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Seven-Year Weight Trajectories and Health Outcomes in the Longitudinal Assessment of Bariatric Surgery (LABS) Study
Open accessAbstract
Importance: More information is needed about the durability of weight loss and health improvements after bariatric surgical procedures. Objective: To examine long-term weight change and health status following Roux-en-Y gastric bypass (RYGB) and laparoscopic adjustable gastric banding (LAGB). Design, Setting, and Participants: The Longitudinal Assessment of Bariatric Surgery (LABS) study is a multicenter observational cohort study at 10 US hospitals in 6 geographically diverse clinical centers. Adults undergoing bariatric surgical procedures as part of clinical care between 2006 and 2009 were recruited and followed up until January 31, 2015. Participants completed presurgery, 6-month, and annual research assessments for up to 7 years. Main Outcome and Measures: Percentage of weight change from baseline, diabetes, dyslipidemia, and hypertension, determined by physical measures, laboratory testing, and medication use. Results: Of 2348 participants, 1738 underwent RYGB (74%) and 610 underwent LAGB (26%). For RYBG, the median age was 45 years (range, 19-75 years), the median body mass index (calculated as weight in kilograms divided by height in meters squared) was 47 (range, 34-81), 1389 participants (80%) were women, and 257 participants (15%) were nonwhite. For LAGB, the median age was 48 years (range, 18-78), the body mass index was 44 (range, 33-87), 465 participants (76%) were women, and 63 participants (10%) were nonwhite. Follow-up weights were obtained in 1300 of 1569 (83%) eligible for a year-7 visit. Seven years following RYGB, mean weight loss was 38.2 kg (95% CI, 36.9-39.5), or 28.4% (95% CI, 27.6-29.2) of baseline weight; between years 3 and 7 mean weight regain was 3.9% (95% CI, 3.4-4.4) of baseline weight. Seven years after LAGB, mean weight loss was 18.8 kg (95% CI, 16.3-21.3) or 14.9% (95% CI, 13.1-16.7), with 1.4% (95% CI, 0.4-2.4) regain. Six distinct weight change trajectory patterns for RYGB and 7 for LAGB were identified. Most participants followed trajectories in which weight regain from 3 to 7 years was small relative to year-3 weight loss, but patterns were variable. Compared with baseline, dyslipidemia prevalence was lower 7 years following both procedures; diabetes and hypertension prevalence were lower following RYGB only. Among those with diabetes at baseline (488 of 1723 with RYGB [28%]; 175 of 604 with LAGB [29%]), the proportion in remission at 1, 3, 5, and 7 years were 71.2% (95% CI, 67.0-75.4), 69.4% (95% CI, 65.0-73.8), 64.6% (95% CI, 60.0-69.2), and 60.2% (95% CI, 54.7-65.6), respectively, for RYGB and 30.7% (95% CI, 22.8-38.7), 29.3% (95% CI, 21.6-37.1), 29.2% (95% CI, 21.0-37.4), and 20.3% (95% CI, 9.7-30.9) for LAGB. The incidence of diabetes at all follow-up assessments was less than 1.5% for RYGB. Bariatric reoperations occurred in 14 RYGB and 160 LAGB participants. Conclusions and Relevance: Following bariatric surgery, different weight loss patterns were observed, but most participants maintained much of their weight loss with variable fluctuations over the long term. There was some decline in diabetes remission over time, but the incidence of new cases is low following RYGB. Trial Registration: clinicaltrials.gov Identifier: NCT00465829.
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“Four studies with a follow-up of at least 5 years were identified. Port-related and band-related complications were documented for 18%, 23%, 27% and 43% of patients [78, 80, 85, 89].”
In the citing paper
“Re-interventions for insufficient weight loss were reported by 3 studies at follow-up > 5 years, and documented for 6%, 12% and 18% of patients [78, 80, 85].”
In the citing paper
“the Longitudinal Assessment of Bariatric Surgery (LABS) study reported a 3.9% WR 3–7 years after RYGB [34].”
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“T2D predicted WR and IWL [34, 79–81, 86]”
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“research suggested that male gender was associated with suboptimal or worse WL after RYGB [34, 78].”
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“hypertension and low HDL cholesterol were both associated with poor weight trajectory [34].”
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Citations
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“The 58% achieved for the full 20-year cohort can be compared to the 57% direct contact follow-up achieved at 7 years for the LABS-2 study [69, 70], a well-funded and strongly committed clinical trial.”
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“Likewise, research suggested that male gender was associated with suboptimal or worse WL after RYGB [34, 78].”
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“This was helpful for (1) highlighting the substantial effect that timing may have on estimates of weight regain and (2) suggesting that the rate of weight regain may be highest during the first year after reaching nadir weight but may continue at a diminishing rate over time.”
InfluentialSelf-citationFive-Year Outcomes of Gastric Bypass in Adolescents as Compared with Adults
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“In addition to prevention of new-onset disease, bariatric surgery effectively improves preexisting diseases including T2DM [10,11,46,47], dyslipidaemia [46,47], and hypertension [47].”
BackgroundElSayed, N. A., Aleppo, G., Aroda, V. R., Bannuru, R. R., Brown, F. M., Bruemmer, D., Collins, B. S., Hilliard, M. E., Isaacs, D., Johnson, E. L., et al. (2023) · Diabetes Care · doi:10.2337/dc23-s008 · Cited by 244
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“77 Regardless of the procedure, most patients will regain some weight over time, typically around 5–10% in the first decade after surgery, and typically higher in the less invasive surgeries (LAGB) compared with the RYGB.”
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“Noteworthy, our results are in line with several studies that observed a weight regain in their cohort (39,43), yet the link with diabetes relapse was not assessed in those studies.”
ResultKing, W. C., Hinerman, A. S., & Courcoulas, A. P. (2020) · Surgery for Obesity and Related Diseases · doi:10.1016/j.soard.2020.03.034 · Cited by 133
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“However, following surgery, patients can experience weight regain and regression in improvements of co-morbidities [42], demonstrating the strong adaptive physiology that drives weight regain.”
BackgroundLoss of Control Eating and Binge Eating in the Seven Years Following Bariatric Surgery
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“In the United States, the Longitudinal Assessment of Bariatric Surgery-2 (LABS-2) study has yielded evidence of similar health benefits with 7-year follow-up (Ahmed et al., 2018; Courcoulas et al., 2018).”
Self-citationA Role for GLP-1 in Treating Hyperphagia and Obesity
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“[12] However, there is major interperson variability in the response to surgery,[13] with some patients with refractory insulin resistance (IR) achieving only modest metabolic and hepatic benefit.”
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“The assumption of weight, comorbidity, and quality-of-life data missing at random in the LABS-2 cohort was evaluated previously, and there was no indication that data were not missing at random.(4,19) Due to the large number of independent variables under consideration, initial variable selection was undertaken using…”
BackgroundMethodBest Practices in the Management of Overweight and Obesity
Tchang, B. G., Saunders, K. H., & Igel, L. I. (2020) · Medical Clinics of North America · doi:10.1016/j.mcna.2020.08.018 · Cited by 97
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Self-citationKalarchian, M. A., King, W. C., Devlin, M. J., Hinerman, A. S., Marcus, M. D., Yanovski, S. Z., & Mitchell, J. E. (2019) · Surgery for Obesity and Related Diseases · doi:10.1016/j.soard.2019.01.008 · Cited by 89
“(17) This report extends findings from the 3-year follow-up of the LABS-3 Psychosocial study,(16) which was a prospective cohort study conducted with 202 patients, most of whom also participated in LABS-2,(5) at three of the six LABS-2 clinical centers: The Neuropsychiatric Research Institute, Fargo, ND; Columbia-Weil…”
BackgroundResultSelf-citationPatients' Experiences of Weight Regain After Bariatric Surgery
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“The Longitudinal Assessment of Bariatric Surgery study (LABS) shows mean weight regain of about 4% after Roux-en-Y gastric bypass (RYGB) 3 to 7 years after surgery [5], while other studies e.”
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“Research suggests that a subgroup of patients presents a less accentuated weight loss and that other patients regain weight starting as soon as at 6 months post-operatively [1, 2].”
BackgroundInfluentialPrediction Model for Screening Patients at Risk of Malnutrition After Gastric Cancer Surgery
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“6% in the second and third years after surgery, respectively [66].”
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“In the Longitudinal Assessment of Bariatric Surgery (LABS) study by Courcoulas et al. [2], the median time to reach nadir weight loss was 2 years after a Roux-en-Y gastric bypass (RYGB).”
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“Weight regain is major concern after bariatric surgery because it can lead to the recurrence of obesity comorbidities, in particular type 2 diabetes [9, 46], decreased quality of life [3], and increasing demand for revisional surgery [47, 48].”
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“It is well established that bariatric surgery controls more efficiently obesity-related diseases and leads to sustained weight loss compared to medical treatment [11, 12].”
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Racial disparities in perioperative outcomes after bariatric surgery
Sheka, A. C., Kizy, S., Wirth, K. M., Grams, J. M., Leslie, D. B., & Ikramuddin, S. (2018) · Surgery for Obesity and Related Diseases · doi:10.1016/j.soard.2018.12.021 · Cited by 62
The Potentially Modifiable Risk Factor in Idiopathic Intracranial Hypertension
Mollan, S. P., Tahrani, A. A., & Sinclair, A. J. (2021) · Neurology Clinical Practice · doi:10.1212/cpj.0000000000001063 · Cited by 60
“reduction with 15-30% weight loss over 15-20 years depending on surgical procedure [14].”
MethodTreatment of Obesity in Mitigating Metabolic Risk
Heffron, S. P., Parham, J. S., Pendse, J., & Alemán, J. O. (2020) · Circulation Research · doi:10.1161/circresaha.119.315897 · Cited by 62
Bariatric Surgery as a Long-Term Treatment for Type 2 Diabetes/Metabolic Syndrome
Hanipah, Z. N., & Schauer, P. R. (2020) · Annual Review of Medicine · doi:10.1146/annurev-med-053117-123246 · Cited by 59
Cassin, S., Leung, S. E., Hawa, R., Wnuk, S. M., Jackson, T., & Sockalingam, S. (2020) · Nutrients · doi:10.3390/nu12102905 · Cited by 42
“The period of most significant weight loss occurs within the first 12 months following surgery [5,6]; however, between 20% to 50% of patients experience weight regain during long-term follow-up [7–9].”
BackgroundInfluentialBaldwin, D., Chennakesavalu, M., & Gangemi, A. (2019) · Surgery for Obesity and Related Diseases · doi:10.1016/j.soard.2019.09.060 · Cited by 57
Safety and Efficacy of Bariatric and Metabolic Surgery
Ghiassi, S., & Morton, J. M. (2020) · Current Obesity Reports · doi:10.1007/s13679-020-00377-y · Cited by 57
Examining the Rates of Obesity and Bariatric Surgery in the United States
Altieri, M. S., Irish, W. D., Pories, W. J., Shah, A., & DeMaria, E. J. (2021) · Obesity Surgery · doi:10.1007/s11695-021-05628-y · Cited by 61
Self-citationTabesh, M. R., Eghtesadi, M., Abolhasani, M., Maleklou, F., Ejtehadi, F., & Alizadeh, Z. (2023) · Obesity Surgery · doi:10.1007/s11695-023-06703-2 · Cited by 68
Meta-Analysis of Differential miRNA Expression after Bariatric Surgery
Langi, G., Szczerbiński, Ł., & Kretowski, A. J. (2019) · Journal of Clinical Medicine · doi:10.3390/jcm8081220 · Cited by 54
Minimum Threshold of Bariatric Surgical Weight Loss for Initial Diabetes Remission
Barthold, D., Brouwer, E., Barton, L. J., Arterburn, D. E., Basu, A., Courcoulas, A. P., Crawford, C. L., Fedorka, P. N., Fischer, H. J., Kim, B. B., et al. (2021) · Diabetes Care · doi:10.2337/dc21-0714 · Cited by 53
Self-citationHepprich, M., Wiedemann, S. J., Schelker, B. L., Trinh, B., Starkle, A., Geigges, M., Loeliger, J., Böni‐Schnetzler, M., Rudofsky, G., & Donath, M. Y. (2020) · Cell Metabolism · doi:10.1016/j.cmet.2020.02.013 · Cited by 55
Use of weight loss medications in patients after bariatric surgery.
Redmond, I. P., Shukla, A. P., & Aronne, L. J. (2021) · Current Obesity Reports · doi:10.1007/s13679-021-00425-1 · Cited by 50
Quality of Life 10 Years After Bariatric Surgery
Major, P., Stefura, T., Dziurowicz, B., Radwan, J., Wysocki, M., Małczak, P., & Pędziwiatr, M. (2020) · Obesity Surgery · doi:10.1007/s11695-020-04726-7 · Cited by 53
Current concepts in management of weight regain following bariatric surgery
Shukla, A. P., He, D., Saunders, K. H., Andrew, C., & Aronne, L. J. (2018) · Expert Review of Endocrinology & Metabolism · doi:10.1080/17446651.2018.1447922 · Cited by 49
“with an inferior weight trajectory [8].”
BackgroundInfluentialKauppila, J. H., Tao, W., Santoni, G., von Euler-Chelpin, M., Lynge, E., Tryggvadóttir, L., Ness-Jensen, E., Romundstad, P., Pukkala, E., & Lagergren, J. (2019) · Gastroenterology · doi:10.1053/j.gastro.2019.03.048 · Cited by 50
The Role of Glucagon-Like Peptide-1 in Energy Homeostasis
Salehi, M., & Purnell, J. Q. (2019) · Metabolic Syndrome and Related Disorders · doi:10.1089/met.2018.0088 · Cited by 51
Self-citationMetabolomic signatures after bariatric surgery – a systematic review
Vaz, M. E. D. L., Pereira, S. S., & Monteiro, M. P. (2021) · Reviews in Endocrine and Metabolic Disorders · doi:10.1007/s11154-021-09695-5 · Cited by 53
The association between socioeconomic factors and weight loss 5 years after gastric bypass surgery
Stenberg, E., Näslund, I., Persson, C., Szabó, É., Sundbom, M., Ottosson, J., & Näslund, E. B. (2020) · International Journal of Obesity · doi:10.1038/s41366-020-0637-0 · Cited by 48
Li, R. A., Liu, L., Arterburn, D. E., Coleman, K. J., Courcoulas, A. P., Fisher, D. P., Haneuse, S., Johnson, E., Theis, M. K., Yoon, T. K., et al. (2019) · Annals of Surgery · doi:10.1097/sla.0000000000003401 · Cited by 48
“0001 Gastroesophageal reflux 3754 (25) 6010 (30) <0.”
Self-citationIvezaj, V., Barnes, R. D., Cooper, Z., & Grilo, C. M. (2018) · General Hospital Psychiatry · doi:10.1016/j.genhosppsych.2018.07.002 · Cited by 46
“A sizeable proportion of those undergoing bariatric surgery do not achieve expected weight loss and even amongst those that do achieve weight loss, weight regain following surgery [3, 9] is a common problem.”
BackgroundMonpellier, V. M., Janssen, I. M. C., Antoniou, E. E., & Jansen, A. T. M. (2018) · Obesity Surgery · doi:10.1007/s11695-018-3560-x · Cited by 46
“Bariatric surgery has proven to effectively treat morbid obesity and its comorbidities [1, 2].”
Backgroundvan de Laar, A. W. J. M., Nienhuijs, S. W., Apers, J. A., van Rijswijk, A.-S., de Zoete, J., & Gadiot, R. P. M. (2018) · Surgery for Obesity and Related Diseases · doi:10.1016/j.soard.2018.11.024 · Cited by 46
Bryant, E. J., Malik, M., Whitford-Bartle, T., & Waters, G. M. (2019) · Appetite · doi:10.1016/j.appet.2019.104575 · Cited by 45
Disordered eating after bariatric surgery
Conceição, E., & Goldschmidt, A. B. (2019) · Current Opinion in Psychiatry · doi:10.1097/yco.0000000000000549 · Cited by 45
“Although most patients experience marked weight loss following surgery, a subset present with suboptimal weight loss and/or weight regain in the long term [1].”
BackgroundInfluentialBariatric Support Groups Predicts Long-term Weight Loss
Andreu, A., Jiménez, A., Vidal, J., Ibarzábal, A., de Hollanda, A., Flores, L., Cañizares, S., Molero, J., & Moizé, V. (2020) · Obesity Surgery · doi:10.1007/s11695-020-04434-2 · Cited by 35
“However, heterogeneity exists in WL trajectories [2] and as many as 25% of patients experience unsuccessful WL outcomes (e.”
BackgroundPolygenic risk score for predicting weight loss after bariatric surgery
de Toro‐Martín, J., Guénard, F., Tchernof, A., Përusse, L., Marceau, S., & Vohl, M. (2018) · JCI Insight · doi:10.1172/jci.insight.122011 · Cited by 44
“However, the degree of weight loss in response to the surgery is subject to a high variability (2).”
BackgroundMethodAliakbarian, H., Bhutta, H. Y., Heshmati, K., Unes Kunju, S., Sheu, E. G., & Tavakkoli, A. (2020) · Obesity Surgery · doi:10.1007/s11695-020-04877-7 · Cited by 43
A microbial signature following bariatric surgery is robustly consistent across multiple cohorts
Fouladi, F., Carroll, I. M., Sharpton, T. J., Bulik‐Sullivan, E. C., Heinberg, L. J., Steffen, K. J., & Fodor, A. A. (2021) · Gut Microbes · doi:10.1080/19490976.2021.1930872 · Cited by 44
“weight loss and improves or resolves many obesity-associated comorbidities including Type II diabetes and cardiovascular diseases [1].”
BackgroundMartin, W. P., Docherty, N. G., & le Roux, C. W. (2018) · Expert Review of Endocrinology & Metabolism · doi:10.1080/17446651.2018.1518130 · Cited by 45
“01 for both) but not the prevalence of diabetes or hypertension [35].”
BackgroundLong-term Outcomes Following Adolescent Metabolic and Bariatric Surgery
Beamish, A. J., Harper, E. R., Järvholm, K., Janson, A., & Olbers, T. (2023) · The Journal of Clinical Endocrinology & Metabolism · doi:10.1210/clinem/dgad155 · Cited by 43
Pinto‐Bastos, A., de Lourdes, M., Brandão, I., Machado, P. P. P., & Conceição, E. (2019) · Surgery for Obesity and Related Diseases · doi:10.1016/j.soard.2019.04.018 · Cited by 42
Weight Loss Prediction after Metabolic and Bariatric Surgery
Park, J. Y. (2023) · Journal of Obesity & Metabolic Syndrome · doi:10.7570/jomes23008 · Cited by 44
Szczerbiński, Ł., & Florez, J. C. (2023) · The Lancet Diabetes & Endocrinology · doi:10.1016/s2213-8587(23)00232-2 · Cited by 42
Remission of type 2 diabetes: always more questions, but enough answers for action
Rothberg, A. E., Lean, M. E. J., & Laferrère, B. (2024) · Diabetologia · doi:10.1007/s00125-023-06069-1 · Cited by 50
“%) that is better sustained over time [11] and associated with more prolonged remission of diabetes [12].”
BackgroundComparative Effectiveness and Safety of Bariatric Procedures in Medicare-Eligible Patients
Panagiotou, O. A., Markozannes, G., Adam, G. P., Kowalski, R., Gazula, A., Di, M., Bond, D. S., Ryder, B. A., & Trikalinos, T. A. (2018) · JAMA Surgery · doi:10.1001/jamasurg.2018.3326 · Cited by 40
“Amongyoungerpatients, bariatric surgery overall as well as certain procedures appear both effective forweight lossandreducing the riskofothernon–weight loss outcomesandsafe.(5-7,36)However, evidence fromstudies inyounger populations is probably not directly generalizable to the broader group of Medicare-eligible patie…”
BackgroundImpact of bariatric surgery on type 2 diabetes: contribution of inflammation and gut microbiome?
Debédat, J., Amouyal, C., Aron‐Wisnewsky, J., & Clément, K. (2019) · Seminars in Immunopathology · doi:10.1007/s00281-019-00738-3 · Cited by 45
Association of Bariatric Surgical Procedures With Changes in Unhealthy Alcohol Use Among US Veterans
Maciejewski, M. L., Smith, V. A., Berkowitz, T. S. Z., Arterburn, D. E., Mitchell, J. E., Olsen, M. K., Liu, C., Livingston, E. H., Funk, L. M., Adeyemo, A., et al. (2020) · JAMA Network Open · doi:10.1001/jamanetworkopen.2020.28117 · Cited by 42
Self-citation
Metadata
- Authors
- Courcoulas, A. P., King, W. C., Belle, S. H., Berk, P., Flum, D. R., Garcia, L., Gourash, W., Horlick, M., Mitchell, J. E., Pomp, A., Pories, W. J., Purnell, J. Q., Singh, A., Spaniolas, K., Thirlby, R., Wolfe, B. M., & Yanovski, S. Z.
- Affiliations
- University of Pittsburgh Medical Center (US)
- University of Pittsburgh (US)
- Columbia University (US)
- University of Washington (US)
- University of North Dakota (US)
- National Institute of Diabetes and Digestive and Kidney Diseases (US)
- Neuropsychiatric Research Institute (US)
- Weill Cornell Medicine (US)
- East Carolina University (US)
- Oregon Health & Science University (US)
- Corresponding author
- Courcoulas, Anita P.
- ORCID
- Venue
- JAMA Surgery
- Publisher
- American Medical Association (AMA)
- Published
- 2018-05-01
- Volume
- 153
- Issue
- 5
- Pages
- 427
- ISSN
- 2168-6254 (ISSN-L)
- PMC
- PMC6584318
- OpenAlex
- W2771736595
- Cited by
- 699
- References
- 18
- Citations by year
- 2026: 63 · 2025: 70 · 2024: 77 · 2023: 92 · 2022: 93 · 2021: 102 · 2020: 97 · 2019: 69 · 2018: 35
- FWCI
- 56.28
- Type
- journal article
- Language
- en
- Open access
- bronze
- doi.org
- Locations
- JAMA Surgery (publishedVersion)
- Europe PMC (PubMed Central) (publishedVersion)
- PubMed Central (publishedVersion)
- PubMed (publishedVersion)
- Funders
- National Institute of Diabetes and Digestive and Kidney Diseases (U01DK066471, U01DK066557, U01DK066526, U01DK066568, U01DK108320, U01DK066667, U01DK066585)
- National Center for Research Resources (UL1RR024153, M01RR000037, UL1RR024996)
- Topics
- Health Sciences › Medicine › Surgery › Bariatric Surgery and Outcomes
- Health Sciences › Medicine › Surgery › Body Contouring and Surgery
- Health Sciences › Medicine › Surgery › Minimally Invasive Surgical Techniques
- Keywords
- bariatric surgery, Roux-en-Y gastric bypass, laparoscopic adjustable gastric banding, weight loss, weight regain, diabetes remission, dyslipidemia, hypertension, obesity, metabolic surgery outcomes, body mass index
- MeSH terms
- Body-Weight Trajectory, Adult, Aged, Female, Follow-Up Studies, Health Status, Humans, Male, Middle Aged, Obesity, Morbid, Retrospective Studies, Time Factors, Weight Loss, Body Mass Index, Treatment Outcome, Bariatric Surgery, Young Adult
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