Definitions of Long-Term Weight Regain and Their Associations with Clinical Outcomes

Vera Voorwinde,Ingrid H M Steenhuis,Maartje M Van Stralen,Ignace M C Janssen,Valerie M Monpellier

doi:10.1007/s11695-019-04210-x

Vera Voorwinde, Ingrid H M Steenhuis + Show 3 more

Open Access

https://doi.org/10.1007/s11695-019-04210-x

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Abstract

IntroductionThe prevalence and clinical significance of weight regain after bariatric surgery remains largely unclear due to the lack of a standardized definition of significant weight regain. The development of a clinically relevant definition of weight regain requires a better understanding of its clinical significance.ObjectivesTo assess rates of weight regain 5 years after Roux-en-Y gastric bypass (RYGB) and sleeve gastrectomy (SG), applying six definitions and investigating their association with clinical outcomes.MethodsPatients were followed up until 5 years after surgery and weight regain was calculated. Regression techniques were used to assess the association of weight regain with health-related quality of life (HRQoL) and the presence of comorbidities.ResultsA total of 868 patients participated in the study, with a mean age of 46.6 (± 10.4) years, of which 79% were female. The average preoperative BMI was 44.8 (± 5.9) kg/m2 and the total maximum weight loss was 32% (± 8%). Eighty-seven percent experienced any regain. Significant weight regain rates ranged from 16 to 37% depending on the definition. Three weight regain definitions were associated with deterioration in physical HRQoL (p < 0.05), while associations between definitions of weight regain and the presence of comorbidities 5 years after surgery were not significant.ConclusionThese results indicate that identifying one single categorical definition of clinically significant weight regain is difficult. Additional research into the clinical significance of weight regain is needed to inform the development of a standardized definition that includes all dimensions of surgery success: weight, HRQoL, and comorbidity remission.

Highlights

The prevalence and clinical significance of weight regain after bariatric surgery remains largely unclear due to the lack of a standardized definition of significant weight regain
A total of 868 patients were included in this study, of which 5year follow-up data was available for 714 patients and 154 patients filled in an online questionnaire
Regarding health-related quality of life (HRQoL), patients who filled in the online questionnaire had lower scores on the physical health scale of the RAND36 at 5-year follow-up and higher scores on the mental health scale

Summary

Introduction

The prevalence and clinical significance of weight regain after bariatric surgery remains largely unclear due to the lack of a standardized definition of significant weight regain. Due to generally excellent results in terms of weight loss, improvements in health-related quality of life (HRQoL), and reduction in overall mortality and morbidity, bariatric surgery is considered the best treatment option for extreme obesity [1, 2]. Weight regain has been associated with deterioration in HRQoL, the reemergence of type 2 diabetes and other comorbidities, and patients’ opinion about surgery success [3, 4, 9,10,11]. The key studies focusing on long-term outcomes after bariatric surgery show that patients generally regain 5 to 10% of their total weight loss (%TWL) within the first decade [2, 6, 12]. In the Swedish Obese Subjects (SOS) study, the first large, long-term prospective study, %TWL decreased from 32 to 25% within 10 years after Roux-en-Y gastric bypass

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