Background

Weight recidivism after metabolic and bariatric surgery (MBS) is a well-described impediment to treating obesity. Currently, there is no nationally accepted protocol for addressing weight recidivism after MBS.

Methods

We conducted a prospective cohort study to standardize the diagnosis and referral process for treatment of weight recidivism after MBS. Patients who achieved <50% excess body weight loss 18 to 24 months following primary sleeve gastrectomy (SG) or gastric bypass (RYGB), or regained >10% of their lowest postoperative weight, were referred for medical weight loss (MWL) intervention. Exclusion criteria were body mass index (BMI) < 27 kg/m2.

Results

2274 patients who were >6 months out from surgery were evaluated over 12 months. 93 patients (86% female) met criteria for inclusion. Mean time from surgery was longer for RYGB (7.85 yrs, SD 16.2 yrs) than SG (2.88 yrs, SD 1.73 yrs) (p = 0.032). 69 (74%) patients agreed to intervention and were followed for an average of 165 days (SD 106.89 days) and lost an average of 5.11 kg (SD 6.86 kg) with change in BMI of -1.81 kg/m2 (SD 2.37 kg/m2). Patients who spent <90 days in a MWL program demonstrated less weight loss (-1.75kg vs -6.48kg, p=0.003) and less BMI change (-0.63kg/m2 vs -2.29kg/m2 , p=0.003) compared to patients who spent > 90 days in the MWL intervention.

Conclusions

This study identifies criteria for intervention in patients suffering weight recidivism after MBS and demonstrates that standardized identification and referral for treatment results in modest weight loss.