Greater early weight loss after metabolic/bariatric surgery predicts greater loss up to 2 years but is also associated with weight regain in the longer term.
- 1Imperial College London
Abstract
BackgroundEarly postoperative weight loss may help predict later outcomes, but its reliability for longer-term weight loss and regain remains unclear. We assessed whether the percentage total weight loss (%TWL) 3 months after metabolic/bariatric surgery predicted later %TWL weight change/regain.
MethodsThis retrospective observational cohort study included 216 patients from the Personalised Medicine for Morbid Obesity cohort who underwent sleeve gastrectomy or Roux-en-Y gastric bypass and had 3-month %TWL and at least one later outcome. Linear regression assessed associations between 3-month %TWL and later %TWL plus weight change/regain outcomes. Adjusted incremental R2 quantified the additional variance explained by 3-month %TWL. Secondary procedure-stratified, diabetes-stratified, and baseline BMI comparator analyses are reported in the Supplementary Material.
ResultsGreater 3-month %TWL was associated with higher 1-year and 2-year %TWL in adjusted models (both p < 0.001) but not longer-term %TWL (p = 0.078). Incremental R2 was 38.23% for 1- year, 11.75% for 2-year %TWL and 2.25% for long-term %TWL. Greater 3-month %TWL was also associated with greater recurrent weight gain from 1 to 2 years and from 1 year to long-term follow-up. In secondary analyses, findings were broadly consistent across procedure and diabetes subgroups, while 3-month %TWL explained more additional variance in 1-year %TWL than baseline BMI
Conclusion3-month %TWL predicted 1-year and 2-year outcomes but not longer-term %TWL, supporting its value as an early marker of postoperative weight trajectory. Heterogeneity in recurrent weight stability may contribute to weaker long-term prediction and warrants further study to determine whether early weight-loss patterns can identify patients requiring closer long-term weight management support.
Key pointsO_LIThree-month %TWL predicted 1-year and 2-year %TWL. C_LIO_LIGreater early %TWL was associated with greater recurrent weight gain. C_LIO_LIThree-month %TWL explained more additional variance in 1-year %TWL than baseline BMI. C_LI
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BibTeX
@misc{pushparajah2026greater,
title = {{Greater early weight loss after metabolic/bariatric surgery predicts greater loss up to 2 years but is also associated with weight regain in the longer term.}},
author = {K. Pushparajah and D. Handley and A. Lobo and S. Almansoori and S. I. Alsters and S. Purkayastha and H. S. Chahal and M. v. Haelst and R. G. Walters and F. Drenos and A. I. F. Blakemore},
howpublished = {medRxiv},
year = {2026},
month = oct,
doi = {10.64898/2026.10.07.26364977},
url = {https://www.medrxiv.org/content/10.64898/2026.10.07.26364977v1},
note = {CC BY},
}
RIS
TY - UNPB
TI - Greater early weight loss after metabolic/bariatric surgery predicts greater loss up to 2 years but is also associated with weight regain in the longer term.
AU - K. Pushparajah
AU - D. Handley
AU - A. Lobo
AU - S. Almansoori
AU - S. I. Alsters
AU - S. Purkayastha
AU - H. S. Chahal
AU - M. v. Haelst
AU - R. G. Walters
AU - F. Drenos
AU - A. I. F. Blakemore
PY - 2026
DA - 2026/10/07
PB - medRxiv
DO - 10.64898/2026.10.07.26364977
UR - https://www.medrxiv.org/content/10.64898/2026.10.07.26364977v1
AB - BackgroundEarly postoperative weight loss may help predict later outcomes, but its reliability for longer-term weight loss and regain remains unclear. We assessed whether the percentage total weight loss (%TWL) 3 months after metabolic/bariatric surgery predicted later %TWL weight change/regain. MethodsThis retrospective observational cohort study included 216 patients from the Personalised Medicine for Morbid Obesity cohort who underwent sleeve gastrectomy or Roux-en-Y gastric bypass and had 3-month %TWL and at least one later outcome. Linear regression assessed associations between 3-month %TWL and later %TWL plus weight change/regain outcomes. Adjusted incremental R2 quantified the additional variance explained by 3-month %TWL. Secondary procedure-stratified, diabetes-stratified, and baseline BMI comparator analyses are reported in the Supplementary Material. ResultsGreater 3-month %TWL was associated with higher 1-year and 2-year %TWL in adjusted models (both p < 0.001) but not longer-term %TWL (p = 0.078). Incremental R2 was 38.23% for 1- year, 11.75% for 2-year %TWL and 2.25% for long-term %TWL. Greater 3-month %TWL was also associated with greater recurrent weight gain from 1 to 2 years and from 1 year to long-term follow-up. In secondary analyses, findings were broadly consistent across procedure and diabetes subgroups, while 3-month %TWL explained more additional variance in 1-year %TWL than baseline BMI Conclusion3-month %TWL predicted 1-year and 2-year outcomes but not longer-term %TWL, supporting its value as an early marker of postoperative weight trajectory. Heterogeneity in recurrent weight stability may contribute to weaker long-term prediction and warrants further study to determine whether early weight-loss patterns can identify patients requiring closer long-term weight management support. Key pointsO_LIThree-month %TWL predicted 1-year and 2-year %TWL. C_LIO_LIGreater early %TWL was associated with greater recurrent weight gain. C_LIO_LIThree-month %TWL explained more additional variance in 1-year %TWL than baseline BMI. C_LI
ER -