Long-Term Weight Regain Outcome Post-Bariatric Surgery: Key Influencing Factors

Why clinicians should know about it

• Picked for Bariatric and Metabolic Surgery (paper of the day, 16 August 2026): Long‑term weight regain after bariatric surgery

Abstract

INTRODUCTION: Weight regain is a major long-term challenge in post-bariatric surgery. This study aimed to assess long-term weight regain (> 2 years) using a 25% cutoff from the maximal weight lost and identify associated factors. METHODS: The study involved men and women aged 18 to 65 who had bariatric surgery, assessing demographic, surgical, lifestyle, support, emotional health, and weight-related factors. The proportion of participants with optimal (less than 25% weight regain from the maximal weight lost) vs. non-optimal weight regain status (≥ 25% weight regain from the maximal weight lost) were calculated. Independent t-tests and chi-square tests compared participants by weight regain outcomes, followed by multivariable logistic regression using the ENTER method. An exploratory stepwise logistic regression model was also conducted. RESULTS: The study included 234 participants (mean age of 46.00 ± 12.3 years). At follow-up, 20.3% had a healthy body mass index. Most participants (75.6%) presented optimal weight regain status. In the primary multivariable logistic regression model, male sex (odds ratio = 3.45), lower inappropriate eating behaviors (odds ratio = 3.17), smoking (odds ratio = 9.75), and dietitian support (odds ratio = 0.34) were significantly associated with optimal weight regain outcome. The smoking finding had a wide confidence interval and should therefore be interpreted as hypothesis-generating only. An exploratory stepwise model showed a similar pattern of findings and explained 27.3% of the variance in weight regain. The largest improvement in model fit occurred with the addition of eating behaviors (healthy, inappropriate, and bariatric), increasing explained variance by 13.5%. CONCLUSION: Most individuals maintained favorable long-term weight outcomes two years post-bariatric surgery, but about one in four had significant weight regain. The strongest factor associated with long-term optimal weight maintenance response was eating behaviors. This underscores the key role of diet and ongoing support in sustaining bariatric surgery benefits.

Abstract as published, via PubMed.