A Five Year Prospective Study on Recurrent Weight Gain and Six BODY-Q Health-Related Quality of Life Scales after Metabolic and Bariatric Surgery

Background

Recurrent weight gain (RWG) after metabolic and bariatric surgery (MBS) is common, but clinically relevant thresholds remain debated. Health-related quality of life (HRQL) may provide a more patient-centered long-term outcome measure.

Objective

To evaluate long-term HRQL trajectories according to eventual RWG phenotype, defined as < 30% versus ≥ 30% RWG after MBS.

Methods

Prospective multicenter cohort study at two Dutch hospitals. HRQL was assessed using six BODY-Q scales and minimal important differences (MIDs) preoperatively, at 4 months and 1–5 years postoperatively. Patients were retrospectively stratified by eventual RWG phenotype. Analyses were performed separately for laparoscopic Roux-en-Y gastric bypass (LRYGB) and laparoscopic sleeve gastrectomy (LSG).

Results

Overall, 337 patients were included (LRYGB: 206 < 30% vs 19 ≥ 30%; LSG: 81 < 30% vs 31 ≥ 30%). Five-year HRQL data were available for 37–55% of patients across procedures and RWG groups. After LRYGB, longitudinal analyses showed no significant time × RWG interactions, although cross-sectional differences in physical function were observed at multiple time points (p = 0.005–0.033). After LSG, a significant time × RWG interaction was observed for physical function (p = 0.043), whereas differences in body image and psychological well-being at year 4 (p = 0.018) were isolated findings. MID achievement was largely similar between groups.

Conclusion

Long-term HRQL improvements and MID-based indicators of patient-perceived benefit were sustained after MBS in both eventual RWG groups. Physical function showed a significant time × RWG interaction after LSG, whereas longitudinal HRQL trajectories after LRYGB were comparable between RWG groups. Findings should be interpreted as associations with eventual RWG phenotype, particularly given the small ≥ 30% RWG subgroup after LRYGB (N = 19).

Key Points

• Both patients who eventually developed < 30% and ≥ 30% RWG sustained HRQL improvements over five years;

• Associations between RWG and physical function differed between procedures, with cross-sectional differences after LRYGB and longitudinal interaction effects after LSG;

• Absolute BODY-Q scores and MIDs provide complementary insights, underscoring the importance of evaluating both statistical and patient-perceived benefits after MBS.