IMPORTANCE Estimates of weight regain following bariatric surgery vary widely. OBJECTIVE Describe weight regain following post-Roux-en-Y gastric bypass (RYGB) weight nadir, and compare common weight regain measures for association with clinical outcomes. SETTING Ten hospitals in six US cities: Portland, OR, Seattle, WA, Fargo, ND, Pittsburgh, PA, New York, NY and Greenville, NC. DESIGN AND PARTICIPANTS Adults undergoing bariatric surgical procedures entered a prospective cohort study between February 2006-February 2009 (N=2458) and completed pre-surgery, six month and annual assessments for up to seven years through January 2015. Participants who underwent RYGB and were followed ≥5 years with ≥5 weight measurements were included (83%; 1406 of 1703, excluding deceased/reversals). EXPOSURE Weight regain assessed by five continuous measures (kg, body mass index [BMI; kg/m2], % pre-surgery weight, % nadir weight and % maximum weight loss) and eight dichotomous measures (per established thresholds) were compared in relation to clinical outcomes based on statistical significance, magnitude of association and model fit. MAIN OUTCOME MEASURES Progression of diabetes, hyperlipidemia, and hypertension, and declines in physical and mental health-related quality of life, and satisfaction with surgery. RESULTS Medians (25th–75thpercentiles) are reported. Pre-surgery age was 47 years (38–55) and BMI was 46.3 (42.3–51.8). Most participants were female (80.3%) and white (84.9%). Follow-up was 6.6 (5.9–7.0) years. Maximum weight loss was 37.4% (31.6%−43.3%) of pre-surgery weight, occurring 2.0 (1.0–3.2) years post-surgery. The rate of weight regain was highest in the first year following weight nadir, but regain continued across follow-up, ranging from 9.5% (4.7%−17.2%) to 26.8% (16.7%−41.5%) of maximum weight lost, one to five years post-nadir. The % participants who regained weight depended on threshold (e.g., five years post-nadir, 43.6% regained ≥5 BMI points, 50.2% regained ≥15% of nadir weight and 67.3% regained ≥20% of maximum weight lost). Percentage of maximum weight lost vs. other continuous weight regain measures, had the strongest associations with, and best model fits for, all outcomes except hyperlipidemia, which had a slightly stronger association with regain in BMI. Of dichotomous measures, ≥20% of maximum weight lost performed best with all outcomes except hyperlipidemia and satisfaction (≥10 kg and ≥25% of maximum weight lost were superior, respectively). CONCLUSIONS Among a large cohort of adults who underwent RYGB, weight regain quantified as percentage of maximum weight lost performed better for association with most clinical outcomes than the alternatives examined. These findings may inform standardizing measurement of weight regain in studies of bariatric surgery.

Objective: This study examines the course of eating pathology and its associations with change in weight and health-related quality of life following bariatric surgery. Method: Participants (N = 184) completed the eating disorder examination-bariatric surgery version (EDE-BSV) and the medical outcomes study 36-Item short form health survey (SF-36) prior to and annually following Roux-en-Y gastric bypass (RYGB) or laparoscopic adjustable gastric banding (LAGB) for up to 7 years. Results: The prevalence of ≥ weekly loss of control (LOC) eating, picking/nibbling, and cravings declined post-RYGB and remained lower through 7 years (LOC: 5.4% at Year-7 vs. 16.2% pre-RYGB, p = .03; picking/nibbling: 7.0% vs. 32.4%, p < .001; and cravings: 19.4% vs. 33.6%, p = .02). The prevalence of picking/nibbling was significantly lower 7 years following LAGB vs. pre-LAGB (29.4% vs 45.8%, p = .049), while cravings (p = .13) and LOC eating (p = .95) were not. EDE-BSV global score and ratings of hunger and enjoyment of eating were lower 7 years following both RYGB and LAGB versus pre-surgery (p's for all <.05). LOC eating following RYGB was associated with less long-term weight loss from surgery (p < .01) and greater weight regain from weight nadir (p < .001). Higher post-surgery EDE-BSV global score was associated with less weight loss/greater regain (both p < .001) and worsening/less improvement from surgery in the SF-36 mental component summary scores (p < .01). Discussion: Initial improvements in eating pathology following RYGB and LAGB were sustained across 7 years of follow-up. Individuals with eating pathology post-RYGB, reflected by LOC eating and/or higher EDE-BSV global score, may be at risk for suboptimal long-term outcomes.

Background: Long-term, longitudinal data are limited on mental disorders after bariatric surgery.Objective: To report mental disorders through 7 years post-surgery and examine their relationship with changes in weight and health-related quality of life (HRQoL).Setting: Three U.S. academic medical centers.Method: As a sub-study of the Longitudinal Assessment of Bariatric Surgery Consortium, 199 adults completed the Structured Clinical Interview for DSM-IV prior to Roux-en-Y Gastric Bypass (RYGB) or Laparoscopic Adjustable Gastric Band (LAGB). Participants who completed ≥1 follow-up through 7-years post-surgery are included (n=173; 86.9%). Mixed models were used to examine mental disorders over time, and among the RYGB subgroup (n=104), their relationship with long-term (≥4 years) pre-to post-surgery changes in weight and HRQoL, measured with the Short Form-36 Health Survey, and with weight regain from nadir.Results: Compared with pre-surgery (34.7%), the prevalence of having any mental disorder was significantly lower 4 years (21.3%; p<.01) and 5 years (19.2%; p=.01), but not 7 years (29.1%; p=.27) following RYGB. The most common disorders were not related to long-term weight loss

Objective: To identify patient behaviors and characteristics related to weight regain after Roux-en-Y gastric bypass surgery (RYGB). Background: There is considerable variation in the magnitude of weight regain after RYGB, highlighting the importance of patient-level factors. Methods: A prospective cohort study of adults who underwent bariatric surgery in 6 US cities between 2006 and 2009 included presurgery, and 6-month and annual assessments for up to 7 years. Of 1573 eligible participants, 1278 (81%) with adequate follow-up were included (80% female, median age 46 years, median body mass index 46 kg/m2). Percentage of maximum weight lost was calculated each year after weight nadir. Results: Weight was measured a median of 8 (25th–75th percentile, 7–8) times over a median of 6.6 (25th–75th percentile, 5.9–7.0) years. β coefficients, that is, the mean weight regain, compared with the reference, and 95% confidence interval, are reported. Postsurgery behaviors independently associated with weight regain were: sedentary time [2.9% (1.2–4.7), for highest vs lowest quartile], eating fast food [0.5% (0.2–0.7) per meal/wk], eating when feeling full [2.9% (1.2–4.5)], eating continuously [1.6% (0.1–3.1)], binge eating and loss-of-control eating [8.0% (5.1–11.0) for binge eating; 1.6 (−0.1 to 3.3) for loss of control, vs neither], and weighing oneself <weekly [4.2% (2.9–5.4)]. Postsurgery characteristics independently associated with greater weight regain included: younger age, venous edema, poorer physical function, and more depressive symptoms. Conclusion: Several behaviors and characteristics associated with greater weight regain were identified, which inform integrated healthcare approaches to patient care and identify high-risk patients to improve long-term weight loss maintenance after RYGB.

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