PD621 - WHEN THE CLOCK OVERRIDES THE PLATE: CIRCADIAN MISALIGNMENT AS A DRIVER OF WEIGHT REGAIN AFTER SLEEVE GASTRECTOMY

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PD621

WHEN THE CLOCK OVERRIDES THE PLATE: CIRCADIAN MISALIGNMENT AS A DRIVER OF WEIGHT REGAIN AFTER SLEEVE GASTRECTOMY

A. Alfarraj1,2,*

1Department of Community Health Sciences, College of Applied Medical Sciences, King Saud University, 2Department of Clinical Nutrition, King Saud Medical City, Riyadh First Health Cluster, Riyadh, Saudi Arabia

 

Rationale: Weight regain after sleeve gastrectomy (SG) occurs despite dietary adherence, suggesting metabolic drivers beyond caloric excess. Circadian misalignment, delayed chronotype, social jetlag, and evening-dominant energy intake dysregulate energy homeostasis independently of intake. This case examines whether chronotype-informed temporal optimization can reverse post-bariatric weight regain without caloric restriction.

Methods: A 35-year-old woman (SG year 3, BMI 32.3 kg/m²) presented with progressive weight regain despite adherence to prescribed targets. Chronotype was assessed by the Munich ChronoType Questionnaire (MCTQ; MSFsc 05:12, social jetlag 1.9h). A 3-day dietary record showed a 14-hour eating window with 55–60% of energy after 20:00. A 3-month non-pharmacological intervention comprised sleep regularisation (onset ~23:30), time-restricted eating (≤10h anchored to wake time), and protein redistribution toward earlier meals, without modifying caloric targets.

Results: Weight decreased 88.0→81.2 kg (BMI 32.3→29.8; −6.8 kg). Fat mass 36.4→30.1 kg with preserved fat-free mass (51.6→51.1 kg) and improved phase angle (4.7°→5.3°). Metabolic outcomes: HOMA-IR 4.6→2.7 (−41%), glucose 104→96 mg/dL, HbA1c 5.9→5.5%, hs-CRP 6.1→3.2 mg/L (−47%), triglycerides 182→138 mg/dL, HDL 41→46 mg/dL, cortisol 21.4→16.8 µg/dL. Waist: 98→89 cm.

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Conclusion: Circadian misalignment can override routine post-bariatric care and promote weight regain independently of caloric intake. Chronotype assessment and temporal optimization of sleep and meal timing produced clinically meaningful improvements across body composition and cardiometabolic parameters, supporting integration of chronotype evaluation into routine post-bariatric follow-up.

References: Roenneberg T, et al. Social jetlag and obesity. Curr Biol. 2012;22:939–943.

Garaulet M, et al. Timing of food intake predicts weight loss. Int J Obes. 2013;37:604–611. 

Disclosure of Interest: None declared