Early weight loss trajectory predicts outcome following bariatric surgery

Background: Early identification of patients at risk of poor weight loss following bariatric surgery may provide an opportunity for timely addition of intervention to optimize weight loss. This study investigates the relationship between early postsurgery weight loss trajectory and final weight loss outcomes. Methods: Data from patients who underwent primary sleeve gastrectomy (SG), Roux-en-Y gastric bypass (RYGB), or one-anastomosis gastric bypass (OAGB) between October 2014 and March 2020 at a single institution were analyzed retrospectively. Total weight loss percentage (%TWL) was calculated at 1, 3, 6, 9, 12, 18, 24, 30, and 36 months postsurgery. Regression analysis demonstrated associations between early weight loss and %TWL between 12 and 36 months. Multivariate analysis identified predictors of maximal weight loss (MWL) and insufficient weight loss (IWL). Results: Six hundred and sixteen patients met the inclusion criteria. Follow-up weights were available at 12 months for n = 571, 18 months for n = 382, 24 months for n = 344, 30 months for n = 198, and 36 months for n = 187. The median (interquartile range) MWL for SG, RYGB, and OAGB was 29.9% (24.3–35.7), 32.5% (27.5–38.2), and 38.0% (32.6–42.4), respectively. On multivariate linear regression, MWL was best predicted by 3–6-month %TWL after both SG (P < 0.001) and OAGB (P < 0.001) and by 6–9-month %TWL following RYGB (P < 0.001). Conclusion: Early weight loss predicts MWL and %TWL up to 36 months following laparoscopic SG, RYGB, and OAGB. Identification of poor weight loss responders early may represent an opportunity to intervene to optimize postsurgical outcomes.