Weight Gain/Regain Following the COVID-19 Quarantine is not Only Common, it’s Expected

| August 1, 2020

by Christopher D. Still, DO, FACN, FACP

Co-clinical Editor of Bariatric Times; Medical Director for the Center for Nutrition and Weight Management, and Director for Geisinger Obesity Research Institute at Geisinger Medical Center in Danville, Pennsylvania.

Dear Colleagues:

As we begin to “Go Green” and come out of our homes and get back to our new normal, many of us has experienced the “Quarantine 15”! To this end, I thought it would be appropriate to review strategies for weight gain/regain. By now, you know that one of my favorite and most frequently used take-home messages for patients is the importance of having realistic expectations through ALL stages of their weight management journey, which often includes some weight regain. Though some might find it disheartening and want to just give up, weight regain in bariatric surgery patients during a drastic lifestyle change is expected and can be successfully treated.

Encourage continued accountability and follow-up. With technology literally at our fingertips, keeping track of diet, physical activity, and weight on a day-to-day basis has never been easier. Moreover, with the advent of telehealth, a consultation with your healthcare provider is only a click away.

Investigate the “why.” Although most of us know “why” weight gain might have occurred over the last five months, it’s important to explore all potential causes. Weight regain is multifactorial and usually diagnosed by evaluating a patient’s medical history and weight over time. There are multiple possible causes of weight regain, some of which require further attention. The following discusses the different categories that might contribute to weight regain regardless of the recent quarantine:

Dietary intake. Dietary “indiscretion” is the most common cause of weight regain following bariatric surgery. Patients often change from eating 2 to 3 structured meals per day to more of a “grazing” pattern. Moreover, the macronutrient composition changes from predominately protein to more carbohydrates and soft calories that might increase appetite. It might be beneficial to have your patient seen by a dietitian to evaluate their eating patterns and food choices.

Exercise and physiologic influences. Like diet, a patient’s adherence to their recommended physical activity was curtailed over the past few months. Exercise is a crucial part of weight maintenance. Following rapid weight loss, patients can experience decreases in muscle mass, and resultant, decreased resting energy expenditure. Physical activity helps maintain muscle mass, which, in turn, maintains one’s resting energy expenditure. An individual’s weight is influenced by several factors, including genetics, environment, and hormonal regulation. There are several physiologic factors that our body possesses to maintain one’s adiposity and regain weight. This “set point” or weight range in which our bodies are programmed to function optimally. When weight is reduced by dieting or other means, hormone levels and adipocytes signal the brain to increase appetite. Because of these processes, it is often difficult for people to maintain a significant weight loss over a long period of time without some weight regain.

Depression. Depression is another cause of weight regain and not unexpected after what we have all gone through. It can cause some patients to “self-medicate” with food, especially carbohydrates, often falling into the grazing eating pattern. It’s important to screen patients for depression using an objective depression inventory.

Medications. Another consideration for weight regain are medications. It is important to take a thorough medication history to ensure that the medications that patients are taking are not causing weight gain or inhibiting weight loss.

Consider weight loss medications. While there might or might not be an identifiable cause for weight regain following bariatric surgery, anti-obesity medication should be considered in patients with weight gain. Similarly to cancer treatment, recurrence often warrants adjuvant chemotherapy. This same mindset should pertain to obesity treatment. Moreover, since the current weight loss medications are approved for weight loss and weight maintenance by the United States Food and Drug Administration (FDA), all our bariatric surgery patients are candidates for weight loss medications regardless of their current body mass index (BMI). This means patients do not need to gain weight to reach a BMI of 27kg/m2 with a comorbidity or BMI of 30kg/m2 alone for they had once met that criteria.

In summary, weight regain is common following all weight loss modalities, regardless of the last five months. Due to a patient’s genetics and physiological pathways that our bodies possess to maintain weight, weight regain is not the FAULT of the patient or what he or she is doing or not doing. Early intervention is key, and continued accountability provides the greatest chance for long-term success.


Christopher D. Still, DO, FACN, FACP

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