Section of Endocrinology, Diabetes, Nutrition, and Weight Management, Department of Medicine, Boston University School of Medicine and Boston Medical Center, Boston, Massachusetts.
Section of Minimally Invasive Surgery, Department of Surgery, Boston University School of Medicine and Boston Medical Center, Boston, Massachusetts.
J Clin Endocrinol Metab. 2021 Jan 1;106(1):251-263. doi: 10.1210/clinem/dgaa702.
Weight regain (WR) after bariatric surgery is emerging as a common clinical problem due to the increase in the number of procedures performed. Early interventions are necessary to curtail the potential recurrence of comorbid conditions. However, it is often difficult to recognize WR early enough to introduce mitigating measures because there are no current guidelines for timely diagnosis and assessment of the severity of this condition.
We present a practical approach for the early recognition of WR, based on 11-year follow-up data from our multiethnic bariatric surgery patient population.
We classify WR according to the rate of increase in weight relative to nadir weight, normalized per 30-day interval. We also review pertinent literature about the etiologic factors contributing to WR after bariatric surgery.
According to our algorithm, mild, moderate, and rapid WR are defined as weight increases of 0.2% to <0.5%, 0.5% to 1.0%, and more than 1.0% of nadir weight per 30 days, respectively. Treatment options, including dietary counseling, use of antiobesity medication, and consideration of surgical revision, are described. A case is presented to illustrate the utility of timely identification of WR and the importance of collaboration between bariatric surgeons, obesity medicine specialists, and dietitians.
Our approach emphasizes the importance of regular long-term follow-up for all bariatric surgery patients.
由于手术数量的增加，肥胖症手术后的体重反弹（WR）正成为一个常见的临床问题。为了遏制潜在的合并症复发，需要早期干预。然而，由于目前没有关于及时诊断和评估这种情况严重程度的指南，因此通常很难及早发现 WR，从而引入缓解措施。
我们根据多民族肥胖症手术患者人群 11 年的随访数据，提出了一种早期识别 WR 的实用方法。
我们根据体重相对于最低点的增加率对 WR 进行分类，归一化为每 30 天间隔的百分比。我们还回顾了有关肥胖症手术后导致 WR 的病因因素的相关文献。
根据我们的算法，轻度、中度和快速 WR 分别定义为体重在 30 天内增加 0.2%至<0.5%、0.5%至 1.0%和超过 1.0%。描述了治疗选择，包括饮食咨询、使用减肥药和考虑手术修正。提出了一个病例来说明及时识别 WR 的效用以及肥胖症外科医生、肥胖症医学专家和营养师之间合作的重要性。
我们的方法强调了对所有肥胖症手术患者进行定期长期随访的重要性。
