Title: Factors Associated With Long Term Weight Regain After Bariatric Surgery
Description: Background. Although bariatric surgery is an effective treatment for morbid obesity, long-term weight regain is a significant problem after surgery. Few studies have assessed the association between eating behaviors, psychological factors and lifestyle factors as well as postoperative factors and long term weight regain. This study assesses all of these factors in patients who have undergone gastric bypass (GBP) and laparoscopic adjustable banding (LAGB) procedures. Methods. One hundred eighty patients who underwent primary GBP (n=128) and LAGB (n=52) between 1996 and 2006 with at least five years of follow up data available were included in this study. Patient characteristics, preoperative eating, lifestyle and psychological factors, were assessed across both procedures and for each procedure separately to determine whether they were predictors of substantial long term weight regain. Similar analyses were conducted in each procedure group to determine the association between postoperative outcomes, follow-up and eating and exercise behaviors, and substantial long-term regain.

Substantial weight regain was defined as a regain of at least 30% or more of lost weight. Results. Percent weight regain was found to be greater in LAGB compared to GBP (41.0% versus 28.3%, p=.0042). Multivariate analyses showed that confidence in weight loss was a predictor of substantial regain in all patients. Past illicit drug use was a predictor of substantial regain in GBP patients (OR: 1.5, p=.02). LAGB patients who reported eating large portions or frequently dining out before surgery were less likely to exhibit substantial regain (OR: 0.68, p=.0475 and OR: 0.64, p=.004, respectively). Years of follow up showed an increased odds of regain after GBP (OR: 1.05, p=.03). No postoperative factors were associated with regain in LAGB patients. Conclusions. These findings suggest that GBP may maintain weight loss more effectively than LAGB, however past drug users may be at risk for regain after GBP. Patients whose problem preoperative behaviors are primarily eating large portions or frequently dining out may be good candidates for LAGB.

Patients who exhibit any lack of confidence in their ability to achieve and maintain weight loss success may be at greater risk of long term regain. Tailored counseling is warranted to address these specific issues in bariatric surgery patients in order to reduce the risk of regain.