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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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Lifestyle, diabetes, and cardiovascular risk factors 10 years after bariatric surgery
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Bariatric Surgery versus Intensive Medical Therapy for Diabetes — 3-Year Outcomes
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Structural Equation Modeling: Applications Using Mplus
Wang, J., & Wang, X. (2012) · Cited by 1,326
Sjöström, L., Peltonen, M., Jacobson, P., Ahlin, S., Andersson-Assarsson, J., Anveden, Å., Bouchard, C., Carlsson, B., Karason, K., Lönroth, H., et al. (2014) · JAMA · doi:10.1001/jama.2014.5988 · Cited by 1,054
Long-term Follow-up After Bariatric Surgery: A Systematic Review
Puzziferri, N., Roshek, T. B., Mayo, H. G., Gallagher, R., Belle, S. H., & Livingston, E. H. (2014) · JAMA · doi:10.1001/jama.2014.10706 · Cited by 819
Self-citationCourcoulas, A. P. (2013) · JAMA · doi:10.1001/jama.2013.280928 · Cited by 799
Self-citationBariatric surgery and prevention of type 2 diabetes in Swedish obese subjects
Carlsson, L. M. S., Peltonen, M., Ahlin, S., Anveden, Å., Bouchard, C., Carlsson, B., Jacobson, P., Lönroth, H., Maglio, C., Näslund, I., et al. (2012) · New England Journal of Medicine · doi:10.1056/nejmoa1112082 · Cited by 794
Bariatric Surgery and Long-term Durability of Weight Loss
Maciejewski, M. L., Arterburn, D. E., Van Scoyoc, L., Smith, V. A., Yancy, W. S., Weidenbacher, H. J., Livingston, E. H., & Olsen, M. K. (2016) · JAMA Surgery · doi:10.1001/jamasurg.2016.2317 · Cited by 720
Health benefits of gastric bypass surgery after 6 years
Adams, T. D., Davidson, L. E., Litwin, S. E., Kolotkin, R. L., LaMonte, M. J., Pendleton, R. C., Strong, M. B., Vinik, R., Wanner, N. A., Hopkins, P. N., et al. (2012) · JAMA · doi:10.1001/2012.jama.11164 · Cited by 674
Courcoulas, A. P., Belle, S. H., Neiberg, R. H., Pierson, S. K., Eagleton, J. K., Kalarchian, M. A., DeLany, J. P., Lang, W., & Jakicic, J. M. (2015) · JAMA Surgery · doi:10.1001/jamasurg.2015.1534 · Cited by 376
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Self-citationO’Brien, P. E., Hindle, A., Brennan, L., Skinner, S., Burton, P., Smith, A., Crosthwaite, G., & Brown, W. (2019) · Obesity Surgery · doi:10.1007/s11695-018-3525-0 · Cited by 815
“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.”
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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