Weight Loss and Eating Pattern 7 Years After Sleeve Gastrectomy: Experience of a Bariatric Center of Excellence



Report the analysis from a single center series of consecutive primary sleeve gastrectomy (SG) on the factors affecting weight loss at long term.

Materials and Methods

Patients submitted to primary SG with a follow-up of 7 years were screened. Weight loss was evaluated with %excess weight loss (%EWL) and %excess BMI loss (%BMIL). Weight regain (WR) was defined as in increase of 25% of the obtained %EWL and insufficient weight loss (IWL) as loss < 50% EWL. Eating behaviors were evaluated with 7 days record (7dR). All the variables potentially affecting the weight loss were cross-matched for correlation. The study population was divided in three groups: group A (WR), group B (IWL), and group C (sustained weight loss) for comparative analysis.


A total of 86 patients (21 M/65 F) with a preoperative BMI of 47.08 ± 6.15 kg/m2 were evaluated. Cumulative 7 years weight loss was as follows: 61.66 ± 22.69% EWL and 32 ± 9% EBMIL. A total of 4.6% had an IWL while 27.9% a WR. The analysis showed a significant difference among the daily calories and fats consuming, number of meals, physical activity, grazing/sweet eating habits, and adherence to follow-up (p < 0.05) between groups A and C. Cox hazard demonstrated a significant risk (p < 0.05) to WR in case of adherence to follow-up shorter than 48 months, high daily calories, and fats intake (hazard ratio (HR) range 5–9). Eight patients (9.3%) had a surgical revision.


Our data demonstrated that long-term results (7 years) of SG are strongly related to eating habits and patient’s behaviors.

This is a preview of subscription content, access via your institution.

Fig. 1
Fig. 2
Fig. 3


  1. 1.

    Hruby A, Hu FB. The epidemiology of obesity: a big picture. Pharmacoeconomics. 2015;33(7):673–89. https://doi.org/10.1007/s40273-014-0243-x. Review

    Article  PubMed  PubMed Central  Google Scholar 

  2. 2.

    Tobias DK, Chen M, Manson JE, et al. Effect of low-fat diet interventions versus other diet interventions on long-term weight change in adults: a systematic review and meta-analysis. Lancet Diabetes Endocrinol. 2015;3(12):968–79. https://doi.org/10.1016/S2213-8587(15)00367-8. Epub 2015 Oct 30

    Article  PubMed  PubMed Central  Google Scholar 

  3. 3.

    Rognoni C, Armeni P, Tarricone R, et al. Cost-benefit analysis in health care: the case of bariatric surgery compared with diet. Clin Ther. 2020;42(1):60–75.e7. https://doi.org/10.1016/j.clinthera.2019.12.001. Epub 2020 Jan 17

    Article  PubMed  Google Scholar 

  4. 4.

    Heymsfield SB, Bourgeois B, Thomas DM. Why is it difficult to lose and maintain large amounts of weight with lifestyle and pharmacologic treatments? Obesity (Silver Spring). 2017;25(12):2017. https://doi.org/10.1002/oby.22045. Epub 2017 Oct 29. No abstract available

    Article  Google Scholar 

  5. 5.

    Angrisani L, Santonicola A, Iovino P, et al. Bariatric surgery and endoluminal procedures: IFSO Worldwide Survey 2014. Obes Surg. 2017;27(9):2279–89. https://doi.org/10.1007/s11695-017-2666-x.

    Article  PubMed  PubMed Central  CAS  Google Scholar 

  6. 6.

    Yu Y, Klem ML, Kalarchian MA, et al. Predictors of weight regain after sleeve gastrectomy: an integrative review. Surg Obes Relat Dis. 2019;15(6):9951005. https://doi.org/10.1016/j.soard.2019.02.009. Epub 2019 Mar 20

    Article  Google Scholar 

  7. 7.

    Sepúlveda M, Alamo M, Saba J, et al. Long-term weight loss in laparoscopic sleeve gastrectomy. Surg Obes Relat Dis. 2017;13(10):1676–81. https://doi.org/10.1016/j.soard.2017.07.017. Epub 2017 Jul 25

    Article  PubMed  Google Scholar 

  8. 8.

    Andreu A, Jimenez A, Vidal J, et al. Bariatric support groups predicts long-term weight loss. Obes Surg. 2020;30:2118–23. https://doi.org/10.1007/s11695-020-04434-2. [Epub ahead of print].

    Article  PubMed  Google Scholar 

  9. 9.

    Gu L, Huang X, Li S, et al. A meta-analysis of the medium- and long-term effects of laparoscopic sleeve gastrectomy and laparoscopic Roux-en-Y gastric bypass. BMC Surg. 2020;20(1):30. https://doi.org/10.1186/s12893-020-00695-x.

    Article  PubMed  PubMed Central  Google Scholar 

  10. 10.

    Lauti M, Kularatna M, Hill AG, et al. Weight regain following sleeve gastrectomy-a systematic review. Obes Surg. 2016;26(6):1326–34. https://doi.org/10.1007/s11695-016-2152-x. Review

    Article  PubMed  Google Scholar 

  11. 11.

    van den Heuvel M, Hörchner R, Wijtsma A, et al. Sweet eating: a definition and the development of the Dutch Sweet Eating Questionnaire. Obes Surg. 2011;21(6):714–21. https://doi.org/10.1007/s11695-010-0094-2. Epub 2010 Mar 5

    Article  PubMed  Google Scholar 

  12. 12.

    Conceição EM, Mitchell JE, Engel SG, et al. What is “grazing”? Reviewing its definition, frequency, clinical characteristics, and impact on bariatric surgery outcomes, and proposing a standardized definition. Surg Obes Relat Dis. 2014;10(5):973–82. https://doi.org/10.1016/j.soard.2014.05.002. Epub 2014 May 15. Review

    Article  PubMed  Google Scholar 

  13. 13.

    Diamantis T, Apostolou KG, Alexandrou A, et al. Review of long-term weight loss results after laparoscopic sleeve gastrectomy. Surg Obes Relat Dis. 2014;10(1):177–83. https://doi.org/10.1016/j.soard.2013.11.007. Epub 2013 Nov 21. Review

    Article  PubMed  Google Scholar 

  14. 14.

    Casella G, Soricelli E, Giannotti D, et al. Long-term results after laparoscopic sleeve gastrectomy in a large monocentric series. Surg Obes Relat Dis. 2016;12(4):757–62. https://doi.org/10.1016/j.soard.2015.09.028. Epub 2015 Oct 1

    Article  PubMed  Google Scholar 

  15. 15.

    Nasta AM, Vyas S, Goel M, et al. Is sleeve gastrectomy overcriticized? A single-center Indian experience with 5-year follow-up results. Surg Obes Relat Dis. 2019;15(11):1883–7. https://doi.org/10.1016/j.soard.2019.08.021. Epub 2019 Aug 28

    Article  PubMed  Google Scholar 

  16. 16.

    Jiménez A, Ibarzabal A, Moizé V, et al. Ten-year outcomes after Roux-en-Y gastric bypass and sleeve gastrectomy: an observational nonrandomized cohort study. Surg Obes Relat Dis. 2019;15(3):382–8. https://doi.org/10.1016/j.soard.2019.01.020. Epub 2019 Jan 29

    Article  PubMed  Google Scholar 

  17. 17.

    Coluzzi I, Raparelli L, Guarnacci L, et al. Food intake and changes in eating behavior after laparoscopic sleeve gastrectomy. Obes Surg. 2016;26(9):2059–67. https://doi.org/10.1007/s11695-015-2043-6.

    Article  PubMed  Google Scholar 

  18. 18.

    Alvarez V, Carrasco F, Cuevas A, et al. Mechanisms of long-term weight regain in patients undergoing sleeve gastrectomy. Nutrition. 2016;32(3):303–8.

    Article  Google Scholar 

  19. 19.

    Essayli JH, LaGrotte CA, Fink-Miller EL, et al. Patients’ reported usage of weight management skills following bariatric surgery. Obes Surg. 2018;28(2):584–8.

    Article  Google Scholar 

  20. 20.

    Keren D, Matter I, Lavy A. Lifestyle modification parallels to sleeve success. Obes Surg. 2014;24(5):735–40.

    Article  Google Scholar 

  21. 21.

    Nicolau J, Ayalaa L, Riveraa R, et al. Postoperative grazing as a risk factor for negative outcomes after bariatric surgery. Eat Behav. 2015;18:147–50.

    Article  Google Scholar 

  22. 22.

    Himpens J, Dobbeleir J, Peeters G. Long-term results of laparoscopic sleeve gastrectomy for obesity. Ann Surg. 2010;252(2):319–24.

    Article  Google Scholar 

  23. 23.

    Lauti M, Stevenson S, Hill AG, et al. Patient perspectives about follow-up care and weight regain following sleeve gastrectomy. Obes Surg. 2016;26(11):2724–31.

    Article  Google Scholar 

  24. 24.

    Noel P, Nedelcu M, Nocca D, et al. Revised sleeve gastrectomy: another option for weight loss failure after sleeve gastrectomy. Surg Endosc. 2014;28(4):1096–102. https://doi.org/10.1007/s00464-013-3277-9. Epub 2013 Oct 30

    Article  PubMed  Google Scholar 

  25. 25.

    Kowalewski PK, Olszewski R, Walędziak MS, et al. Long-term outcomes of laparoscopic sleeve gastrectomy-a single-center, Retrospective Study. Obes Surg. 2018;28(1):130–4. https://doi.org/10.1007/s11695-017-2795-2.

    Article  PubMed  Google Scholar 

Download references

Author information



Corresponding author

Correspondence to Angelo Iossa.

Ethics declarations

This article does not contain any studies with human participants or animals performed by any of the authors. For this type of study formal consent is not required. All procedures performed in studies involving human participants were in accordance with the ethical standards of the institutional and/or national research committee and with the 1964 Helsinki declaration and its later amendments or comparable ethical standards.

Conflict of Interest

The authors declare that they have no conflict of interest.

Additional information

Publisher’s Note

Springer Nature remains neutral with regard to jurisdictional claims in published maps and institutional affiliations.

Rights and permissions

Reprints and Permissions

About this article

Verify currency and authenticity via CrossMark

Cite this article

Iossa, A., Coluzzi, I., Giannetta, I.B. et al. Weight Loss and Eating Pattern 7 Years After Sleeve Gastrectomy: Experience of a Bariatric Center of Excellence. OBES SURG 30, 3747–3752 (2020). https://doi.org/10.1007/s11695-020-04699-7

Download citation


  • Weight regain
  • Sleeve gastrectomy
  • Insufficient weight loss
  • Bariatric surgery failure
  • Long-term results