Cited by 699Bariatric Surgery and OutcomesBody Contouring and SurgeryMinimally Invasive Surgical Techniques

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Seven-Year Weight Trajectories and Health Outcomes in the Longitudinal Assessment of Bariatric Surgery (LABS) Study

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Courcoulas, Anita P., King, Wendy C., Belle, Steven H., Berk, Paul, Flum, David R., Garcia, Luis, Gourash, William, Horlick, Mary, Mitchell, James E., Pomp, Alfons, Pories, Walter J., Purnell, Jonathan Q., Singh, Ashima, Spaniolas, Konstantinos, Thirlby, Richard, Wolfe, Bruce M., Yanovski, Susan Z.·2018·JAMA Surgery

DOI 10.1001/jamasurg.2017.5025PMC PMC6584318

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Abstract

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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Influential
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Activité physique et obésité : effets d'un programme sur la condition physique et la qualité de vie chez des femmes opérées d'une chirurgie bariatrique
Asselin, M. (2021) · theses.fr (ABES) · doi:10.70675/5e667185ze47bz4027za1b2zeacdfa5a11b1
Mathematics of statistical sequential decision making : concentration, risk-awareness and modelling in stochastic bandits, with applications to bariatric surgery
Saux, P. (2024) · theses.fr (ABES) · doi:10.70675/fb3107f5z8cc0z45adzbbb0z72057aab4b87
Attention-Deficit/Hyperactivity Disorder, Anxiety, and Weight Loss Outcomes After Sleeve Gastrectomy: A 12-Month Prospective StudyPreprint
Rajtar-Zembaty, A., Wysocki, M., Starowicz–Filip, A., Bętkowska-Korpała, B., & Budzynski, A. Z. (2026) · Research Square · doi:10.21203/rs.3.rs-9290663/v1
Hernia recurrence after concomitant laparoscopic ventral hernia repair using intraperitoneal biologic mesh: a retrospective analysis
Hlavin, C. A., Donohue, J. K., Mayer, N., Lu, L., Bernardi, K., Brown, J., Neal, M. D., & Courcoulas, A. P. (2026) · Hernia · doi:10.1007/s10029-026-03681-z
Self-citation
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“The WL outcomes following bariatric surgery can vary depending on patient characteristics and type of surgical procedure, though the vast majority of patients typically reach their maximum WL within one to two years after surgery [49,50].”
Eating behaviors following metabolic bariatric surgery in lower, medium, and higher responders
Vuorela, L., Tuure, S., Meriläinen, S., Koivukangas, V., Karppinen, J. E., Muniandy, M., Per‐Henrik, G., Juuti, A., Pietiläinen, K. H., Berntzen, B. J., et al. (2026) · Eating Behaviors · doi:10.1016/j.eatbeh.2026.102090
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Kim, Y., Kim, K. H., Lee, S. H., Moon, Y., Oh, Y., & Seo, K. W. (2026) · Journal of Metabolic and Bariatric Surgery · doi:10.17476/jmbs.2026.15.1.10
“Historically, Roux-en-Y gastric bypass (RYGB) has demonstrated greater durability compared to laparoscopic adjustable gastric banding [6].”
Influential
Pregnancy After Bariatric Surgery: Understanding and Managing Postprandial (Reactive) Hypoglycemia
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Abulfaraj, M. W. (2026) · Frontiers in Surgery · doi:10.3389/fsurg.2026.1760249
“Thus, future multicenter randomized controlled trials with long-term follow-up are warranted to validate these ﬁndings (30).”
Prevention and Management of Recurrent Weight Gain After Bariatric Surgery: Integrating Behavioural, Pharmacological and Procedural Approaches
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“A patient who never reaches an adequate postoperative nadir is not equivalent to one who initially responds and subsequently regains weight [3].”
A Five Year Prospective Study on Recurrent Weight Gain and Six BODY-Q Health-Related Quality of Life Scales after Metabolic and Bariatric Surgery
van Gelder, S. B., de Castro, S. M. M., Dijkhorst, P. J., de Vries, C. E. E., van Rutte, P. W. J., Wiezer, M. J., & van Veen, R. N. (2026) · Obesity Surgery · doi:10.1007/s11695-026-08762-7
“The observed later divergence in the LSG cohort contrasts with previous reports that RWG typically begins within 1–2 years after MBS [11 , 53 , 54 ].”
Predictive Markers for Diabetes Remission Post-Bariatric Surgery at King Abdulaziz Medical City in Jeddah: A Retrospective Cohort StudyPreprint
Radi, S., Fallatah, A. A., Lugtum, A. M., Alghanem, K. F., Alhammadi, Q. K., Gari, M. A., Alshehri, M. N., & Ahmed, M. E. (2026) · Research Square · doi:10.21203/rs.3.rs-9749792/v1
Identifying subgroups of individuals undergoing metabolic bariatric surgery based on behavioral and psychosocial factors: A latent profile analysis
Kuipers, E. A. M., Timmerman, J. G., van Det, M. J., Vermeer, M., & Vollenbroek-Hutten, M. M. R. (2026) · PLoS ONE · doi:10.1371/journal.pone.0352252
“Compared with large multicenter cohorts such as the Longitudinal Assessment of Bariatric Surgery (LABS) study in the United States (US), our cohort showed a similar proportion of female participants and a predominantly white ethnic composition [44].”
Ten-year comparative outcomes of one-anastomosis gastric bypass versus single-anastomosis duodeno-ileal bypass as revisional procedures after sleeve gastrectomy
Yahmadi, A., Salama, A. F., Baba, H. E., Baazaoui, J., Bougmiza, M. I., & Kuwari, M. A. (2026) · International Journal of Obesity · doi:10.1038/s41366-026-02171-7
Preconception Weight Change and Pregnancy Outcomes After Bariatric Surgery
Guthrie, T. M., Lee, S., Kothari, A., Perez, W. F. P., Kumar, S., Truby, H., & de Jersey, S. (2026) · Journal of Clinical Medicine · doi:10.3390/jcm15155851
“These varying results may be explained by weight regain, which occurs in 20 to 40% of cases, and can begin from 6 months up to 3 years after bariatric surgery [37,38].”
MicroRNAs and Bariatric/Metabolic Surgery: Biomarkers, Mediators of Metabolic Remission, or Both?
Gerganova, A., Grozdev, K., Gateva, A., Kaneva, R. P., Nedeva, I., Assyov, Y. S., Karamfilova, V., Gatev, T., Kachakova, D., Petkova, V., et al. (2026) · Obesities · doi:10.3390/obesities6040056
“According to Courcoulas et al. (2018), 60,2% of patients who underwent RYGB achieved remission of their condition seven years after surgery compared to 20,3% for AGB [22].”
Rethinking obesity management targets: Findings from an international MoSCoW prioritization workshop
Sockalingam, S., Racey, M., Sherifali, D., Alberga, A. S., Ard, J. D., Horn, D. B., Busetto, L., Kaplan, L. M., le Roux, C. W., Macklin, D., et al. (2026) · Obesity Pillars · doi:10.1016/j.obpill.2026.100311
Clinical, Economic, and System-Level Outcomes of Bariatric Surgery in Adults: Protocol for a Systematic Review
Bystram, M., Robakowska, M., & Proczko-Stepaniak, M. (2026) · JMIR Research Protocols · doi:10.2196/98976
“Extensive evidence indicates that bariatric surgery is an effective method for achieving significant and sustained weight loss in people with obesity [10-12].”
Clinical-genetic predisposition and medium-term outcomes after bariatric surgery: A 5-year validation of the OBEGEN score
Zorzano-Martínez, M., SWITZER-RODRIGUEZ, A., Bueno, M., Herrerías, F., Caixàs, A., Luna, A., Ciudin, A., Petrola, C., Vilarrasa, N., Lazzara, C., et al. (2026) · Obesity Pillars · doi:10.1016/j.obpill.2026.100318
Long-Term Weight Regain Outcome Post-Bariatric Surgery: Key Influencing Factors
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“Even among landmark prospective cohorts, follow-up durations have typically been limited to 7 years [68 ].”
The Value of Adding Obesity Medications After Bariatric Surgery
Shaikh, S., & le Roux, C. W. (2026) · Current Surgery Reports · doi:10.1007/s40137-026-00530-x
“Importantly, weight recurrence may be associated with progression or worsening of obesity complications, highlighting that obesity remains an active, chronic disease process often requiring ongoing management beyond surgical intervention [5, 8].”
Influential
Psychosocial Functioning and Body Experiences Three Years After Bariatric Surgery
Roussat-Boulanger, C., Dany, L., Valéro, R., & Corroller, A. B. (2026) · Bariatric Surgical Practice and Patient Care · doi:10.1177/2168023x261479406
Impact of Bariatric Surgery on Medication Costs and Disease Burden in Obesity: A Retrospective Cohort Study
Oliveira, A., Bulhosa, C., Apolónia, P., Borges, M., Lima-da-Costa, E., Santos-Sousa, H., & Freitas, P. A. (2026) · Obesity Surgery · doi:10.1007/s11695-026-08894-w
“These findings are in line with previous studies documenting improvement in metabolic comorbidities and reduced use of obesity-related medication after MBS [16 – 18].”
Effects of Bariatric Surgery in Patients With Class I Obesity (BMI 30–35 kg/m 2 ): A Meta-Analysis of Retrospective Studies
Khan, M. K., AlHarbi, A., Alzamil, M. A. S., Liaqat, A., Sifran, S. S. B. M. B., & Amin, A. M. (2026) · Journal of Metabolic and Bariatric Surgery · doi:10.17476/jmbs.2026.15.2.77
“The modest reduction in weight loss between 12 and 24 months is consistent with established postoperative weight trajectories described by Courcoulas et al. [13] and reflects the physiological plateau commonly observed after the first postoperative year.”
The Future of Metabolic and Bariatric Surgery in the Era of Obesity Management Medications – A Prophecy
Baig, S. J., Varma, A., & Biswas, A. K. (2026) · Indian Journal of Surgery · doi:10.1007/s12262-026-04667-y
GLP ‐1 Receptor Agonists Post‐Bariatric Surgery ( GRABS ) Trial: Rationale, Design and Baseline Characteristics
Samuels, J. M., Williams, C. R., Patel, M. B., Self, W. H., Funk, L. M., Roumie, C. L., Spann, M. D., Northup, C. J., Ye, F., Irlmeier, R., et al. (2026) · Diabetes Obesity and Metabolism · doi:10.1111/dom.71320
Optimising Long-term Outcomes after Metabolic Bariatric Surgery: Lessons Learned from Integrating Obesity Management Medications into Clinical Practice
Wadhawan, R. (2025) · Journal of Bariatric Surgery · doi:10.4103/jbs.jbs_12_26
Ethical Dimensions of Bariatric Surgery: A Narrative Review of Principles, Challenges, and Practice Implications
Soltani, H. R., Toolabi, K., Safavi, S. A. S., Najjari, K., & Latif, A. (2026) · Obesity Surgery · doi:10.1007/s11695-026-08933-6
“…including postprandial hypo-glycemia and dumping syndrome after Roux-en-Y gastric bypass, gallstone formation, worsening gastroesophageal reflux disease following sleeve gastrectomy, internal hernia, and clinically significant recurrent weight gain in the years following surgery [ 33 , 34 ].”
Preoperative BMI and five-year proportional weight-loss maintenance after Roux-en-Y gastric bypass: a retrospective cohort studyPreprint
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Systematic review of cost-effectiveness analyses of weight loss interventions for knee osteoarthritis
Gao, Y., Mistry, H., Dhaif, F. G., Mcmurray, B., Susarla, S., & Naghdi, S. (2026) · BMJ Open · doi:10.1136/bmjopen-2026-117500
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Effects of Laparoscopic Sleeve Gastrectomy on Vascular and Myocardial Recovery: Type 2 Diabetes and Echocardiographic Indices of Diastolic Function
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Reframing Obesity Treatment: Integrating Incretin-Based Therapy with Metabolic Surgery in a Multimodal Longitudinal Care Model
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Sex differences in weight loss and metabolic outcomes following bariatric surgery: the Dutch bariatric quality registry
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Recidiva de peso em pacientes submetidos à cirurgia bariátrica: a adesão nutricional como diferencial para prevenção
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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: Courcoulas, Anita P.
King, Wendy C.
Flum, David R.
Gourash, William
Mitchell, James E.
Pomp, Alfons
Pories, Walter J.
Purnell, Jonathan Q.
Singh, Ashima
Spaniolas, Konstantinos
Wolfe, Bruce M.
Venue: JAMA Surgery
Publisher: American Medical Association (AMA)
Published: 2018-05-01
Volume: 153
Issue: 5
Pages: 427
ISSN: 2168-6254 (ISSN-L)
DOI: 10.1001/jamasurg.2017.5025
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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Seven-Year Weight Trajectories and Health Outcomes in the Longitudinal Assessment of Bariatric Surgery (LABS) Study

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