHOD This retrospective study recruited patients submitted to Roux-en-Y gastric bypass (N = 166) for a 10-year follow-up. The following variables were investigated: body mass index (BMI), percentage of excess weight loss (%EWL), weight regain (WR), and percentage of weight regain (%WG). The chi-squared test or Fisher's exact test compared proportions, and the Mann-Whitney test compared numerical measurements between the groups. Analysis of variance (ANOVA) compared the measurements over time. The significance level was set at 5 %. RESULTS The sample had a mean age of 39.59 ± 11.69 years, and females prevailed (71.7 %). In the long-term follow-up, 41 % of the patients had weight regain. Seventy-two months after surgery, excess weight, preoperative BMI, gender, age, nutritional monitoring, and iron deficiency did not explain weight regain. Younger patients had regained significantly more weight 96 (p = 0.008) and 120 months (p = 0.004) after surgery than older patients. Patients who regained weight had ferritin <15 μg/dL 96 months after surgery (p = 0.019). CONCLUSION Patients submitted to Roux-en-Y gastric bypass presented weight regain, which increased over time. Age, iron deficiency, and time since surgery were associated with weight regain in the long-term follow-up.
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Abstract
BACKGROUND The aim of this study is to investigate changes in iron metabolism and verify whether biochemical parameters are related to the use of oral iron supplement 10 years after Roux-en-Y gastric bypass. METHODS This longitudinal retrospective study included 151 patients submitted to Roux-en-Y gastric bypass. The collected data included use of an oral iron supplement, hemoglobin, hematocrit, serum iron, and ferritin. The chi-squared or Fisher's exact test was used to analyze the association between use of iron supplement and nutritional deficiency. The generalized estimating equations (GEEs) analyzed the nutritional deficiencies over time. RESULTS Of the study patients with iron-deficiency anemia (n = 15) in the 12-month follow-up, 73.33% (n = 11) were taking an iron supplement, and 26.67% (n = 4) were not (p = 0.0010). The effect of time was significant for hemoglobin, ferritin, iron overload (p < 0.0001), and hematocrit (p = 0.0007). Of the patients who remained in the study until the 120-month follow-up, 37.5 and 45.0% were diagnosed with iron-deficiency anemia, defined as ferritin <15 μg/L and ferritin <30 μg/L, respectively. CONCLUSIONS Iron-deficiency anemia increased over time even in patients taking oral iron supplements.
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Abstract
BACKGROUND The laparoscopic Roux-en-Y gastric bypass (LRYGB) has been considered a reference procedure in the bariatric surgery. The linear-stapled gastrojejunostomy (GJ) has proved to be safe and effective, but its optimal size referred to postoperative weight loss remains poorly understood. OBJECTIVES Evaluate the role of the linear-stapled GJ size in the mid-term post-LRYGB weight loss and occurrence of complications. MATERIALS AND METHODS From January to April 2014, 128 patients underwent LRYGB with linear-stapled GJ in a 2-year follow-up. The LRYGB were carried out with the same technical steps, except for the length of the GJ. In GJ-15-mm group (n = 64), the GJ was constructed with white 45-mm cartridge in an extension of only 15 mm whereas in GJ-45-mm group (n = 64), the GJ was achieved using full extension of the cartridge. The body mass index (BMI) reduction was recorded for 24 months after procedure. RESULTS The mean ages were 38 ± 10.6 and 41.3 ± 12.3 years, and there were 45 (70.3%) and 51 (79.7%) females in the GJ-15-mm and GJ-45-mm groups, respectively. The analysis on raw BMI data showed that both groups had significant reduction of BMI over time (p ≤ 0.05); however, reduction was greater in the GJ-15-mm group from 18 months onwards (p ≤ 0.05). The only complication observed was a case (1.56%) of stenosis in the group GJ-15 mm. CONCLUSION The global analysis of BMI reduction indicated that the narrower GJ used (GJ-15-mm group) represented a favoring factor decreasing significantly more the BMI when compared to the wider one (GJ-45-mm group).
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Nett PC, Kröll D, Borbély Y. Re-sleeve gastrectomy as revisional bariatric procedure after biliopancreatic diversion with duodenal switch. Surg Endosc 2016; 30:3511-5. [DOI: 10.1007/s00464-015-4640-9] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/27/2015] [Accepted: 10/22/2015] [Indexed: 12/25/2022]
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