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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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References

  1. Hales CM, Fryar CD, Carroll MD, Freedman DS, Ogden CL (2018) Trends in obesity and severe obesity prevalence in US youth and adults by sex and age, 2007–2008 to 2015–2016. JAMA 319:1723–1725

    Article  PubMed  PubMed Central  Google Scholar 

  2. Burguera B, Jesus Tur J, Escudero AJ, Alos M, Pagan A, Cortes B, Gonzalez XF, Soriano JB (2015) An intensive lifestyle intervention is an effective treatment of morbid obesity: the TRAMOMTANA Study-A two-year randomized controlled clinical trial. Int J Endocrinol 2015:194696

    Article  PubMed  PubMed Central  CAS  Google Scholar 

  3. Brethauer SA, Chand B, Schauer PR (2006) Risks and benefits of bariatric surgery: current evidence. Cleve Clin J Med 73:993–1007

    Article  PubMed  Google Scholar 

  4. Karmali S, Brar B, Shi X, Sharma AM, de Gara C, Birch DW (2013) Weight recidivism post-bariatric surgery: a systematic review. Obes Surg 23:1922–1933

    Article  PubMed  Google Scholar 

  5. Sarwer DB, Steffen KJ (2015) Quality of life, body image and sexual functioning in bariatric surgery patients. Eur Eat Disord Rev 23:504–508

    Article  PubMed  Google Scholar 

  6. King WC, Hinerman AS, Belle SH, Wahed AS, Courcoulas AP (2018) Comparison of the performance of common measures of weight regain after bariatric surgery for association with clinical outcomes. JAMA 320:1560–1569

    Article  PubMed  PubMed Central  Google Scholar 

  7. Diamantis T, Apostolou KG, Alexandrou A, Griniatsos J, Felekouras E, Tsigris C (2014) Review of long-term weight loss results after laparoscopic sleeve gastrectomy. Surg Obes Relat Dis 10:177–183

    Article  PubMed  Google Scholar 

  8. Cooper TC, Simmons EB, Webb K, Burns JL, Kushner RF (2015) Trends in weight regain following Roux-en-Y gastric bypass (RYGB) bariatric surgery. Obes Surg 25:1474–1481

    Article  PubMed  Google Scholar 

  9. Christou NV, Look D, Maclean LD (2006) Weight gain after short- and long-limb gastric bypass in patients followed for longer than 10 years. Ann Surg 244:734–740

    Article  PubMed  PubMed Central  Google Scholar 

  10. Shah M, Simha V, Garg A (2006) Review: long-term impact of bariatric surgery on body weight, comorbidities, and nutritional status. J Clin Endocrinol Metab 91:4223–4231

    Article  CAS  PubMed  Google Scholar 

  11. Sjostrom L, Lindroos AK, Peltonen M, Torgerson J, Bouchard C, Carlsson B, Dahlgren S, Larsson B, Narbro K, Sjostrom CD, Sullivan M, Wedel H, Swedish Obese Subjects Study Scientific G (2004) Lifestyle, diabetes, and cardiovascular risk factors 10 years after bariatric surgery. N Engl J Med 351:2683–2693

    Article  PubMed  Google Scholar 

  12. Abu Dayyeh BK, Jirapinyo P, Thompson CC (2017) Plasma ghrelin levels and weight regain after Roux-en-Y gastric bypass surgery. Obes Surg 27:1031–1036

    Article  PubMed  Google Scholar 

  13. King WC, Belle SH, Hinerman AS, Mitchell JE, Steffen KJ, Courcoulas AP (2019) Patient behaviors and characteristics related to weight regain after Roux-en-Y gastric bypass: a multicenter prospective Cohort Study. Ann Surg 272:1044

    Article  Google Scholar 

  14. Yu Y, Klem ML, Kalarchian MA, Ji M, Burke LE (2019) Predictors of weight regain after sleeve gastrectomy: an integrative review. Surg Obes Relat Dis 15:995–1005

    Article  PubMed  Google Scholar 

  15. Hozo SP, Djulbegovic B, Hozo I (2005) Estimating the mean and variance from the median, range, and the size of a sample. BMC Med Res Methodol 5:13

    Article  PubMed  PubMed Central  Google Scholar 

  16. Wan X, Wang W, Liu J, Tong T (2014) Estimating the sample mean and standard deviation from the sample size, median, range and/or interquartile range. BMC Med Res Methodol 14:135

    Article  PubMed  PubMed Central  Google Scholar 

  17. Wells GASB, O’Connell D, Peterson J, Welch V, Losos M, Tugwell P (2016) The Newcastle-Ottawa Scale (NOS) for assessing the quality of nonrandomised studies in meta-analyses. https://www.ohri.ca/programs/clinical_epidemiology/oxford.asp. Accessed 25 Apr 2016

  18. Modesti PA, Reboldi G, Cappuccio FP, Agyemang C, Remuzzi G, Rapi S, Perruolo E, Parati G, Settings ESHWGoCRiLR (2016) Panethnic differences in blood pressure in Europe: a systematic review and meta-analysis. PLoS ONE 11:e0147601

    Article  PubMed  PubMed Central  CAS  Google Scholar 

  19. Abu Dayyeh BK, Lautz DB, Thompson CC (2011) Gastrojejunal stoma diameter predicts weight regain after Roux-en-Y gastric bypass. Clin Gastroenterol Hepatol 9:228–233

    Article  PubMed  Google Scholar 

  20. Jirapinyo P, Abu Dayyeh BK, Thompson CC (2017) Weight regain after Roux-en-Y gastric bypass has a large negative impact on the Bariatric Quality of Life Index. BMJ Open Gastroenterol 4:e000153

    Article  PubMed  PubMed Central  Google Scholar 

  21. Nicolau J, Ayala L, Rivera R, Speranskaya A, Sanchis P, Julian X, Fortuny R, Masmiquel L (2015) Postoperative grazing as a risk factor for negative outcomes after bariatric surgery. Eat Behav 18:147–150

    Article  PubMed  Google Scholar 

  22. Nicolau J, Simo R, Sanchis P, Ayala L, Fortuny R, Rivera R, Masmiquel L (2017) Effects of depressive symptoms on clinical outcomes, inflammatory markers and quality of life after a significant weight loss in a bariatric surgery sample. Nutr Hosp 34:81–87

    Article  CAS  PubMed  Google Scholar 

  23. Devlin MJ, King WC, Kalarchian MA, Hinerman A, Marcus MD, Yanovski SZ, Mitchell JE (2018) Eating pathology and associations with long-term changes in weight and quality of life in the longitudinal assessment of bariatric surgery study. Int J Eat Disord 51:1322–1330

    Article  PubMed  PubMed Central  Google Scholar 

  24. Kofman MD, Lent MR, Swencionis C (2010) Maladaptive eating patterns, quality of life, and weight outcomes following gastric bypass: results of an Internet survey. Obesity (Silver Spring) 18:1938–1943

    Article  Google Scholar 

  25. Livhits M, Mercado C, Yermilov I, Parikh JA, Dutson E, Mehran A, Ko CY, Gibbons MM (2011) Patient behaviors associated with weight regain after laparoscopic gastric bypass. Obes Res Clin Pract 5:e169-266

    Article  PubMed  Google Scholar 

  26. Odom J, Zalesin KC, Washington TL, Miller WW, Hakmeh B, Zaremba DL, Altattan M, Balasubramaniam M, Gibbs DS, Krause KR, Chengelis DL, Franklin BA, McCullough PA (2010) Behavioral predictors of weight regain after bariatric surgery. Obes Surg 20:349–356

    Article  PubMed  Google Scholar 

  27. Roslin M, Damani T, Oren J, Andrews R, Yatco E, Shah P (2011) Abnormal glucose tolerance testing following gastric bypass demonstrates reactive hypoglycemia. Surg Endosc 25:1926–1932

    Article  PubMed  Google Scholar 

  28. Shantavasinkul PC, Omotosho P, Corsino L, Portenier D, Torquati A (2016) Predictors of weight regain in patients who underwent Roux-en-Y gastric bypass surgery. Surg Obes Relat Dis 12:1640–1645

    Article  PubMed  Google Scholar 

  29. Varma S, Clark JM, Schweitzer M, Magnuson T, Brown TT, Lee CJ (2017) Weight regain in patients with symptoms of post-bariatric surgery hypoglycemia. Surg Obes Relat Dis 13:1728–1734

    Article  PubMed  PubMed Central  Google Scholar 

  30. Yanos BR, Saules KK, Schuh LM, Sogg S (2015) Predictors of lowest weight and long-term weight regain among Roux-en-Y gastric bypass patients. Obes Surg 25:1364–1370

    Article  PubMed  Google Scholar 

  31. Alvarez V, Carrasco F, Cuevas A, Valenzuela B, Munoz G, Ghiardo D, Burr M, Lehmann Y, Leiva MJ, Berry M, Maluenda F (2016) Mechanisms of long-term weight regain in patients undergoing sleeve gastrectomy. Nutrition 32:303–308

    Article  PubMed  Google Scholar 

  32. Bastos EC, Barbosa EM, Soriano GM, dos Santos EA, Vasconcelos SM (2013) Determinants of weight regain after bariatric surgery. Arq Bras Cir Dig 26(Suppl 1):26–32

    Article  PubMed  Google Scholar 

  33. Cardeal MA, Faria SL, Faria OP, Facundes M, Ito MK (2016) Diet-induced thermogenesis in postoperatve Roux-en-Y gastric bypass patients with weight regain. Surg Obes Relat Dis 12:1098–1107

    Article  PubMed  Google Scholar 

  34. da Silva FB, Gomes DL, de Carvalho KM (2016) Poor diet quality and postoperative time are independent risk factors for weight regain after Roux-en-Y gastric bypass. Nutrition 32:1250–1253

    Article  PubMed  Google Scholar 

  35. Farias G, Thieme RD, Teixeira LM, Heyde ME, Bettini SC, Radominski RB (2016) Good weight loss responders and poor weight loss responders after Roux-en-Y gastric bypass: clinical and nutritional profiles. Nutr Hosp 33:574

    Article  PubMed  CAS  Google Scholar 

  36. Gomes DL, de Almeida OD, Dutra ES, Pizato N, de Carvalho KM (2016) Resting energy expenditure and body composition of women with weight regain 24 months after bariatric surgery. Obes Surg 26:1443–1447

    Article  PubMed  Google Scholar 

  37. Monaco-Ferreira DV, Leandro-Merhi VA (2017) Weight regain 10 years after Roux-en-Y gastric bypass. Obes Surg 27:1137–1144

    Article  PubMed  Google Scholar 

  38. Nicoletti CF, de Oliveira BA, de Pinhel MA, Donati B, Marchini JS, Salgado Junior W, Nonino CB (2015) Influence of excess weight loss and weight regain on biochemical indicators during a 4-year follow-up after Roux-en-Y gastric bypass. Obes Surg 25:279–284

    Article  PubMed  Google Scholar 

  39. Santo MA, Riccioppo D, Pajecki D, Kawamoto F, de Cleva R, Antonangelo L, Marcal L, Cecconello I (2016) Weight regain after gastric bypass: influence of gut hormones. Obes Surg 26:919–925

    Article  PubMed  Google Scholar 

  40. Vieira FT, Faria S, Dutra ES, Ito MK, Reis CEG, da Costa THM, de Carvalho KMB (2019) Perception of hunger/satiety and nutrient intake in women who regain weight in the postoperative period after bariatric surgery. Obes Surg 29:958–963

    Article  PubMed  Google Scholar 

  41. Amundsen T, Strommen M, Martins C (2017) Suboptimal weight loss and weight regain after gastric bypass surgery-postoperative status of energy intake, eating behavior, physical activity, and psychometrics. Obes Surg 27:1316–1323

    Article  PubMed  Google Scholar 

  42. Ciudin A, Fidilio E, Ortiz A, Pich S, Salas E, Mesa J, Hernandez C, Simo-Servat O, Lecube A, Simo R (2019) Genetic testing to predict weight loss and diabetes remission and long-term sustainability after bariatric surgery: a Pilot Study. J Clin Med 8:964

    Article  CAS  PubMed Central  Google Scholar 

  43. Conceicao E, Mitchell JE, Vaz AR, Bastos AP, Ramalho S, Silva C, Cao L, Brandao I, Machado PP (2014) The presence of maladaptive eating behaviors after bariatric surgery in a cross sectional study: importance of picking or nibbling on weight regain. Eat Behav 15:558–562

    Article  PubMed  Google Scholar 

  44. Pellitero S, Perez-Romero N, Martinez E, Granada ML, Moreno P, Balibrea JM, Tarasco J, Lucas A, Puig-Domingo M (2015) Baseline circulating ghrelin does not predict weight regain neither maintenance of weight loss after gastric bypass at long term. Am J Surg 210:340–344

    Article  PubMed  Google Scholar 

  45. Baig SJ, Priya P, Mahawar KK, Shah S, Indian Bariatric Surgery Outcome Reporting G (2019) Weight regain after bariatric surgery-a Multicentre Study of 9617 patients from indian bariatric surgery outcome reporting group. Obes Surg 29:1583–1592

    Article  PubMed  Google Scholar 

  46. Chou JJ, Lee WJ, Almalki O, Chen JC, Tsai PL, Yang SH (2017) Dietary intake and weight changes 5 years after laparoscopic sleeve gastrectomy. Obes Surg 27:3240–3246

    Article  PubMed  Google Scholar 

  47. Liu SY, Wong SK, Lam CC, Yung MY, Kong AP, Ng EK (2015) Long-term results on weight loss and diabetes remission after laparoscopic sleeve gastrectomy for a morbidly obese Chinese population. Obes Surg 25:1901–1908

    Article  CAS  PubMed  Google Scholar 

  48. Bakr AA, Fahmy MH, Elward AS, Balamoun HA, Ibrahim MY, Eldahdoh RM (2019) Analysis of medium-term weight regain 5 years after laparoscopic sleeve gastrectomy. Obes Surg 29:3508–3513

    Article  PubMed  Google Scholar 

  49. Lauti M, Kularatna M, Hill AG, MacCormick AD (2016) Weight regain following sleeve gastrectomy-a systematic review. Obes Surg 26:1326–1334

    Article  PubMed  Google Scholar 

  50. Heneghan HM, Yimcharoen P, Brethauer SA, Kroh M, Chand B (2012) Influence of pouch and stoma size on weight loss after gastric bypass. Surg Obes Relat Dis 8:408–415

    Article  PubMed  Google Scholar 

  51. Ferrer-Marquez M, Garcia-Diaz JJ, Moreno-Serrano A, Garcia-Diez JM, Ferrer-Ayza M, Alarcon-Rodriguez R, Artero EG, Soriano-Maldonado A (2017) Changes in gastric volume and their implications for weight loss after laparoscopic sleeve gastrectomy. Obes Surg 27:303–309

    Article  PubMed  Google Scholar 

  52. Singh JP, Tantia O, Chaudhuri T, Khanna S, Patil PH (2014) Is resected stomach volume related to weight loss after laparoscopic sleeve gastrectomy? Obes Surg 24:1656–1661

    Article  PubMed  Google Scholar 

  53. Thaker VV (2017) Genetic and epigenetic causes of obesity. Adolesc Med State Art Rev 28:379–405

    PubMed  PubMed Central  Google Scholar 

  54. Voorwinde V, Steenhuis IHM, Janssen IMC, Monpellier VM, van Stralen MM (2020) Definitions of long-term weight regain and their associations with clinical outcomes. Obes Surg 30:527–536

    Article  PubMed  Google Scholar 

  55. Hsu LK, Benotti PN, Dwyer J, Roberts SB, Saltzman E, Shikora S, Rolls BJ, Rand W (1998) Nonsurgical factors that influence the outcome of bariatric surgery: a review. Psychosom Med 60:338–346

    Article  CAS  PubMed  Google Scholar 

  56. Wharton S, Raiber L, Serodio KJ, Lee J, Christensen RA (2018) Medications that cause weight gain and alternatives in Canada: a narrative review. Diabetes Metab Syndr Obes 11:427–438

    Article  CAS  PubMed  PubMed Central  Google Scholar 

  57. Zhang JP, Lencz T, Zhang RX, Nitta M, Maayan L, John M, Robinson DG, Fleischhacker WW, Kahn RS, Ophoff RA, Kane JM, Malhotra AK, Correll CU (2016) Pharmacogenetic associations of antipsychotic drug-related weight gain: a systematic review and meta-analysis. Schizophr Bull 42:1418–1437

    Article  PubMed  PubMed Central  Google Scholar 

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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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