Review article
Weight regain after bariatric surgery: a systematic literature review and comparison across studies using a large reference sample

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Abstract

Published estimates of weight regain (WR) after bariatric surgery vary greatly. Understanding the sources of variability in the literature and clarifying the magnitude of WR after Roux-en-Y gastric bypass (RYGB) and sleeve gastrectomy (SG) are critical for informing expectations and planning interventions. A literature search through January 2019 yielded 15 English-language studies that reported WR in at least 30 participants, not selected based on weight loss or WR, at least 3 years after primary RYGB (n = 11) or SG (n = 5). Median follow-up was 5.0 (range, 3.2–10.0) years. Median sample size was 62 (range, 33–464). Samples represented a median of 54.3% (range, 10.7%–100%) of eligible participants. Nadir weight was determined by serial research assessments (n = 1), medical records (n = 7), participant recall (n = 4), or an undisclosed method (n = 4). Three continuous and 8 binary WR measures (the latter, based on various thresholds for clinically meaningful WR) were reported. To enable comparison across studies, the percentage difference in WR in each study versus a reference sample (n = 1433 RYGB), matched on time since surgery and WR measure, was calculated. Median WR in the reference sample increased from 8.2 (25th–75th percentile: 0–19.5) to 23.8 (25th–75th percentile: 9.0–33.9) percent of maximum weight lost, 3 to 6 years post RYGB surgery. Studies of RYGB versus SG, with larger versus smaller samples, with higher versus lower participation rates, that determined nadir weight via participant recall versus medical records, and reported continuous versus binary WR measures tended to have WR values closer to the reference sample and each other. Variation in WR estimates was explained by heterogeneity in WR measures, timing of assessment, surgical procedure, and study design characteristics. The best estimate of WR after RYGB likely comes from the large reference sample. WR after SG versus RYGB appears higher. However, additional high-quality studies with uniform reporting of WR by surgical procedure are needed.

Section snippets

Methods

The reporting checklist from the Meta-analysis Of Observational Studies in Epidemiology Guidelines was used to ensure reporting of relevant background, methods (including search strategy), results, discussion, and conclusion [15].

Literature search

The literature search yielded 2096 studies, 2023 of which were excluded based on the title or abstract alone (e.g., nonhuman models, surgical procedures other than RYGB or SG). Of 73 reports that were reviewed in full, 58 were excluded because ≥1 criterion (see Appendix 2, supplemental material). The most frequent first identified exclusion criteria were (1) WR was not reported after RYGB alone or SG alone, and (2) sample selected based on weight loss or WR (Fig. 1). Of 15 studies that met

Discussion

The clinical problem of WR after bariatric surgery is poorly and inconsistently assessed and reported. In particular, the lack of a standard measure of WR in the bariatric literature and the variability in timing of assessment has precluded comparisons of the magnitude or extent of WR across studies [1,2,4,5]. This literature review addressed these limitations by making comparisons between each study and a reference sample, that is, the percentage difference in WR in each study versus a large

Conclusions

This literature review suggests the large variation in reported WR across studies is partly, but not entirely, explained by heterogeneity in WR measures and timing of assessment. WR also appears to differ by surgical procedure and study design characteristics. In particular, small samples, low participation or data completeness rates, determination of nadir weight with medical records (of unspecified frequency), and use of binary WR measures appear to contribute to unreliable estimates.

Disclosures

The authors have no commercial associations that might be a conflict of interest in relation to this article.

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    The reference data used in this study were collected as part of the Longitudinal Assessment of Bariatric Surgery-2 (LABS-2) study funded by the following grants: this clinical study was a cooperative agreement funded by the National Institute of Diabetes and Digestive and Kidney Diseases (NIDDK). Grant numbers: DCC -U01 DK066557; Columbia - U01-DK66667 (in collaboration with Cornell University Medical Center CTRC, Grant UL1-RR024996); University of Washington - U01-DK66568 (in collaboration with CTRC, Grant M01 RR-00037); Neuropsychiatric Research Institute - U01-DK66471; East Carolina UniversityU01-DK66526; University of Pittsburgh Medical CenterU01-DK66585 (in collaboration with CTRC, Grant UL1-RR024153); Oregon Health & Science UniversityU01-DK66555.

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