SAT-120 Weight Regain after Bariatric Surgery Rectified by Dietary Intervention and Metformin

Patients who undergo bariatric surgery may often report weight regain (1). A study by Ferreira and Merhi found that 41% of patients had weight regain 10 years after Roux-en-Y Gastric bypass (2). Recent studies are investigating the efficacy of weight loss pharmacotherapy as an adjunct to bariatric surgery in patients with weight regain (3). The aim of this study was to investigate the impact of a dietary intervention coupled with metformin on the weight and metabolic profile of patients complaining of weight regain after bariatric surgery. We reviewed the medical charts of 157 non-diabetic patients (23% male) who attended our clinic in Beirut and Dubai with the chief complaint of weight regain (BMI of 36.7±0.6kg/m(2)) after a mean of 5 years of bariatric surgery. Their mean age was 40.8±0.8years, and average weight lost following surgery was 33.3±1.6kg. An outstanding feature in their metabolic profile was their insulin resistance reflected by a fasting insulin 12.0±0.8 µIU/mL and HOMA ratio 3.0±0.3. We instructed patients on an ad-libitum, low carbohydrate non-ketogenic high-protein (LCNK) diet coupled with Metformin (1800±350mg/day). No restrictions on use, amount, or type of fat were made, though use of canola and olive oil was recommended. The diet provided 130-150g of carbohydrate per day to prevent ketosis. A total of 110 patients came for a follow-up visit within 2.4 months of being instructed on diet and given metformin. Significant weight loss was observed in these patients (104.2±2.4 vs. 99.4±2.3 Kg, p<0.001); almost equivalent to a 5% decrease in weight. We also observed a significant decrease in fasting blood sugar (100.5±4.3 vs. 91.2±1.8 mg/dl; P<0.05); HBA1c (5.8±0.2 vs. 5.3±0.1; P<0.05); cholesterol (209.8±6.7 vs. 188.1±6.6 mg/dl; P<0.05); LDL (133.6±5.8 vs. 119.1±5.8 mg/dl; P<0.05); and HOMA-IR (4.1±0.7 vs. 2.7±0.4; P<0.05). We observed a noteworthy improvement in patient’s weight and metabolic profile following our intervention. We recommend that non-diabetic patients complaining of weight regain following bariatric surgery be tested for insulin resistance and given metformin along with a LCNK diet for a safe and immediate improvement in weight and metabolic profile. References: (1) Velapati, S.R., Shah, M., Kuchkuntla, A.R. et al. Weight Regain After Bariatric Surgery: Prevalence, Etiology, and Treatment. Curr Nutr Rep 2018; 1-6. (2) Monaco-Ferreira, D.V. & Leandro-Merhi, V.A. Weight Regain 10 Years After Roux-en-Y Gastric Bypass. Obes Surg 2017; 27: 1137. (3) Stanford FC, Alfaris N, Gomez G, Ricks ET, et al. The utility of weight loss medications after bariatric surgery for weight regain or inadequate weight loss: A multi-center study. Surg Obes Relat Dis. 2017 Mar;13(3):491-500.