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Early postoperative weight loss predicts nadir weight and weight regain after laparoscopic sleeve gastrectomy and Roux-en-Y gastric bypass

  • 2022 SAGES Oral
  • Published:
Surgical Endoscopy Aims and scope Submit manuscript

Abstract

Background

Weight regain (WR) post bariatric surgery affects almost 20% of patients. It has been theorized that a complex interplay between physiologic adaptations and epigenetic mechanisms promotes WR in obesity, however, reliable predictors have not been identified. Our study examines the relationship between early postoperative weight loss (WL), nadir weight (NW), and WR following laparoscopic Roux-en-Y gastric bypass (LRYGB) and sleeve gastrectomy (LSG).

Methods

A retrospective review of prospectively collected data was conducted for LRYGB or LSG patients from 2012 to 2016. Demographics, preoperative BMI, procedure type, and postoperative weight at 6, 12, 24, 36, and 48 months were recorded. WR was defined as > 20% increase from NW. Univariate and multivariate linear and logistic regression models were used to determine the association between early postoperative WL with NW and WR at 4 years.

Results

Thousand twenty-six adults were included (76.8% female, mean age 44.9 ± 11.9 years, preoperative BMI 46.1 ± 8); 74.6% had LRYGB and 25.3% had LSG. Multivariable linear regression models showed that greater WL was associated with lower NW at 6 months (Coef − 2.16; 95% CI − 2.51, − 1.81), 1 year (Coef − 2.33; 95% CI − 2.58, − 2.08), 2 years (Coef − 2.04; 95% CI − 2.25, − 1.83), 3 years (Coef − 1.95; 95% CI − 2.14, − 1.76), and 4 years (Coef − 1.89; 95% CI − 2.10, − 1.68), p ≤ 0.001. WR was independently associated with increased WL between 6 months and 1 year (Coef 1.59; 95% CI 1.05,2.14; p ≤ 0.001) and at 1 year (Coef 1.24; 95% CI 0.84,1.63;p ≤ 0.001) postoperatively. The multivariable logistic regression model showed significantly increased risk of WR at 4 years for patients with greater WL at 6 months (OR 1.20, 95% CI 1.08,1.33; p = 0.001) and 1 year (OR 1.14; 95% CI 1.06,1.23; p ≤ 0.001).

Conclusion

Our findings demonstrate that higher WL at 6 and 12 months post bariatric surgery may be risk factors for WR at 4 years. Surgeons may need to follow patients with high early weight loss more closely and provide additional treatment options to maximize their long-term success.

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Acknowledgements

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Funding

No funding was received for this study.

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Authors and Affiliations

  1. Department of Surgery, Indiana University School of Medicine, 545 Emerson Hall, EH 130, Indianapolis, IN, 46202, USA

    Bhavani Pokala, Edward Hernandez, Spyridon Giannopoulos, Dimitrios I. Athanasiadis, Lava Timsina, Nikki Sorg, Keith Makhecha & Dimitrios Stefanidis

  2. Bariatric Surgery Program, Indiana University Health North Hospital, Carmel, IN, USA

    Bhavani Pokala & Dimitrios Stefanidis

  3. Department of Surgery, Center for Outcomes Research in Surgery, Indiana University School of Medicine, Indianapolis, IN, USA

    Lava Timsina

  4. Purdue University College of Science, West Lafayette, IN, USA

    Sathvik Madduri

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  1. Bhavani Pokala
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Correspondence to Dimitrios Stefanidis.

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Disclosures

Dr. Dimitrios Stefanidis has received research grants from Beckton Dickinson and Intuitive Surgical. Drs. Bhavani Pokala, Edward Hernandez, Spyridon Giannopoulos, Dimitrios I. Athanasiadis, Lava Timsina, Nikki Sorg, Keith Makhecha, and Sathvik Madduri have no conflicts of interest or financial ties to disclose.

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Pokala, B., Hernandez, E., Giannopoulos, S. et al. Early postoperative weight loss predicts nadir weight and weight regain after laparoscopic sleeve gastrectomy and Roux-en-Y gastric bypass. Surg Endosc 37, 4934–4941 (2023). https://doi.org/10.1007/s00464-022-09658-0

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