Bariatric surgery can be a life-changing procedure that leads to significant weight loss and other health improvements. Long-term, regular follow-up is recommended to ensure successful patient outcomes. Despite this recommendation, rates of long-term, regular follow-up remain low, with many patients only resuming care if they develop problematic symptoms or complications.
To garner new insights about this large and understudied group of bariatric patients—and determine what prompts Mass General Brigham patients to re-seek care—researchers at Brigham and Women’s Hospital undertook a first-of-its-kind retrospective study. Led by Ali Tavakkoli, MD, chief of the Division of General and GI Surgery, the research team presented its findings at the 104th annual meeting of the New England Surgical Society in 2023.
“Regular and long-term follow-up allows clinicians to monitor patients’ progress and nutritional status,” Dr. Tavakkoli says. “Studies suggest that patients who adhere to follow-up recommendations achieve better long-term weight loss and can benefit from earlier detection of complications. However, compliance remains poor, with follow-up rates below 50% after the first two years.”
Weight Regain Prompts Majority of Patients to Re-seek Care
The study looked at patients who underwent sleeve gastrectomy (SG), Roux-en-Y gastric bypass (RYGB), or adjustable gastric banding (AGB) procedures. Overall, recurrent weight gain (RWG) was the most common reason for returning to the clinic for all three procedures (81.2% in SG, 62.7% in RYGB, and 65.2% in AGB). Other frequently reported symptoms included reflux, abdominal pain, vomiting, and dysphagia.
The study also identified the most common interventional strategies used to address RWG in each patient group. The investigators found that SG patients were more likely to receive a surgical revision than RYGB patients (16.9% versus 5.8%), while RYGB patients were more likely to receive an endoscopic intervention than SG patients (17.5% versus 7.8%). Response to anti-obesity medications (AOMs), specifically GLP-1 drugs, was better in RYGB patients than SG patients.
The study also evaluated total weight loss associated with various combinations of original bariatric surgery and follow-up interventions. Among patients who originally underwent SG, a combination of surgical revision, often to RYGB, and AOM was the most effective. A surgical revision resulted in 11% total weight loss; this approach resulted in a 16% weight loss when coupled with AOM.
For RYGB patients, who had the highest amount of weight loss and the lowest percentage of postsurgical weight recurrence among all patients, a combination of AOM and endoscopic revisions was most effective for total weight loss. AGB patients saw the highest weight loss (15%) following a surgical conversion to another bariatric operation.
“Until now, there was a paucity of data on the symptoms that most commonly prompt patients to re-establish bariatric care after being lost to follow-up, as well as which interventions were subsequently initiated to help manage these symptoms,” Dr. Tavakkoli says. “These insights will help clinicians identify nutritional deficiencies and other complications, tailor the appropriate postsurgical interventions to individual patients, and counsel patients about realistic weight-loss expectations.”
Weight Management Requires Comprehensive Approach
According to Dr. Tavakkoli, this study’s results make an excellent case for a comprehensive approach to weight management, a historically siloed practice. Today, the Brigham’s Center for Weight Management and Wellness offers three avenues to help patients achieve meaningful weight loss: surgery, endoscopy, and medically supervised weight-loss plans. It also provides ongoing nutritional and dietary guidance and identifies behavioral strategies to promote long-term maintenance of weight loss.
“Over the last 10 years, and with the approval of injectable weight-management medications, our care model has evolved,” Dr. Tavakkoli says. “As one of the region’s premier integrated weight-management centers, the Brigham has an extremely strong foundation supported by surgical, gastrointestinal, and medical thought leaders who are pioneers in their fields. We also have the advantage of a large and complex patient cohort, allowing us to do important studies like this one and guide continuous improvement in the weight-management field.”