Weight Regain Following Sleeve Gastrectomy

Abstract

Aim To decrease weight regain following sleeve gastrectomy. Methods A mixed methods approach was used to address the study aim. All study populations were taken from Counties Manukau Health patients who had undergone sleeve gastrectomy. The following studies were conducted: 1. Systematic review of weight regain specifically following sleeve gastrectomy in relation to its definition, rate and aetiology 2. Retrospective review of the cohort of first sleeve gastrectomy patients to investigate the significance of weight regain 3. Focus group discussions with patients who had experienced weight regain following sleeve gastrectomy to understand the patients’ perspective 4. Randomised controlled clinical trial of an intervention to reduce weight regain following sleeve gastrectomy developed using the knowledge gained from the previous studies. Results Systematic review identified several definitions for weight regain employed in the literature. Rates of reported regain ranged from 6% at two years to 76% at six years and varied according to the definition used. Five causes for weight regain following sleeve gastrectomy were identified. These were technical factors contributing to sleeve size, sleeve dilatation, ghrelin levels, follow‐up support and maladaptive lifestyle behaviours. Applying the range of identified definitions to the cohort of first sleeve gastrectomy patients demonstrated the significant effect non‐standardised definitions have on reporting clinical outcomes. The rates of regain ranged from 9% to 91% when these different definitions were applied to this same group of patients. Focus group discussions with almost 40 weight regain patients who had undergone sleeve gastrectomy at least two years prior also identified a lack of follow‐up support, maladaptive eating and exercise behaviours as important factors contributing to weight regain. In addition, patients described non‐traditional methods of increased support, such as text messaging, as appropriate delivery methods for follow‐up care. Based on these findings, a text message intervention was designed to reduce weight regain and implemented at the time of discharge from the bariatric service. Following one year of receiving a daily text message, patients tended to have less weight regain, though this did not reach statistical significance, and a significantly better Bariatric Analysis and Reporting Outcome System score than those randomised to standard care. Conclusion Weight regain following sleeve gastrectomy is an important and common, but not well understood, phenomenon. The lack of standardised reporting has significant effects not only on understanding weight regain but also on reporting patient outcomes. Despite this, both patients and clinicians have identified maladaptive behaviours and a lack of follow‐up support as important contributors to weight regain. Targeting interventions to these factors appears to be promising for reducing weight regain and improving patient well‐being.