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Factors associated with weight regain post-bariatric surgery: a systematic review

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Abstract

Introduction

To systematically review the literature to assess the incidence and risk factors of weight regain (WR) after bariatric surgery. Bariatric surgery is the most effective intervention for sustained weight loss of morbidly obese patients, but WR remains a concern.

Materials and methods

A PRISMA compliant systematic literature review was performed using the PubMed database, Embase and the Cochrane Library in July of 2019. Studies that reported ≥ 10% WR after Roux-en-Y gastric bypass (RYGB) and sleeve gastrectomy (SG) were included. The Newcastle–Ottawa scale (NOS) was used for assessing study quality.

Results

Out of 2915 retrieved abstracts, 272 full papers were reviewed, and 32 studies included (25 of high and 7 of fair quality) reporting weight outcomes on 7391 RYGB and 5872 SG patients. 17.6% (95% CI 16.9–18.3) had a WR ≥ 10%. Risk factors related with WR fell into 5 categories, namely anatomical, genetic, dietary, psychiatric, and temporal. Specifically, gastrojejunal stoma diameter, gastric volume following sleeve, anxiety, time after surgery, sweet consumption, emotional eating, portion size, food urges, binge eating, loss of control/disinhibition when eating, and genetics have been positively associated with WR while postprandial GLP-1, eagerness to change physical activity habits, self-esteem, social support, fruit and zinc consumption, HDL, quality of life have been negatively associated.

Conclusion

At least 1 in 6 patients after bariatric surgery had ≥ 10% WR. This review identified several factors related to WR that can be used to counsel patients preoperatively and direct postoperative strategies that minimize WR risk.

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Author notes

  1. Dimitrios I. Athanasiadis and Anna Martin have equally contributed to the manuscript and thus share the first authorship.

Authors and Affiliations

  1. Department of Surgery, Section of Bariatric and Minimally Invasive Surgery, Indiana University School of Medicine, 545 Barnhill Dr., EH 130, Indianapolis, IN, 46202, USA

    Dimitrios I. Athanasiadis, Sara Monfared & Dimitrios Stefanidis

  2. Purdue School of Science, Indiana University-Purdue University Indianapolis, Indianapolis, IN, USA

    Anna Martin

  3. Department of Surgery, National and Kapodistrian University of Athens School of Medicine, Athens, Greece

    Panagiotis Kapsampelis

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  1. Dimitrios I. Athanasiadis
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Correspondence to Dimitrios Stefanidis.

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Dimitrios I. Athanasiadis, Anna Martin, Panagiotis Kapsampelis, Sara Monfared and Dimitrios Stefanidis have no conflicts of interest or financial ties to disclose.

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Athanasiadis, D.I., Martin, A., Kapsampelis, P. et al. Factors associated with weight regain post-bariatric surgery: a systematic review. Surg Endosc 35, 4069–4084 (2021). https://doi.org/10.1007/s00464-021-08329-w

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