Obesity is a chronic disease; surgery by itself does not cure it. Permanent changes in lifestyle are the only answer to preventing weight regain. The No. 1 reason people gain weight after weight-loss surgery is that they do not follow the post-surgery dietary guidelines. If you follow the diet, you will be successful.

You will need to stay motivated, disciplined and committed to your new lifestyle:

• Get back to your exercise regimen. Physical activity is a powerful predictor of weight maintenance.
  
• Return to the basics. Start your food diary again and pay special attention to your snacking behavior, because it is frequently the cause of weight regain.
  
• When you are feeling overwhelmed by emotional and stressful situations and you see that you are beginning to gain weight, run, don’t walk, to your psychological support group for strength. The group will help you get back on track.
  
• If you need more help, see a clinical psychologist or other health-care professional who specializes in treating eating disorders.

In most cases, regaining weight represents a change in behavior, and it usually begins about a year after surgery. At this point, patients have become more tolerant of larger quantities of food and can eat many of the high-calorie or sugary foods that they ate before surgery. Those who start to regain weight are probably not complying with the eating habits they were taught and have reduced their physical activity. Patients who succeed in maintaining their weight loss continue to eat appropriately and remain physically active.

For patients who have the adjustable gastric band, weight regain usually means that the band needs to be tightened. However, band erosion may be at the root of a loss of restriction and weight gain. Patients who abused their pouch by chronically overeating may also have developed a concentric pouch dilatation. After gastric bypass, the ability to eat larger portions of food is normal, but it may expand the pouch and widen the passageway between the pouch and intestine. When that happens food moves out of the pouch faster and increases appetite. In either case, the patient should go back to their surgeon for an evaluation.

This is a loaded question—with an answer that may surprise you. You will likely have a small bit of weight regain months or years after surgery, and it is perfectly normal. During active weight loss, you’ll have a target weight in mind, and oftentimes you can achieve this.

The first part of the surgery is losing the weight. The second part is keeping it off. Regaining about 10 to 15 percent of your weight loss is not uncommon. Actually, it just means that you’ve reached the weight that you can maintain with moderate, but not heroic, effort. Surgery is meant to make healthy eating easier, not replace it. Sometimes a weight-loss goal is set too low for optimal, long-term success. If you’re moderate in your eating and activity but have gained a few pounds, don’t fret. You’ve simply found your stable weight. If you find your weight creeping up after a few steady years, get back to basics: Count calories and increase your activity. The best advice I give patients is to set a weight range, rather than a single number, to allow a little “wiggle room.” Remaining within a 5- to 10-pound range works for most people.

It’s human nature to believe that a pill or surgery can “fix” the problem of obesity. Most of us know better. But the dramatic visual results and the ads and marketing around weight-loss surgery can lead to a belief that surgery alone will produce and maintain your weight loss.

The question is not whether there will be some eventual weight regain after surgery, but how to minimize it. Surgery is not a cure, but rather a tool to help you in your overall program of weight loss. Education, lifestyle changes and long-term support are the other critical tools that will yield successful, long-term weight loss.

In the majority of cases, post-surgery weight loss can be maintained for years, even decades. However, patients need to be educated early on about the importance of developing excellent habits, such as attention to exercise, hydration and patterned eating. The need to reinforce these habits never ends and can be aided over the years through participation in support groups and other activities.

If, despite your best efforts, weight regain continues, your surgeon can determine if you need band adjustments for tightness or surgical revisions. Before turning back to surgery, get a full nutritional and behavioral evaluation and try to work diligently on your exercise, diet and support plan.