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Predictive Factors of Weight Regain Following Bariatric Surgery
Charles J. Keith*, Allison A. Gullick, Joshua Richman, richard stahl, Jayleen Grams
University of Alabama, Birmingham, AL
INTRODUCTION: Weight regain following bariatric surgery is a difficult problem and contributing factors are poorly understood. Effective or targeted strategies to prevent or improve weight recidivism could be developed if patients at risk were able to be identified in advance. The aim of this study was to determine predictive factors that contribute to weight regain. We hypothesized that higher preoperative body mass index (BMI) contributes to weight regain.
METHODS: Retrospective review was performed of all patients who underwent laparoscopic Roux-en-Y gastric bypass (LRYGB) from January 1, 2004 to December 31, 2013 at a single institution. Group based trajectory modeling (Proc Traj in SAS v9.4) was used to estimate trajectories of weight regain based on % weight loss. Patients were stratified into two groups: those with stable weight and those with weight regain. Neighborhood socioeconomic status was estimated by linking individual patient zip code information with data from the United States Census Bureau to calculate six aggregate census tract measures. These were then summed to produce a summary Z-score. Associations between trajectories and patient-related factors were estimated utilizing chi-square comparisons, Wilcoxon Rank Sums and t-tests where appropriate. Adjusted predictors of inclusion into groups were selected using backwards logistic regression. Significance was determined as p-value ≤0.05.
RESULTS: Of 581 patients, the majority were female (77.5%), white (72.6%), and median age was 43 years (IQR 36.0-51.0). Of these, 301 patients were weight stable and 280 regained weight. The patients who regained weight were male (p=0.018), of black race (p<0.001), older (p=0.004), and they had a higher nadir weight (p<0.001) and lower nadir % weight loss (p<0.001). Preoperative weight, BMI, and postoperative length of follow up were not significantly different between the groups. There were also no significant differences between the groups in social determinants of health: marital status, children, insurance type, or distance to the hospital. However, patients who regained weight did have lower socioeconomic status based on summary Z-score (p=0.044). On adjusted multivariate analysis, those who regained weight were more likely to be older (OR=1.02, CI 1.00-1.04), male (OR=1.63, CI 1.07-2.48), of black race (OR=2.92, CI 1.95-4.37), of lower socioeconomic status (OR=1.63, CI 1.15-2.32), and they did not have GERD (OR=1.44, CI 1.01-2.05) but did have diabetes (OR=1.80, CI 1.26-2.58).
CONCLUSIONS: Preoperative BMI was not associated with weight regain after LRYGB. However, several other patient-related factors did predict an increased likelihood of weight regain. Further studies are needed to elucidate how these factors contribute to weight recidivism following bariatric surgery.
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