The Role of Revision Surgery in Gastric Bypass and Sleeve Gastrectomy After Weight Regain

Weight regain is a concern that patients often face after bariatric surgery [1]. While primary bariatric surgery, such as a gastric bypass or sleeve gastrectomy, offers effective and substantial weight loss, some patients may require a revision surgery. Revision surgery is a secondary bariatric procedure that's performed when the initial weight loss surgery doesn't yield the desired results or leads to complications. This can occur due to several reasons such as inadequate weight loss, weight regain, or medical complications like gastric ulcers or gastroesophageal reflux disease (GERD) [2].

In the context of gastric bypass or sleeve gastrectomy, revision surgery may involve adjusting the size of the stomach pouch, changing the length of the bypassed small intestine, or converting to a different type of bariatric surgery altogether, such as a duodenal switch. Revision surgery, such as a re-sleeve gastrectomy, gastric bypass, or duodenal switch, is performed to help patients achieve their weight loss goals and to improve obesity-related health conditions [3].

Dietary Counseling and Behavioral Modifications and Psychological Support After Revision Surgery

Following revision surgery, patients absolutely need to see a dietician. Revision surgeries have unique nutritional implications, and dietary counseling is crucial for successful weight management post-procedure [4]. Dietitians offer personalized nutrition plans to accommodate the new structure of the digestive system and the individual's nutritional needs [5]. Counseling sessions can help ensure that patients meet their nutrient requirements, maintain weight loss, and prevent nutritional deficiencies.

Simultaneously, patients must also consider attending behavior modification sessions with psychologists after a revision. Psychological factors significantly influence the outcomes of bariatric surgery and weight regain, and postoperative psychological care is integral to the success of the procedure [6]. Professionals in the field help patients address emotional eating, develop healthier coping mechanisms, and foster an improved relationship with food and body image [7].

Support Groups and Weight Loss Success

Support groups offer a unique avenue for individuals to share experiences, learn from others, and receive emotional support. Recent research suggests that participation in such groups improves long-term outcomes following bariatric surgery [8]. These outcomes include greater weight loss, better adherence to diet and exercise plans, and improved psychological wellbeing [9].

Revision surgery for weight regain following a gastric bypass or sleeve gastrectomy is a crucial tool for achieving weight loss goals. However, it is evident that success after surgery isn't only about the procedure itself. At Bariatric Associates, we believe in a comprehensive and patient-centered approach. We provide our patients with access to experienced dietitians who guide them in creating personalized nutritional plans, ensuring a healthy and balanced diet tailored to their new digestive structure.

Understanding that psychological factors have a significant influence on weight management outcomes, we have a team of psychologists on board to support behavior modifications. They are equipped to help our patients develop healthier eating habits, improve body image, and build robust coping mechanisms. Additionally, we recognize the importance of community and shared experiences in this journey. That's why we also offer support groups, where you can share your experiences, draw strength from others who are on the same journey, and never feel that you're alone in this process.

We strive to provide not just the surgical solutions but also comprehensive post-surgical care. Our multidisciplinary team is dedicated to your long-term success in weight management and to improving your overall health and wellbeing. Your journey is our journey, and at Bariatric Associates, we walk alongside you every step of the way. Reach out to our team for your weight management concerns and let's explore the best route for you together.


1. Magro, D.O., Geloneze, B., Delfini, R., Pareja, B.C., Callejas, F., Pareja, J.C. (2008). Long-term weight regain after gastric bypass: A 5-year prospective study. Obesity Surgery, 18, 648-651.

2. Brethauer, S.A., Kothari, S., Sudan, R., et al. (2014). Systematic review on reoperative bariatric surgery: American Society for Metabolic and Bariatric Surgery Revision Task Force. Surgery for Obesity and Related Diseases, 10, 952-972.

3. Stefanidis, D., Kuwada, T.S., Gersin, K.S. (2013). The importance of the length of the limbs for gastric bypass patients—an evidence-based review. Obesity Surgery, 23, 59-68.

4. Mechanick, J.I., Youdim, A., Jones, D.B., et al. (2013). Clinical practice guidelines for the perioperative nutritional, metabolic, and nonsurgical support of the bariatric surgery patient—2013 update. Obesity, 21, S1-27.

5. Ziegler, O., Sirveaux, M.A., Brunaud, L., et al. (2009). Medical follow-up after bariatric surgery: nutritional and drug issues. General recommendations for the prevention and treatment of nutritional deficiencies. Diabetes & Metabolism, 35, 544-557.

6. Livhits, M., Mercado, C., Yermilov, I., et al. (2012). Preoperative predictors of weight loss following bariatric surgery: systematic review. Surgery for Obesity and Related Diseases, 8, 575-582.

7. Sarwer, D.B., Wadden, T.A., Fabricatore, A.N. (2005). Psychosocial and behavioral aspects of bariatric surgery. Obesity Research, 13, 639-648.

8. Elakkary, E., Elhorr, A., Aziz, F., et al. (2006). Do support groups play a role in weight loss after laparoscopic adjustable gastric banding? Obesity Surgery, 16, 331-334.

9. Klem, M.L., Wing, R.R., McGuire, M.T., Seagle, H.M., Hill, J.O. (1997). A descriptive study of individuals successful at long-term maintenance of substantial weight loss. The American Journal of Clinical Nutrition, 66, 239-246.

Maximizing Weight Loss Outcomes:
Combining Surgery and Medication

Understanding Sleeve Gastrectomy

Sleeve gastrectomy is a potent tool in our armory against obesity. It is a surgical procedure that entails the reduction of the stomach's size to about 15% of its original volume1. The result is a smaller, banana-shaped stomach that restricts the amount of food a person can consume and hence the number of calories they can take in. The surgery also reduces the production of hunger-inducing hormones, which helps to suppress appetite, making it easier for patients to adopt healthier eating habits.

The primary goal is to promote weight loss by creating a physical limitation on intake, encouraging satiety earlier in a meal. Numerous studies have shown that sleeve gastrectomy effectively aids significant weight loss in obese patients, often leading to an improved quality of life and reduction in obesity-related conditions like type 2 diabetes and hypertension2.

The Role of Weight Loss Medications: Saxenda and Wegovy

While sleeve gastrectomy plays a transformative role, it alone does not offer a remedy for weight loss. For various reasons, including the body's adaptive responses to weight loss, some patients may encounter weight loss plateaus or even regain weight after surgery3. This is where the pivotal role of weight loss medications like Saxenda and Wegovy comes in.

These FDA-approved drugs work by mimicking a hormone that targets areas of the brain to regulate appetite. As a result, you feel less hungry and more satisfied after eating4. Saxenda and Wegovy have shown promising results in enhancing weight loss outcomes when incorporated into a comprehensive weight loss plan. This plan includes dietary changes, regular physical activity, and behavioral changes5.

The Combined Approach: Harnessing the Benefits of Surgery and Medication

Bariatric Associates believes in the power of a combined approach to tackling obesity. Sleeve gastrectomy, coupled with post-operative weight loss medication, has yielded superior results in our practice.

For those patients who have plateaued after weight loss surgery or regained weight, the addition of Saxenda or Wegovy often proves to be a game-changer, empowering patients to overcome weight plateaus and regain control over their progress. The tandem use of surgery with medications allows for more predictable, controlled, and sustainable weight loss6.

Moreover, combining these treatments provides a two-pronged attack against obesity. The sleeve gastrectomy limits physical intake while the medications help manage appetite and metabolic responses. This dual strategy optimizes the weight loss journey and helps patients achieve sustainable and long-lasting results.

Patient-Centered Care at Bariatric Associates

Weight loss is a complex, individual journey. At Bariatric Associates, we understand this intricacy and tailor our approach to fit each patient's unique needs and circumstances. Our team is committed to helping you find the right combination of treatments to reach your health goals.

The combined approach of sleeve gastrectomy and weight loss medications offers comprehensive, personalized care. It goes beyond merely treating obesity – we aim to help our patients embrace a healthier lifestyle, improve their quality of life, and sustain their weight loss over the long term. If you are ready to start your weight loss journey, we are here to guide you every step of the way. Contact us today to explore the possibilities towards a healthier future.


  1. Mayo Clinic. (2020). Gastric sleeve surgery: Who is it for?
  2. Gagner, M., & Hutchinson, C. (2016). Sleeve Gastrectomy and Type 2 Diabetes. Canadian Journal of Diabetes, 40(5), 398–402.
  3. MacLean, P. S., Bergouignan, A., Cornier, M. A., & Jackman, M. R. (2011). Biology's response to dieting: the impetus for weight regain. American Journal of Physiology-Regulatory, Integrative and Comparative Physiology, 301(3), R581-R600.
  4. U.S. Food and Drug Administration, “FDA Approves New Drug Treatment for Chronic Weight Management, First since 2014.” FDA Approves New Drug Treatment for Chronic Weight Management - First in 2014
  5. Astrup, A., Carraro, R., Finer, N., Harper, A., Kunesova, M., Lean, M. E., & Van Gaal, L. (2012). Safety, tolerability and sustained weight loss over 2 years with the once-daily human GLP-1 analog, liraglutide. International journal of obesity, 36(6), 843–854.
  6. Rubino, F., Nathan, D. M., Eckel, R. H., Schauer, P. R., Alberti, K. G., Zimmet, P. Z., ... & Dixon, J. B. (2016). Metabolic surgery in the treatment algorithm for type 2 diabetes: a joint statement by international diabetes organizations. Diabetes care, 39(6), 861-877.

Challenge Recap: A Year of Transformation in 2019

As we look back on the year 2019, we couldn't be prouder of our amazing patients and the dedication they showed in adopting a healthy lifestyle. From September to December, we embarked on a series of challenges that brought our community closer together and inspired each other to make positive changes. Let's take a journey through the activities our patients embraced throughout the year!

September: Breakfast Inspiration Challenge - with frequency, consistency, and timing in mind, we encouraged our patients to start their day off right by sharing pictures of their daily breakfasts throughout September. The response was fantastic, as our patients shared a variety of nutritious, high-protein breakfast ideas. This challenge not only fostered a sense of community but also motivated everyone to prioritize a healthy start to their day.

October: The Energizing Team Challenge -  In October, our patients embraced the spirit of friendly competition with our green, yellow, red, and blue teams. Each team participant reported their daily activity to their team captain, and total active minutes and steps were tallied. The teams pushed each other to new heights of physical activity, and by the end of October, the competition was neck and neck. The sense of camaraderie was palpable, and we celebrated all four teams for their dedication to getting stronger together.

November: Prioritizing Restorative Sleep - Recognizing the crucial role of sleep in maintaining a healthy lifestyle is important, November was dedicated to focusing on our sleep patterns. While participation might have slowed down a bit, we gained many new followers and participants who understood the importance of restorative sleep. Raising awareness about the need for a good night's rest helped us all adjust our bedtime routines, resulting in improved sleep quality and overall well-being.

December: Embracing the Full FACTS and Holiday Challenge - As the year came to a close, we faced two challenges in December: the Full FACTS Challenge and the Holiday Challenge. During the festive season, it's easy to slip off track, but our patients remained committed to their intentions. They maintained their eating schedules, stayed active, and prioritized their sleep routines, all while celebrating the holidays with their loved ones. Sharing their journey on social media platforms like Facebook and Instagram inspired and motivated one another, creating a positive and uplifting environment.

Our 2019 Challenge Winners:

Reflecting on the activities our patients undertook in 2019 fills us with pride and gratitude. It was incredible to witness the determination and enthusiasm with which they embraced each challenge. By supporting and encouraging each other, our Bariatric Associates community demonstrated that we are more than just a medical practice; we are a family dedicated to transforming lives for the better.

As we move forward into the new year, let us carry the lessons learned from these challenges, supporting one another in our journey to a healthier, happier life. Thank you to all our patients who made 2019 a remarkable year, and we can't wait to embark on new adventures with you in the coming months! Stay tuned for more inspiring stories and activities to come. Together, we are unstoppable!

What does being fit look like? An 80 year-old Female Bodybuilder?

I was fascinated by reading about Ernestine Shepherd, 80, who began bodybuilding at the age of 56. After her sister Velvet died of brain aneurism, she began seriously training in memory of her sister. At 74 she was the most successful competitive bodybuilder for her age group. She looks even better today.
Every morning she runs 10 miles and drinks liquid egg whites. She eats 1700 calories a day: mostly chicken, vegetables, and egg whites. And, she never did any real exercise before the age of 56. This is what we can look to if we put in the time, are disciplined, and determined.

3 AM

  • 2 wheat waffles with peaches
  • 3 boiled eggs with yolk
  • Runs 10 miles

6 AM

  • 4 boiled egg whites
  • 2 wheat waffles
  • Gym bench presses & bicep curls with dumbbells

Morning Snack

  • 1 cup of egg whites


  • Baked chicken
  • 1 cup of veggies
  • 1 cup brown rice

Afternoon Snack

  • Can of tuna fish
  • 1 cup of veggies
  • 1 baked potato


  • Baked chicken
  • 1 cup of veggies
  • 1 cup of brown rice

With Ernestine as our inspiration, please join me on for a 5K walk/run:

  • Date: Saturday, July 23rd
  • Time: Registration is at 8:30 AM (5K run/walk will start at 9:00 AM)
  • Location: South Mountain Recreation Complex, 9 Cherry Lane, West Orange, NJ

Until then walk, jog, dance or do elliptical for at least a half an hour a day 5-6 times per week leading up to the 5K Walk. Try and eat 5 servings of vegetables a day, two green, sweet potatoes, and brown rice.
Not only will this change your body, but it can change your life.
To your health!
Dr. Andrei

Nothing to Laugh About

A healthy 31 year-old comedian warned,” While visiting my parents in Massachusetts, I developed flu-like symptoms and ended up testing positive for COVID-19. Despite having no pre-existing conditions, I landed in the ICU on a ventilator before being airlifted to a second hospital for 99 days.”

This is no laughing matter: prepare for the second wave of COVID-19. Please get your flu shot. Coming down with the flu can cause confusion as to whether, or not, you have COVID and/or compromise your immune system in fighting off this infection.

In addition to getting your flu shot, make sure you have a thermometer and an oximeter. If you contract COVID, readings on these two instruments can save your life.
Thermometer-higher than 100.4
Oximeter-lower than 93.

If you would like to learn more about this story, click here to read the full article.

Stay Safe,
Dr. Andrei

Why Should You Walk Instead of Run?

Brisk walking can be a safe guard to developing diabetes says Krauss from Duke University. In a study with prediabetic patients, those who just did brisk walking for 7.5 miles a week and brisk walking for 11.5 miles a week had a 5% and 7% improvement in their glucose tolerance. This is an indicator how effectively the body processes its sugar. In contrast to the brisk walking group, the jogging group who ran for 11.5 miles had only a 2% improvement in glucose tolerance.

The researchers explained these interesting findings in that the jogging or high intensity exercise burns sugar, whereas brisk walking burns off fat in the muscles where excess sugar ( Diabetologia Jul 15, 2016)

Briskly walking 7 miles a week can help put diabetes in check or even prevent it. This along with a healthy diet can extend and enrich your having an active and chronic disease free life.

Best wishes,
Dr. Andrei

Walk the Walk with Dr.Andrei

April 20, 2016

It’s 5:30 in the morning and I’m on my way to the hospital, and today I’m taking a sweet potato that I microwaved and a tangerine instead of my usual brioche. I’ve put on an extra 15 pounds and I get out of breath easier than I used to. One of my main problems is that I skip meals, particularly breakfast. There just doesn’t seem to be enough time in the day to do everything; but I know that I have to make time to eat the foods rich in vitamins and minerals to keep my body strong.

I have been inspired by the stories of the Okinawans, a Japanese people, who lived well into the 100s. They live quite free of anemia, diabetes, hypertension, and strokes. Their diet is 30% green and yellow vegetables, sweet potatoes instead of rice, and a tiny bit of fish.

For lunch for the next two weeks, I’m going to try and eat 4 ounces of canned tuna (packed in water) on whole wheat bread, and I’ll pack it with spinach leaves, shredded carrots, and red pepper slices. But if I’m derailed, I’ll eat yogurt with some walnuts and a tangerine or orange. I’m trying to eat more green and more veggies, but yogurt and fruit are my back up if life interferes.
I’ve managed to work-out on the elliptical for an hour after work for the past two days. I’m just going to keep going just 31 more days to go!


April 24, 2016

I lost two pounds, but fell off the wagon. For dinner I had my usual healthy chicken cutlet and tomato salad, but also wolfed down 4 slices of fresh whole wheat bread. I think I craved the bread because I’m not in good blood sugar; I’m not snacking. I’m going to try and correct this by eating snacks, every 2 hours following breakfast until lunch.
Then after lunch, I’m going to eat a snack every 3 hours before dinner. My snacks will be carrots and red peppers before lunch, and apples and tangerines after lunch until dinner. This should keep my blood sugar steady and at an optimal level.
I’m thinking of my body as a kind of race car that I’m getting ready for May 21st. I have to put premium fuel in the tank every 2-3 hours. Then work it for 30 to 60 minutes every day.

This is a second job, but it’s worth it.


April 28, 2016

Yesterday I tried to push myself to go to gym and workout on elliptical but I didn’t make it. My daughter was back from her first year at college, and we met at one of our favorite restaurants for our traditional breakfast of Eggs Benedict. As the waiter put the English muffins with Canadian bacon, eggs and hollandaise, I heard my conscience saying, “Stop, what are you doing? You know that this is very high in fat, calories and cholesterol.”
Then when I looked it up, it was almost 600 calories. If I had simply had two poached eggs on whole wheat toast, it would have added up to half of that, and much less fat, and cholesterol. But it is hard for me to give up my traditions, especially with my daughter. If only I could have gotten myself to the gym and worked out on the elliptical, I could have burned off around 780 calories. But my resolve to put in the hard work of not indulging myself was low.

Tomorrow I will eat my snacks and my chicken cutlet with nutritious salad, and hop back on the elliptical!

There are 23 days left until the Walk.


May 2, 2016

Yesterday was a pretty good day for me – I had my usual sweet potato for breakfast and added a black cherry yogurt. It probably would have been healthier to have a plain yogurt and just add some berries or fruit, but I really enjoyed the black cherry flavoring.
For lunch it was just easier to microwave a frozen Amy’s Asian Noodle stir-fry dinner. Because the ingredients are rice noodles, vegetables, and tofu, I consider this a healthy fast food. Snacks were an apple and a tangerine. Dinner was a large Mediterranean salad and a veal cutlet. I’m going to try and add beans to my salads because they are an excellent source of proteins, and that will help me keep my muscle mass as I lose weight. Working out will also maintain my muscle mass.

I worked out on elliptical for an hour and burned 600 calories!


May 5, 2016

I lost 7 pounds in the last two weeks and I’ve become a potato-eater. I’m eating all kinds of potatoes: sweet potatoes, white potatoes, red potatoes and yams. Even for breakfast I often have a sweet potato.  For lunch and dinner I’m also trying to have some kind of a potato. Contrary to most people’s belief, the potato isn’t fattening (a medium is about 147 calorie); it’s the oil and butter you put on it that’s fattening. Potatoes are absorbed into the bloodstream slowly and that gives us a sense of fullness. For me, I often feel full  for up to 4 or 5 hours after eating one.

These wonderful potatoes move into our bloodstream in a slow and even manner, and interestingly, this reduces the amount of insulin required to deal with the sugar in our bloodstream. And if we are doing increased physical activity, hopefully ½ to 1 hour a day, that also eliminates some of our body’s blood sugar, thus the need for more insulin. Less insulin in the blood stream results in a decreased appetite and better weight loss. Try a potato without any guilt.
By the way, I also gave up on bread and my occasional beer.


May 16, 2016

A few days ago I was out of town at conference. I was exhausted and had a craving to eat beef and French fries. I thought to myself that I have to find a way to say , “No”. So I took myself to a salad bar. I looked for food that was fresh, steamed, or grilled. I filled my plate with asparagus, eggplant, small red potatoes, yellow peppers and a few slices of grilled chicken. For dessert I had grapes. I also had green tea. I find that green tea cuts my appetite.  I was so pleased that I made the right choices.
I know I’m going to make mistakes in my choices, but I’m convinced the best thing is to count that as an indulgence and just get back on track. As a matter of fact, I know of a celebrity nutritionist who encourages people to one day a week have one really delicious indulgence and if they fall off the wagon before their special day, just count that as their indulgence. Yesterday mine was a chocolate peppermint patty.
I have been on elliptical an hour at the time for at least 4 times a week.


May 20, 2016

On my way to work, at 5:30 this morning, I again thought about the wonderful man who came to me for surgery. He had diabetes, hypertension, sleep apnea, and high lipids, all of which means he was at high risk for heart attack. He was only in his forties, and a father of young children. Like many men I’ve been seeing lately, he’s overweight but not obese; nevertheless, if he gains any more weight he might die.
I thought of my own progress in preparing for the Walk: I’ve lost about ten pounds; I’ve been on the Elliptical at least 4 times a week; I’ve cut out bread and alcohol; I’m eating more vegetables; but I still skip meals and snacks and this increases my hunger and bad food choices. But I’m on the right road and going forward I am going to try and snack every two to three hours on apples, carrots, rice cakes, or pears. Having Amy’s frozen foods available for lunch and/or dinner saves me from ordering junk food and over eating.
I hope to see you tomorrow.


June 4, 2016

I felt very inspired to see so many of you walking next to me determined to regain or maintain your health. I thought that the three things we must do, as quickly as possible, is lose any life-threatening weight, eat the right foods, and exercise every day.

I have to confess that since our walk, I fell off the wagon; my Achilles heel being I again found myself skipping meals, especially breakfast. When the demands of my life started intruding at 5:30 in the morning, I overlooked breakfast and that put me in bad blood sugar, which resulted in me craving fast food, the kind of food loaded with fat and salt; eating this way tired me, so of course, I skipped the gym. I know that bad habits are hard to break but my health depends on me doing just that. So, for the next week I will jump back on the elliptical for at least a half hour, 5 times a week. I will either have my sweet potato or an apple with healthy peanut butter for breakfast. For my snack, I’ll eat an apple with peanut butter or a carrot. For lunch, I’ll try and have a healthy salad with spinach or kale, tomatoes, carrots, beets, and beans for protein or an Amy’s frozen dinner like the Teriyaki bowl. Mid-day snack will be a tangerine or some strawberries. For dinner, I’ll try and eat broccoli, Brussel sprouts, or asparagus, a healthy potato and a chicken or veal cutlet. I’m going to try and eat the same menu every day for a week to eliminate the temptation of choices.

Meanwhile, I’m arranging another walk for us. This walk will increase in difficulty, but not too much. I hope you will join me.

In planning your vacation I encourage you to do things that involve exercise- swimming, walking, biking, and/or dancing. Meet you in a month at our next venue.