It is common knowledge among bariatric surgeons that, sometime after surgery, patients tend to present with higher weight than the least measured in the period between 18 and 24 months after the procedure, the interval in which weight loss plateau is reached. Weight regain occurs usually between 2 and 5 years after gastric bypass, in a significant percentage of the patient population depending on patient compliance and the attention given by the bariatric medical staff and support groups.
In a seminar of the American Society for Bariatric Surgery and the Academy of Alimentary Disorders, Carol Signore1 asked surgeons and colleagues from support groups (psychologists, nutritionists) about the extent of weight regain in operated patients and if they considered support groups important to improve weight loss. Many of the attending professionals agreed that the number of patients regaining weight was certainly increasing along with the follow-up time. A consensus was reached and patients having gastric bypass were divided into groups regarding weight regain:
GROUP 1—about 25% of patients lose 80%–100% of their excess weight, regardless of medical or support groups’ aid.
GROUP 2—25% of patients do not lose enough weight, or display weight regains, even with medical and support group care.
GROUP 3—about 50% of patients might achieve good results, but this is primarily dependent of the efficacy of medical staff and the attention of support groups. For these patients, the ability of the multi-professional team to keep patients involved in support group programs is vital. Should these data be confirmed, it is possible that, in long-term analysis (5–10 years after surgery), almost half of the patients could experience suboptimal results.
According to the professionals attending the seminar, many patients do not take advantage of the help from these groups, without which they may not reach the expected goals.
There are few published works to date on patient's long-term follow-up, but most surgeons are aware that weight regain is really taking place. Long-term weight-loss maintenance after bariatric surgery depends, among other things, on change in alimentary habits, being essential to identify those patients who present with binge eating disorder (BED) before the procedure so that these patients can receive more adequate treatment in the postoperatory period. BED, as stated by Saunders,2 was present in 33.3% of the cases studied by her. These data are similar to those found by Spitzer,3 from which BED prevalence was 30% in patients who submitted to medical treatment for weight loss. Hsu et al.4 found 38% of BED in preoperative bariatric surgery patients.
It is important to consider other eating disorders that do not fulfill BED's criteria, but may cause problems to the patients postoperatively. A high incidence of depression is associated with severe binge eating (BE) in the postoperative period, showing that the patient's psychological state is related to BE regardless ...