Predictors of Weight Regain after Bariatric Surgery.

Abstract

Background: After bariatric surgery, a lifelong threat of weight regain remains. Behavior influences are believed to play a modulating role in this problem. Accordingly, we sought to identify these predictors in patients with extreme obesity after Roux-en-Y gastric bypass (RYGB). Methods: In a large tertiary hospital with an established bariatric program, including a multidisciplinary outpatient center specializing in bariatric medicine, with two bariatric surgeons, we mailed a survey to 1,117 patients after RYGB. Of these, 203 (24.8%) were completed, returned, and suitable for analysis. Respondents were excluded if they were less than 1 year after RYGB. Baseline demographic history, preoperative Beck Depression Inventory (BDI), and Brief Symptom Inventory-18 scores were abstracted from the subjects' medical records; pre- and postoperative well-being scores were compared. Results: Of the study population, mean age was 50.6+/-9.8 years, 147 (85%) were female, and 42 (18%) were male. Preoperative weight was 134.1+/-23.6 kg (295+/-52 lb) and 170.0+/-29.1 kg (374.0+/-64.0 lb) for females and males, respectively, p<0.0001. The mean follow-up after bariatric surgery was 28.1+/-18.9 months. Overall, the mean pre- versus postoperative well-being scores improved from 3.7 to 4.2, on a five-point Likert scale, p=0.001. A total of 160 of the 203 respondents (79%) reported some weight regain from the nadir. Of those who reported weight regain, 30 (15%) experienced significant regain defined as an increase of >15% from the nadir. Independent predictors of significant weight regain were increased food urges (odds ratios (OR)=5.10, 95% CI 1.83-14.29, p=0.002), severely decreased postoperative well-being (OR=21.5, 95% CI 2.50-183.10, p<0.0001), and concerns over alcohol or drug use (OR=12.74, 95% CI 1.73-93.80, p=0.01). Higher BDI scores were associated with lesser risk of significant weight regain (OR=0.94 for each unit increase, 95% CI 0.91- 0.98, p=0.001). Subjects who engaged in self-monitoring were less likely to regain any weight following bariatric surgery (OR=0.54, 95% CI 0.30-0.98, p=0.01). Although the frequency of postoperative follow-up visits was inversely related to weight regain, this variable was not statistically significant in the multivariate model. Conclusions: Predictors of significant postoperative weight regain after bariatric surgery include indicators of baseline increased food urges, decreased well-being, and concerns over addictive behaviors. Postoperative self-monitoring behaviors are strongly associated with freedom from regain. These data suggest that weight regain can be anticipated, in part, during the preoperative evaluation and potentially reduced with self-monitoring strategies after RYGB. © 2009 Springer Science + Business Media, LLC.