Hormonal
Bariatric surgery (BS) induces initial weight loss through foregut exclusion-mediated hormonal upregulation of satiety hormones (GLP-1, PYY) and downregulation of ghrelin, but long-term weight regain (WR) is driven by the subsequent normalization or decline of these hormonal levels, alongside behavioral factors like dietary non-adherence and grazing.
If you had bariatric surgery and are regaining weight, recognize that your body's hormonal signals (hunger/satiety) may have changed back towards pre-surgery levels. This is a known biological mechanism, not just a personal failure. Focus on behavioral strategies (dietary counseling, monitoring) to counteract these biological drives, as hormonal interventions alone have shown mixed results.
Weight loss after BS is due to the anatomical exclusion of the foregut. This leads to a hormonal upregulation of pancreatic peptide YY, glucagon-like peptide-1 (GLP-1), and gastric inhibitory polypeptide hormones which promote satiety and minimize hunger, as well as down-regulation of ghrelin with subsequent decrease in food intake [40, 41]. With time, alterations in the levels of ghrelin, leptin, and incretins diminish, resulting in WR [42–44].
Why this rating
This is a scoping review summarizing multiple studies; while mechanisms are well-cited, the review itself notes gaps in long-term evidence and small sample sizes for some hormonal markers.
Source
Weight Regain and Insufficient Weight Loss After Bariatric Surgery: Definitions, Prevalence, Mechanisms, Predictors, Prevention and Management Strategies, and Knowledge Gaps—a Scoping Review
Walid El Ansari et al. · Obesity Surgery · 2021
DOI 10.1007/s11695-020-05160-5
More from this paper
- Dietary non-adherence, specifically the consumption of high-calorie liquids, 'grazing' (repeated small meals), and food indiscretion (sweets/fats), is a primary behavioral cause of weight regain and insufficient weight loss after bariatric surgery.Moderate
- Pharmacotherapy (specifically topiramate, phentermine, liraglutide, and bupropion/naltrexone) can facilitate weight loss in post-bariatric surgery patients with weight regain or insufficient weight loss, with topiramate showing higher likelihood of significant weight loss compared to other medications.Moderate
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