Maintaining weight loss after bariatric surgery: when the spectator role is no longer enough.

Bariatric (weight loss) surgery is the gold standard treatment for severe obesity. Concern exists that patients are regaining weight in the longer term. Success and cost-effectiveness of surgery are threatened due to the re-emergence of related conditions such as diabetes. This exploratory qualitative study investigates patients' expectations and experiences of weight regain (WR) 2 years or more after Roux-en-Y gastric bypass (RYGB). Ten participants (two men and eight women) who experienced WR were interviewed between 2 and 6 years following surgery. Findings highlight that participants reacted to initial weight loss as passive spectators and were unprepared for subsequent WR. Their tolerability of WR reduced as the amount of regain increased, suggesting a 'line of tolerance' for WR. WR was influenced by a new vulnerability arising from weight loss over time, and participants struggled to manage their own weight actively as surgical effects waned. They considered self-management skills, and carer and professional support to be limited at the time when WR was most likely to occur. Degrees of tolerability are noted in individuals regaining weight after RYGB. More studies are needed to further understand these problems. Pre- and post-operative support and teaching patients self-management skills may be helpful to minimize WR.