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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].”
In the citing paper
“T2D predicted WR and IWL [34, 79–81, 86]”
In the citing paper
“research suggested that male gender was associated with suboptimal or worse WL after RYGB [34, 78].”
In the citing paper
“hypertension and low HDL cholesterol were both associated with poor weight trajectory [34].”
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“However, the diminishing difference at 6 and 12 months indicates a convergence of weight outcomes over time, which aligns with previous reports suggesting that the initial advantages of more complex procedures may attenuate as patients reach a weight plateau [20,21].”
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“…two previous randomized controlled trials among patients with T2DM comparing the long-term outcomes of medical management versus surgical intervention (including SG) demonstrated significant reductions in HbA1c from 8.7% baseline to 7.2% year 7 [26] and from 9.5% baseline to 7.1% year 5 [27].”
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“Bariatric surgery remains the most effective intervention for addressing severe obesity and its associated metabolic diseases [5].”
Petcka, N. L., Wu, J., Smith, S. R., Arshad, S. A., Yost, C., Srinivasan, J. K., Davis, S. S., Lin, E., Hechenbleikner, E. M., & Mou, D. (2025) · Surgical Endoscopy · doi:10.1007/s00464-025-11844-9 · Cited by 2
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Does Long-Term Post-Bariatric Weight Change Differ Across Antidepressants?
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“We excluded those patients who had reoperations, did not have documented obesity, had preoperative cancer, had other medical exclusions, received uncommon bariatric procedures, and patients who either (1) did not have depression, (2) were not receiving antidepressant treatment, or (3) or were receiving multiple antide…”
BackgroundSelf-citationHealth change awareness and its association with weight loss following bariatric surgery.
Wolfe, M. B. W., Williams, T. J., Dewey, E. N., Mitchell, J. E., Pomp, A., & Wolfe, B. M. (2023) · Health Psychology · doi:10.1037/hea0001279 · Cited by 2
“The fi rst year following surgery revealed dramatic perceptions of improved health, in alignment with the substantial weight loss at that point (Courcoulas et al., 2018).”
BackgroundResultInfluentialSelf-citationPratt, K. J., Stroup, H. J., Breslin, L. M., Kiser, H. M., Noria, S. F., Brethauer, S. A., & NEEDLEMAN, B. J. (2023) · Obesity Surgery · doi:10.1007/s11695-023-06738-5 · Cited by 2
Maroszczuk, T., Lewandowska, J. A., Kapała, J. M., Lech, P., & Dowgiałło‐Gornowicz, N. (2023) · Polish Journal of Surgery · doi:10.5604/01.3001.0053.9293 · Cited by 2
Surgical Management of Bariatric Complications and Weight Regain
Higa, K. D. (2023) · Gastroenterology Clinics of North America · doi:10.1016/j.gtc.2023.09.003 · Cited by 2
Elmamlook, S. M., Sabry, A. A.-A., Elrefai, M., & Eldeen, A. B. (2024) · Obesity Surgery · doi:10.1007/s11695-023-07033-z · Cited by 2
“Bariatric surgery is considered the most effective treatment modality for morbid obesity resulting in significant improvement or reduction of comorbidities due to obesity [1].”
BackgroundPugin, F., Burgard, M., Cherbanyk, F., & Egger, B. (2024) · Surgery for Obesity and Related Diseases · doi:10.1016/j.soard.2024.01.020 · Cited by 2
Pyykkö, J. E., Zwartjes, M. S. Z., Nieuwdorp, M., van Olst, N., Bruin, S. C., van de Laar, A. W. J. M., Sanderman, R., Hagedoorn, M., & Gerdes, V. E. A. (2024) · Obesity Surgery · doi:10.1007/s11695-024-07171-y · Cited by 2
“It is also possible that the effects of pain severity on weight outcomes become more evident in the longer term, after the strong surgical effects on weight loss wear off [49] and weight maintenance depends more on the patient themselves [49].”
BackgroundMoro, O., Albert, U., De, E. F., Palmisano, S., Mastronardi, M., & Blas, L. D. (2024) · Eating and Weight Disorders - Studies on Anorexia Bulimia and Obesity · doi:10.1007/s40519-024-01660-w · Cited by 2
“…rapidly lose weight during the first semester and reach the maximum percentage of excess weight loss between 12 and 18 months after intervention; weight reduction gradually stagnates during the second year and risk for weight regain increases between 3 and 7 years after intervention [13, 14].”
BackgroundResultCost-effectiveness analysis of duodenal–jejunal bypass sleeve device for people with obesity
Xu, Q., Yan, W., Li, L., & Liu, B. (2025) · Health Economics Review · doi:10.1186/s13561-025-00623-w · Cited by 3
Long-Term Weight Maintenance and Dietary and Behavioral Management of Weight Recurrence
Grothe, K. B., Koball, A. M., Ames, G. E., & Czerwony, B. A. (2025) · Springer eBooks · doi:10.1007/978-981-96-5099-6_17 · Cited by 2
Nuijten, M. A. H., de Roos, B. M., Karregat, J. H. M., Hazebroek, E. J., Monpellier, V. M., Janssen, I. M. C., Hopman, M. T. E., Bakker, E. A., & Eijsvogels, T. M. H. (2025) · Clinical Obesity · doi:10.1111/cob.70054 · Cited by 3
“However, a previous study has shown that the magnitude and rate of initial weight loss were predictive of long-term weight outcomes [37].”
Cotter, L. J., Scholtz, S., Das, S., Lee, J. T., Lee‐Baggley, D., & Barley, E. A. (2019) · International Journal of Clinical Trials · doi:10.18203/2349-3259.ijct20194655 · Cited by 2
“This will be measured by, (1) The willingness of participants to be randomised, measured by recording the number of participants who drop out of the study after they have been randomised, (2) the number of eligible patients attending clinic, as assessed by calculating the percentage of patients who meet eligibility cr…”
Despaigne, L., Barbeito, A. T., Ortiz, T. O. M., & Alberto, L. (2021) · doi:10.51941/amcr.2021.1101 · Cited by 1
“…depend on the surgical technique (in-line suture hemorrhage, fistula, stenosis, suture dehiscence and ulcers among others) (Puzziferri et al., 2014; Courcoulas et al., 2018; Builes et al., 2019) and they do not refer to clinical complications such as those analyzed in the present investigation.”
BackgroundHulme, P. A., Kupzyk, K. A., Anthone, G. J., Capron, K. A., & Nguyen, T. (2018) · Obesity Surgery · doi:10.1007/s11695-018-3166-3 · Cited by 2
Recuperación de peso perdido en pacientes que han tenido cirugía bariátrica: Una mirada psicológica
Ugarte, C. A., Quiñones, Á., & Vicente, B. (2019) · Revista médica de Chile · doi:10.4067/s0034-98872019001101390 · Cited by 2
Altieri, M. S., DeMaria, E. J., Lensing, C. J., Derecho, J., Fallorina, R., Mehrotra, S., Pories, W. J., & Irish, W. D. (2021) · Surgery for Obesity and Related Diseases · doi:10.1016/j.soard.2021.11.013 · Cited by 2
Self-citationReflux, Barrett’s Esophagus, and Esophageal Adenocarcinoma After Bariatric Surgery
Medina, B. D., & Molena, D. (2021) · Foregut The Journal of the American Foregut Society · doi:10.1177/26345161211068367 · Cited by 2
Taste and Smell in Weight Loss Surgery
Nicanor-Carreón, J. G., Acevedo, M. B., Rowitz, B. M., & Pepino, M. Y. (2021) · Springer eBooks · doi:10.1007/978-3-030-86282-4_6 · Cited by 2
de Melo, P. R. E., Braga, T. C., Minari, D. F., & Resende, J. H. C. (2022) · Surgical Science · doi:10.4236/ss.2022.131158 · Cited by 2
Suboptimal Weight Loss After Bariatric Surgery: Mechanisms and Treatment Algorithms
Mok, J., & Batterham, R. L. (2023) · Springer eBooks · doi:10.1007/978-3-030-60596-4_118 · Cited by 2
Smith, C. E., Dilip, A., Ivezaj, V., Duffy, A. J., & Grilo, C. M. (2023) · Clinical Obesity · doi:10.1111/cob.12603 · Cited by 2
“The Longitudinal Assessment of Bariatric Surgery (LABS) study, which included cohorts of post-surgical patients from multiple centres across the United States, recently examined 7-year weight trajectories and found the majority of patients maintained weight loss during this time frame.(11) Investigations using LABS ou…”
MethodThereaux, J., Bennani, M., Khémis, J., Ohayon, É., Buissez, I. V., Lafourcade, A., Quiriconi, L., Philippe, C., & Oppert, J. (2024) · Surgery · doi:10.1016/j.surg.2024.07.048 · Cited by 2
Histoire naturelle et trajectoires des obésités
Ziegler, O., Clément, K., & Aron‐Wisnewsky, J. (2021) · Elsevier eBooks · doi:10.1016/b978-2-294-76753-1.00026-6 · Cited by 2
Considerations When Calculating Data Completeness
King, W. C., Belle, S. H., & Courcoulas, A. P. (2018) · JAMA Surgery · doi:10.1001/jamasurg.2018.1159 · Cited by 2
Self-citationEffects of obesity and weight-loss surgery shift the microbiome and impact alloimmune responses
Zhou, H., & Tullius, S. G. (2021) · Current Opinion in Organ Transplantation · doi:10.1097/mot.0000000000000920 · Cited by 1
“Bariatric surgery (BS) induces rapid and durable weight loss while improving or resolving many obesity-associated co-morbidities including cardiovascular diseases, type 2 diabetes mellitus, and nonalcoholic steatohepatitis (NASH) [1].”
BackgroundInfluentialHegland, P. A., McAleavey, A. A., Aasprang, A., Moltu, C., Kolotkin, R. L., & Andersen, J. R. (2021) · Clinical Obesity · doi:10.1111/cob.12491 · Cited by 1
Henao, D. C., Gómez, A. M., Múñoz, Ó., Rubio, C., Rodríguez, N., Ursida, V., Forero, A. M., Pinzón, F. E., & Mikler, R. (2023) · Revista Colombiana de Endocrinología Diabetes & Metabolismo · doi:10.53853/encr.10.1.760 · Cited by 1
Association Between the Success of Bariatric Surgery and Personality Traits
İmre, O., & Toprak, Ş. S. (2023) · European Journal of Therapeutics · doi:10.58600/eurjther1683 · Cited by 3
“[2].”
The Influence of Pregnancy on Weight Loss After Previous Bariatric Surgery
Berk, R. H., Lima, D. L., Steinberger, M., Viscarret, V., Seu, R., Konovalova, V., & Camacho, D. R. (2023) · Journal of Laparoendoscopic & Advanced Surgical Techniques · doi:10.1089/lap.2023.0176 · Cited by 1
Salman, M. A., Conway, N., Bateman, L., Albon, L., Mabrook, M., Khalid, A., & Salman, A. (2024) · Bariatric Surgical Practice and Patient Care · doi:10.1089/bari.2023.0030 · Cited by 1
Patel, S., Chen, J., Cowan, B., Yin, J., Schaefer, C. A., Dutta, S., Mostaedi, R., & Choquet, H. (2024) · Annals of Surgery Open · doi:10.1097/as9.0000000000000437 · Cited by 1
“2,6,9,21 Postoperative %TBWL trajectories were estimated for each patient by latent class growth analysis implemented using Proc Traj in SAS 9.4 (SAS Institute Inc.).”
InfluentialPrice, C., Fraser, K., Bartel, S. J., Vallis, M., Jad, A., & Keshen, A. R. (2025) · Obesities · doi:10.3390/obesities5020019 · Cited by 1
Gastric bypass: evolution toward mini-invasive techniques and long-term results
Brockmeyer, J. R., & Coffin, E. (2025) · Mini-invasive Surgery · doi:10.20517/2574-1225.2024.86 · Cited by 1
Shea, M. K., Lynch, S. D., Brinkley, T. E., & Kritchevsky, S. B. (2025) · Current Developments in Nutrition · doi:10.1016/j.cdnut.2025.107485 · Cited by 2
“It is, therefore, somewhat unsurprising that individual responses to obesity treatments vary signi fi cantly [130,131].”
Guthrie, T. M., Lee, S., Kothari, A., Perez, W. F. P., Kumar, S., Truby, H., & de Jersey, S. (2025) · Journal of Clinical Medicine · doi:10.3390/jcm14134666 · Cited by 1
“Weight loss following bariatric surgery varies widely, some individuals regain weight within 6 months and others continue to lose weight 3 years after surgery [26].”
Aldegheri, L., Cipullo, C., Rosso, N., Catamo, E., Casagranda, B., Giraudi, P. J., de Manzini, N., Palmisano, S., & Robino, A. (2025) · International Journal of Molecular Sciences · doi:10.3390/ijms26157337 · Cited by 1
“…higher BMI at all time points compared to those who underwent RYGB or OAGB and showed a lower %TWL at six months after surgery compared to RYGB patients, confirming previous studies that have already reported that the type of bariatric surgery influences the weight loss trajectory [33,34].”
The effect of weight change on death and cardiovascular events after Roux-en-Y gastric bypass
Stenberg, E., Näslund, E. B., Cao, Y., Ottosson, J., & Näslund, I. (2025) · British journal of surgery · doi:10.1093/bjs/znaf170 · Cited by 1
“Although some recurrent weight gain is common after reaching a nadir weight loss, most patients retain a good and sustainable weight loss long term 5 .”
Influential
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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