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Predictors of Weight Regain After Bariatric Surgery

Predictors of Weight Regain After Bariatric Surgery

Not everyone who undergoes weight loss surgery can maintain the weight loss. These predictors of regaining weight are crucial to track.

Bariatric surgery has proven to be the most effective way to lose weight and boasts the highest rates of long-term weight maintenance. While this may be true, unfortunately, not all who undergo bariatric surgery can maintain weight loss. There are predictors of weight regain, which should be monitored for and intervened on before weight regain occurs.

In addition to psychological well-being, four main categories are important for success after bariatric surgery. These include your support system, nutrition intake, physical activity, and eating behaviors. Not following recommended guidelines allows for the increased potential weight regain after surgery.


The absence of a support system has been shown to correlate with weight regain after surgery strongly. This includes no longer following up with your surgeon or dietitian, as well as a lack of support from friends and family. Both can lead to the development of unfavorable dietary choices and eating behaviors. This is why we believe that having a strong support system in place is crucial for your success after surgery. 


Adherence to new dietary recommendations following surgery is important for weight loss and maintenance. A generally healthy diet consisting of lean proteins, vegetables, fruits, healthy fats, legumes, and whole grains in appropriate portion sizes is imperative to maintain health and prevent excessive calorie intake. Limiting intake of sugar-sweetened beverages (soda, juice, etc.), candy, desserts, fried foods, and other high-calorie options is also important. 

Adequate protein intake is crucial after surgery -- for a longer feeling of fullness after meals, preserving muscle mass, and maintaining your resting energy expenditure (calories burned at rest). It has been shown that muscle breakdown can decrease your resting energy expenditure by 25 percent. Make sure to include a protein food with each meal and focus on nutrient-dense options.

Physical Activity

Maintaining an exercise routine helps to burn more calories and preserve lean muscle mass. When physical activity gets pushed aside due to a busy schedule or lack of enjoyment, it puts you at risk for weight gain. We recommend finding an activity that you enjoy doing. It helps maintain motivation and allows you to make time for exercise.

Maladaptive Eating Behaviors

The habits surrounding our dietary intake are just as important as the types of foods that we choose to eat. Our eating behaviors are typically controlled by our feelings and are often associated with a sense of loss of control. There are many dietary patterns considered to be undesirable, some of which are described below:

Mindless eating: This is sometimes described as “eating on autopilot.” We often lack awareness of the amount of food that is being consumed when eating this way. When eating mindlessly, it is common to eat when not hungry, and distractions while eating can cause us to eat beyond fullness.

Grazing: This is eating small amounts of food continuously over an extended period of time. The food choice is usually a high-calorie, carbohydrate-based food such as chips or pretzels. You may justify the snack because “just a little won’t hurt,” but the calories add up when the intake is repetitive. Bariatric surgery patients who suffered from binge eating disorders before surgery are at risk for developing grazing behaviors since they can no longer consume a large volume of food at one time.

Emotional eating: Eating in response to feelings instead of hunger. Often triggered by sadness, anxiety, or stress, food is used as a distraction and form of comfort. This is where the term “comfort food” comes from. Another form of emotional eating is when food is used as a reward. 

Night Eating Syndrome: This is not the same as sleep eating. Night eating syndrome is when someone eats minimal to no food throughout the day and a larger volume of food in the evening. Reasons for not eating during the day include a busy lifestyle, lack of hunger, and distractions. People with this eating behavior often subconsciously feel the need to “catch up” on calories missed during the day and often choose high carbohydrate snacks.

Recommendations for avoiding weight gain after bariatric surgery:

  • Have a regular, planned meal and snack times.
  • Keep a food log and also document how you are feeling that day.
  • Find a form of exercise that you enjoy.
  • Find healthy coping mechanisms that aren’t food-related to help handle big emotions.
  • Attend LVMC’s Bariatric Support Group. Learn more about our bariatric services by calling 805-737-3382.