Can a medical procedure cause weight gain?

From the Guidelines

Yes, certain procedures can cause weight gain, as evidenced by the potential for weight gain after bariatric surgery, despite its primary intention of promoting weight loss, as noted in a study published in 2017 1.

Key Points to Consider

• Bariatric surgery, while intended for weight loss, can lead to weight regain if lifestyle changes are not maintained, and in some cases, may directly contribute to weight gain due to changes in metabolism and eating habits.
• Medications used during or after procedures, such as corticosteroids, can increase appetite and fluid retention, leading to weight gain, as highlighted in a study from 2020 1.
• The stress response to surgery, including the release of cortisol, can promote fat storage and contribute to weight gain.
• Recovery periods that involve reduced physical activity can also lead to weight gain due to decreased calorie expenditure.
• Certain procedures, like those affecting the thyroid gland or involving the use of corticosteroids, can have a direct impact on metabolism and weight, as discussed in a review from 2020 1 and a more recent study from 2023 1.

Recommendations for Prevention

• Discuss concerns about weight gain with a healthcare provider before undergoing a procedure.
• Develop strategies for prevention, such as appropriate nutrition and gradually increasing physical activity as recovery allows.
• Consider the potential effects of medications on weight and discuss alternatives or adjunctive therapies, like metformin or topiramate, that can counteract weight gain, as suggested in a 2023 review 1.
• Monitor weight trajectory during recovery and adjust strategies as needed to prevent significant weight gain.

From the FDA Drug Label

Menstrual irregularities Development of Cushingoid state Decreased carbohydrate tolerance Manifestations of latent diabetes mellitus Increased requirements for insulin or oral hypoglycemic agents in diabetics

The Cushingoid state is a condition that can cause weight gain.

• Corticosteroids can lead to this condition. The answer to whether the procedure can cause weight gain is yes, as it is associated with the development of a Cushingoid state 2

From the Research

Procedure-Related Weight Gain

• Weight regain after bariatric surgery is a common phenomenon, with a significant percentage of patients experiencing weight regain, resulting in frustration, depression, and return of obesity-related co-morbidities 3
• Certain procedures, such as bariatric surgery, can lead to weight regain due to various factors, including changes in appetite, eating habits, and physical activity levels
• The use of corticosteroids in transplant patients undergoing bariatric surgery can independently impact outcomes, with patients on corticosteroids having a significantly higher overall morbidity rate 4

Factors Contributing to Weight Gain

• Chronic use of steroid or immunosuppressant medications is a strong predictor of 30-day postoperative morbidity and mortality following primary bariatric surgery 5
• Changes in thyroid replacement therapy after bariatric surgery can also contribute to weight gain, with differences in levothyroxine (LT4) dose requirements between laparoscopic Roux-en-Y gastric bypass (LRYGB) and laparoscopic sleeve gastrectomy (LSG) 6
• Abdominal pain is a common reason for bariatric patients to present to the Emergency Department, and can represent a diagnostic challenge due to the unique altered anatomy following bariatric procedures 7

Procedure-Specific Complications

• Laparoscopic Adjustable Gastric Banding (LAGB), Laparoscopic Sleeve Gastrectomy (LSG), and Roux-en-Y Gastric Bypass (RYGB) are common bariatric procedures, each with specific complications related to the altered anatomy 7
• New endoscopic procedures and their associated complications can also cause patients to present to the Emergency Department, highlighting the need for improved understanding and vigilance in managing bariatric surgery patients 7