Factors associated with weight regain post-bariatric surgery: a systematic review
Abstract
Introduction To systematically review the literature to assess the incidence and risk factors of weight regain (WR) after bariatric surgery. Bariatric surgery is the most effective intervention for sustained weight loss of morbidly obese patients, but WR remains a concern. Materials and methods A PRISMA compliant systematic literature review was performed using the PubMed database, Embase and the Cochrane Library in July of 2019. Studies that reported ≥ 10% WR after Roux-en-Y gastric bypass (RYGB) and sleeve gastrectomy (SG) were included. The Newcastle-Ottawa scale (NOS) was used for assessing study quality. Results Out of 2915 retrieved abstracts, 272 full papers were reviewed, and 32 studies included (25 of high and 7 of fair quality) reporting weight outcomes on 7391 RYGB and 5872 SG patients. 17.6% (95% CI 16.9-18.3) had a WR ≥ 10%. Risk factors related with WR fell into 5 categories, namely anatomical, genetic, dietary, psychiatric, and temporal. Specifically, gastrojejunal stoma diameter, gastric volume following sleeve, anxiety, time after surgery, sweet consumption, emotional eating, portion size, food urges, binge eating, loss of control/disinhibition when eating, and genetics have been positively associated with WR while postprandial GLP-1, eagerness to change physical activity habits, self-esteem, social support, fruit and zinc consumption, HDL, quality of life have been negatively associated. Conclusion At least 1 in 6 patients after bariatric surgery had ≥ 10% WR. This review identified several factors related to WR that can be used to counsel patients preoperatively and direct postoperative strategies that minimize WR risk.
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Common factors associated with weight regain after bariatric surgery include anxiety, sweet consumption, emotional eating, portion size, food urges, binge eating, and a loss of control/disinhibition when eating.
“Common factors associated with weight regain after bariatric surgery include anxiety, sweet consumption, emotional eating, portion size, food urges, binge eating, and a loss of control/disinhibition when eating.”
From Lifestyle Medicine for Obesity in the Era of Highly Effective Anti-Obesity Treatment (2025) · cites this paper as [117]
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“Referral to a behavioral health provider may be helpful in addressing these behaviors [117].”
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- Authors
- Athanasiadis, D. I., Martin, A., Kapsampelis, P., Monfared, S., & Stefanidis, D.
- Affiliations
- Indiana University Indianapolis (US)
- Indiana University – Purdue University Indianapolis (US)
- National and Kapodistrian University of Athens (GR)
- Indiana University Hospital (US)
- Corresponding author
- Stefanidis, Dimitrios
- ORCID
- Venue
- Surgical Endoscopy
- Published
- 2021-03-01
- Volume
- 35
- Issue
- 8
- Pages
- 4069-4084
- ISSN
- 0930-2794 (ISSN-L)
- 1432-2218
- OpenAlex
- W3134719856
- Cited by
- 333
- References
- 5
- Citations by year
- 2026: 46 · 2025: 71 · 2024: 74 · 2023: 93 · 2022: 40 · 2021: 9
- FWCI
- 13.00
- Type
- journal article
- Language
- en
- Open access
- closed
- Locations
- Surgical Endoscopy (publishedVersion)
- PubMed (publishedVersion)
- Topics
- Health Sciences › Medicine › Surgery › Bariatric Surgery and Outcomes
- Health Sciences › Medicine › Surgery › Body Contouring and Surgery
- Health Sciences › Medicine › Public Health, Environmental and Occupational Health › Obesity, Physical Activity, Diet
- Keywords
- weight regain, bariatric surgery, Roux-en-Y gastric bypass, sleeve gastrectomy, morbid obesity, risk factors, binge eating, emotional eating, glucagon-like peptide-1, social support, zinc intake, self-esteem, postoperative counseling
- MeSH terms
- Gastrectomy, Humans, Obesity, Morbid, Quality of Life, Retrospective Studies, Gastric Bypass, Weight Gain, Bariatric Surgery
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