Predictors of Weight Regain and Insufficient Weight Loss According to Different Definitions After Sleeve Gastrectomy: a Retrospective Analytical Study

Abstract

Background: Weight regain (WR) and insufficient weight loss (IWL) after sleeve gastrectomy (SG) are challenging issues. This study aimed to evaluate the predictors of WR and IWL after SG.

Methods: In this retrospective analytical study, 568 patients who underwent SG at Hazrat-e Rasool General Hospital, Tehran, Iran, between January 2015 and April 2022 were evaluated. A total of 333 patients were included. WR and IWL were evaluated by multiple criteria such as a BMI of > 35 kg/m², an increase in BMI of > 5 kg/m² above nadir, an increase in weight of > 10 kg above nadir, percentage of excess weight loss (%EWL) < 50% at 18 months, an increase in weight of > 25% of EWL from nadir at 36 months, and percentage of total weight loss (%TWL) < 20% at 36 months. All participants were followed up for 36 months.

Result: The univariate analysis showed that preoperative BMI, obstructive sleep apnea, metformin consumption, and grades 2 and 3 fatty liver disease were associated with WR and IWL (P < 0.05). WR or IWL incidence varied (0-19.3%) based on different definitions. The multivariate analysis showed that a preoperative BMI of > 45 kg/m² [odds ratio_Adjusted (OR_Adj) 1.77, 95% CI: 1.12-4.11, P = 0.038] and metformin consumption [OR_Adj: 0.48, 95% CI: 0.19-0.78, P = 0.001] were associated with WR and IWL after SG, regardless of the definition of WR or IWL.

Conclusion: This study showed that preoperative BMI of > 45 kg/m², obstructive sleep apnea, metformin consumption, and grades 2 and 3 of fatty liver disease were associated with WR or IWL.

Keywords: Bariatric surgery; Insufficient weight loss; Sleeve gastrectomy; Weight regain.