TOPLINE

Patients who experienced 30% or more recurrent weight gain after metabolic and bariatric surgery sustained health-related quality of life (HRQOL) improvements over 5 years, with physical function being the domain most consistently associated with eventual recurrent weight gain. This association differed by procedure, showing cross-sectional differences after Roux-en-Y gastric bypass and a longitudinal interaction after sleeve gastrectomy.

METHODOLOGY

• Recurrent weight gain after metabolic and bariatric surgery is common and often perceived as a suboptimal outcome. The 2023 international consensus defines clinically meaningful recurrent weight gain as more than 30% of the maximum weight lost or recurrence of associated medical problems, but because weight alone does not capture the full outcome after surgery, HRQOL may be a more patient-centered measure of long-term benefit.
• Researchers conducted a prospective multicenter cohort study at two Dutch hospitals to evaluate long-term HRQOL trajectories according to the eventual recurrent weight-gain phenotype, defined as less than 30% vs 30% or more recurrent weight gain after metabolic and bariatric surgery.
• They included 337 patients, of whom 225 underwent laparoscopic Roux-en-Y gastric bypass and 112 underwent laparoscopic sleeve gastrectomy; the cohort consisted mostly of women, with a mean age of 47.7-50.1 years in the laparoscopic Roux-en-Y gastric bypass group and 42.0-42.9 years in the laparoscopic sleeve gastrectomy group; patients were retrospectively stratified by the eventual recurrent weight-gain phenotype.
• The BODY-Q (a patient-reported questionnaire) was used to measure six aspects of HRQOL (body image; physical function; physical symptoms; and psychological, social, and sexual well-being) on a 0-100 scale, with higher scores indicating better HRQOL.
• HRQOL was measured before surgery and at 4 months and 1-5 years after surgery.

TAKEAWAY

• After Roux-en-Y gastric bypass, both recurrent weight-gain groups showed clear improvements in QOL across the six BODY-Q scales; although the group with less than 30% weight regain had better physical function at years 1-5 (P < .05 for all) and a few other isolated differences appeared, the overall pattern over time did not differ significantly between the two groups.
• After sleeve gastrectomy, both groups improved in QOL over time, but those with 30% or more weight regain had worse body image and psychological well-being at 4 years; a significant time × eventual recurrent weight-gain phenotype interaction was observed for physical function (P = .043), whereas trajectories for the other HRQOL scales did not differ significantly between the two groups over time.
• Overall, meaningful improvement in QOL was similar between the weight regain groups, with only a few isolated differences, and after sleeve gastrectomy, the group with 30% or more weight regain was more likely to lose improvement in physical function over time.

IN PRACTICE

“Eventual substantial RWG [recurrent weight gain] did not necessarily correspond to diminished long-term patient-perceived benefit after MBS [metabolic and bariatric surgery], supporting HRQL [HRQOL] as a complementary outcome alongside weight-based measures,” the authors of the study wrote.

SOURCE

The study was led by Stans B. van Gelder, OLVG, Amsterdam, Netherlands. It was published online in Obesity Surgery.

LIMITATIONS

Fewer patients were available at the longer follow-up points, which may have biased the results. Because the study was observational, it can show an association but cannot prove that weight regain caused changes in QOL. The group with 30% or more weight regain was small, especially after Roux-en-Y gastric bypass.

DISCLOSURES

No external funding was received for the study. The authors reported having no competing interests.

This article was created using several editorial tools, including AI, as part of the process. Human editors reviewed this content before publication.