After body contouring, bariatric surgery patients regain more weight than non-bariatric patients: Study

Patients with previous bariatric surgery who undergo body contouring (BC) regain more weight at long-term follow-up, compared to BC patients who did not have bariatric surgery, reports a study in Plastic and Reconstructive Surgery.

"While most patients regain some weight after BC surgery, those who have undergone bariatric surgery gain slightly more weight at long-term follow-up," comments lead author Joshua T. Henderson, MD, of West Virginia University Division of Plastic, Reconstructive, and Hand Surgery, Morgantown. "Our findings should not challenge the benefit of BC for patients with massive weight loss, but they do clarify the outcomes that patients and surgeons can expect in the years after surgery."

New evidence on long-term weight gain after body contouring

Body contouring refers to a range of surgical procedures to remove excess skin and soft tissue in patients with major weight loss, with the aim of "improving patients' quality of life, increasing function, and further motivating healthy lifestyles," according to the authors. However, there is limited data on how BC surgery affects weight control—including potential differences between patients who underwent bariatric surgery, compared to other groups of patients with massive weight loss.

Dr. Henderson and colleagues analyzed weight regain after trunk-based BC surgery in 121 patients, 60 of whom had previously undergone bariatric surgery. Multiple measures of body weight were monitored at an average follow-up period of about 3.5 years. The two groups were similar in terms of initial body weight before undergoing BC. The study focused primarily on the effects of removing excess abdominal skin, hence surgery consisted of either panniculectomy or abdominoplasty ("tummy tuck").

Compared to immediately before BC surgery, the patients had an average increase of 2.30% of body weight during long-term follow-up. Weight gain was significantly greater in the bariatric surgery group: 4.39%, compared to 0.25% in non-bariatric patients.

Average time to lowest (nadir) body weight after BC surgery was about four months. From this point, weight regain through long-term follow-up was 11.81% in patients who had undergone bariatric surgery, compared to 7.56% in the non-bariatric group.

Call for new standard weight measures for long-term BC outcomes

Previous studies of long-term weight control after BC surgery have focused mainly on bariatric surgery patients, with little information on other groups of patients. Studies have also used varying measures of body weight—for example, absolute versus percent total weight loss versus percent excess weight loss.

Percent change (loss) in total and excess weight "should become standard" in evaluating the long-term outcomes of BC surgery, Dr. Henderson and colleagues believe. They write, "Weight control at long-term follow-up should also be the focus, rather than maximum weight loss."

While weight regain is somewhat greater for bariatric surgery patients, "All patients tend to regain weight after achieving their nadir following trunk-based BC surgeries, eventually surpassing their preoperative weight," the researchers add.

"This is not clinically surprising, nor does it contend with the psychological benefits of [BC surgery]," Dr. Henderson and colleagues conclude. "It primarily increases the confidence with which these patients can receive counsel of their expected postoperative course."