Weight regain after bariatric surgery: incidence at a tertiary-care center

Main Article Content

Ana Karen Hernández-Guzmán https://orcid.org/0000-0002-5007-5778
Luis Osvaldo Suárez-Carreón https://orcid.org/0000-0002-8375-6545
Jazmin Montserrat Guzmán-Díaz https://orcid.org/0000-0001-5048-0637
Alejandro Rubén Villaseñor Rodríguez https://orcid.org/0009-0000-9871-6506
José Pablo Gomez-Sierra https://orcid.org/0009-0002-2173-396X
Alejandro González-Ojeda https://orcid.org/0000-0003-2935-8703
Clotilde Fuentes-Orozco https://orcid.org/0000-0001-6230-8359

Keywords

Weight Gain, Bariatric Surgery, Obesity, Morbid, Comorbidity

Abstract

Background: Obesity is a global epidemic whose treatment includes alternatives such as bariatric surgery, in which weight regain is considered a common postoperative complication.


Objective: To compare the incidence of weight regain at 2 years between sleeve gastrectomy and gastric bypass.


Material and methods: Descriptive report of a retrospective cohort study including patients undergoing sleeve gastrectomy or gastric bypass, with postoperative body weight recorded and 2-year follow-up in the outpatient clinic at a tertiary care hospital in Mexico. Pre- and postoperative weight, body mass index (BMI), ideal weight, preoperative excess weight, percentage of excess weight lost, weight regain, and total weight loss were analyzed.


Results: 83 patients were included: 61 (73.4%) women and 22 (26.5%) men with a mean age of 43.3 years, pre-surgical weight of 127.12 ± 28.7 kg and BMI of 47.2 ± 9.14 kg/m². Of these, 15.6% received gastric sleeve and 84.3% gastric bypass. The overall incidence of weight regain was lower after bypass according to the second Voorwinde definition (p = 0.02), and higher in women (62.3%) compared to men (31.8%) in both procedures (p = 0.014).


Conclusions: Gastric bypass had a lower incidence of weight regain compared to gastric sleeve, and it was more common in women. No significant differences in the remission of comorbidities were identified between the 2 techniques.

Abstract 15 | PDF (Spanish) Downloads 8

References

1. Charles-Lozoya S, Cobos-Aguilar H, Tamez-Montes JC, et al. Obesity, depression and factors associated to the quality of life in total knee arthroplasty. Cir Cir. 2020;88(2):143-9. doi: 10.24875/CIRU.19000989

2. Instituto Nacional de Salud Pública. Encuesta Nacional de Salud y Nutrición Continua 2023 (ENSANUT 2023) Resultados Nacionales. México; INSP; última actualización 4 de marzo de 2025. Disponible en: https://insp.mx/novedades-editoriales/encuesta-nacional-de-salud-y-nutricion-continua-2023-resultados-nacionales

3. Barquera S, Hernández-Barrera L, Oviedo-Solis C, et al. Obesidad en adultos. Salud Publica Mex. 2024;66:414-24. doi: https://doi.org/10.21149/15863

4. Campos-Nonato I, Galván-Valencia O, Hernández-Barrera L, et al. Prevalencia de obesidad y factores de riesgo asociados en adultos mexicanos: resultados de la Ensanut 2022. Salud Publica Mex. 2023;65(supl I):S238-47. doi: 10.21149/14809

5. Gálvez-Gallo G, Plascencia-Posada FJ, Cárdenas-Figueroa JA, et al. Enhanced recovery after bariatric surgery: Implementation of program and clinical outcomes from a bariatric surgery and metabolic diseases reference center. Cir Cir. 2020;88(2):194-9. doi: 10.24875/CIRU.19001199

6. Hernández-Marín JD, Marrufo-Patrón CA, López-Rosales F. Metabolic changes in obese patients after laparoscopic gastric bypass: five-year experience in a tertiary referral hospital. Cir Cir. 2018;86(4):338-46. doi: 10.24875/CIRU.M18000052

7. Cornier MA. A review of current guidelines for the treatment of obesity. Am J Manag Care. 2020;28 (15 Suppl):S288-96. doi: 10.37765/ajmc.2022.89292

8. Garvey WT, Mechanick JI, Brett EM, et al. American Association of Clinical Endocrinologist and American College of Endocrinology Comprehensive Clinical Practice Guidelines for Medical Care of Patients with obesity. Endocr Pract. 2016;22 (Suppl 3): 1-203. doi: 10.4158/EP161365.GL

9. Barriguete-Meléndez JA, Hercberg S, Galán P, et al. NutriNet-Salud México. Estudio prospectivo por Internet: 2018-2028. Cir Cir. 2018;86(1):8-19. doi: 10.24875/CIRU.M18000011

10. Castagneto-Gissey L, Casella-Mariolo J, Mingrone G. Bariatric/Metabolic Surgery. In: Eckel J, Clément K, editors. From Obesity to Diabetes. Handbook of Experimental Pharmacology. Cham: Springer; 2021. pp. 371-386. doi: 10.1007/164_2021_565

11. Rubino F. From bariatric to metabolic surgery: definition of a new discipline and implications for clinical practice. Curr Atheroscler Rep. 2013;15(4):369. doi: 10.1007/s11883-013-0369-x

12. Eisenberg D, Shikora SA, Aarts E, et al. 2022 American Society for Metabolic and Bariatric Surgery (ASMBS) and International Federation for the Surgery of Obesity and Metabolic Disorders (IFSO): Indications for metabolic and bariatric surgery. Surg Obes Relat Dis. 2022;18(12):1345-56. doi: 10.1016/j.soard.2022.08.013

13. Voorwinde V, Steenhuis IHM, Janssen IMC, et al. Definitions of long-term weight regain and their associations with clinical outcomes. Obes Surg. 2020;30(2):527-36. doi: 10.1007/s11695-019-04210-x

14. Lunel T, Iceta S, Pasquer A, et al. Third bariatric procedure for insufficient weight loss or weight regain: how far should we go? Surg Obes Relat Dis. 2021;17(1):96-103. doi: 10.1016/j.soard.2020.08.032

15. Shantavasinkul PC, Omotosho P, Corsino L, et al.Predictors of weight regain in patients who underwent Roux-en-Y gastric bypass surgery. Surg Obes Relat Dis. 2016;12(9):1640-5. doi: 10.1016/j.soard.2016.08.028

16. Lauti M, Kularatna M, Hill AG et al. Weight Regain Following Sleeve Gastrectomy- a Systematic Review. Obes Surg. 2016;26(6):1326-34. doi: 10.1007/s11695-016-2152-x

17. King WC, Hinerman AS, Courcoulas AP. Weight regain after bariatric surgery: a systematic literature review and comparison across studies using a large reference sample. Surg Obes Relat Dis. 2020;16(8):1133-44. doi: 10.1016/j.soard.2020.03.034

18. Athanasiadis DI, Martin A, Kapsampelis P, et al. Factors associated with weight regain post-bariatric surgery: a systematic review. Surg Endosc. 2021;35(8):4069-84. doi: 10.1007/s00464-021-08329-w

19. Istfan NW, Lipartia M, Anderson WA, et al. Management of the post-bariatric surgery patient with weight regain. J Clin Endocrinol Metab. 2021;106(1):251-63. doi: 10.1210/clinem/dgaa702

20. Franken RJ, Sluiter NR, Franken J, et al. Treatment options for weight regain or insufficient weight loss after sleeve gastrectomy: a systematic review and meta-analysis. Obes Surg. 2022;32(6):2035-46. doi: 10.1007/s11695-022-06020-0

21. Nahler G. Lorentz-formula. In: Dictionary of Pharmaceutical Medicine. Vienna: Springer; 2009. pp. 107. doi: 10.1007/978-3-211-89836-9_803

22. American Diabetes Association Professional Practice Committee. 2. Diagnosis and Classification of Diabetes: Standards of Care in Diabetes–2025. Diabetes Care. 2025; 48 (Supplement_1): S27–S49. doi: 10.2337/dc25-S002

23. Whelton PK, Carey RM, Aronow WS, et al. 2017 ACC/AHA/AAPA/ABC/ACPM/AGS/APhA/ASH/ASPC/NMA/PCNA guideline for the prevention, detection, evaluation, and management of high blood pressure in adults: Executive summary. Hypertension. 2018;71(6):1269-324. doi: 10.1161/HYP.0000000000000066

24. Instituto Mexicano del Seguro Social. Guía de Práctica Clínica IMSS-233-09: Diagnóstico y tratamiento de dislipidemias (hipercolesterolemia) en el adulto. México: IMSS; 2016. Disponible en: https://www.imss.gob.mx/sites/all/statics/guiasclinicas/233GER.pdf

25. Kapur VK, Auckley DH, Chowdhuri S, et al. Clinical practice guideline for diagnostic testing for adult obstructive sleep apnea: an American Academy of Sleep Medicine clinical practice guideline. J Clin Sleep Med. 2017;13(3):479-504. doi: 10.5664/jcsm.6506

26. World Medical Association. Declaration of Helsinki: Recommendations guiding physicians in biomedical research involving human subjects. Disponible en: https://www.wma.net/what-we-do/medical-ethics/declaration-of-helsinki/doh-sept1989/

27. Ley General de Salud. México: Cámara de Diputados; actualizada el 7 de junio de 2024. Disponible en: https://www.diputados.gob.mx/LeyesBiblio/pdf/LGS.pdf

28. Okut G, Turgut E, Kaplan K, et al. Can revision of RYGB to sleeve gastrectomy be a solution to inadequate weight loss treatment? Cir Cir. 2022;90(S1):25-30. doi: 10.24875/CIRU.21000458

29. Stapleton P, Clark A, Sabot D, et al. Portion perfection and Emotional Freedom Techniques to assist bariatric patients post surgery: a randomised control trial. Heliyon. 2020;6(6):e04058. doi: 10.1016/j.heliyon.2020.e04058

30. Baig SJ, Priya P, Mahawar KK, et al; Indian Bariatric Surgery Outcome Reporting Group. Weight regain after bariatric surgery: a multicentre study of 9617 patients. Obes Surg. 2019;29(5):1583-92. doi: 10.1007/s11695-019-03734-6

31. Chierici A, Chevalier N, Lannelli A . Postoperative morbidity and weight loss after revisional bariatric surgery: a systematic review and network meta-analysis. Int J Surg. 2022;102:106677. doi: 10.1016/j.ijsu.2022.106677

32. O'Brien PE, Hindle A, Brennan L, et al. Long-term outcomes after bariatric surgery: a systematic review of weight loss at ≥10 years. Obes Surg. 2019;29(1):3-14. doi: 10.1007/s11695-018-3525-0

33. Almeida RR, Aidar FJ, Souza MFC, et al. Bariatric surgery: late outcomes in patients who reduced comorbidities at early follow-up. Medicina (Kaunas). 2021;57(9):995. doi: 10.3390/medicina57090995

34. Felsenreich DM, Bichler C, Langer FB, et al. Sleeve gastrectomy: surgical technique, outcomes, and complications. Surg Technol Int. 2020;36:63-9.

35. Felsenreich DM, Langer FB, Bichler C, et al. Surgical therapy of weight regain after Roux-en-Y gastric bypass. Surg Obes Relat Dis. 2019;15(10):1719-28. doi: 10.1016/j.soard.2019.07.002

36. Salinas-Garza RJ, Garza-Cantú AA, Martínez-Escalante JE, et al. Intususcepción como complicación de bypass en Y de Roux en pacientes embarazadas. Cir Cir. 2020;88(Suppl 2):9-12. doi: 10.24875/CIRU.20000068

37. Haal S, Guman MSS, Acherman YIZ, et al. Gallstone formation follows a different trajectory in bariatric patients. Metabolites. 2021;11(10):682. doi: 10.3390/metabo11100682

38. Sneineh MA, Harel L, Elnasasra A, et al. Increased incidence of symptomatic cholelithiasis after bariatric Roux-en-Y gastric bypass. Obes Surg. 2020;30(3):846-50. doi: 10.1007/s11695-019-04366-6

39. Velotti N, Vitiello A, Berardi G, et al. Roux-en-Y gastric bypass vs one anastomosis-mini gastric bypass as rescue after failed restrictive surgery: a systematic review. Updates Surg. 2021;73(2):639-47. doi: 10.1007/s13304-020-00938-9

40. Peng BQ, Zhang GX, Chen G, et al. Gastroesophageal reflux disease complicating laparoscopic sleeve gastrectomy: current knowledge and surgical therapies. Surg Obes Relat Dis. 2020;16(8):1145-55. doi: 10.1016/j.soard.2020.04.025

41. Dayan D, Kanani F, Bendayan A, et al. Revisional OAGB after sleeve gastrectomy vs RYGB: GERD symptoms and quality of life outcomes. Obes Surg. 2023;33(7):2125-31. doi: 10.1007/s11695-023-06636-w