Preoperative Weight Change and Outcomes After Bariatric Surgery

Preoperative Weight Change and Outcomes After Bariatric Surgery | Research Square window.SnipcartSettings = { analytics: { enabled: false } }; (function() { var accessVector = localStorage.getItem('access_vector') || ''; window.dataLayer = window.dataLayer || []; if (accessVector) { window.dataLayer.push({ user: { profile: { profileInfo: { snid: accessVector } } } }); } })(); (function(w,d,s,l,i){w[l]=w[l]||[];w[l].push({'gtm.start':new Date().getTime(),event:'gtm.js'});var f=d.getElementsByTagName(s)[0],j=d.createElement(s),dl=l!='dataLayer'?'&l='+l:'';j.async=true;j.src='https://www.googletagmanager.com/gtm.js?id='+i+dl;f.parentNode.insertBefore(j,f);})(window,document,'script','dataLayer','GTM-K279D39R'); Browse Preprints In Review Journals COVID-19 Preprints AJE Video Bytes Research Tools Research Promotion AJE Professional Editing AJE Rubriq About Preprint Platform In Review Editorial Policies Our Team Advisory Board Help Center Sign In Submit a Preprint Cite Share Download PDF Research Article Preoperative Weight Change and Outcomes After Bariatric Surgery João Pedro Araújo-Teixeira, Inês Faria-Teixeira, Joana Lamego, and 10 more This is a preprint; it has not been peer reviewed by a journal. https://doi.org/ 10.21203/rs.3.rs-9313191/v1 This work is licensed under a CC BY 4.0 License Status: Under Review Version 1 posted 7 You are reading this latest preprint version Abstract Background and objectives: Preoperative weight loss remains controversial before metabolic and bariatric surgery, and its impact on postoperative outcomes is not clearly established. Most studies focus exclusively on preoperative weight loss, with limited evaluation of preoperative weight gain and objective thresholds for clinically meaningful weight variation. This study aimed to evaluate the association between preoperative weight variation—maintenance, loss, or gain—and postoperative outcomes, and to identify clinically relevant cutoffs for both minimum beneficial weight loss and maximum tolerable weight gain. Materials and Methods: We conducted a retrospective cohort study including patients who underwent Roux-en-Y gastric bypass (RYGB) or sleeve gastrectomy (SG), with follow-up to two years. Patients were stratified according to preoperative weight variation. Primary outcomes were total weight loss (TWL) >20% and excess weight loss (EWL) >50% at 1 and 2 years. Secondary outcomes included remission of obesity-related comorbidities and determination of optimal thresholds for preoperative weight change using receiver operating characteristic (ROC) analysis and the Youden index. Results: A total of 1,094 patients were included, of whom 82.2% were female. The median presurgical body mass index was 41.6 kg/m², and 71.8% underwent RYGB. At two years, patients who maintained their weight preoperatively had the highest success rates (97% achieved TWL >20%, p=0.025). Preoperative weight gain was independently associated with a lower likelihood of achieving both TWL >20% (adjusted OR 0.41; 95% CI 0.18–0.93) and EWL >50% (adjusted OR 0.41; 95% CI 0.18–0.95). Although preoperative weight loss was not associated with superior long-term weight outcomes in the overall cohort, stratified analyses demonstrated significant early benefits at 1 year, particularly after RYGB, as well as higher rates of diabetes remission. ROC analysis identified minimum beneficial preoperative weight loss thresholds of 10.91% (for TWL) and 4.96% (for EWL), and maximum tolerable weight gain thresholds of 6.67% and 5.51%, respectively. Conclusion: Preoperative weight gain is an independent predictor of poorer postoperative weight outcomes, while modest preoperative weight loss (approximately 5–10%) may confer selective early benefits, particularly in patients undergoing RYGB and in those with type 2 diabetes (T2D). The identification of objective, clinically applicable thresholds for both beneficial weight loss and harmful weight gain supports an individualized preoperative optimization strategy focused on preventing weight gain and encouraging achievable, targeted weight reduction rather than enforcing universal mandates. KEY POINTS ● Preoperative weight gain >5–7% predicts poorer postoperative outcomes. ● Modest 5–10% preoperative weight loss improves early weight and metabolic results. ● Identified thresholds support individualized preoperative counseling strategies. INTRODUCTION The role of preoperative weight variation (loss or gain) in bariatric surgery outcomes remains controversial. Although some healthcare systems and insurance providers historically required preoperative weight loss as a prerequisite for surgery, major professional societies—including the American Society for Metabolic and Bariatric Surgery (ASMBS)—explicitly state that mandatory preoperative weight loss (PWL) lacks consistent evidence of benefit and should not be required prior to metabolic surgery (1) . Systematic reviews and meta-analyses have reinforced this position, demonstrating that structured or mandated preoperative weight loss programs do not reliably improve postoperative weight loss or comorbidity resolution and may instead delay access to care (2,3) . Thus, while encouraging weight optimization is common practice, the scientific basis for mandating weight loss remains uncertain. Importantly, most published studies have focused almost exclusively on preoperative weight loss, with limited evaluation of preoperative weight gain and its potential consequences. This represents a relevant knowledge gap, as weight gain before surgery may reflect behavioral, metabolic, or system-related factors that could influence postoperative trajectories. Clarifying the impact of both weight loss and weight gain prior to surgery is therefore essential to inform evidence-based preoperative counseling. We hypothesized that preoperative weight gain would be associated with poorer postoperative weight and metabolic outcomes, whereas preoperative weight loss would confer selective benefits. Accordingly, the primary aim of this study was to evaluate the association between preoperative weight variation (maintenance, loss, or gain) and postoperative weight outcomes at 1 and 2 years. Secondary aims included assessing comorbidity remission and defining clinically relevant thresholds for minimum beneficial weight loss and maximum tolerable weight gain using ROC analysis. MATERIALS AND METHODS Study design We performed a retrospective cohort study at a high-volume bariatric center, including adult patients who underwent primary Roux-en-Y gastric bypass (RYGB) or sleeve gastrectomy (SG) between 2019 and 2023, with follow-up of up to two years. Patients were stratified according to preoperative weight trajectory (maintenance, loss, or gain). Baseline characteristics included demographics, comorbidities, presurgical body mass index (BMI), and hospital response time, defined as the interval between the first multidisciplinary consultation and the date of surgery. This study was approved by the institutional ethics committee of our hospital. Given the retrospective design, informed consent was waived. Inclusion criteria were adult patients (≥18 years) undergoing primary laparoscopic RYGB or SG during the study period. Eligible patients were required to have objective body weight recorded both at the first multidisciplinary bariatric consultation and at hospital admission immediately prior to surgery, allowing calculation of preoperative weight variation. Additionally, inclusion required availability of postoperative weight data at 12 and 24 months and sufficient clinical information to assess postoperative comorbidity status. Exclusion criteria were revisional, conversion, or re-operative bariatric procedures; previous bariatric surgery; and bariatric procedures other than RYGB or SG. Patients with missing or unreliable preoperative weight measurements or without postoperative follow-up at the predefined time points were excluded. Patients with medical conditions likely to substantially influence weight trajectory independently of bariatric surgery, such as active malignancy, when identifiable in medical records, were also excluded to minimize confounding. Only patients meeting all inclusion criteria and none of the exclusion criteria were included in the final analytic cohort. The preoperative period was defined as the interval between the initial multidisciplinary consultation and the date of surgery. Patients were categorized according to exact weight variation between first consultation and hospital admission. If admission weight was identical to initial consultation weight, patients were classified as “weight maintenance.” Any reduction in weight was classified as “weight loss,” and any increase as “weight gain.” Preoperative weight variation was calculated using body weight measured at the first consultation and body weight recorded at hospital admission prior to surgery. The duration of this period corresponded to the institutional response time for bariatric surgery, as presented in Table 1, reflecting routine waiting time within our healthcare system rather than participation in a mandated weight loss program. Primary outcomes were total weight loss (TWL) >20% and excess weight loss (EWL) >50% at both 1 and 2 years postoperatively. Percentage total weight loss (TWL) was calculated as [(preoperative weight − postoperative weight) / preoperative weight] × 100. Percentage excess weight loss (EWL) was calculated using ideal body weight corresponding to a BMI of 25 kg/m 2 . Secondary outcomes included remission of type 2 diabetes, hypertension, dyslipidemia, and obstructive sleep apnea, as well as identification of optimal thresholds for preoperative weight variation using receiver operating characteristic (ROC) curve analysis and the Youden index. Internal validation was performed using bootstrap resampling with 1,000 replications to assess robustness of the estimates and compute corresponding 95% confidence intervals. Type 2 diabetes was defined by fasting plasma glucose ≥126 mg/dL or A1C ≥6.5%, and/or use of glucose-lowering medication. Remission was defined as A1C <6.5% and fasting glucose <126 mg/dL in the absence of pharmacologic therapy. For hypertension, dyslipidemia, and obstructive sleep apnea, remission was defined by discontinuation of disease-specific treatment (antihypertensive medication, lipid-lowering therapy, or continuous positive airway pressure). Comparisons between groups were performed using the χ² test for categorical variables and the Kruskal–Wallis test for continuous variables. Multivariable logistic regression models were constructed to evaluate the independent association between preoperative weight trajectory and postoperative outcomes, adjusting for sex, presurgical BMI, hypertension, and hospital response time. The weight maintenance group served as the reference category. Odds ratios (OR) with 95% confidence intervals (CI) were calculated, and statistical significance was defined as p<0.05. All statistical analyses were performed using Stata. Surgical technique All procedures were performed laparoscopically. No primary open bariatric procedures were recorded during the study period. As for the Roux-en-Y Gastric Bypass (RYGB), it was performed using a standardized five-port laparoscopic approach (10-mm umbilical port for camera, 10-mm left hypochondrium, 5-mm epigastric port for liver retraction, 5-mm right hypochondrium, and 5-mm left flank). Ultrasonic energy was used for division of ligaments and vascular pedicles. Gastric and jejunal transections were performed using a linear stapler (length of 45mm; triple staple line; 1–2 mm thickness). A gastric pouch of approximately 30–50 mL was created and calibrated by an orogastric tube of 36-Fr. The biliopancreatic limb measured 100–120 cm from the ligament of Treitz, adjusted according to the presence of metabolic disease. The alimentary limb measured 120–140 cm. The gastrojejunostomy (antecolic, end-to-lateral) and jejunojejunostomy (latero-lateral) were constructed using linear stapling techniques. The gastrojejunostomy diameter was approximately 30–35 mm, and the jejunojejunostomy approximately 40–45 mm. Stapler entry sites were closed with continuous single-layer sutures using slow-absorbable material (threads thickness of 3-0), which was also used for anastomotic reinforcement and loop fixation. Mesenteric defects were closed with continuous absorbable sutures (threads thickness of 0). Petersen’s space was not routinely closed. Ten-millimeter trocar sites were closed with absorbable sutures. As for Sleeve gastrectomy, it was performed using the same laparoscopic port configuration. Gastric calibration was achieved using a 48-Fr orogastric tube. Gastric transection began approximately 6 cm proximal to the pylorus and proceeded toward the angle of His. No staple line reinforcement with suturing was routinely performed. RESULTS During the study period (2019–2023), 3,348 metabolic bariatric procedures were performed. Of these, 2,600 were primary procedures. Preoperative admission weight was available for 2,597 patients, of whom 2,572 underwent either Roux-en-Y gastric bypass or sleeve gastrectomy. Two-year follow-up weight data were available for 1,094 patients, who comprised the final analytic cohort, so these were included in the following analysis. Most exclusions were due to missing retrospective data, mainly incomplete preoperative weight records preventing calculation of weight variation and insufficient follow-up data to assess weight outcomes and comorbidity remission. The same patients included in the 2-year analysis were also analyzed at 1 year. The cohort was 82.2% female, with a median age of 45 years and median preoperative BMI of 41.6 kg/m 2 . Most patients underwent Roux-en-Y gastric bypass (RYGB) (71.8%), while 28.2% underwent sleeve gastrectomy (SG). Significant differences between preoperative weight trajectory groups (maintenance, loss, gain) were observed in sex (p=0.005), preoperative BMI (p<0.001), hypertension prevalence (p=0.042), hospital response time (p=0.005), and type of surgery (p=0.024) (Table 1). Patients who gained weight were predominantly female and had lower median BMI, whereas those who lost weight had higher hypertension prevalence and longer waiting times. At 2 years, TWL >20% was achieved by 97.0% of patients who maintained weight, 94.2% who lost weight, and 91.8% who gained weight (p=0.025). EWL >50% followed a similar pattern without reaching statistical significance (p=0.074) (Table 2). At 1 year, preoperative weight loss was associated with higher TWL >20% after RYGB (p=0.015) and higher EWL >50% in both procedures (p=0.049). In adjusted logistic regression (Table 3), preoperative weight gain independently predicted lower likelihood of achieving TWL >20% (adjusted OR 0.41; 95% CI 0.18–0.93) and EWL >50% (adjusted OR 0.41; 95% CI 0.18–0.95), representing approximately 60% lower odds compared with weight maintenance. When analyzed as a continuous variable, preoperative weight loss percentage was positively associated with postoperative total weight loss percentage at 2 years in the overall cohort (adjusted β 0.116; 95% CI 0.040–0.191). This association remained significant in SG (adjusted β 0.224; 95% CI 0.071–0.377) but was attenuated after adjustment in RYGB (adjusted β 0.075; 95% CI −0.007–0.157). These findings suggest a graded relationship between preoperative and postoperative weight change, particularly in SG. Only type 2 diabetes showed significant association with preoperative weight change. At 1 year, remission was more frequent among patients with preoperative weight loss (p=0.014 overall; p=0.024 in RYGB), though differences were not sustained at 2 years. No significant associations were observed for hypertension, dyslipidemia, or OSA. ROC analysis identified clinically relevant thresholds (Table 4). For TWL >20% at 2 years, minimum beneficial preoperative weight loss was >10.91%, and maximum tolerable weight gain was >6.67%. For EWL >50%, thresholds were >4.96% weight loss and >5.51% weight gain. Lower thresholds were observed for comorbidity remission, particularly for T2D (0.83% at 1 year; 2.45% at 2 years), whereas weight gain >18% was detrimental. For hypertension and dyslipidemia, favorable weight-loss thresholds ranged between 1.8% and 2.7%, while gains exceeding 6–17% were associated with reduced remission probability. For OSA, even small weight losses (~0.5%) were sufficient to yield benefit. Bootstrap internal validation using 1,000 replications demonstrated modest robustness of several thresholds, consistent with the relatively low Youden index values observed (Table 4). DISCUSSION In this retrospective study conducted in a high-volume bariatric center, we demonstrated that preoperative weight trajectory is significantly associated with postoperative outcomes up to two years after surgery. Preoperative weight gain was independently associated with a reduced likelihood of achieving TWL >20% and EWL >50%, whereas modest preoperative weight loss conferred selective early benefits, particularly for type 2 diabetes remission and early weight outcomes after RYGB. These findings contribute to the ongoing debate regarding the clinical value of preoperative weight modification. The impact of preoperative weight variation Several studies support the potential benefits of modest preoperative weight loss regarding postoperative weight outcomes, comorbidity remission, and surgical morbidity. Mocanu et al. (6) reported that >10% preoperative weight loss was associated with reduced anastomotic leak and 30-day mortality, and data from the Scandinavian Obesity Registry (SOReg) demonstrated reduced complications among patients achieving approximately 9.5% preoperative weight loss (7) . Sun et al. (19) similarly found that even modest preoperative weight reduction (>0% to <5%) was associated with lower short-term mortality. Other studies observed improved early weight outcomes, though not consistently sustained beyond 1–2 years (4,5,14) . Biologically, modest preoperative weight loss may reduce hepatic steatosis and visceral adiposity (18,15) , facilitating operative exposure and improving insulin sensitivity (8) . In our cohort, early benefits were evident at one year—particularly in RYGB—and type 2 diabetes remission was higher among patients who lost weight preoperatively. However, sustained superiority at two years was not universal. Conversely, progressive preoperative weight gain may reflect worsening insulin resistance, systemic inflammation, and adverse behavioral patterns. From a surgical perspective, greater intra-abdominal adiposity may increase technical complexity. In our study, preoperative weight gain was independently associated with approximately 60% lower odds of achieving TWL >20% and EWL >50% at two years. These findings are consistent with prior reports suggesting that preoperative weight gain may predict suboptimal postoperative response (13,16) . Importantly, when preoperative weight change was analyzed as a continuous variable, a positive association was observed between percentage of preoperative weight loss and percentage of postoperative weight loss at two years in the overall cohort. This association remained significant after adjustment. Notably, the relationship was particularly evident among patients undergoing sleeve gastrectomy, whereas in RYGB the adjusted association was attenuated. These findings suggest that incremental preoperative weight reduction may translate into greater postoperative weight loss magnitude, especially in sleeve gastrectomy, while the intrinsic metabolic mechanisms of RYGB may partially mitigate this effect. Despite these associations, most contemporary literature does not support mandatory preoperative weight loss requirements (1-3) . Although perioperative benefits have been reported in selected cohorts (20) , aggressive or insurance-mandated targets have not consistently improved long-term weight outcomes and may delay access to surgery (21,22) . Collectively, available evidence favors individualized metabolic optimization rather than rigid preoperative mandates. Among obesity-related comorbidities in our study, only type 2 diabetes demonstrated an early association with preoperative weight loss, particularly after RYGB. This may reflect improved insulin sensitivity prior to surgery. No significant associations were observed for hypertension, dyslipidemia, or obstructive sleep apnea, consistent with prior literature (2,3,17) . The increasing use of glucagon-like peptide-1 receptor agonists has renewed interest in pharmacologic preoperative optimization. However, current evidence does not support routine preoperative use solely to enhance long-term postoperative outcomes (9-12,17,18) . Their role appears primarily related to short-term metabolic stabilization. Defining thresholds for weight variation Taken together, our results both align with and refine existing evidence. While we did not observe universal long-term superiority of preoperative weight loss at two years, we identified selective early benefits and a clear independent adverse effect of preoperative weight gain. ROC analysis identified clinically relevant thresholds. Preoperative weight loss exceeding 10.9% was associated with improved likelihood of achieving TWL >20%, while approximately 5% favored EWL >50%. Conversely, weight gain exceeding 6–7% was consistently associated with poorer postoperative outcomes. These findings suggest that preventing weight gain beyond 5–7% may be as clinically important as achieving modest preoperative weight reduction. However, internal bootstrap validation demonstrated modest stability of several cutoffs, reflecting the relatively low Youden index values and reinforcing that these thresholds should be interpreted as exploratory rather than definitive. The continuous regression analysis complements these threshold findings. While ROC-derived cutoffs provide practical clinical targets, the observed linear association indicates that the relationship between preoperative and postoperative weight change may operate along a continuum, particularly in sleeve gastrectomy. Thus, benefit may not be purely dichotomous but graded, supporting counseling strategies that encourage achievable preoperative weight reduction without enforcing rigid universal thresholds. Our findings reinforce prior observations that even modest preoperative weight gain may have lasting adverse consequences for postoperative trajectories (13,16) . Rather than supporting mandatory weight loss requirements, these results advocate for a balanced approach focused on preventing weight gain and promoting realistic metabolic optimization before surgery. The influence of the surgical technique Surgical technical factors may also influence postoperative weight loss and metabolic outcomes and should be acknowledged. Smaller gastric pouches and reduced calibration diameters in sleeve gastrectomy (e.g., smaller orogastric tubes) have been associated with greater restriction and potentially enhanced weight loss. Similarly, longer biliopancreatic limb lengths in RYGB may increase the hypoabsorptive component of the procedure, potentially augmenting weight loss and metabolic effects, particularly in patients with metabolic disease. Variations in alimentary limb length or anastomotic diameter may also influence nutrient exposure and hormonal signaling. In our cohort, however, procedures were performed using a standardized laparoscopic technique with consistent pouch size, limb lengths, and sleeve calibration. This technical uniformity reduces intra-cohort variability and limits confounding related to surgical configuration. Consequently, while theoretical differences in technique may influence outcomes, our study cannot assess their independent impact. Strengths and limitations The strengths of this study include its large sample size, two-year follow-up, and evaluation of both weight outcomes and comorbidity remission in a real-world cohort from a high-volume bariatric center. The inclusion of both RYGB and SG enhances generalizability. Importantly, the identification of preoperative weight loss and gain thresholds through ROC analysis provides objective, data-driven and clinically applicable parameters for preoperative counseling. Furthermore, the simultaneous evaluation of both minimum beneficial weight loss and maximum tolerable weight gain extends beyond prior literature, which has predominantly focused only on weight loss targets. Several limitations should be acknowledged. The retrospective design introduces potential selection bias and residual confounding despite multivariable adjustment. Comorbidity assessment relied on clinical records, which may affect data accuracy, and body composition data were not available to distinguish fat mass from lean mass changes. The present study was not designed to evaluate specific preoperative weight loss strategies, and detailed data regarding dietary programs, physical activity interventions, or weight loss medications were not systematically collected. Therefore, the independent contribution of these approaches to postoperative outcomes could not be assessed. Future prospective studies specifically designed to investigate structured preoperative optimization strategies may help clarify whether particular interventions confer additional benefit beyond the magnitude of weight change alone. As a single-center study, external validity may be limited, and longer follow-up is required to determine the durability of the observed associations beyond two years. CONCLUSIONS Our findings demonstrate that preoperative weight gain is independently associated with poorer postoperative weight outcomes, whereas modest preoperative weight loss (approximately 5–10%) may provide selective early advantages, particularly among patients undergoing RYGB and those with type 2 diabetes. Importantly, by identifying objective thresholds for both minimum beneficial weight loss and maximum tolerable weight gain, this study advances the current debate beyond universal preoperative mandates. Rather than enforcing rigid targets, a personalized strategy that prioritizes prevention of weight gain and encourages achievable metabolic optimization appears more appropriate. The proposed cutoffs offer clinically applicable guidance for preoperative counseling and shared decision-making, potentially improving early postoperative success while avoiding unnecessary barriers to surgery. Declarations CONFLICTS OF INTEREST The authors declare that they have no conflict of interest. ETHICAL APPROVAL All procedures performed in studies involving human participants were in accordance with the ethical standards of the institutional research committee and with the 1964 Helsinki declaration and its later amendments. For this type of retrospective study, formal consent was not required. References Mechanick, J. I., Apovian, C., Brethauer, S., Timothy Garvey, W., Joffe, A. M., Kim, J., Kushner, R. F., Lindquist, R., Pessah-Pollack, R., Seger, J., Urman, R. D., Adams, S., Cleek, J. B., Correa, R., Figaro, M. K., Flanders, K., Grams, J., Hurley, D. L., Kothari, S., Seger, M. V., … Still, C. D. (2020). Clinical Practice Guidelines for the Perioperative Nutrition, Metabolic, and Nonsurgical Support of Patients Undergoing Bariatric Procedures - 2019 Update: Cosponsored by American Association of Clinical Endocrinologists/American College of Endocrinology, The Obesity Society, American Society for Metabolic and Bariatric Surgery, Obesity Medicine Association, and American Society of Anesthesiologists. Obesity (Silver Spring, Md.), 28(4), O1–O58. https://doi.org/10.1002/oby.22719 Monfared, S., Athanasiadis, D. I., Furiya, A., Butler, A., Selzer, D., Hilgendorf, W., Banerjee, A., & Stefanidis, D. (2020). Do Mandated Weight Loss Goals Prior to Bariatric Surgery Improve Postoperative Outcomes?. Obesity surgery, 30(3), 889–894. https://doi.org/10.1007/s11695-019-04275-8 MacVicar, E., Lucocq, J., Geropoulos, G., Lamb, P. J., & Robertson, A. G. (2025). The Role of Preoperative Weight Loss Interventions on Long-Term Bariatric Surgery Outcomes: A Systematic Review. Journal of clinical medicine, 14(9), 3147. https://doi.org/10.3390/jcm14093147. Romaen, I. F. L., Jense, M. T. F., Palm-Meinders, I. H., de Witte, E., Fransen, S. A. F., Greve, J. W. M., & Boerma, E. G. (2022). Higher Preoperative Weight loss Is Associated with Greater Weight Loss up to 12 Months After Bariatric Surgery. Obesity surgery, 32(9), 2860–2868. https://doi.org/10.1007/s11695-022-06176-9 Rodríguez, F., Herrera, A., Sepúlveda, E. M., Guilbert, L., Hernández, L. A., Peñuñuri, L. F., Rodríguez, F. M., & Zerrweck, C. (2022). Weight loss before bariatric surgery and its impact on poor versus excellent outcomes at 2 years. Langenbeck's archives of surgery, 407(3), 1047–1053. https://doi.org/10.1007/s00423-021-02399-z Mocanu, V., Marcil, G., Dang, J. T., Birch, D. W., Switzer, N. J., & Karmali, S. (2021). Preoperative weight loss is linked to improved mortality and leaks following elective bariatric surgery: an analysis of 548,597 patients from 2015-2018. Surgery for obesity and related diseases : official journal of the American Society for Bariatric Surgery, 17(11), 1846–1853. https://doi.org/10.1016/j.soard.2021.06.021 Anderin, C., Gustafsson, U. O., Heijbel, N., & Thorell, A. (2015). Weight loss before bariatric surgery and postoperative complications: data from the Scandinavian Obesity Registry (SOReg). Annals of surgery, 261(5), 909–913. https://doi.org/10.1097/SLA.0000000000000839 Colles, S. L., Dixon, J. B., Marks, P., Strauss, B. J., & O'Brien, P. E. (2006). Preoperative weight loss with a very-low-energy diet: quantitation of changes in liver and abdominal fat by serial imaging. The American journal of clinical nutrition, 84(2), 304–311. https://doi.org/10.1093/ajcn/84.1.304 Esparham, A., Sheikhbahaei, E., Anari Moghadam, H., & Khorgami, Z. (2025). Preoperative Glucagon-Like Peptide-1 Receptor Agonists and Bariatric Surgery Outcomes: A Systematic Review. Obesity surgery, 35(9), 3939–3946. https://doi.org/10.1007/s11695-025-08137-4. AbuHasan, Q., Funk, L. M., Holl, J. L., Draucker, C., Grannis, S., Bilimoria, K. Y., Stefanidis, D., & Yuce, T. K. (2025). Preoperative Glucagon-Like Peptide-1 Receptor Agonist Utilization and Association with Bariatric Surgery Outcomes. Obesity surgery, 35(2), 556–560. https://doi.org/10.1007/s11695-024-07651-1. Luc, G., Dedieu, A., Canard, G., Cesard, A., Brunet, A., Furois, C., Leterrier, A., Daridon, B., Mendes, L., Brighen, E., Fournet, L., David, A., & Muzard, L. (2025). Exploratory Assessment of Preoperative GLP-1 Receptor Agonists Before Sleeve Gastrectomy: A Retrospective Matched Analysis. Obesity surgery, 35(10), 4383–4392. https://doi.org/10.1007/s11695-025-08258-w. Ilanga, M., Heard, J. C., McClintic, J., Lewis, D., Martin, G., Horn, C., Khorgami, Z., Richards, J., Chow, G. S., & Lim, R. B. (2023). Use of GLP-1 agonists in high risk patients prior to bariatric surgery: a cohort study. Surgical endoscopy, 37(12), 9509–9513. https://doi.org/10.1007/s00464-023-10387-1. Jacobs, A., Al Nawas, M., Deden, L. N., Dijksman, L. M., Boerma, E. G., Demirkiran, A., Hazebroek, E. J., Wiezer, M. R. J., Derksen, W. J. M., & Monpellier, V. M. (2023). Preoperative Weight Gain Is Not Related to Lower Postoperative Weight Loss, But to Lower Total Weight Loss up to 3 Years After Bariatric-Metabolic Surgery. Obesity surgery, 33(12), 3746–3754. https://doi.org/10.1007/s11695-023-06835-5. Cassie, S., Menezes, C., Birch, D. W., Shi, X., & Karmali, S. (2011). Effect of preoperative weight loss in bariatric surgical patients: a systematic review. Surgery for obesity and related diseases: official journal of the American Society for Bariatric Surgery, 7(6), 760–767. https://doi.org/10.1016/j.soard.2011.08.011 Edholm, D., Kullberg, J., Haenni, A., Karlsson, F. A., Ahlström, A., Hedberg, J., Ahlström, H., & Sundbom, M. (2011). Preoperative 4-week low-calorie diet reduces liver volume and intrahepatic fat, and facilitates laparoscopic gastric bypass in morbidly obese. Obesity surgery, 21(3), 345–350. https://doi.org/10.1007/s11695-010-0337-2 Still, C. D., Benotti, P., Wood, G. C., Gerhard, G. S., Petrick, A., Reed, M., & Strodel, W. (2007). Outcomes of preoperative weight loss in high-risk patients undergoing gastric bypass surgery. Archives of surgery (Chicago, Ill. : 1960), 142(10), 994–999. https://doi.org/10.1001/archsurg.142.10.994. Tan, Y. W., Shang, M., Davis, S., & Gananadha, S. (2025). GLP-1 receptor agonists as an adjunct to bariatric surgery for weight loss and metabolic outcome improvement: a systematic review and meta-analysis. Langenbeck's archives of surgery, 410(1), 295. https://doi.org/10.1007/s00423-025-03831-4 Ferguson, J., Fisher, O., Talbot, M., & Rigas, G. (2025). Effectiveness of Adjuvant Semaglutide Following Bariatric Metabolic Surgery. Obesity surgery, 35(3), 694–700. https://doi.org/10.1007/s11695-025-07703-0 Sun Y, Liu B, Smith JK, et al. Association of preoperative body weight and weight loss with risk of death after bariatric surgery. JAMA Netw Open. 2020;3(5):e204803. doi:10.1001/jamanetworkopen.2020.4803 Roman M, Monaghan A, Serraino GF, Miller D, Pathak S, Lai F, et al. Meta-analysis of the influence of lifestyle changes for preoperative weight loss on surgical outcomes. Br J Surg. 2019;106(3):181–189. doi:10.1002/bjs.11001 Ness C, Giorgi M, Pickering J, Ortega-Goddard E, Luhrs A. Extensive weight loss prior to bariatric surgery is associated with worse outcomes. Obes Surg. 2026. doi:10.1007/s11695-026-08509-4 Hutcheon, D. A., Ewing, J. A., St Ville, M., Miller, M., Kirkland, L., Kothari, S. N., & Scott, J. D. (2023). Insurance-mandated weight management program completion before bariatric surgery provides no long-term clinical benefit. Surgery for obesity and related diseases : official journal of the American Society for Bariatric Surgery, 19(4), 290–300. https://doi.org/10.1016/j.soard.2022.10.022. Tables Table 1. Baseline characteristics according to preoperative weight trajectory. Values Total (n=1094) Weight maintenance (n=231) Weight loss (n=311) Weight gain (n=552) p Age (years) Median (min-max) 45 (39-53) 45 (39-53) 46 (40-53) 45 (38-54) 0.536 Female N (%) 899 (82.2) 182 (78.8) 243 (78.1) 474 (85.9) 0.005 Preoperative BMI (kg/m 2 ) Median (min-max) 41.6 (38.6-45.0) 41.9 (38.8-45.6) 42.8 (39.6-46.0) 40.9 (38.1-44.1) <0.001 Diabetes N (%) 241 (22.0) 51 (22.1) 77 (24.8) 113 (20.5) 0.345 Hypertension N (%) 488 (44.6) 101 (43.7) 157 (50.5) 230 (41.7) 0.042 Dyslipidemia N (%) 348 (31.8) 82 (35.5) 107 (34.4) 159 (28.8) 0.095 OSA N (%) 149 (13.6) 27 (11.7) 42 (13.5) 80 (14.5) 0.579 Hospital response time (months) Median (min-max) 15.0 (10.6-19.4) 13.8 (9.2-18.0) 14.9 (9.4-20.1) 15.2 (11.7-19.6) 0.005 Surgery RYGB Sleeve N (%) 786 (71.8) 308 (28.2) 162 (70.1) 69 (29.9) 208 (66.9) 103 (33.1) 416 (75.4) 136 (24.6) 0.024 BMI – body mass index; OSA – obstructive sleep apnea; RYGB – Roux em Y gastric bypass. Table 2. Postoperative weight and comorbidity outcomes according to preoperative weight trajectory, overall and by procedure. Total RYGB Sleeve TWL ≤ 20% N (%) > 20% N (%) p ≤ 20% N (%) > 20% N (%) p ≤ 20% N (%) > 20% N (%) p At 1 year Weight maintenance 5 (2.2) 218 (97.8) 0.004 3 (1.9) 155 (98.1) 0.015 2 (3.1) 63 (96.9) 0.132 Weight loss 8 (2.6) 295 (97.4) 3 (1.5) 200 (98.5) 5 (5.0) 95 (95.0) Weight gain 36 (6.7) 500 (93.3) 23 (5.7) 383 (94.3) 13 (10.0) 117 (90.0) At 2 years Weight maintenance 7 (3.0) 224 (97.0) 0.025 4 (2.5) 158 (97.5) 0.117 3 (4.4) 66 (95.6) 0.081 Weight loss 18 (5.8) 293 (94.2) 7 (3.4) 201 (96.6) 11 (10.7) 92 (89.3) Weight gain 45 (8.2) 507 (91.8) 25 (6.0) 391 (94.0) 20 (14.7) 116 (85.3) EWL ≤ 50% N (%) > 50% N (%) p ≤ 50% N (%) > 50% N (%) p ≤ 50% N (%) > 50% N (%) p At 1 year Weight maintenance 8 (3.6) 215 (96.4) 0.049 5 (3.2) 153 (96.8) 0.130 3 (4.6) 62 (95.4) 0.104 Weight loss 7 (2.3) 296 (97.7) 2 (1.0) 201 (99.0) 5 (5.0) 95 (95.0) Weight gain 31 (5.8) 505 (94.2) 16 (3.9) 390 (96.1) 15 (11.5) 115 (88.5) At 2 years Weight maintenance 7 (3.0) 224 (97.0) 0.074 4 (2.5) 158 (97.5) 0.236 3 (4.4) 66 (95.6) 0.112 Weight loss 18 (5.8) 293 (94.2) 6 (2.9) 202 (97.1) 12 (11.6) 91 (88.4) Weight gain 40 (7.2) 512 (92.8) 21 (5.0) 395 (95.0) 19 (14.0) 117 (86.0) Diabetes No remission N (%) Remission N (%) p No remission N (%) Remission N (%) p No remission N (%) Remission N (%) p At 1 year Weight maintenance 23 (52.3) 21 (47.7) 0.014 15 (46.9) 17 (53.1) 0.024 8 (66.7) 4 (33.3) 0.409 Weight loss 16 (25.0) 48 (75.0) 8 (17.8) 37 (82.2) 8 (42.1) 11 (57.9) Weight gain 34 (35.0) 63 (65.0) 26 (32.1) 55 (67.9) 8 (50.0) 8 (50.0) At 2 years Weight maintenance 20 (43.5) 26 (56.5) 0.184 13 (38.2) 21 (61.8) 0.149 7 (58.3) 5 (41.7) 0.751 Weight loss 18 (26.9) 49 (73.1) 9 (19.2) 38 (80.8) 9 (45.0) 11 (55.0) Weight gain 34 (35.0) 63 (65.0) 25 (31.2) 55 (68.8) 9 (52.9) 8 (47.1) Hypertension No remission N (%) Remission N (%) p No remission N (%) Remission N (%) p No remission N (%) Remission N (%) p At 1 year Weight maintenance 44 (50.0) 44 (50.0) 0.811 28 (45.9) 33 (54.1) 0.895 16 (59.3) 11 (40.7) 0.636 Weight loss 62 (47.0) 70 (53.0) 42 (46.7) 48 (53.3) 20 (47.6) 22 (52.4) Weight gain 95 (45.9) 112 (54.1) 70 (43.8) 90 (56.2) 25 (53.2) 22 (46.8) At 2 years Weight maintenance 40 (44.4) 50 (55.6) 0.835 25 (39.7) 38 (60.3) 0.926 15 (55.6) 12 (44.4) 0.467 Weight loss 59 (44.0) 75 (56.0) 39 (42.9) 52 (57.1) 20 (46.5) 23 (53.5) Weight gain 86 (41.4) 122 (58.6) 66 (41.5) 93 (58.5) 20 (40.8) 29 (59.2) Dyslipidemia No remission N (%) Remission N (%) p No remission N (%) Remission N (%) p No remission N (%) Remission N (%) p At 1 year Weight maintenance 33 (49.2) 34 (50.8) 0.830 21 (44.7) 26 (55.3) 0.632 12 (60.0) 8 (40.0) 0.516 Weight loss 40 (46.0) 47 (54.0) 21 (36.2) 37 (63.8) 19 (65.5) 10 (34.5) Weight gain 64 (44.8) 79 (55.2) 46 (42.6) 62 (57.4) 18 (51.4) 17 (48.6) At 2 years Weight maintenance 27 (39.7) 41 (60.3) 0.732 16 (33.3) 32 (66.7) 0.239 11 (55.0) 9 (45.0) 0.450 Weight loss 38 (43.2) 50 (56.8) 19 (32.2) 40 (67.8) 19 (65.5) 10 (34.5) Weight gain 65 (45.4) 78 (54.6) 47 (43.9) 60 (56.1) 18 (50.0) 18 (50.0) OSA No remission N (%) Remission N (%) p No remission N (%) Remission N (%) p No remission N (%) Remission N (%) p At 1 year Weight maintenance 8 (33.3) 16 (66.7) 0.984 3 (23.1) 10 (76.9) 0.826 5 (45.4) 6 (54.6) 0.694 Weight loss 12 (31.6) 26 (68.4) 8 (32.0) 17 (68.0) 4 (30.8) 9 (69.2) Weight gain 22 (31.4) 48 (68.6) 16 (31.4) 35 (68.6) 6 (31.6) 13 (68.4) At 2 years Weight maintenance 8 (30.8) 18 (69.2) 0.924 3 (20.0) 12 (80.0) 0.778 5 (45.4) 6 (54.6) 0.502 Weight loss 10 (26.3) 28 (73.7) 6 (24.0) 19 (76.0) 4 (30.8) 9 (69.2) Weight gain 19 (27.5) 50 (72.5) 14 (28.6) 35 (71.4) 5 (25.0) 15 (75.0) EWL – percentage of excessive weight loss; OSA – obstructive sleep apnea; TWL – percentage of total weight loss. Table 3. Crude and adjusted associations between preoperative weight trajectory and postoperative weight outcomes at 2 years. Total RYGB Sleeve Crude OR (95%CI) Adjusted* OR (95%CI) Crude OR (95%CI) Adjusted* OR (95%CI) Crude OR (95%CI) Adjusted* OR (95%CI) TWL at 2 years > 20% Weight maintenance 1 [ref] 1 [ref] 1 [ref] 1 [ref] 1 [ref] 1 [ref] Weight loss 0.51 (0.21-1.24) 0.57 (0.23-1.41) 0.73 (0.21-2.53) 0.85 (0.23-3.08) 0.38 (0.10-1.42) 0.40 (0.11-1.53) Weight gain 0.35 (0.16-0.79) 0.41 (0.18-0.93) 0.40 (0.14-1.16) 0.48 (0.16-1.44) 0.26 (0.08-0.92) 0.32 (0.09-1.14) EWL at 2 years > 50% Weight maintenance 1 [ref] 1 [ref] 1 [ref] 1 [ref] 1 [ref] 1 [ref] Weight loss 0.51 (0.21-1.24) 0.61 (0.25-1.50) 0.85 (0.24-3.07) 1.02 (0.28-3.76) 0.34 (0.09-1.27) 0.40 (0.11-1.52) Weight gain 0.40 (0.18-0.91) 0.41 (0.18-0.95) 0.48 (0.16-1.41) 0.50 (0.17-1.51) 0.28 (0.08-0.98) 0.31 (0.08-1.10) Post-operative weight loss percentage at 2 years Crude β (95%CI) Adjusted* β (95%CI) Crude β (95%CI) Adjusted* β (95%CI) Crude β (95%CI) Adjusted* β (95%CI) Pre-operative weight loss percentage 0.182 (0.103, 0.260) 0.116 (0.040, 0.191) 0.155 (0.070, 0.240) 0.075 (-0.007, 0.157) 0.290 (0.132, 0.449) 0.224 (0.071, 0.377) EWL – percentage of excessive weight loss; RYGB – Roux en Y gastric bypass; TWL – percentage of total weight loss. Table 4. Optimal cutoffs for preoperative weight loss and weight gain. Optimal cutpoint Youden index (SE) Sensitivity at cutpoint Specificity at cutpoint AUC at cutpoint TWL At 1 year Weight loss (%) 1.96 0.228 (0.1735) 0.60 0.63 0.61 Weight gain (%) 4.59 0.267 (0.0816) 0.60 0.67 0.63 At 2 years Weight loss (%) 10.91 0.099 (0.0174) 0.10 1.00 0.55 Weight gain (%) 6.67 0.220 (0.0768) 0.75 0.47 0.61 EWL At 1 year Weight loss (%) 1.23 0.573 (0.1348) 0.72 0.86 0.79 Weight gain (%) 6.93 0.279 (0.0917) 0.76 0.52 0.64 At 2 years Weight loss (%) 4.96 0.092 (0.1017) 0.31 0.78 0.55 Weight gain (%) 5.51 0.228 (0.0813) 0.68 0.55 0.61 Diabetes At 1 year Weight loss (%) 0.83 0.208 (0.1120) 0.96 0.25 0.60 Weight gain (%) 18.00 0.029 (0.0290) 1.00 0.03 0.51 At 2 years Weight loss (%) 2.45 0.185 (0.1285) 0.80 0.39 0.59 Weight gain (%) 18.00 0.014 (0.0330) 0.98 0.03 0.51 Hypertension At 1 year Weight loss (%) 2.66 0.132 (0.0863) 0.60 0.53 0.57 Weight gain (%) 6.15 0.094 (0.0625) 0.77 0.33 0.55 At 2 years Weight loss (%) 1.83 0.127 (0.0823) 0.72 0.41 0.56 Weight gain (%) 17.35 0.050 (0.0265) 0.99 0.06 0.52 Dyslipidemia At 1 year Weight loss (%) 1.77 0.252 (0.1031) 0.70 0.55 0.63 Weight gain (%) 18.00 0.034 (0.0293) 0.99 0.05 0.52 At 2 years Weight loss (%) 1.77 0.206 (0.1045) 0.68 0.53 0.60 Weight gain (%) 18.00 0.049 (0.0324) 0.99 0.06 0.52 OSA At 1 year Weight loss (%) 0.48 0.256 (0.1458) 0.92 0.33 0.63 Weight gain (%) 7.22 0.061 (0.1043) 0.83 0.23 0.53 At 2 years Weight loss (%) 0.48 0.329 (0.1624) 0.93 0.40 0.66 Weight gain (%) 0.41 0.040 (0.0277) 0.04 1.00 0.52 AUC – area under the curve; EWL – percentage of excessive weight loss; OSA – obstructive sleep apnea; TWL – percentage of total weight loss. Additional Declarations No competing interests reported. Cite Share Download PDF Status: Under Review Version 1 posted Reviewers agreed at journal 14 May, 2026 Reviewers agreed at journal 13 May, 2026 Reviewers agreed at journal 21 Apr, 2026 Reviewers invited by journal 21 Apr, 2026 Editor assigned by journal 09 Apr, 2026 Submission checks completed at journal 09 Apr, 2026 First submitted to journal 03 Apr, 2026 You are reading this latest preprint version Research Square lets you share your work early, gain feedback from the community, and start making changes to your manuscript prior to peer review in a journal. As a division of Research Square Company, we’re committed to making research communication faster, fairer, and more useful. We do this by developing innovative software and high quality services for the global research community. Our growing team is made up of researchers and industry professionals working together to solve the most critical problems facing scientific publishing. Also discoverable on Platform About Our Team In Review Editorial Policies Advisory Board Help Center Resources Author Services Accessibility API Access RSS feed Manage Cookie Preferences © Research Square 2026 | ISSN 2693-5015 (online) Privacy Policy Terms of Service Do Not Sell My Personal Information {"props":{"pageProps":{"initialData":{"identity":"rs-9313191","acceptedTermsAndConditions":true,"allowDirectSubmit":false,"archivedVersions":[],"articleType":"Research Article","associatedPublications":[],"authors":[{"id":630552158,"identity":"ad1907c2-8b9f-45df-a999-af164871cf1e","order_by":0,"name":"João Pedro Araújo-Teixeira","email":"","orcid":"","institution":"Hospital de São João","correspondingAuthor":false,"prefix":"","firstName":"João","middleName":"Pedro","lastName":"Araújo-Teixeira","suffix":""},{"id":630552159,"identity":"a98b90c5-fb60-43be-937a-2d43d13ed786","order_by":1,"name":"Inês Faria-Teixeira","email":"","orcid":"","institution":"Hospital de São João","correspondingAuthor":false,"prefix":"","firstName":"Inês","middleName":"","lastName":"Faria-Teixeira","suffix":""},{"id":630552160,"identity":"e8a2eee3-22da-4eb4-b9df-2ddbfe244fbe","order_by":2,"name":"Joana Lamego","email":"","orcid":"","institution":"Hospital de São João","correspondingAuthor":false,"prefix":"","firstName":"Joana","middleName":"","lastName":"Lamego","suffix":""},{"id":630552161,"identity":"d35eae56-6143-4ae3-8458-fe6ba6b4400c","order_by":3,"name":"Bárbara Peleteiro","email":"","orcid":"","institution":"Hospital de São João","correspondingAuthor":false,"prefix":"","firstName":"Bárbara","middleName":"","lastName":"Peleteiro","suffix":""},{"id":630552162,"identity":"368fa467-9203-444b-8257-eb9edf398af9","order_by":4,"name":"Frederica Gonçalves","email":"","orcid":"","institution":"Hospital de São João","correspondingAuthor":false,"prefix":"","firstName":"Frederica","middleName":"","lastName":"Gonçalves","suffix":""},{"id":630552163,"identity":"9102347d-2778-4a59-b434-84c3a9797a90","order_by":5,"name":"César Alvarez","email":"","orcid":"","institution":"Hospital de São João","correspondingAuthor":false,"prefix":"","firstName":"César","middleName":"","lastName":"Alvarez","suffix":""},{"id":630552164,"identity":"a72b980c-1c1f-4c4e-a600-6508d276d4e8","order_by":6,"name":"Fernando Resende","email":"","orcid":"","institution":"Hospital de São João","correspondingAuthor":false,"prefix":"","firstName":"Fernando","middleName":"","lastName":"Resende","suffix":""},{"id":630552165,"identity":"c5261973-08c5-4349-8fb1-77ca1acb0cf5","order_by":7,"name":"André Costa-Pinho","email":"","orcid":"","institution":"Hospital de São João","correspondingAuthor":false,"prefix":"","firstName":"André","middleName":"","lastName":"Costa-Pinho","suffix":""},{"id":630552166,"identity":"9252f981-0237-4345-804b-7fcbc367daed","order_by":8,"name":"John Preto","email":"","orcid":"","institution":"Hospital de São João","correspondingAuthor":false,"prefix":"","firstName":"John","middleName":"","lastName":"Preto","suffix":""},{"id":630552167,"identity":"284ff660-e323-478b-88a3-ea50cf7ab7a8","order_by":9,"name":"Paula Freitas","email":"","orcid":"","institution":"Hospital de São João","correspondingAuthor":false,"prefix":"","firstName":"Paula","middleName":"","lastName":"Freitas","suffix":""},{"id":630552168,"identity":"89b0b1a7-ce3a-4f52-876d-0d178cb54138","order_by":10,"name":"Silvestre Carneiro","email":"","orcid":"","institution":"Hospital de São João","correspondingAuthor":false,"prefix":"","firstName":"Silvestre","middleName":"","lastName":"Carneiro","suffix":""},{"id":630552169,"identity":"07b89b29-2775-41f2-9495-4b4dcffc3ea9","order_by":11,"name":"Hugo Santos-Sousa","email":"data:image/png;base64,iVBORw0KGgoAAAANSUhEUgAAAZAAAAAyAQMAAABI0h/eAAAABlBMVEX///8AAABVwtN+AAAACXBIWXMAAA7EAAAOxAGVKw4bAAAA9klEQVRIiWNgGAWjYBACAzS+DRAzNh4grCUBzk8DaWkgScthMIlXizkD+8PPhT9s7Bn4Dx+T/FFz3m5t+2GgLTU20bi0WDbwGEvPSEhLbJBIS5PmOXY7eduZRKCWY2m5DbgcdoCHQZon4XACgwSPmTQD2+1kswNALYwNh/FoYX/8G6gF6LAzZpI//p1LNjv/kJAWBjOQLYwNDDlmErxtB+zMbhCy5TCPmTVPWlpim0RasjVvX3KC2Q2gLQn4/HK8/fFtHhsbe37+wwdv/vhmZ292Pv3hgw81Nji1MDBDaTYonQhWmYBLOTZgT4riUTAKRsEoGBkAAJTQWrf5ILRRAAAAAElFTkSuQmCC","orcid":"","institution":"Hospital de São João","correspondingAuthor":true,"prefix":"","firstName":"Hugo","middleName":"","lastName":"Santos-Sousa","suffix":""},{"id":630552170,"identity":"d1046179-87b2-4737-82f5-80f0cd242e23","order_by":12,"name":"Eduardo Lima-da-Costa","email":"","orcid":"","institution":"Hospital de São João","correspondingAuthor":false,"prefix":"","firstName":"Eduardo","middleName":"","lastName":"Lima-da-Costa","suffix":""}],"badges":[],"createdAt":"2026-04-03 13:09:12","currentVersionCode":1,"declarations":"","doi":"10.21203/rs.3.rs-9313191/v1","doiUrl":"https://doi.org/10.21203/rs.3.rs-9313191/v1","draftVersion":[],"editorialEvents":[],"editorialNote":"","failedWorkflow":false,"files":[{"id":108178177,"identity":"ef26d053-d026-42e3-8d38-9e5e4dea27c0","added_by":"auto","created_at":"2026-04-30 08:24:34","extension":"pdf","order_by":0,"title":"","display":"","copyAsset":false,"role":"manuscript-pdf","size":674205,"visible":true,"origin":"","legend":"","description":"","filename":"manuscript.pdf","url":"https://assets-eu.researchsquare.com/files/rs-9313191/v1/90590d12-89b4-4b38-899d-60e0eeded815.pdf"}],"financialInterests":"No competing interests reported.","formattedTitle":"\u003cp\u003ePreoperative Weight Change and Outcomes After Bariatric Surgery\u003c/p\u003e","fulltext":[{"header":"KEY POINTS","content":"\u003cp\u003e●\u0026nbsp; \u0026nbsp; \u0026nbsp; \u0026nbsp; \u0026nbsp;\u0026nbsp;Preoperative weight gain \u0026gt;5–7% predicts poorer postoperative outcomes.\u003c/p\u003e\n\u003cp\u003e●\u0026nbsp; \u0026nbsp; \u0026nbsp; \u0026nbsp; \u0026nbsp;\u0026nbsp;Modest 5–10% preoperative weight loss improves early weight and metabolic results.\u003c/p\u003e\n\u003cp\u003e● \u0026nbsp; \u0026nbsp; \u0026nbsp; \u0026nbsp; \u0026nbsp;Identified thresholds support individualized preoperative counseling strategies.\u003c/p\u003e"},{"header":"INTRODUCTION","content":"\u003cp\u003eThe role of preoperative weight variation (loss or gain) in bariatric surgery outcomes remains controversial. Although some healthcare systems and insurance providers historically required preoperative weight loss as a prerequisite for surgery, major professional societies—including the American Society for Metabolic and Bariatric Surgery (ASMBS)—explicitly state that mandatory preoperative weight loss (PWL) lacks consistent evidence of benefit and should not be required prior to metabolic surgery\u003csup\u003e(1)\u003c/sup\u003e. Systematic reviews and meta-analyses have reinforced this position, demonstrating that structured or mandated preoperative weight loss programs do not reliably improve postoperative weight loss or comorbidity resolution and may instead delay access to care\u003csup\u003e(2,3)\u003c/sup\u003e. Thus, while encouraging weight optimization is common practice, the scientific basis for mandating weight loss remains uncertain.\u003c/p\u003e\n\u003cp\u003eImportantly, most published studies have focused almost exclusively on preoperative weight loss, with limited evaluation of preoperative weight gain and its potential consequences. This represents a relevant knowledge gap, as weight gain before surgery may reflect behavioral, metabolic, or system-related factors that could influence postoperative trajectories. Clarifying the impact of both weight loss and weight gain prior to surgery is therefore essential to inform evidence-based preoperative counseling.\u003c/p\u003e\n\u003cp\u003eWe hypothesized that preoperative weight gain would be associated with poorer postoperative weight and metabolic outcomes, whereas preoperative weight loss would confer selective benefits. Accordingly, the primary aim of this study was to evaluate the association between preoperative weight variation (maintenance, loss, or gain) and postoperative weight outcomes at 1 and 2 years. Secondary aims included assessing comorbidity remission and defining clinically relevant thresholds for minimum beneficial weight loss and maximum tolerable weight gain using ROC analysis.\u003c/p\u003e"},{"header":"MATERIALS AND METHODS","content":"\u003cp\u003e\u003cem\u003eStudy design\u003c/em\u003e\u003c/p\u003e\n\u003cp\u003eWe performed a retrospective cohort study at a high-volume bariatric center, including adult patients who underwent primary Roux-en-Y gastric bypass (RYGB) or sleeve gastrectomy (SG) between 2019 and 2023, with follow-up of up to two years. Patients were stratified according to preoperative weight trajectory (maintenance, loss, or gain). Baseline characteristics included demographics, comorbidities, presurgical body mass index (BMI), and hospital response time, defined as the interval between the first multidisciplinary consultation and the date of surgery. This study was approved by the institutional ethics committee of our hospital. Given the retrospective design, informed consent was waived.\u003c/p\u003e\n\u003cp\u003eInclusion criteria were adult patients (≥18 years) undergoing primary laparoscopic RYGB or SG during the study period. Eligible patients were required to have objective body weight recorded both at the first multidisciplinary bariatric consultation and at hospital admission immediately prior to surgery, allowing calculation of preoperative weight variation. Additionally, inclusion required availability of postoperative weight data at 12 and 24 months and sufficient clinical information to assess postoperative comorbidity status.\u003c/p\u003e\n\u003cp\u003eExclusion criteria were revisional, conversion, or re-operative bariatric procedures; previous bariatric surgery; and bariatric procedures other than RYGB or SG. Patients with missing or unreliable preoperative weight measurements or without postoperative follow-up at the predefined time points were excluded. Patients with medical conditions likely to substantially influence weight trajectory independently of bariatric surgery, such as active malignancy, when identifiable in medical records, were also excluded to minimize confounding. Only patients meeting all inclusion criteria and none of the exclusion criteria were included in the final analytic cohort.\u003c/p\u003e\n\u003cp\u003eThe preoperative period was defined as the interval between the initial multidisciplinary consultation and the date of surgery. Patients were categorized according to exact weight variation between first consultation and hospital admission. If admission weight was identical to initial consultation weight, patients were classified as “weight maintenance.” Any reduction in weight was classified as “weight loss,” and any increase as “weight gain.” Preoperative weight variation was calculated using body weight measured at the first consultation and body weight recorded at hospital admission prior to surgery. The duration of this period corresponded to the institutional response time for bariatric surgery, as presented in Table 1, reflecting routine waiting time within our healthcare system rather than participation in a mandated weight loss program.\u003c/p\u003e\n\u003cp\u003ePrimary outcomes were total weight loss (TWL) \u0026gt;20% and excess weight loss (EWL) \u0026gt;50% at both 1 and 2 years postoperatively. Percentage total weight loss (TWL) was calculated as [(preoperative weight − postoperative weight) / preoperative weight] × 100. Percentage excess weight loss (EWL) was calculated using ideal body weight corresponding to a BMI of 25 kg/m\u003csup\u003e2\u003c/sup\u003e. Secondary outcomes included remission of type 2 diabetes, hypertension, dyslipidemia, and obstructive sleep apnea, as well as identification of optimal thresholds for preoperative weight variation using receiver operating characteristic (ROC) curve analysis and the Youden index. Internal validation was performed using bootstrap resampling with 1,000 replications to assess robustness of the estimates and compute corresponding 95% confidence intervals. Type 2 diabetes was defined by fasting plasma glucose ≥126 mg/dL or A1C ≥6.5%, and/or use of glucose-lowering medication. Remission was defined as A1C \u0026lt;6.5% and fasting glucose \u0026lt;126 mg/dL in the absence of pharmacologic therapy. For hypertension, dyslipidemia, and obstructive sleep apnea, remission was defined by discontinuation of disease-specific treatment (antihypertensive medication, lipid-lowering therapy, or continuous positive airway pressure).\u003c/p\u003e\n\u003cp\u003eComparisons between groups were performed using the χ² test for categorical variables and the Kruskal–Wallis test for continuous variables. Multivariable logistic regression models were constructed to evaluate the independent association between preoperative weight trajectory and postoperative outcomes, adjusting for sex, presurgical BMI, hypertension, and hospital response time. The weight maintenance group served as the reference category. Odds ratios (OR) with 95% confidence intervals (CI) were calculated, and statistical significance was defined as p\u0026lt;0.05. All statistical analyses were performed using Stata.\u003c/p\u003e\n\u003cp\u003e\u003cem\u003eSurgical technique\u003c/em\u003e\u003c/p\u003e\n\u003cp\u003eAll procedures were performed laparoscopically. No primary open bariatric procedures were recorded during the study period. As for the Roux-en-Y Gastric Bypass (RYGB), it was performed using a standardized five-port laparoscopic approach (10-mm umbilical port for camera, 10-mm left hypochondrium, 5-mm epigastric port for liver retraction, 5-mm right hypochondrium, and 5-mm left flank). Ultrasonic energy was used for division of ligaments and vascular pedicles. Gastric and jejunal transections were performed using a linear stapler (length of 45mm; triple staple line; 1–2 mm thickness). A gastric pouch of approximately 30–50 mL was created and calibrated by an orogastric tube of 36-Fr. The biliopancreatic limb measured 100–120 cm from the ligament of Treitz, adjusted according to the presence of metabolic disease. The alimentary limb measured 120–140 cm. The gastrojejunostomy (antecolic, end-to-lateral) and jejunojejunostomy (latero-lateral) were constructed using linear stapling techniques. The gastrojejunostomy diameter was approximately 30–35 mm, and the jejunojejunostomy approximately 40–45 mm. Stapler entry sites were closed with continuous single-layer sutures using slow-absorbable material (threads thickness of 3-0), which was also used for anastomotic reinforcement and loop fixation. Mesenteric defects were closed with continuous absorbable sutures (threads thickness of 0). Petersen’s space was not routinely closed. Ten-millimeter trocar sites were closed with absorbable sutures.\u003c/p\u003e\n\u003cp\u003eAs for Sleeve gastrectomy, it was performed using the same laparoscopic port configuration. Gastric calibration was achieved using a 48-Fr orogastric tube. Gastric transection began approximately 6 cm proximal to the pylorus and proceeded toward the angle of His. No staple line reinforcement with suturing was routinely performed.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003e\u003cbr clear=\"all\"\u003e\u0026nbsp;\u003c/strong\u003e\u003c/p\u003e"},{"header":"RESULTS","content":"\u003cp\u003eDuring the study period (2019–2023), 3,348 metabolic bariatric procedures were performed. Of these, 2,600 were primary procedures. Preoperative admission weight was available for 2,597 patients, of whom 2,572 underwent either Roux-en-Y gastric bypass or sleeve gastrectomy. Two-year follow-up weight data were available for 1,094 patients, who comprised the final analytic cohort, so these were included in the following analysis. Most exclusions were due to missing retrospective data, mainly incomplete preoperative weight records preventing calculation of weight variation and insufficient follow-up data to assess weight outcomes and comorbidity remission. The same patients included in the 2-year analysis were also analyzed at 1 year. The cohort was 82.2% female, with a median age of 45 years and median preoperative BMI of 41.6 kg/m\u003csup\u003e2\u003c/sup\u003e. Most patients underwent Roux-en-Y gastric bypass (RYGB) (71.8%), while 28.2% underwent sleeve gastrectomy (SG). Significant differences between preoperative weight trajectory groups (maintenance, loss, gain) were observed in sex (p=0.005), preoperative BMI (p\u0026lt;0.001), hypertension prevalence (p=0.042), hospital response time (p=0.005), and type of surgery (p=0.024) (Table 1). Patients who gained weight were predominantly female and had lower median BMI, whereas those who lost weight had higher hypertension prevalence and longer waiting times.\u003c/p\u003e\n\u003cp\u003eAt 2 years, TWL \u0026gt;20% was achieved by 97.0% of patients who maintained weight, 94.2% who lost weight, and 91.8% who gained weight (p=0.025). EWL \u0026gt;50% followed a similar pattern without reaching statistical significance (p=0.074) (Table 2). At 1 year, preoperative weight loss was associated with higher TWL \u0026gt;20% after RYGB (p=0.015) and higher EWL \u0026gt;50% in both procedures (p=0.049).\u003c/p\u003e\n\u003cp\u003eIn adjusted logistic regression (Table 3), preoperative weight gain independently predicted lower likelihood of achieving TWL \u0026gt;20% (adjusted OR 0.41; 95% CI 0.18–0.93) and EWL \u0026gt;50% (adjusted OR 0.41; 95% CI 0.18–0.95), representing approximately 60% lower odds compared with weight maintenance.\u003c/p\u003e\n\u003cp\u003eWhen analyzed as a continuous variable, preoperative weight loss percentage was positively associated with postoperative total weight loss percentage at 2 years in the overall cohort (adjusted β 0.116; 95% CI 0.040–0.191). This association remained significant in SG (adjusted β 0.224; 95% CI 0.071–0.377) but was attenuated after adjustment in RYGB (adjusted β 0.075; 95% CI −0.007–0.157). These findings suggest a graded relationship between preoperative and postoperative weight change, particularly in SG.\u003c/p\u003e\n\u003cp\u003eOnly type 2 diabetes showed significant association with preoperative weight change. At 1 year, remission was more frequent among patients with preoperative weight loss (p=0.014 overall; p=0.024 in RYGB), though differences were not sustained at 2 years. No significant associations were observed for hypertension, dyslipidemia, or OSA.\u003c/p\u003e\n\u003cp\u003eROC analysis identified clinically relevant thresholds (Table 4). For TWL \u0026gt;20% at 2 years, minimum beneficial preoperative weight loss was \u0026gt;10.91%, and maximum tolerable weight gain was \u0026gt;6.67%. For EWL \u0026gt;50%, thresholds were \u0026gt;4.96% weight loss and \u0026gt;5.51% weight gain. Lower thresholds were observed for comorbidity remission, particularly for T2D (0.83% at 1 year; 2.45% at 2 years), whereas weight gain \u0026gt;18% was detrimental. For hypertension and dyslipidemia, favorable weight-loss thresholds ranged between 1.8% and 2.7%, while gains exceeding 6–17% were associated with reduced remission probability. For OSA, even small weight losses (~0.5%) were sufficient to yield benefit. Bootstrap internal validation using 1,000 replications demonstrated modest robustness of several thresholds, consistent with the relatively low Youden index values observed (Table 4).\u003c/p\u003e"},{"header":"DISCUSSION","content":"\u003cp\u003eIn this retrospective study conducted in a high-volume bariatric center, we demonstrated that preoperative weight trajectory is significantly associated with postoperative outcomes up to two years after surgery. Preoperative weight gain was independently associated with a reduced likelihood of achieving TWL \u0026gt;20% and EWL \u0026gt;50%, whereas modest preoperative weight loss conferred selective early benefits, particularly for type 2 diabetes remission and early weight outcomes after RYGB. These findings contribute to the ongoing debate regarding the clinical value of preoperative weight modification.\u003c/p\u003e\n\u003cp\u003e\u003cem\u003eThe impact of preoperative weight variation\u003c/em\u003e\u003c/p\u003e\n\u003cp\u003eSeveral studies support the potential benefits of modest preoperative weight loss regarding postoperative weight outcomes, comorbidity remission, and surgical morbidity. Mocanu et al.\u003csup\u003e(6)\u003c/sup\u003e reported that \u0026gt;10% preoperative weight loss was associated with reduced anastomotic leak and 30-day mortality, and data from the Scandinavian Obesity Registry (SOReg) demonstrated reduced complications among patients achieving approximately 9.5% preoperative weight loss\u003csup\u003e(7)\u003c/sup\u003e. Sun et al.\u003csup\u003e(19)\u003c/sup\u003e similarly found that even modest preoperative weight reduction (\u0026gt;0% to \u0026lt;5%) was associated with lower short-term mortality. Other studies observed improved early weight outcomes, though not consistently sustained beyond 1–2 years\u003csup\u003e(4,5,14)\u003c/sup\u003e.\u003c/p\u003e\n\u003cp\u003eBiologically, modest preoperative weight loss may reduce hepatic steatosis and visceral adiposity\u003csup\u003e(18,15)\u003c/sup\u003e, facilitating operative exposure and improving insulin sensitivity\u003csup\u003e(8)\u003c/sup\u003e. In our cohort, early benefits were evident at one year—particularly in RYGB—and type 2 diabetes remission was higher among patients who lost weight preoperatively. However, sustained superiority at two years was not universal.\u003c/p\u003e\n\u003cp\u003eConversely, progressive preoperative weight gain may reflect worsening insulin resistance, systemic inflammation, and adverse behavioral patterns. From a surgical perspective, greater intra-abdominal adiposity may increase technical complexity. In our study, preoperative weight gain was independently associated with approximately 60% lower odds of achieving TWL \u0026gt;20% and EWL \u0026gt;50% at two years. These findings are consistent with prior reports suggesting that preoperative weight gain may predict suboptimal postoperative response\u003csup\u003e(13,16)\u003c/sup\u003e.\u003c/p\u003e\n\u003cp\u003eImportantly, when preoperative weight change was analyzed as a continuous variable, a positive association was observed between percentage of preoperative weight loss and percentage of postoperative weight loss at two years in the overall cohort. This association remained significant after adjustment. Notably, the relationship was particularly evident among patients undergoing sleeve gastrectomy, whereas in RYGB the adjusted association was attenuated. These findings suggest that incremental preoperative weight reduction may translate into greater postoperative weight loss magnitude, especially in sleeve gastrectomy, while the intrinsic metabolic mechanisms of RYGB may partially mitigate this effect.\u003c/p\u003e\n\u003cp\u003eDespite these associations, most contemporary literature does not support mandatory preoperative weight loss requirements\u003csup\u003e(1-3)\u003c/sup\u003e. Although perioperative benefits have been reported in selected cohorts\u003csup\u003e(20)\u003c/sup\u003e, aggressive or insurance-mandated targets have not consistently improved long-term weight outcomes and may delay access to surgery\u003csup\u003e(21,22)\u003c/sup\u003e. Collectively, available evidence favors individualized metabolic optimization rather than rigid preoperative mandates.\u003c/p\u003e\n\u003cp\u003eAmong obesity-related comorbidities in our study, only type 2 diabetes demonstrated an early association with preoperative weight loss, particularly after RYGB. This may reflect improved insulin sensitivity prior to surgery. No significant associations were observed for hypertension, dyslipidemia, or obstructive sleep apnea, consistent with prior literature\u003csup\u003e(2,3,17)\u003c/sup\u003e.\u003c/p\u003e\n\u003cp\u003eThe increasing use of glucagon-like peptide-1 receptor agonists has renewed interest in pharmacologic preoperative optimization. However, current evidence does not support routine preoperative use solely to enhance long-term postoperative outcomes\u003csup\u003e(9-12,17,18)\u003c/sup\u003e. Their role appears primarily related to short-term metabolic stabilization.\u003c/p\u003e\n\u003cp\u003e\u003cem\u003eDefining thresholds for weight variation\u003c/em\u003e\u003c/p\u003e\n\u003cp\u003eTaken together, our results both align with and refine existing evidence. While we did not observe universal long-term superiority of preoperative weight loss at two years, we identified selective early benefits and a clear independent adverse effect of preoperative weight gain.\u003c/p\u003e\n\u003cp\u003eROC analysis identified clinically relevant thresholds. Preoperative weight loss exceeding 10.9% was associated with improved likelihood of achieving TWL \u0026gt;20%, while approximately 5% favored EWL \u0026gt;50%. Conversely, weight gain exceeding 6–7% was consistently associated with poorer postoperative outcomes. These findings suggest that preventing weight gain beyond 5–7% may be as clinically important as achieving modest preoperative weight reduction. However, internal bootstrap validation demonstrated modest stability of several cutoffs, reflecting the relatively low Youden index values and reinforcing that these thresholds should be interpreted as exploratory rather than definitive.\u003c/p\u003e\n\u003cp\u003eThe continuous regression analysis complements these threshold findings. While ROC-derived cutoffs provide practical clinical targets, the observed linear association indicates that the relationship between preoperative and postoperative weight change may operate along a continuum, particularly in sleeve gastrectomy. Thus, benefit may not be purely dichotomous but graded, supporting counseling strategies that encourage achievable preoperative weight reduction without enforcing rigid universal thresholds.\u003c/p\u003e\n\u003cp\u003eOur findings reinforce prior observations that even modest preoperative weight gain may have lasting adverse consequences for postoperative trajectories\u003csup\u003e(13,16)\u003c/sup\u003e. Rather than supporting mandatory weight loss requirements, these results advocate for a balanced approach focused on preventing weight gain and promoting realistic metabolic optimization before surgery.\u003c/p\u003e\n\u003cp\u003e\u003cem\u003eThe influence of the surgical technique\u003c/em\u003e\u003c/p\u003e\n\u003cp\u003eSurgical technical factors may also influence postoperative weight loss and metabolic outcomes and should be acknowledged. Smaller gastric pouches and reduced calibration diameters in sleeve gastrectomy (e.g., smaller orogastric tubes) have been associated with greater restriction and potentially enhanced weight loss. Similarly, longer biliopancreatic limb lengths in RYGB may increase the hypoabsorptive component of the procedure, potentially augmenting weight loss and metabolic effects, particularly in patients with metabolic disease. Variations in alimentary limb length or anastomotic diameter may also influence nutrient exposure and hormonal signaling. In our cohort, however, procedures were performed using a standardized laparoscopic technique with consistent pouch size, limb lengths, and sleeve calibration. This technical uniformity reduces intra-cohort variability and limits confounding related to surgical configuration. Consequently, while theoretical differences in technique may influence outcomes, our study cannot assess their independent impact.\u003c/p\u003e\n\u003cp\u003e\u003cem\u003eStrengths and limitations\u003c/em\u003e\u003c/p\u003e\n\u003cp\u003eThe strengths of this study include its large sample size, two-year follow-up, and evaluation of both weight outcomes and comorbidity remission in a real-world cohort from a high-volume bariatric center. The inclusion of both RYGB and SG enhances generalizability. Importantly, the identification of preoperative weight loss and gain thresholds through ROC analysis provides objective, data-driven and clinically applicable parameters for preoperative counseling. Furthermore, the simultaneous evaluation of both minimum beneficial weight loss and maximum tolerable weight gain extends beyond prior literature, which has predominantly focused only on weight loss targets. Several limitations should be acknowledged. The retrospective design introduces potential selection bias and residual confounding despite multivariable adjustment. Comorbidity assessment relied on clinical records, which may affect data accuracy, and body composition data were not available to distinguish fat mass from lean mass changes. The present study was not designed to evaluate specific preoperative weight loss strategies, and detailed data regarding dietary programs, physical activity interventions, or weight loss medications were not systematically collected. Therefore, the independent contribution of these approaches to postoperative outcomes could not be assessed. Future prospective studies specifically designed to investigate structured preoperative optimization strategies may help clarify whether particular interventions confer additional benefit beyond the magnitude of weight change alone. As a single-center study, external validity may be limited, and longer follow-up is required to determine the durability of the observed associations beyond two years.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003e\u003cbr clear=\"all\"\u003e\u0026nbsp;\u003c/strong\u003e\u003c/p\u003e"},{"header":"CONCLUSIONS","content":"\u003cp\u003eOur findings demonstrate that preoperative weight gain is independently associated with poorer postoperative weight outcomes, whereas modest preoperative weight loss (approximately 5–10%) may provide selective early advantages, particularly among patients undergoing RYGB and those with type 2 diabetes. Importantly, by identifying objective thresholds for both minimum beneficial weight loss and maximum tolerable weight gain, this study advances the current debate beyond universal preoperative mandates. Rather than enforcing rigid targets, a personalized strategy that prioritizes prevention of weight gain and encourages achievable metabolic optimization appears more appropriate. The proposed cutoffs offer clinically applicable guidance for preoperative counseling and shared decision-making, potentially improving early postoperative success while avoiding unnecessary barriers to surgery.\u003c/p\u003e\n\u003cp\u003e\u003cbr\u003e\u003c/p\u003e"},{"header":"Declarations","content":"\u003cp\u003e\u003cstrong\u003eCONFLICTS OF INTEREST\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eThe authors declare that they have no conflict of interest.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eETHICAL APPROVAL\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eAll procedures performed in studies involving human participants were in accordance with the ethical standards of the institutional research committee and with the 1964 Helsinki declaration and its later amendments. For this type of retrospective study, formal consent was not required.\u003c/p\u003e"},{"header":"References","content":"\u003col\u003e\n \u003cli\u003eMechanick, J. I., Apovian, C., Brethauer, S., Timothy Garvey, W., Joffe, A. M., Kim, J., Kushner, R. F., Lindquist, R., Pessah-Pollack, R., Seger, J., Urman, R. D., Adams, S., Cleek, J. B., Correa, R., Figaro, M. K., Flanders, K., Grams, J., Hurley, D. L., Kothari, S., Seger, M. V., … Still, C. D. (2020). Clinical Practice Guidelines for the Perioperative Nutrition, Metabolic, and Nonsurgical Support of Patients Undergoing Bariatric Procedures - 2019 Update: Cosponsored by American Association of Clinical Endocrinologists/American College of Endocrinology, The Obesity Society, American Society for Metabolic and Bariatric Surgery, Obesity Medicine Association, and American Society of Anesthesiologists. Obesity (Silver Spring, Md.), 28(4), O1–O58. https://doi.org/10.1002/oby.22719\u003c/li\u003e\n \u003cli\u003eMonfared, S., Athanasiadis, D. I., Furiya, A., Butler, A., Selzer, D., Hilgendorf, W., Banerjee, A., \u0026amp; Stefanidis, D. (2020). Do Mandated Weight Loss Goals Prior to Bariatric Surgery Improve Postoperative Outcomes?. Obesity surgery, 30(3), 889–894. https://doi.org/10.1007/s11695-019-04275-8\u003c/li\u003e\n \u003cli\u003eMacVicar, E., Lucocq, J., Geropoulos, G., Lamb, P. J., \u0026amp; Robertson, A. G. (2025). The Role of Preoperative Weight Loss Interventions on Long-Term Bariatric Surgery Outcomes: A Systematic Review. Journal of clinical medicine, 14(9), 3147. https://doi.org/10.3390/jcm14093147.\u003c/li\u003e\n \u003cli\u003eRomaen, I. F. L., Jense, M. T. F., Palm-Meinders, I. H., de Witte, E., Fransen, S. A. F., Greve, J. W. M., \u0026amp; Boerma, E. G. (2022). Higher Preoperative Weight loss Is Associated with Greater Weight Loss up to 12 Months After Bariatric Surgery. Obesity surgery, 32(9), 2860–2868. https://doi.org/10.1007/s11695-022-06176-9\u003c/li\u003e\n \u003cli\u003eRodríguez, F., Herrera, A., Sepúlveda, E. M., Guilbert, L., Hernández, L. A., Peñuñuri, L. F., Rodríguez, F. M., \u0026amp; Zerrweck, C. (2022). Weight loss before bariatric surgery and its impact on poor versus excellent outcomes at 2 years. Langenbeck's archives of surgery, 407(3), 1047–1053. https://doi.org/10.1007/s00423-021-02399-z\u003c/li\u003e\n \u003cli\u003eMocanu, V., Marcil, G., Dang, J. T., Birch, D. W., Switzer, N. J., \u0026amp; Karmali, S. (2021). Preoperative weight loss is linked to improved mortality and leaks following elective bariatric surgery: an analysis of 548,597 patients from 2015-2018. Surgery for obesity and related diseases : official journal of the American Society for Bariatric Surgery, 17(11), 1846–1853. https://doi.org/10.1016/j.soard.2021.06.021\u003c/li\u003e\n \u003cli\u003eAnderin, C., Gustafsson, U. O., Heijbel, N., \u0026amp; Thorell, A. (2015). Weight loss before bariatric surgery and postoperative complications: data from the Scandinavian Obesity Registry (SOReg). Annals of surgery, 261(5), 909–913. https://doi.org/10.1097/SLA.0000000000000839\u003c/li\u003e\n \u003cli\u003eColles, S. L., Dixon, J. B., Marks, P., Strauss, B. J., \u0026amp; O'Brien, P. E. (2006). Preoperative weight loss with a very-low-energy diet: quantitation of changes in liver and abdominal fat by serial imaging. The American journal of clinical nutrition, 84(2), 304–311. https://doi.org/10.1093/ajcn/84.1.304\u003c/li\u003e\n \u003cli\u003eEsparham, A., Sheikhbahaei, E., Anari Moghadam, H., \u0026amp; Khorgami, Z. (2025). Preoperative Glucagon-Like Peptide-1 Receptor Agonists and Bariatric Surgery Outcomes: A Systematic Review. Obesity surgery, 35(9), 3939–3946. https://doi.org/10.1007/s11695-025-08137-4.\u0026nbsp;\u003c/li\u003e\n \u003cli\u003e\u0026nbsp;AbuHasan, Q., Funk, L. M., Holl, J. L., Draucker, C., Grannis, S., Bilimoria, K. Y., Stefanidis, D., \u0026amp; Yuce, T. K. (2025). Preoperative Glucagon-Like Peptide-1 Receptor Agonist Utilization and Association with Bariatric Surgery Outcomes. Obesity surgery, 35(2), 556–560. https://doi.org/10.1007/s11695-024-07651-1.\u003c/li\u003e\n \u003cli\u003e\u0026nbsp;Luc, G., Dedieu, A., Canard, G., Cesard, A., Brunet, A., Furois, C., Leterrier, A., Daridon, B., Mendes, L., Brighen, E., Fournet, L., David, A., \u0026amp; Muzard, L. (2025). Exploratory Assessment of Preoperative GLP-1 Receptor Agonists Before Sleeve Gastrectomy: A Retrospective Matched Analysis. Obesity surgery, 35(10), 4383–4392. https://doi.org/10.1007/s11695-025-08258-w.\u003c/li\u003e\n \u003cli\u003eIlanga, M., Heard, J. C., McClintic, J., Lewis, D., Martin, G., Horn, C., Khorgami, Z., Richards, J., Chow, G. S., \u0026amp; Lim, R. B. (2023). Use of GLP-1 agonists in high risk patients prior to bariatric surgery: a cohort study. Surgical endoscopy, 37(12), 9509–9513. https://doi.org/10.1007/s00464-023-10387-1.\u0026nbsp;\u003c/li\u003e\n \u003cli\u003e\u0026nbsp;Jacobs, A., Al Nawas, M., Deden, L. N., Dijksman, L. M., Boerma, E. G., Demirkiran, A., Hazebroek, E. J., Wiezer, M. R. J., Derksen, W. J. M., \u0026amp; Monpellier, V. M. (2023). Preoperative Weight Gain Is Not Related to Lower Postoperative Weight Loss, But to Lower Total Weight Loss up to 3 Years After Bariatric-Metabolic Surgery. Obesity surgery, 33(12), 3746–3754. https://doi.org/10.1007/s11695-023-06835-5.\u003c/li\u003e\n \u003cli\u003eCassie, S., Menezes, C., Birch, D. W., Shi, X., \u0026amp; Karmali, S. (2011). Effect of preoperative weight loss in bariatric surgical patients: a systematic review. Surgery for obesity and related diseases: official journal of the American Society for Bariatric Surgery, 7(6), 760–767. https://doi.org/10.1016/j.soard.2011.08.011\u003c/li\u003e\n \u003cli\u003eEdholm, D., Kullberg, J., Haenni, A., Karlsson, F. A., Ahlström, A., Hedberg, J., Ahlström, H., \u0026amp; Sundbom, M. (2011). Preoperative 4-week low-calorie diet reduces liver volume and intrahepatic fat, and facilitates laparoscopic gastric bypass in morbidly obese. Obesity surgery, 21(3), 345–350. https://doi.org/10.1007/s11695-010-0337-2\u003c/li\u003e\n \u003cli\u003eStill, C. D., Benotti, P., Wood, G. C., Gerhard, G. S., Petrick, A., Reed, M., \u0026amp; Strodel, W. (2007). Outcomes of preoperative weight loss in high-risk patients undergoing gastric bypass surgery. Archives of surgery (Chicago, Ill. : 1960), 142(10), 994–999. https://doi.org/10.1001/archsurg.142.10.994.\u003c/li\u003e\n \u003cli\u003eTan, Y. W., Shang, M., Davis, S., \u0026amp; Gananadha, S. (2025). GLP-1 receptor agonists as an adjunct to bariatric surgery for weight loss and metabolic outcome improvement: a systematic review and meta-analysis. Langenbeck's archives of surgery, 410(1), 295. https://doi.org/10.1007/s00423-025-03831-4\u003c/li\u003e\n \u003cli\u003eFerguson, J., Fisher, O., Talbot, M., \u0026amp; Rigas, G. (2025). Effectiveness of Adjuvant Semaglutide Following Bariatric Metabolic Surgery. Obesity surgery, 35(3), 694–700. https://doi.org/10.1007/s11695-025-07703-0\u003c/li\u003e\n \u003cli\u003eSun Y, Liu B, Smith JK, et al. Association of preoperative body weight and weight loss with risk of death after bariatric surgery.\u0026nbsp;\u003cem\u003eJAMA Netw Open.\u003c/em\u003e 2020;3(5):e204803. doi:10.1001/jamanetworkopen.2020.4803\u003c/li\u003e\n \u003cli\u003eRoman M, Monaghan A, Serraino GF, Miller D, Pathak S, Lai F, et al. Meta-analysis of the influence of lifestyle changes for preoperative weight loss on surgical outcomes.\u0026nbsp;\u003cem\u003eBr J Surg.\u003c/em\u003e 2019;106(3):181–189. doi:10.1002/bjs.11001\u003c/li\u003e\n \u003cli\u003eNess C, Giorgi M, Pickering J, Ortega-Goddard E, Luhrs A. Extensive weight loss prior to bariatric surgery is associated with worse outcomes.\u0026nbsp;\u003cem\u003eObes Surg.\u003c/em\u003e 2026. doi:10.1007/s11695-026-08509-4\u003c/li\u003e\n \u003cli\u003eHutcheon, D. A., Ewing, J. A., St Ville, M., Miller, M., Kirkland, L., Kothari, S. N., \u0026amp; Scott, J. D. (2023). Insurance-mandated weight management program completion before bariatric surgery provides no long-term clinical benefit. Surgery for obesity and related diseases : official journal of the American Society for Bariatric Surgery, 19(4), 290–300. https://doi.org/10.1016/j.soard.2022.10.022.\u003c/li\u003e\n\u003c/ol\u003e"},{"header":"Tables","content":"\u003cp\u003eTable 1. Baseline characteristics according to preoperative weight trajectory.\u003c/p\u003e\n\u003ctable border=\"1\" cellspacing=\"0\" cellpadding=\"0\" width=\"100%\"\u003e\n \u003ctbody\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 137px;\"\u003e\n \u003cp\u003e\u003cstrong\u003e\u0026nbsp;\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 84px;\"\u003e\n \u003cp\u003e\u003cstrong\u003eValues\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 81px;\"\u003e\n \u003cp\u003e\u003cstrong\u003eTotal\u003c/strong\u003e\u003c/p\u003e\n \u003cp\u003e\u003cstrong\u003e(n=1094)\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 96px;\"\u003e\n \u003cp\u003e\u003cstrong\u003eWeight maintenance\u003c/strong\u003e\u003c/p\u003e\n \u003cp\u003e\u003cstrong\u003e(n=231)\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 77px;\"\u003e\n \u003cp\u003e\u003cstrong\u003eWeight loss\u003c/strong\u003e\u003c/p\u003e\n \u003cp\u003e\u003cstrong\u003e(n=311)\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 77px;\"\u003e\n \u003cp\u003e\u003cstrong\u003eWeight gain\u003c/strong\u003e\u003c/p\u003e\n \u003cp\u003e\u003cstrong\u003e(n=552)\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 50px;\"\u003e\n \u003cp\u003e\u003cstrong\u003e\u003cem\u003ep\u003c/em\u003e\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 137px;\"\u003e\n \u003cp\u003e\u003cstrong\u003eAge (years)\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 84px;\"\u003e\n \u003cp\u003eMedian (min-max)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 81px;\"\u003e\n \u003cp\u003e45 (39-53)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 96px;\"\u003e\n \u003cp\u003e45 (39-53)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 77px;\"\u003e\n \u003cp\u003e46 (40-53)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 77px;\"\u003e\n \u003cp\u003e45 (38-54)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 50px;\"\u003e\n \u003cp\u003e0.536\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 137px;\"\u003e\n \u003cp\u003e\u003cstrong\u003eFemale\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 84px;\"\u003e\n \u003cp\u003eN (%)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 81px;\"\u003e\n \u003cp\u003e899 (82.2)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 96px;\"\u003e\n \u003cp\u003e182 (78.8)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 77px;\"\u003e\n \u003cp\u003e243 (78.1)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 77px;\"\u003e\n \u003cp\u003e474 (85.9)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 50px;\"\u003e\n \u003cp\u003e0.005\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 137px;\"\u003e\n \u003cp\u003e\u003cstrong\u003ePreoperative BMI (kg/m\u003csup\u003e2\u003c/sup\u003e)\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 84px;\"\u003e\n \u003cp\u003eMedian (min-max)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 81px;\"\u003e\n \u003cp\u003e41.6 (38.6-45.0)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 96px;\"\u003e\n \u003cp\u003e41.9 (38.8-45.6)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 77px;\"\u003e\n \u003cp\u003e42.8 (39.6-46.0)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 77px;\"\u003e\n \u003cp\u003e40.9 (38.1-44.1)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 50px;\"\u003e\n \u003cp\u003e\u0026lt;0.001\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 137px;\"\u003e\n \u003cp\u003e\u003cstrong\u003eDiabetes\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 84px;\"\u003e\n \u003cp\u003eN (%)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 81px;\"\u003e\n \u003cp\u003e241 (22.0)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 96px;\"\u003e\n \u003cp\u003e51 (22.1)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 77px;\"\u003e\n \u003cp\u003e77 (24.8)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 77px;\"\u003e\n \u003cp\u003e113 (20.5)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 50px;\"\u003e\n \u003cp\u003e0.345\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 137px;\"\u003e\n \u003cp\u003e\u003cstrong\u003eHypertension\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 84px;\"\u003e\n \u003cp\u003eN (%)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 81px;\"\u003e\n \u003cp\u003e488 (44.6)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 96px;\"\u003e\n \u003cp\u003e101 (43.7)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 77px;\"\u003e\n \u003cp\u003e157 (50.5)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 77px;\"\u003e\n \u003cp\u003e230 (41.7)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 50px;\"\u003e\n \u003cp\u003e0.042\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 137px;\"\u003e\n \u003cp\u003e\u003cstrong\u003eDyslipidemia\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 84px;\"\u003e\n \u003cp\u003eN (%)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 81px;\"\u003e\n \u003cp\u003e348 (31.8)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 96px;\"\u003e\n \u003cp\u003e82 (35.5)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 77px;\"\u003e\n \u003cp\u003e107 (34.4)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 77px;\"\u003e\n \u003cp\u003e159 (28.8)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 50px;\"\u003e\n \u003cp\u003e0.095\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 137px;\"\u003e\n \u003cp\u003e\u003cstrong\u003eOSA\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 84px;\"\u003e\n \u003cp\u003eN (%)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 81px;\"\u003e\n \u003cp\u003e149 (13.6)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 96px;\"\u003e\n \u003cp\u003e27 (11.7)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 77px;\"\u003e\n \u003cp\u003e42 (13.5)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 77px;\"\u003e\n \u003cp\u003e80 (14.5)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 50px;\"\u003e\n \u003cp\u003e0.579\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 137px;\"\u003e\n \u003cp\u003e\u003cstrong\u003eHospital response time (months)\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 84px;\"\u003e\n \u003cp\u003eMedian (min-max)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 81px;\"\u003e\n \u003cp\u003e15.0 (10.6-19.4)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 96px;\"\u003e\n \u003cp\u003e13.8 (9.2-18.0)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 77px;\"\u003e\n \u003cp\u003e14.9 (9.4-20.1)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 77px;\"\u003e\n \u003cp\u003e15.2 (11.7-19.6)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 50px;\"\u003e\n \u003cp\u003e0.005\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 137px;\"\u003e\n \u003cp\u003e\u003cstrong\u003eSurgery\u003c/strong\u003e\u003c/p\u003e\n \u003cp\u003e\u003cstrong\u003e\u0026nbsp; \u0026nbsp;RYGB\u003c/strong\u003e\u003c/p\u003e\n \u003cp\u003e\u003cstrong\u003e\u0026nbsp; \u0026nbsp;Sleeve\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 84px;\"\u003e\n \u003cp\u003eN (%)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 81px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003cp\u003e786 (71.8)\u003c/p\u003e\n \u003cp\u003e308 (28.2)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 96px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003cp\u003e162 (70.1)\u003c/p\u003e\n \u003cp\u003e69 (29.9)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 77px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003cp\u003e208 (66.9)\u003c/p\u003e\n \u003cp\u003e103 (33.1)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 77px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003cp\u003e416 (75.4)\u003c/p\u003e\n \u003cp\u003e136 (24.6)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 50px;\"\u003e\n \u003cp\u003e0.024\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003c/tbody\u003e\n\u003c/table\u003e\n\u003cp\u003eBMI \u0026ndash; body mass index; OSA \u0026ndash; obstructive sleep apnea; RYGB \u0026ndash; Roux em Y gastric bypass.\u003c/p\u003e\n\u003cp\u003e\u0026nbsp;\u003c/p\u003e\n\u003cp\u003e\u0026nbsp;\u003c/p\u003e\n\u003cp\u003eTable 2. Postoperative weight and comorbidity outcomes according to preoperative weight trajectory, overall and by procedure.\u003c/p\u003e\n\u003ctable border=\"1\" cellspacing=\"0\" cellpadding=\"0\" width=\"100%\"\u003e\n \u003ctbody\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 91px;\"\u003e\n \u003cp\u003e\u003cstrong\u003e\u0026nbsp;\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd colspan=\"3\" valign=\"top\" style=\"width: 174px;\"\u003e\n \u003cp\u003e\u003cstrong\u003eTotal\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd colspan=\"3\" valign=\"top\" style=\"width: 175px;\"\u003e\n \u003cp\u003e\u003cstrong\u003eRYGB\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd colspan=\"3\" valign=\"top\" style=\"width: 165px;\"\u003e\n \u003cp\u003e\u003cstrong\u003eSleeve\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd colspan=\"10\" valign=\"top\" style=\"width: 605px;\"\u003e\n \u003cp\u003e\u003cstrong\u003eTWL\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 91px;\"\u003e\n \u003cp\u003e\u003cstrong\u003e\u0026nbsp;\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 67px;\"\u003e\n \u003cp\u003e\u003cstrong\u003e\u0026le; 20%\u003c/strong\u003e\u003c/p\u003e\n \u003cp\u003e\u003cstrong\u003e\u003cem\u003eN\u003c/em\u003e\u003c/strong\u003e\u003cstrong\u003e\u0026nbsp;(%)\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 63px;\"\u003e\n \u003cp\u003e\u003cstrong\u003e\u0026gt; 20%\u003c/strong\u003e\u003c/p\u003e\n \u003cp\u003e\u003cstrong\u003e\u003cem\u003eN\u003c/em\u003e\u003c/strong\u003e\u003cstrong\u003e\u0026nbsp;(%)\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 44px;\"\u003e\n \u003cp\u003e\u003cstrong\u003e\u003cem\u003ep\u003c/em\u003e\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 63px;\"\u003e\n \u003cp\u003e\u003cstrong\u003e\u0026le; 20%\u003c/strong\u003e\u003c/p\u003e\n \u003cp\u003e\u003cstrong\u003e\u003cem\u003eN\u003c/em\u003e\u003c/strong\u003e\u003cstrong\u003e\u0026nbsp;(%)\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 63px;\"\u003e\n \u003cp\u003e\u003cstrong\u003e\u0026gt; 20%\u003c/strong\u003e\u003c/p\u003e\n \u003cp\u003e\u003cstrong\u003e\u003cem\u003eN\u003c/em\u003e\u003c/strong\u003e\u003cstrong\u003e\u0026nbsp;(%)\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 49px;\"\u003e\n \u003cp\u003e\u003cstrong\u003e\u003cem\u003ep\u003c/em\u003e\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 58px;\"\u003e\n \u003cp\u003e\u003cstrong\u003e\u0026le; 20%\u003c/strong\u003e\u003c/p\u003e\n \u003cp\u003e\u003cstrong\u003e\u003cem\u003eN\u003c/em\u003e\u003c/strong\u003e\u003cstrong\u003e\u0026nbsp;(%)\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 63px;\"\u003e\n \u003cp\u003e\u003cstrong\u003e\u0026gt; 20%\u003c/strong\u003e\u003c/p\u003e\n \u003cp\u003e\u003cstrong\u003e\u003cem\u003eN\u003c/em\u003e\u003c/strong\u003e\u003cstrong\u003e\u0026nbsp;(%)\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 44px;\"\u003e\n \u003cp\u003e\u003cstrong\u003e\u003cem\u003ep\u003c/em\u003e\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd colspan=\"10\" valign=\"top\" style=\"width: 605px;\"\u003e\n \u003cp\u003e\u003cstrong\u003eAt 1 year\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 91px;\"\u003e\n \u003cp\u003e\u003cstrong\u003e\u0026nbsp; \u0026nbsp; \u0026nbsp; Weight maintenance\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 67px;\"\u003e\n \u003cp\u003e5 (2.2)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 63px;\"\u003e\n \u003cp\u003e218 (97.8)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd rowspan=\"3\" valign=\"top\" style=\"width: 44px;\"\u003e\n \u003cp\u003e0.004\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 63px;\"\u003e\n \u003cp\u003e3 (1.9)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 63px;\"\u003e\n \u003cp\u003e155 (98.1)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd rowspan=\"3\" valign=\"top\" style=\"width: 49px;\"\u003e\n \u003cp\u003e0.015\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 58px;\"\u003e\n \u003cp\u003e2 (3.1)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 63px;\"\u003e\n \u003cp\u003e63 (96.9)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd rowspan=\"3\" valign=\"top\" style=\"width: 44px;\"\u003e\n \u003cp\u003e0.132\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 91px;\"\u003e\n \u003cp\u003e\u003cstrong\u003e\u0026nbsp; \u0026nbsp; \u0026nbsp; Weight loss\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 67px;\"\u003e\n \u003cp\u003e8 (2.6)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 63px;\"\u003e\n \u003cp\u003e295 (97.4)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 63px;\"\u003e\n \u003cp\u003e3 (1.5)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 63px;\"\u003e\n \u003cp\u003e200 (98.5)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 58px;\"\u003e\n \u003cp\u003e5 (5.0)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 63px;\"\u003e\n \u003cp\u003e95 (95.0)\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 91px;\"\u003e\n \u003cp\u003e\u003cstrong\u003e\u0026nbsp; \u0026nbsp; \u0026nbsp; Weight gain\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 67px;\"\u003e\n \u003cp\u003e36 (6.7)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 63px;\"\u003e\n \u003cp\u003e500 (93.3)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 63px;\"\u003e\n \u003cp\u003e23 (5.7)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 63px;\"\u003e\n \u003cp\u003e383 (94.3)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 58px;\"\u003e\n \u003cp\u003e13 (10.0)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 63px;\"\u003e\n \u003cp\u003e117 (90.0)\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd colspan=\"10\" valign=\"top\" style=\"width: 605px;\"\u003e\n \u003cp\u003e\u003cstrong\u003eAt 2 years\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 91px;\"\u003e\n \u003cp\u003e\u003cstrong\u003e\u0026nbsp; \u0026nbsp; \u0026nbsp; Weight maintenance\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 67px;\"\u003e\n \u003cp\u003e7 (3.0)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 63px;\"\u003e\n \u003cp\u003e224 (97.0)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd rowspan=\"3\" valign=\"top\" style=\"width: 44px;\"\u003e\n \u003cp\u003e0.025\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 63px;\"\u003e\n \u003cp\u003e4 (2.5)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 63px;\"\u003e\n \u003cp\u003e158 (97.5)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd rowspan=\"3\" valign=\"top\" style=\"width: 49px;\"\u003e\n \u003cp\u003e0.117\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 58px;\"\u003e\n \u003cp\u003e3 (4.4)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 63px;\"\u003e\n \u003cp\u003e66 (95.6)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd rowspan=\"3\" valign=\"top\" style=\"width: 44px;\"\u003e\n \u003cp\u003e0.081\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 91px;\"\u003e\n \u003cp\u003e\u003cstrong\u003e\u0026nbsp; \u0026nbsp; \u0026nbsp; Weight loss\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 67px;\"\u003e\n \u003cp\u003e18 (5.8)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 63px;\"\u003e\n \u003cp\u003e293 (94.2)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 63px;\"\u003e\n \u003cp\u003e7 (3.4)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 63px;\"\u003e\n \u003cp\u003e201 (96.6)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 58px;\"\u003e\n \u003cp\u003e11 (10.7)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 63px;\"\u003e\n \u003cp\u003e92 (89.3)\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 91px;\"\u003e\n \u003cp\u003e\u003cstrong\u003e\u0026nbsp; \u0026nbsp; \u0026nbsp; Weight gain\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 67px;\"\u003e\n \u003cp\u003e45 (8.2)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 63px;\"\u003e\n \u003cp\u003e507 (91.8)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 63px;\"\u003e\n \u003cp\u003e25 (6.0)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 63px;\"\u003e\n \u003cp\u003e391 (94.0)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 58px;\"\u003e\n \u003cp\u003e20 (14.7)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 63px;\"\u003e\n \u003cp\u003e116 (85.3)\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd colspan=\"10\" valign=\"top\" style=\"width: 605px;\"\u003e\n \u003cp\u003e\u003cstrong\u003eEWL\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 91px;\"\u003e\n \u003cp\u003e\u003cstrong\u003e\u0026nbsp;\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 67px;\"\u003e\n \u003cp\u003e\u003cstrong\u003e\u0026le; 50%\u003c/strong\u003e\u003c/p\u003e\n \u003cp\u003e\u003cstrong\u003e\u003cem\u003eN\u003c/em\u003e\u003c/strong\u003e\u003cstrong\u003e\u0026nbsp;(%)\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 63px;\"\u003e\n \u003cp\u003e\u003cstrong\u003e\u0026gt; 50%\u003c/strong\u003e\u003c/p\u003e\n \u003cp\u003e\u003cstrong\u003e\u003cem\u003eN\u003c/em\u003e\u003c/strong\u003e\u003cstrong\u003e\u0026nbsp;(%)\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 44px;\"\u003e\n \u003cp\u003e\u003cstrong\u003e\u003cem\u003ep\u003c/em\u003e\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 63px;\"\u003e\n \u003cp\u003e\u003cstrong\u003e\u0026le; 50%\u003c/strong\u003e\u003c/p\u003e\n \u003cp\u003e\u003cstrong\u003e\u003cem\u003eN\u003c/em\u003e\u003c/strong\u003e\u003cstrong\u003e\u0026nbsp;(%)\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 63px;\"\u003e\n \u003cp\u003e\u003cstrong\u003e\u0026gt; 50%\u003c/strong\u003e\u003c/p\u003e\n \u003cp\u003e\u003cstrong\u003e\u003cem\u003eN\u003c/em\u003e\u003c/strong\u003e\u003cstrong\u003e\u0026nbsp;(%)\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 49px;\"\u003e\n \u003cp\u003e\u003cstrong\u003e\u003cem\u003ep\u003c/em\u003e\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 58px;\"\u003e\n \u003cp\u003e\u003cstrong\u003e\u0026le; 50%\u003c/strong\u003e\u003c/p\u003e\n \u003cp\u003e\u003cstrong\u003e\u003cem\u003eN\u003c/em\u003e\u003c/strong\u003e\u003cstrong\u003e\u0026nbsp;(%)\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 63px;\"\u003e\n \u003cp\u003e\u003cstrong\u003e\u0026gt; 50%\u003c/strong\u003e\u003c/p\u003e\n \u003cp\u003e\u003cstrong\u003e\u003cem\u003eN\u003c/em\u003e\u003c/strong\u003e\u003cstrong\u003e\u0026nbsp;(%)\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 44px;\"\u003e\n \u003cp\u003e\u003cstrong\u003e\u003cem\u003ep\u003c/em\u003e\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd colspan=\"10\" valign=\"top\" style=\"width: 605px;\"\u003e\n \u003cp\u003e\u003cstrong\u003eAt 1 year\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 91px;\"\u003e\n \u003cp\u003e\u003cstrong\u003e\u0026nbsp; \u0026nbsp; \u0026nbsp; Weight maintenance\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 67px;\"\u003e\n \u003cp\u003e8 (3.6)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 63px;\"\u003e\n \u003cp\u003e215 (96.4)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd rowspan=\"3\" valign=\"top\" style=\"width: 44px;\"\u003e\n \u003cp\u003e0.049\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 63px;\"\u003e\n \u003cp\u003e5 (3.2)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 63px;\"\u003e\n \u003cp\u003e153 (96.8)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd rowspan=\"3\" valign=\"top\" style=\"width: 49px;\"\u003e\n \u003cp\u003e0.130\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 58px;\"\u003e\n \u003cp\u003e3 (4.6)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 63px;\"\u003e\n \u003cp\u003e62 (95.4)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd rowspan=\"3\" valign=\"top\" style=\"width: 44px;\"\u003e\n \u003cp\u003e0.104\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 91px;\"\u003e\n \u003cp\u003e\u003cstrong\u003e\u0026nbsp; \u0026nbsp; \u0026nbsp; Weight loss\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 67px;\"\u003e\n \u003cp\u003e7 (2.3)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 63px;\"\u003e\n \u003cp\u003e296 (97.7)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 63px;\"\u003e\n \u003cp\u003e2 (1.0)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 63px;\"\u003e\n \u003cp\u003e201 (99.0)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 58px;\"\u003e\n \u003cp\u003e5 (5.0)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 63px;\"\u003e\n \u003cp\u003e95 (95.0)\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 91px;\"\u003e\n \u003cp\u003e\u003cstrong\u003e\u0026nbsp; \u0026nbsp; \u0026nbsp; Weight gain\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 67px;\"\u003e\n \u003cp\u003e31 (5.8)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 63px;\"\u003e\n \u003cp\u003e505 (94.2)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 63px;\"\u003e\n \u003cp\u003e16 (3.9)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 63px;\"\u003e\n \u003cp\u003e390 (96.1)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 58px;\"\u003e\n \u003cp\u003e15 (11.5)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 63px;\"\u003e\n \u003cp\u003e115 (88.5)\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd colspan=\"10\" valign=\"top\" style=\"width: 605px;\"\u003e\n \u003cp\u003e\u003cstrong\u003eAt 2 years\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 91px;\"\u003e\n \u003cp\u003e\u003cstrong\u003e\u0026nbsp; \u0026nbsp; \u0026nbsp; Weight maintenance\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 67px;\"\u003e\n \u003cp\u003e7 (3.0)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 63px;\"\u003e\n \u003cp\u003e224 (97.0)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd rowspan=\"3\" valign=\"top\" style=\"width: 44px;\"\u003e\n \u003cp\u003e0.074\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 63px;\"\u003e\n \u003cp\u003e4 (2.5)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 63px;\"\u003e\n \u003cp\u003e158 (97.5)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd rowspan=\"3\" valign=\"top\" style=\"width: 49px;\"\u003e\n \u003cp\u003e0.236\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 58px;\"\u003e\n \u003cp\u003e3 (4.4)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 63px;\"\u003e\n \u003cp\u003e66 (95.6)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd rowspan=\"3\" valign=\"top\" style=\"width: 44px;\"\u003e\n \u003cp\u003e0.112\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 91px;\"\u003e\n \u003cp\u003e\u003cstrong\u003e\u0026nbsp; \u0026nbsp; \u0026nbsp; Weight loss\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 67px;\"\u003e\n \u003cp\u003e18 (5.8)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 63px;\"\u003e\n \u003cp\u003e293 (94.2)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 63px;\"\u003e\n \u003cp\u003e6 (2.9)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 63px;\"\u003e\n \u003cp\u003e202 (97.1)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 58px;\"\u003e\n \u003cp\u003e12 (11.6)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 63px;\"\u003e\n \u003cp\u003e91 (88.4)\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 91px;\"\u003e\n \u003cp\u003e\u003cstrong\u003e\u0026nbsp; \u0026nbsp; \u0026nbsp; Weight gain\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 67px;\"\u003e\n \u003cp\u003e40 (7.2)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 63px;\"\u003e\n \u003cp\u003e512 (92.8)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 63px;\"\u003e\n \u003cp\u003e21 (5.0)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 63px;\"\u003e\n \u003cp\u003e395 (95.0)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 58px;\"\u003e\n \u003cp\u003e19 (14.0)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 63px;\"\u003e\n \u003cp\u003e117 (86.0)\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd colspan=\"10\" valign=\"top\" style=\"width: 605px;\"\u003e\n \u003cp\u003e\u003cstrong\u003eDiabetes\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 91px;\"\u003e\n \u003cp\u003e\u003cstrong\u003e\u0026nbsp;\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 67px;\"\u003e\n \u003cp\u003e\u003cstrong\u003eNo remission\u003c/strong\u003e\u003c/p\u003e\n \u003cp\u003e\u003cstrong\u003e\u003cem\u003eN (%)\u003c/em\u003e\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 63px;\"\u003e\n \u003cp\u003e\u003cstrong\u003eRemission\u003c/strong\u003e\u003c/p\u003e\n \u003cp\u003e\u003cstrong\u003e\u003cem\u003eN (%)\u003c/em\u003e\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 44px;\"\u003e\n \u003cp\u003e\u003cstrong\u003e\u003cem\u003ep\u003c/em\u003e\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 63px;\"\u003e\n \u003cp\u003e\u003cstrong\u003eNo remission\u003c/strong\u003e\u003c/p\u003e\n \u003cp\u003e\u003cstrong\u003e\u003cem\u003eN (%)\u003c/em\u003e\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 63px;\"\u003e\n \u003cp\u003e\u003cstrong\u003eRemission\u003c/strong\u003e\u003c/p\u003e\n \u003cp\u003e\u003cstrong\u003e\u003cem\u003eN (%)\u003c/em\u003e\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 49px;\"\u003e\n \u003cp\u003e\u003cstrong\u003e\u003cem\u003ep\u003c/em\u003e\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 58px;\"\u003e\n \u003cp\u003e\u003cstrong\u003eNo remission\u003c/strong\u003e\u003c/p\u003e\n \u003cp\u003e\u003cstrong\u003e\u003cem\u003eN (%)\u003c/em\u003e\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 63px;\"\u003e\n \u003cp\u003e\u003cstrong\u003eRemission\u003c/strong\u003e\u003c/p\u003e\n \u003cp\u003e\u003cstrong\u003e\u003cem\u003eN (%)\u003c/em\u003e\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 44px;\"\u003e\n \u003cp\u003e\u003cstrong\u003e\u003cem\u003ep\u003c/em\u003e\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd colspan=\"10\" valign=\"top\" style=\"width: 605px;\"\u003e\n \u003cp\u003e\u003cstrong\u003eAt 1 year\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 91px;\"\u003e\n \u003cp\u003e\u003cstrong\u003e\u0026nbsp; \u0026nbsp; \u0026nbsp; Weight maintenance\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 67px;\"\u003e\n \u003cp\u003e23 (52.3)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 63px;\"\u003e\n \u003cp\u003e21 (47.7)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd rowspan=\"3\" valign=\"top\" style=\"width: 44px;\"\u003e\n \u003cp\u003e0.014\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 63px;\"\u003e\n \u003cp\u003e15 (46.9)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 63px;\"\u003e\n \u003cp\u003e17 (53.1)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd rowspan=\"3\" valign=\"top\" style=\"width: 49px;\"\u003e\n \u003cp\u003e0.024\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 58px;\"\u003e\n \u003cp\u003e8 (66.7)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 63px;\"\u003e\n \u003cp\u003e4 (33.3)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd rowspan=\"3\" valign=\"top\" style=\"width: 44px;\"\u003e\n \u003cp\u003e0.409\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 91px;\"\u003e\n \u003cp\u003e\u003cstrong\u003e\u0026nbsp; \u0026nbsp; \u0026nbsp; Weight loss\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 67px;\"\u003e\n \u003cp\u003e16 (25.0)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 63px;\"\u003e\n \u003cp\u003e48 (75.0)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 63px;\"\u003e\n \u003cp\u003e8 (17.8)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 63px;\"\u003e\n \u003cp\u003e37 (82.2)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 58px;\"\u003e\n \u003cp\u003e8 (42.1)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 63px;\"\u003e\n \u003cp\u003e11 (57.9)\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 91px;\"\u003e\n \u003cp\u003e\u003cstrong\u003e\u0026nbsp; \u0026nbsp; \u0026nbsp; Weight gain\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 67px;\"\u003e\n \u003cp\u003e34 (35.0)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 63px;\"\u003e\n \u003cp\u003e63 (65.0)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 63px;\"\u003e\n \u003cp\u003e26 (32.1)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 63px;\"\u003e\n \u003cp\u003e55 (67.9)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 58px;\"\u003e\n \u003cp\u003e8 (50.0)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 63px;\"\u003e\n \u003cp\u003e8 (50.0)\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd colspan=\"10\" valign=\"top\" style=\"width: 605px;\"\u003e\n \u003cp\u003e\u003cstrong\u003eAt 2 years\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 91px;\"\u003e\n \u003cp\u003e\u003cstrong\u003e\u0026nbsp; \u0026nbsp; \u0026nbsp; Weight maintenance\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 67px;\"\u003e\n \u003cp\u003e20 (43.5)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 63px;\"\u003e\n \u003cp\u003e26 (56.5)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd rowspan=\"3\" valign=\"top\" style=\"width: 44px;\"\u003e\n \u003cp\u003e0.184\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 63px;\"\u003e\n \u003cp\u003e13 (38.2)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 63px;\"\u003e\n \u003cp\u003e21 (61.8)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd rowspan=\"3\" valign=\"top\" style=\"width: 49px;\"\u003e\n \u003cp\u003e0.149\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 58px;\"\u003e\n \u003cp\u003e7 (58.3)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 63px;\"\u003e\n \u003cp\u003e5 (41.7)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd rowspan=\"3\" valign=\"top\" style=\"width: 44px;\"\u003e\n \u003cp\u003e0.751\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 91px;\"\u003e\n \u003cp\u003e\u003cstrong\u003e\u0026nbsp; \u0026nbsp; \u0026nbsp; Weight loss\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 67px;\"\u003e\n \u003cp\u003e18 (26.9)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 63px;\"\u003e\n \u003cp\u003e49 (73.1)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 63px;\"\u003e\n \u003cp\u003e9 (19.2)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 63px;\"\u003e\n \u003cp\u003e38 (80.8)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 58px;\"\u003e\n \u003cp\u003e9 (45.0)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 63px;\"\u003e\n \u003cp\u003e11 (55.0)\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 91px;\"\u003e\n \u003cp\u003e\u003cstrong\u003e\u0026nbsp; \u0026nbsp; \u0026nbsp; Weight gain\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 67px;\"\u003e\n \u003cp\u003e34 (35.0)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 63px;\"\u003e\n \u003cp\u003e63 (65.0)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 63px;\"\u003e\n \u003cp\u003e25 (31.2)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 63px;\"\u003e\n \u003cp\u003e55 (68.8)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 58px;\"\u003e\n \u003cp\u003e9 (52.9)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 63px;\"\u003e\n \u003cp\u003e8 (47.1)\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd colspan=\"10\" valign=\"top\" style=\"width: 605px;\"\u003e\n \u003cp\u003e\u003cstrong\u003eHypertension\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 91px;\"\u003e\n \u003cp\u003e\u003cstrong\u003e\u0026nbsp;\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 67px;\"\u003e\n \u003cp\u003e\u003cstrong\u003eNo remission\u003c/strong\u003e\u003c/p\u003e\n \u003cp\u003e\u003cstrong\u003e\u003cem\u003eN (%)\u003c/em\u003e\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 63px;\"\u003e\n \u003cp\u003e\u003cstrong\u003eRemission\u003c/strong\u003e\u003c/p\u003e\n \u003cp\u003e\u003cstrong\u003e\u003cem\u003eN (%)\u003c/em\u003e\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 44px;\"\u003e\n \u003cp\u003e\u003cstrong\u003e\u003cem\u003ep\u003c/em\u003e\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 63px;\"\u003e\n \u003cp\u003e\u003cstrong\u003eNo remission\u003c/strong\u003e\u003c/p\u003e\n \u003cp\u003e\u003cstrong\u003e\u003cem\u003eN (%)\u003c/em\u003e\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 63px;\"\u003e\n \u003cp\u003e\u003cstrong\u003eRemission\u003c/strong\u003e\u003c/p\u003e\n \u003cp\u003e\u003cstrong\u003e\u003cem\u003eN (%)\u003c/em\u003e\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 49px;\"\u003e\n \u003cp\u003e\u003cstrong\u003e\u003cem\u003ep\u003c/em\u003e\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 58px;\"\u003e\n \u003cp\u003e\u003cstrong\u003eNo remission\u003c/strong\u003e\u003c/p\u003e\n \u003cp\u003e\u003cstrong\u003e\u003cem\u003eN (%)\u003c/em\u003e\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 63px;\"\u003e\n \u003cp\u003e\u003cstrong\u003eRemission\u003c/strong\u003e\u003c/p\u003e\n \u003cp\u003e\u003cstrong\u003e\u003cem\u003eN (%)\u003c/em\u003e\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 44px;\"\u003e\n \u003cp\u003e\u003cstrong\u003e\u003cem\u003ep\u003c/em\u003e\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd colspan=\"10\" valign=\"top\" style=\"width: 605px;\"\u003e\n \u003cp\u003e\u003cstrong\u003eAt 1 year\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 91px;\"\u003e\n \u003cp\u003e\u003cstrong\u003e\u0026nbsp; \u0026nbsp; \u0026nbsp; Weight maintenance\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 67px;\"\u003e\n \u003cp\u003e44 (50.0)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 63px;\"\u003e\n \u003cp\u003e44 (50.0)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd rowspan=\"3\" valign=\"top\" style=\"width: 44px;\"\u003e\n \u003cp\u003e0.811\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 63px;\"\u003e\n \u003cp\u003e28 (45.9)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 63px;\"\u003e\n \u003cp\u003e33 (54.1)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd rowspan=\"3\" valign=\"top\" style=\"width: 49px;\"\u003e\n \u003cp\u003e0.895\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 58px;\"\u003e\n \u003cp\u003e16 (59.3)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 63px;\"\u003e\n \u003cp\u003e11 (40.7)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd rowspan=\"3\" valign=\"top\" style=\"width: 44px;\"\u003e\n \u003cp\u003e0.636\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 91px;\"\u003e\n \u003cp\u003e\u003cstrong\u003e\u0026nbsp; \u0026nbsp; \u0026nbsp; Weight loss\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 67px;\"\u003e\n \u003cp\u003e62 (47.0)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 63px;\"\u003e\n \u003cp\u003e70 (53.0)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 63px;\"\u003e\n \u003cp\u003e42 (46.7)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 63px;\"\u003e\n \u003cp\u003e48 (53.3)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 58px;\"\u003e\n \u003cp\u003e20 (47.6)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 63px;\"\u003e\n \u003cp\u003e22 (52.4)\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 91px;\"\u003e\n \u003cp\u003e\u003cstrong\u003e\u0026nbsp; \u0026nbsp; \u0026nbsp; Weight gain\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 67px;\"\u003e\n \u003cp\u003e95 (45.9)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 63px;\"\u003e\n \u003cp\u003e112 (54.1)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 63px;\"\u003e\n \u003cp\u003e70 (43.8)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 63px;\"\u003e\n \u003cp\u003e90 (56.2)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 58px;\"\u003e\n \u003cp\u003e25 (53.2)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 63px;\"\u003e\n \u003cp\u003e22 (46.8)\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd colspan=\"10\" valign=\"top\" style=\"width: 605px;\"\u003e\n \u003cp\u003e\u003cstrong\u003eAt 2 years\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 91px;\"\u003e\n \u003cp\u003e\u003cstrong\u003e\u0026nbsp; \u0026nbsp; \u0026nbsp; Weight maintenance\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 67px;\"\u003e\n \u003cp\u003e40 (44.4)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 63px;\"\u003e\n \u003cp\u003e50 (55.6)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd rowspan=\"3\" valign=\"top\" style=\"width: 44px;\"\u003e\n \u003cp\u003e0.835\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 63px;\"\u003e\n \u003cp\u003e25 (39.7)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 63px;\"\u003e\n \u003cp\u003e38 (60.3)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd rowspan=\"3\" valign=\"top\" style=\"width: 49px;\"\u003e\n \u003cp\u003e0.926\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 58px;\"\u003e\n \u003cp\u003e15 (55.6)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 63px;\"\u003e\n \u003cp\u003e12 (44.4)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd rowspan=\"3\" valign=\"top\" style=\"width: 44px;\"\u003e\n \u003cp\u003e0.467\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 91px;\"\u003e\n \u003cp\u003e\u003cstrong\u003e\u0026nbsp; \u0026nbsp; \u0026nbsp; Weight loss\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 67px;\"\u003e\n \u003cp\u003e59 (44.0)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 63px;\"\u003e\n \u003cp\u003e75 (56.0)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 63px;\"\u003e\n \u003cp\u003e39 (42.9)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 63px;\"\u003e\n \u003cp\u003e52 (57.1)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 58px;\"\u003e\n \u003cp\u003e20 (46.5)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 63px;\"\u003e\n \u003cp\u003e23 (53.5)\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 91px;\"\u003e\n \u003cp\u003e\u003cstrong\u003e\u0026nbsp; \u0026nbsp; \u0026nbsp; Weight gain\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 67px;\"\u003e\n \u003cp\u003e86 (41.4)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 63px;\"\u003e\n \u003cp\u003e122 (58.6)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 63px;\"\u003e\n \u003cp\u003e66 (41.5)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 63px;\"\u003e\n \u003cp\u003e93 (58.5)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 58px;\"\u003e\n \u003cp\u003e20 (40.8)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 63px;\"\u003e\n \u003cp\u003e29 (59.2)\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd colspan=\"10\" valign=\"top\" style=\"width: 605px;\"\u003e\n \u003cp\u003e\u003cstrong\u003eDyslipidemia\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 91px;\"\u003e\n \u003cp\u003e\u003cstrong\u003e\u0026nbsp;\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 67px;\"\u003e\n \u003cp\u003e\u003cstrong\u003eNo remission\u003c/strong\u003e\u003c/p\u003e\n \u003cp\u003e\u003cstrong\u003e\u003cem\u003eN (%)\u003c/em\u003e\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 63px;\"\u003e\n \u003cp\u003e\u003cstrong\u003eRemission\u003c/strong\u003e\u003c/p\u003e\n \u003cp\u003e\u003cstrong\u003e\u003cem\u003eN (%)\u003c/em\u003e\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 44px;\"\u003e\n \u003cp\u003e\u003cstrong\u003e\u003cem\u003ep\u003c/em\u003e\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 63px;\"\u003e\n \u003cp\u003e\u003cstrong\u003eNo remission\u003c/strong\u003e\u003c/p\u003e\n \u003cp\u003e\u003cstrong\u003e\u003cem\u003eN (%)\u003c/em\u003e\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 63px;\"\u003e\n \u003cp\u003e\u003cstrong\u003eRemission\u003c/strong\u003e\u003c/p\u003e\n \u003cp\u003e\u003cstrong\u003e\u003cem\u003eN (%)\u003c/em\u003e\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 49px;\"\u003e\n \u003cp\u003e\u003cstrong\u003e\u003cem\u003ep\u003c/em\u003e\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 58px;\"\u003e\n \u003cp\u003e\u003cstrong\u003eNo remission\u003c/strong\u003e\u003c/p\u003e\n \u003cp\u003e\u003cstrong\u003e\u003cem\u003eN (%)\u003c/em\u003e\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 63px;\"\u003e\n \u003cp\u003e\u003cstrong\u003eRemission\u003c/strong\u003e\u003c/p\u003e\n \u003cp\u003e\u003cstrong\u003e\u003cem\u003eN (%)\u003c/em\u003e\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 44px;\"\u003e\n \u003cp\u003e\u003cstrong\u003e\u003cem\u003ep\u003c/em\u003e\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd colspan=\"10\" valign=\"top\" style=\"width: 605px;\"\u003e\n \u003cp\u003e\u003cstrong\u003eAt 1 year\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 91px;\"\u003e\n \u003cp\u003e\u003cstrong\u003e\u0026nbsp; \u0026nbsp; \u0026nbsp; Weight maintenance\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 67px;\"\u003e\n \u003cp\u003e33 (49.2)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 63px;\"\u003e\n \u003cp\u003e34 (50.8)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd rowspan=\"3\" valign=\"top\" style=\"width: 44px;\"\u003e\n \u003cp\u003e0.830\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 63px;\"\u003e\n \u003cp\u003e21 (44.7)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 63px;\"\u003e\n \u003cp\u003e26 (55.3)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd rowspan=\"3\" valign=\"top\" style=\"width: 49px;\"\u003e\n \u003cp\u003e0.632\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 58px;\"\u003e\n \u003cp\u003e12 (60.0)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 63px;\"\u003e\n \u003cp\u003e8 (40.0)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd rowspan=\"3\" valign=\"top\" style=\"width: 44px;\"\u003e\n \u003cp\u003e0.516\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 91px;\"\u003e\n \u003cp\u003e\u003cstrong\u003e\u0026nbsp; \u0026nbsp; \u0026nbsp; Weight loss\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 67px;\"\u003e\n \u003cp\u003e40 (46.0)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 63px;\"\u003e\n \u003cp\u003e47 (54.0)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 63px;\"\u003e\n \u003cp\u003e21 (36.2)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 63px;\"\u003e\n \u003cp\u003e37 (63.8)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 58px;\"\u003e\n \u003cp\u003e19 (65.5)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 63px;\"\u003e\n \u003cp\u003e10 (34.5)\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 91px;\"\u003e\n \u003cp\u003e\u003cstrong\u003e\u0026nbsp; \u0026nbsp; \u0026nbsp; Weight gain\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 67px;\"\u003e\n \u003cp\u003e64 (44.8)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 63px;\"\u003e\n \u003cp\u003e79 (55.2)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 63px;\"\u003e\n \u003cp\u003e46 (42.6)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 63px;\"\u003e\n \u003cp\u003e62 (57.4)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 58px;\"\u003e\n \u003cp\u003e18 (51.4)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 63px;\"\u003e\n \u003cp\u003e17 (48.6)\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd colspan=\"10\" valign=\"top\" style=\"width: 605px;\"\u003e\n \u003cp\u003e\u003cstrong\u003eAt 2 years\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 91px;\"\u003e\n \u003cp\u003e\u003cstrong\u003e\u0026nbsp; \u0026nbsp; \u0026nbsp; Weight maintenance\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 67px;\"\u003e\n \u003cp\u003e27 (39.7)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 63px;\"\u003e\n \u003cp\u003e41 (60.3)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd rowspan=\"3\" valign=\"top\" style=\"width: 44px;\"\u003e\n \u003cp\u003e0.732\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 63px;\"\u003e\n \u003cp\u003e16 (33.3)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 63px;\"\u003e\n \u003cp\u003e32 (66.7)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd rowspan=\"3\" valign=\"top\" style=\"width: 49px;\"\u003e\n \u003cp\u003e0.239\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 58px;\"\u003e\n \u003cp\u003e11 (55.0)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 63px;\"\u003e\n \u003cp\u003e9 (45.0)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd rowspan=\"3\" valign=\"top\" style=\"width: 44px;\"\u003e\n \u003cp\u003e0.450\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 91px;\"\u003e\n \u003cp\u003e\u003cstrong\u003e\u0026nbsp; \u0026nbsp; \u0026nbsp; Weight loss\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 67px;\"\u003e\n \u003cp\u003e38 (43.2)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 63px;\"\u003e\n \u003cp\u003e50 (56.8)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 63px;\"\u003e\n \u003cp\u003e19 (32.2)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 63px;\"\u003e\n \u003cp\u003e40 (67.8)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 58px;\"\u003e\n \u003cp\u003e19 (65.5)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 63px;\"\u003e\n \u003cp\u003e10 (34.5)\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 91px;\"\u003e\n \u003cp\u003e\u003cstrong\u003e\u0026nbsp; \u0026nbsp; \u0026nbsp; Weight gain\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 67px;\"\u003e\n \u003cp\u003e65 (45.4)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 63px;\"\u003e\n \u003cp\u003e78 (54.6)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 63px;\"\u003e\n \u003cp\u003e47 (43.9)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 63px;\"\u003e\n \u003cp\u003e60 (56.1)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 58px;\"\u003e\n \u003cp\u003e18 (50.0)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 63px;\"\u003e\n \u003cp\u003e18 (50.0)\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd colspan=\"10\" valign=\"top\" style=\"width: 605px;\"\u003e\n \u003cp\u003e\u003cstrong\u003eOSA\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 91px;\"\u003e\n \u003cp\u003e\u003cstrong\u003e\u0026nbsp;\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 67px;\"\u003e\n \u003cp\u003e\u003cstrong\u003eNo remission\u003c/strong\u003e\u003c/p\u003e\n \u003cp\u003e\u003cstrong\u003e\u003cem\u003eN (%)\u003c/em\u003e\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 63px;\"\u003e\n \u003cp\u003e\u003cstrong\u003eRemission\u003c/strong\u003e\u003c/p\u003e\n \u003cp\u003e\u003cstrong\u003e\u003cem\u003eN (%)\u003c/em\u003e\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 44px;\"\u003e\n \u003cp\u003e\u003cstrong\u003e\u003cem\u003ep\u003c/em\u003e\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 63px;\"\u003e\n \u003cp\u003e\u003cstrong\u003eNo remission\u003c/strong\u003e\u003c/p\u003e\n \u003cp\u003e\u003cstrong\u003e\u003cem\u003eN (%)\u003c/em\u003e\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 63px;\"\u003e\n \u003cp\u003e\u003cstrong\u003eRemission\u003c/strong\u003e\u003c/p\u003e\n \u003cp\u003e\u003cstrong\u003e\u003cem\u003eN (%)\u003c/em\u003e\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 49px;\"\u003e\n \u003cp\u003e\u003cstrong\u003e\u003cem\u003ep\u003c/em\u003e\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 58px;\"\u003e\n \u003cp\u003e\u003cstrong\u003eNo remission\u003c/strong\u003e\u003c/p\u003e\n \u003cp\u003e\u003cstrong\u003e\u003cem\u003eN (%)\u003c/em\u003e\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 63px;\"\u003e\n \u003cp\u003e\u003cstrong\u003eRemission\u003c/strong\u003e\u003c/p\u003e\n \u003cp\u003e\u003cstrong\u003e\u003cem\u003eN (%)\u003c/em\u003e\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 44px;\"\u003e\n \u003cp\u003e\u003cstrong\u003e\u003cem\u003ep\u003c/em\u003e\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd colspan=\"10\" valign=\"top\" style=\"width: 605px;\"\u003e\n \u003cp\u003e\u003cstrong\u003eAt 1 year\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 91px;\"\u003e\n \u003cp\u003e\u003cstrong\u003e\u0026nbsp; \u0026nbsp; \u0026nbsp; Weight maintenance\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 67px;\"\u003e\n \u003cp\u003e8 (33.3)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 63px;\"\u003e\n \u003cp\u003e16 (66.7)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd rowspan=\"3\" valign=\"top\" style=\"width: 44px;\"\u003e\n \u003cp\u003e0.984\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 63px;\"\u003e\n \u003cp\u003e3 (23.1)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 63px;\"\u003e\n \u003cp\u003e10 (76.9)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd rowspan=\"3\" valign=\"top\" style=\"width: 49px;\"\u003e\n \u003cp\u003e0.826\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 58px;\"\u003e\n \u003cp\u003e5 (45.4)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 63px;\"\u003e\n \u003cp\u003e6 (54.6)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd rowspan=\"3\" valign=\"top\" style=\"width: 44px;\"\u003e\n \u003cp\u003e0.694\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 91px;\"\u003e\n \u003cp\u003e\u003cstrong\u003e\u0026nbsp; \u0026nbsp; \u0026nbsp; Weight loss\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 67px;\"\u003e\n \u003cp\u003e12 (31.6)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 63px;\"\u003e\n \u003cp\u003e26 (68.4)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 63px;\"\u003e\n \u003cp\u003e8 (32.0)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 63px;\"\u003e\n \u003cp\u003e17 (68.0)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 58px;\"\u003e\n \u003cp\u003e4 (30.8)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 63px;\"\u003e\n \u003cp\u003e9 (69.2)\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 91px;\"\u003e\n \u003cp\u003e\u003cstrong\u003e\u0026nbsp; \u0026nbsp; \u0026nbsp; Weight gain\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 67px;\"\u003e\n \u003cp\u003e22 (31.4)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 63px;\"\u003e\n \u003cp\u003e48 (68.6)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 63px;\"\u003e\n \u003cp\u003e16 (31.4)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 63px;\"\u003e\n \u003cp\u003e35 (68.6)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 58px;\"\u003e\n \u003cp\u003e6 (31.6)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 63px;\"\u003e\n \u003cp\u003e13 (68.4)\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd colspan=\"10\" valign=\"top\" style=\"width: 605px;\"\u003e\n \u003cp\u003e\u003cstrong\u003eAt 2 years\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 91px;\"\u003e\n \u003cp\u003e\u003cstrong\u003e\u0026nbsp; \u0026nbsp; \u0026nbsp; Weight maintenance\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 67px;\"\u003e\n \u003cp\u003e8 (30.8)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 63px;\"\u003e\n \u003cp\u003e18 (69.2)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd rowspan=\"3\" valign=\"top\" style=\"width: 44px;\"\u003e\n \u003cp\u003e0.924\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 63px;\"\u003e\n \u003cp\u003e3 (20.0)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 63px;\"\u003e\n \u003cp\u003e12 (80.0)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd rowspan=\"3\" valign=\"top\" style=\"width: 49px;\"\u003e\n \u003cp\u003e0.778\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 58px;\"\u003e\n \u003cp\u003e5 (45.4)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 63px;\"\u003e\n \u003cp\u003e6 (54.6)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd rowspan=\"3\" valign=\"top\" style=\"width: 44px;\"\u003e\n \u003cp\u003e0.502\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 91px;\"\u003e\n \u003cp\u003e\u003cstrong\u003e\u0026nbsp; \u0026nbsp; \u0026nbsp; Weight loss\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 67px;\"\u003e\n \u003cp\u003e10 (26.3)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 63px;\"\u003e\n \u003cp\u003e28 (73.7)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 63px;\"\u003e\n \u003cp\u003e6 (24.0)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 63px;\"\u003e\n \u003cp\u003e19 (76.0)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 58px;\"\u003e\n \u003cp\u003e4 (30.8)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 63px;\"\u003e\n \u003cp\u003e9 (69.2)\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 91px;\"\u003e\n \u003cp\u003e\u003cstrong\u003e\u0026nbsp; \u0026nbsp; \u0026nbsp; Weight gain\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 67px;\"\u003e\n \u003cp\u003e19 (27.5)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 63px;\"\u003e\n \u003cp\u003e50 (72.5)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 63px;\"\u003e\n \u003cp\u003e14 (28.6)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 63px;\"\u003e\n \u003cp\u003e35 (71.4)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 58px;\"\u003e\n \u003cp\u003e5 (25.0)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 63px;\"\u003e\n \u003cp\u003e15 (75.0)\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003c/tbody\u003e\n\u003c/table\u003e\n\u003cp\u003eEWL \u0026ndash; percentage of excessive weight loss; OSA \u0026ndash; obstructive sleep apnea; TWL \u0026ndash; percentage of total weight loss.\u003c/p\u003e\n\u003cp\u003e\u0026nbsp;\u003c/p\u003e\n\u003cp\u003eTable 3. Crude and adjusted associations between preoperative weight trajectory and postoperative weight outcomes at 2 years.\u003c/p\u003e\n\u003ctable border=\"1\" cellspacing=\"0\" cellpadding=\"0\" width=\"100%\"\u003e\n \u003ctbody\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 90px;\"\u003e\n \u003cp\u003e\u003cstrong\u003e\u0026nbsp;\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd colspan=\"2\" style=\"width: 172px;\"\u003e\n \u003cp\u003e\u003cstrong\u003eTotal\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd colspan=\"2\" style=\"width: 175px;\"\u003e\n \u003cp\u003e\u003cstrong\u003eRYGB\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd colspan=\"2\" style=\"width: 172px;\"\u003e\n \u003cp\u003e\u003cstrong\u003eSleeve\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 90px;\"\u003e\n \u003cp\u003e\u003cstrong\u003e\u0026nbsp;\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 86px;\"\u003e\n \u003cp\u003e\u003cstrong\u003eCrude OR\u003c/strong\u003e\u003c/p\u003e\n \u003cp\u003e\u003cstrong\u003e(95%CI)\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 86px;\"\u003e\n \u003cp\u003e\u003cstrong\u003eAdjusted* OR\u003c/strong\u003e\u003c/p\u003e\n \u003cp\u003e\u003cstrong\u003e(95%CI)\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 86px;\"\u003e\n \u003cp\u003e\u003cstrong\u003eCrude OR\u003c/strong\u003e\u003c/p\u003e\n \u003cp\u003e\u003cstrong\u003e(95%CI)\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 89px;\"\u003e\n \u003cp\u003e\u003cstrong\u003eAdjusted* OR\u003c/strong\u003e\u003c/p\u003e\n \u003cp\u003e\u003cstrong\u003e(95%CI)\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 86px;\"\u003e\n \u003cp\u003e\u003cstrong\u003eCrude OR\u003c/strong\u003e\u003c/p\u003e\n \u003cp\u003e\u003cstrong\u003e(95%CI)\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 86px;\"\u003e\n \u003cp\u003e\u003cstrong\u003eAdjusted* OR\u003c/strong\u003e\u003c/p\u003e\n \u003cp\u003e\u003cstrong\u003e(95%CI)\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd colspan=\"7\" valign=\"top\" style=\"width: 609px;\"\u003e\n \u003cp\u003e\u003cstrong\u003eTWL at 2 years \u0026gt; 20%\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 90px;\"\u003e\n \u003cp\u003e\u003cstrong\u003eWeight maintenance\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 86px;\"\u003e\n \u003cp\u003e1 [ref]\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 86px;\"\u003e\n \u003cp\u003e1 [ref]\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 86px;\"\u003e\n \u003cp\u003e1 [ref]\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 89px;\"\u003e\n \u003cp\u003e1 [ref]\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 86px;\"\u003e\n \u003cp\u003e1 [ref]\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 86px;\"\u003e\n \u003cp\u003e1 [ref]\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 90px;\"\u003e\n \u003cp\u003e\u003cstrong\u003eWeight loss\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 86px;\"\u003e\n \u003cp\u003e0.51 (0.21-1.24)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 86px;\"\u003e\n \u003cp\u003e0.57 (0.23-1.41)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 86px;\"\u003e\n \u003cp\u003e0.73 (0.21-2.53)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 89px;\"\u003e\n \u003cp\u003e0.85 (0.23-3.08)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 86px;\"\u003e\n \u003cp\u003e0.38 (0.10-1.42)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 86px;\"\u003e\n \u003cp\u003e0.40 (0.11-1.53)\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 90px;\"\u003e\n \u003cp\u003e\u003cstrong\u003eWeight gain\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 86px;\"\u003e\n \u003cp\u003e0.35 (0.16-0.79)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 86px;\"\u003e\n \u003cp\u003e0.41 (0.18-0.93)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 86px;\"\u003e\n \u003cp\u003e0.40 (0.14-1.16)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 89px;\"\u003e\n \u003cp\u003e0.48 (0.16-1.44)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 86px;\"\u003e\n \u003cp\u003e0.26 (0.08-0.92)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 86px;\"\u003e\n \u003cp\u003e0.32 (0.09-1.14)\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd colspan=\"7\" valign=\"top\" style=\"width: 609px;\"\u003e\n \u003cp\u003e\u003cstrong\u003eEWL at 2 years \u0026gt; 50%\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 90px;\"\u003e\n \u003cp\u003e\u003cstrong\u003eWeight maintenance\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 86px;\"\u003e\n \u003cp\u003e1 [ref]\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 86px;\"\u003e\n \u003cp\u003e1 [ref]\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 86px;\"\u003e\n \u003cp\u003e1 [ref]\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 89px;\"\u003e\n \u003cp\u003e1 [ref]\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 86px;\"\u003e\n \u003cp\u003e1 [ref]\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 86px;\"\u003e\n \u003cp\u003e1 [ref]\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 90px;\"\u003e\n \u003cp\u003e\u003cstrong\u003eWeight loss\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 86px;\"\u003e\n \u003cp\u003e0.51 (0.21-1.24)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 86px;\"\u003e\n \u003cp\u003e0.61 (0.25-1.50)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 86px;\"\u003e\n \u003cp\u003e0.85 (0.24-3.07)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 89px;\"\u003e\n \u003cp\u003e1.02 (0.28-3.76)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 86px;\"\u003e\n \u003cp\u003e0.34 (0.09-1.27)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 86px;\"\u003e\n \u003cp\u003e0.40 (0.11-1.52)\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 90px;\"\u003e\n \u003cp\u003e\u003cstrong\u003eWeight gain\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 86px;\"\u003e\n \u003cp\u003e0.40 (0.18-0.91)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 86px;\"\u003e\n \u003cp\u003e0.41 (0.18-0.95)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 86px;\"\u003e\n \u003cp\u003e0.48 (0.16-1.41)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 89px;\"\u003e\n \u003cp\u003e0.50 (0.17-1.51)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 86px;\"\u003e\n \u003cp\u003e0.28 (0.08-0.98)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 86px;\"\u003e\n \u003cp\u003e0.31 (0.08-1.10)\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd colspan=\"7\" valign=\"top\" style=\"width: 609px;\"\u003e\n \u003cp\u003e\u003cstrong\u003ePost-operative weight loss percentage at 2 years\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 90px;\"\u003e\n \u003cp\u003e\u003cstrong\u003e\u0026nbsp;\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 86px;\"\u003e\n \u003cp\u003e\u003cstrong\u003eCrude \u0026beta;\u003c/strong\u003e\u003c/p\u003e\n \u003cp\u003e\u003cstrong\u003e(95%CI)\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 86px;\"\u003e\n \u003cp\u003e\u003cstrong\u003eAdjusted* \u0026beta;\u003c/strong\u003e\u003c/p\u003e\n \u003cp\u003e\u003cstrong\u003e(95%CI)\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 86px;\"\u003e\n \u003cp\u003e\u003cstrong\u003eCrude \u0026beta;\u003c/strong\u003e\u003c/p\u003e\n \u003cp\u003e\u003cstrong\u003e(95%CI)\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 89px;\"\u003e\n \u003cp\u003e\u003cstrong\u003eAdjusted* \u0026beta;\u003c/strong\u003e\u003c/p\u003e\n \u003cp\u003e\u003cstrong\u003e(95%CI)\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 86px;\"\u003e\n \u003cp\u003e\u003cstrong\u003eCrude \u0026beta;\u003c/strong\u003e\u003c/p\u003e\n \u003cp\u003e\u003cstrong\u003e(95%CI)\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 86px;\"\u003e\n \u003cp\u003e\u003cstrong\u003eAdjusted* \u0026beta;\u003c/strong\u003e\u003c/p\u003e\n \u003cp\u003e\u003cstrong\u003e(95%CI)\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 90px;\"\u003e\n \u003cp\u003e\u003cstrong\u003ePre-operative weight loss percentage\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 86px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003cp\u003e0.182 (0.103, 0.260)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 86px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003cp\u003e0.116 (0.040, 0.191)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 86px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003cp\u003e0.155 (0.070, 0.240)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 89px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003cp\u003e0.075 (-0.007, 0.157)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 86px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003cp\u003e0.290 (0.132, 0.449)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 86px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003cp\u003e0.224 (0.071, 0.377)\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003c/tbody\u003e\n\u003c/table\u003e\n\u003cp\u003eEWL \u0026ndash; percentage of excessive weight loss; RYGB \u0026ndash; Roux en Y gastric bypass; TWL \u0026ndash; percentage of total weight loss.\u003c/p\u003e\n\u003cp\u003e\u0026nbsp;\u003c/p\u003e\n\u003cp\u003eTable 4. Optimal cutoffs for preoperative weight loss and weight gain.\u003c/p\u003e\n\u003ctable border=\"1\" cellspacing=\"0\" cellpadding=\"0\" width=\"100%\"\u003e\n \u003ctbody\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 113px;\"\u003e\n \u003cp\u003e\u003cstrong\u003e\u0026nbsp;\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 85px;\"\u003e\n \u003cp\u003e\u003cstrong\u003eOptimal\u003c/strong\u003e\u003c/p\u003e\n \u003cp\u003e\u003cstrong\u003ecutpoint\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 105px;\"\u003e\n \u003cp\u003e\u003cstrong\u003eYouden index\u003c/strong\u003e\u003c/p\u003e\n \u003cp\u003e\u003cstrong\u003e(SE)\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 102px;\"\u003e\n \u003cp\u003e\u003cstrong\u003eSensitivity\u003c/strong\u003e\u003c/p\u003e\n \u003cp\u003e\u003cstrong\u003eat cutpoint\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 102px;\"\u003e\n \u003cp\u003e\u003cstrong\u003eSpecificity\u003c/strong\u003e\u003c/p\u003e\n \u003cp\u003e\u003cstrong\u003eat cutpoint\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 95px;\"\u003e\n \u003cp\u003e\u003cstrong\u003eAUC\u003c/strong\u003e\u003c/p\u003e\n \u003cp\u003e\u003cstrong\u003eat cutpoint\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd colspan=\"6\" valign=\"top\" style=\"width: 603px;\"\u003e\n \u003cp\u003e\u003cstrong\u003eTWL\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd colspan=\"6\" valign=\"top\" style=\"width: 603px;\"\u003e\n \u003cp\u003e\u003cstrong\u003eAt 1 year\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 113px;\"\u003e\n \u003cp\u003e\u003cstrong\u003e\u0026nbsp; \u0026nbsp; \u0026nbsp; Weight loss (%)\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 85px;\"\u003e\n \u003cp\u003e1.96\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 105px;\"\u003e\n \u003cp\u003e0.228 (0.1735)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 102px;\"\u003e\n \u003cp\u003e0.60\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 102px;\"\u003e\n \u003cp\u003e0.63\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 95px;\"\u003e\n \u003cp\u003e0.61\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 113px;\"\u003e\n \u003cp\u003e\u003cstrong\u003e\u0026nbsp; \u0026nbsp; \u0026nbsp; Weight gain (%)\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 85px;\"\u003e\n \u003cp\u003e4.59\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 105px;\"\u003e\n \u003cp\u003e0.267 (0.0816)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 102px;\"\u003e\n \u003cp\u003e0.60\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 102px;\"\u003e\n \u003cp\u003e0.67\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 95px;\"\u003e\n \u003cp\u003e0.63\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd colspan=\"6\" valign=\"top\" style=\"width: 603px;\"\u003e\n \u003cp\u003e\u003cstrong\u003eAt 2 years\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 113px;\"\u003e\n \u003cp\u003e\u003cstrong\u003e\u0026nbsp; \u0026nbsp; \u0026nbsp; Weight loss (%)\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 85px;\"\u003e\n \u003cp\u003e10.91\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 105px;\"\u003e\n \u003cp\u003e0.099 (0.0174)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 102px;\"\u003e\n \u003cp\u003e0.10\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 102px;\"\u003e\n \u003cp\u003e1.00\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 95px;\"\u003e\n \u003cp\u003e0.55\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 113px;\"\u003e\n \u003cp\u003e\u003cstrong\u003e\u0026nbsp; \u0026nbsp; \u0026nbsp; Weight gain (%)\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 85px;\"\u003e\n \u003cp\u003e6.67\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 105px;\"\u003e\n \u003cp\u003e0.220 (0.0768)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 102px;\"\u003e\n \u003cp\u003e0.75\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 102px;\"\u003e\n \u003cp\u003e0.47\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 95px;\"\u003e\n \u003cp\u003e0.61\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd colspan=\"6\" valign=\"top\" style=\"width: 603px;\"\u003e\n \u003cp\u003e\u003cstrong\u003eEWL\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd colspan=\"6\" valign=\"top\" style=\"width: 603px;\"\u003e\n \u003cp\u003e\u003cstrong\u003eAt 1 year\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 113px;\"\u003e\n \u003cp\u003e\u003cstrong\u003e\u0026nbsp; \u0026nbsp; \u0026nbsp; Weight loss (%)\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 85px;\"\u003e\n \u003cp\u003e1.23\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 105px;\"\u003e\n \u003cp\u003e0.573 (0.1348)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 102px;\"\u003e\n \u003cp\u003e0.72\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 102px;\"\u003e\n \u003cp\u003e0.86\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 95px;\"\u003e\n \u003cp\u003e0.79\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 113px;\"\u003e\n \u003cp\u003e\u003cstrong\u003e\u0026nbsp; \u0026nbsp; \u0026nbsp; Weight gain (%)\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 85px;\"\u003e\n \u003cp\u003e6.93\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 105px;\"\u003e\n \u003cp\u003e0.279 (0.0917)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 102px;\"\u003e\n \u003cp\u003e0.76\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 102px;\"\u003e\n \u003cp\u003e0.52\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 95px;\"\u003e\n \u003cp\u003e0.64\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd colspan=\"6\" valign=\"top\" style=\"width: 603px;\"\u003e\n \u003cp\u003e\u003cstrong\u003eAt 2 years\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 113px;\"\u003e\n \u003cp\u003e\u003cstrong\u003e\u0026nbsp; \u0026nbsp; \u0026nbsp; Weight loss (%)\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 85px;\"\u003e\n \u003cp\u003e4.96\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 105px;\"\u003e\n \u003cp\u003e0.092 (0.1017)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 102px;\"\u003e\n \u003cp\u003e0.31\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 102px;\"\u003e\n \u003cp\u003e0.78\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 95px;\"\u003e\n \u003cp\u003e0.55\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 113px;\"\u003e\n \u003cp\u003e\u003cstrong\u003e\u0026nbsp; \u0026nbsp; \u0026nbsp; Weight gain (%)\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 85px;\"\u003e\n \u003cp\u003e5.51\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 105px;\"\u003e\n \u003cp\u003e0.228 (0.0813)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 102px;\"\u003e\n \u003cp\u003e0.68\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 102px;\"\u003e\n \u003cp\u003e0.55\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 95px;\"\u003e\n \u003cp\u003e0.61\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd colspan=\"6\" valign=\"top\" style=\"width: 603px;\"\u003e\n \u003cp\u003e\u003cstrong\u003eDiabetes\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd colspan=\"6\" valign=\"top\" style=\"width: 603px;\"\u003e\n \u003cp\u003e\u003cstrong\u003eAt 1 year\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 113px;\"\u003e\n \u003cp\u003e\u003cstrong\u003e\u0026nbsp; \u0026nbsp; \u0026nbsp; Weight loss (%)\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 85px;\"\u003e\n \u003cp\u003e0.83\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 105px;\"\u003e\n \u003cp\u003e0.208 (0.1120)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 102px;\"\u003e\n \u003cp\u003e0.96\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 102px;\"\u003e\n \u003cp\u003e0.25\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 95px;\"\u003e\n \u003cp\u003e0.60\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 113px;\"\u003e\n \u003cp\u003e\u003cstrong\u003e\u0026nbsp; \u0026nbsp; \u0026nbsp; Weight gain (%)\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 85px;\"\u003e\n \u003cp\u003e18.00\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 105px;\"\u003e\n \u003cp\u003e0.029 (0.0290)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 102px;\"\u003e\n \u003cp\u003e1.00\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 102px;\"\u003e\n \u003cp\u003e0.03\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 95px;\"\u003e\n \u003cp\u003e0.51\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd colspan=\"6\" valign=\"top\" style=\"width: 603px;\"\u003e\n \u003cp\u003e\u003cstrong\u003eAt 2 years\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 113px;\"\u003e\n \u003cp\u003e\u003cstrong\u003e\u0026nbsp; \u0026nbsp; \u0026nbsp; Weight loss (%)\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 85px;\"\u003e\n \u003cp\u003e2.45\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 105px;\"\u003e\n \u003cp\u003e0.185 (0.1285)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 102px;\"\u003e\n \u003cp\u003e0.80\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 102px;\"\u003e\n \u003cp\u003e0.39\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 95px;\"\u003e\n \u003cp\u003e0.59\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 113px;\"\u003e\n \u003cp\u003e\u003cstrong\u003e\u0026nbsp; \u0026nbsp; \u0026nbsp; Weight gain (%)\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 85px;\"\u003e\n \u003cp\u003e18.00\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 105px;\"\u003e\n \u003cp\u003e0.014 (0.0330)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 102px;\"\u003e\n \u003cp\u003e0.98\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 102px;\"\u003e\n \u003cp\u003e0.03\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 95px;\"\u003e\n \u003cp\u003e0.51\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd colspan=\"6\" valign=\"top\" style=\"width: 603px;\"\u003e\n \u003cp\u003e\u003cstrong\u003eHypertension\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd colspan=\"6\" valign=\"top\" style=\"width: 603px;\"\u003e\n \u003cp\u003e\u003cstrong\u003eAt 1 year\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 113px;\"\u003e\n \u003cp\u003e\u003cstrong\u003e\u0026nbsp; \u0026nbsp; \u0026nbsp; Weight loss (%)\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 85px;\"\u003e\n \u003cp\u003e2.66\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 105px;\"\u003e\n \u003cp\u003e0.132 (0.0863)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 102px;\"\u003e\n \u003cp\u003e0.60\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 102px;\"\u003e\n \u003cp\u003e0.53\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 95px;\"\u003e\n \u003cp\u003e0.57\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 113px;\"\u003e\n \u003cp\u003e\u003cstrong\u003e\u0026nbsp; \u0026nbsp; \u0026nbsp; Weight gain (%)\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 85px;\"\u003e\n \u003cp\u003e6.15\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 105px;\"\u003e\n \u003cp\u003e0.094 (0.0625)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 102px;\"\u003e\n \u003cp\u003e0.77\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 102px;\"\u003e\n \u003cp\u003e0.33\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 95px;\"\u003e\n \u003cp\u003e0.55\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd colspan=\"6\" valign=\"top\" style=\"width: 603px;\"\u003e\n \u003cp\u003e\u003cstrong\u003eAt 2 years\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 113px;\"\u003e\n \u003cp\u003e\u003cstrong\u003e\u0026nbsp; \u0026nbsp; \u0026nbsp; Weight loss (%)\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 85px;\"\u003e\n \u003cp\u003e1.83\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 105px;\"\u003e\n \u003cp\u003e0.127 (0.0823)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 102px;\"\u003e\n \u003cp\u003e0.72\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 102px;\"\u003e\n \u003cp\u003e0.41\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 95px;\"\u003e\n \u003cp\u003e0.56\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 113px;\"\u003e\n \u003cp\u003e\u003cstrong\u003e\u0026nbsp; \u0026nbsp; \u0026nbsp; Weight gain (%)\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 85px;\"\u003e\n \u003cp\u003e17.35\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 105px;\"\u003e\n \u003cp\u003e0.050 (0.0265)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 102px;\"\u003e\n \u003cp\u003e0.99\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 102px;\"\u003e\n \u003cp\u003e0.06\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 95px;\"\u003e\n \u003cp\u003e0.52\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd colspan=\"6\" valign=\"top\" style=\"width: 603px;\"\u003e\n \u003cp\u003e\u003cstrong\u003eDyslipidemia\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd colspan=\"6\" valign=\"top\" style=\"width: 603px;\"\u003e\n \u003cp\u003e\u003cstrong\u003eAt 1 year\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 113px;\"\u003e\n \u003cp\u003e\u003cstrong\u003e\u0026nbsp; \u0026nbsp; \u0026nbsp; Weight loss (%)\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 85px;\"\u003e\n \u003cp\u003e1.77\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 105px;\"\u003e\n \u003cp\u003e0.252 (0.1031)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 102px;\"\u003e\n \u003cp\u003e0.70\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 102px;\"\u003e\n \u003cp\u003e0.55\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 95px;\"\u003e\n \u003cp\u003e0.63\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 113px;\"\u003e\n \u003cp\u003e\u003cstrong\u003e\u0026nbsp; \u0026nbsp; \u0026nbsp; Weight gain (%)\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 85px;\"\u003e\n \u003cp\u003e18.00\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 105px;\"\u003e\n \u003cp\u003e0.034 (0.0293)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 102px;\"\u003e\n \u003cp\u003e0.99\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 102px;\"\u003e\n \u003cp\u003e0.05\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 95px;\"\u003e\n \u003cp\u003e0.52\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd colspan=\"6\" valign=\"top\" style=\"width: 603px;\"\u003e\n \u003cp\u003e\u003cstrong\u003eAt 2 years\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 113px;\"\u003e\n \u003cp\u003e\u003cstrong\u003e\u0026nbsp; \u0026nbsp; \u0026nbsp; Weight loss (%)\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 85px;\"\u003e\n \u003cp\u003e1.77\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 105px;\"\u003e\n \u003cp\u003e0.206 (0.1045)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 102px;\"\u003e\n \u003cp\u003e0.68\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 102px;\"\u003e\n \u003cp\u003e0.53\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 95px;\"\u003e\n \u003cp\u003e0.60\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 113px;\"\u003e\n \u003cp\u003e\u003cstrong\u003e\u0026nbsp; \u0026nbsp; \u0026nbsp; Weight gain (%)\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 85px;\"\u003e\n \u003cp\u003e18.00\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 105px;\"\u003e\n \u003cp\u003e0.049 (0.0324)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 102px;\"\u003e\n \u003cp\u003e0.99\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 102px;\"\u003e\n \u003cp\u003e0.06\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 95px;\"\u003e\n \u003cp\u003e0.52\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd colspan=\"6\" valign=\"top\" style=\"width: 603px;\"\u003e\n \u003cp\u003e\u003cstrong\u003eOSA\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd colspan=\"6\" valign=\"top\" style=\"width: 603px;\"\u003e\n \u003cp\u003e\u003cstrong\u003eAt 1 year\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 113px;\"\u003e\n \u003cp\u003e\u003cstrong\u003e\u0026nbsp; \u0026nbsp; \u0026nbsp; Weight loss (%)\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 85px;\"\u003e\n \u003cp\u003e0.48\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 105px;\"\u003e\n \u003cp\u003e0.256 (0.1458)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 102px;\"\u003e\n \u003cp\u003e0.92\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 102px;\"\u003e\n \u003cp\u003e0.33\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 95px;\"\u003e\n \u003cp\u003e0.63\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 113px;\"\u003e\n \u003cp\u003e\u003cstrong\u003e\u0026nbsp; \u0026nbsp; \u0026nbsp; Weight gain (%)\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 85px;\"\u003e\n \u003cp\u003e7.22\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 105px;\"\u003e\n \u003cp\u003e0.061 (0.1043)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 102px;\"\u003e\n \u003cp\u003e0.83\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 102px;\"\u003e\n \u003cp\u003e0.23\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 95px;\"\u003e\n \u003cp\u003e0.53\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd colspan=\"6\" valign=\"top\" style=\"width: 603px;\"\u003e\n \u003cp\u003e\u003cstrong\u003eAt 2 years\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 113px;\"\u003e\n \u003cp\u003e\u003cstrong\u003e\u0026nbsp; \u0026nbsp; \u0026nbsp; Weight loss (%)\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 85px;\"\u003e\n \u003cp\u003e0.48\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 105px;\"\u003e\n \u003cp\u003e0.329 (0.1624)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 102px;\"\u003e\n \u003cp\u003e0.93\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 102px;\"\u003e\n \u003cp\u003e0.40\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 95px;\"\u003e\n \u003cp\u003e0.66\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 113px;\"\u003e\n \u003cp\u003e\u003cstrong\u003e\u0026nbsp; \u0026nbsp; \u0026nbsp; Weight gain (%)\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 85px;\"\u003e\n \u003cp\u003e0.41\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 105px;\"\u003e\n \u003cp\u003e0.040 (0.0277)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 102px;\"\u003e\n \u003cp\u003e0.04\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 102px;\"\u003e\n \u003cp\u003e1.00\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 95px;\"\u003e\n \u003cp\u003e0.52\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003c/tbody\u003e\n\u003c/table\u003e\n\u003cp\u003eAUC \u0026ndash; area under the curve; EWL \u0026ndash; percentage of excessive weight loss; OSA \u0026ndash; obstructive sleep apnea; TWL \u0026ndash; percentage of total weight loss.\u003c/p\u003e"}],"fulltextSource":"","fullText":"","funders":[],"hasAdminPriorityOnWorkflow":false,"hasManuscriptDocX":true,"hasOptedInToPreprint":true,"hasPassedJournalQc":"","hasAnyPriority":false,"hideJournal":false,"highlight":"","institution":"","isAcceptedByJournal":false,"isAuthorSuppliedPdf":false,"isDeskRejected":"","isHiddenFromSearch":false,"isInQc":false,"isInWorkflow":false,"isPdf":false,"isPdfUpToDate":true,"isWithdrawnOrRetracted":false,"journal":{"display":true,"email":"[email protected]","identity":"obesity-surgery","isNatureJournal":false,"hasQc":true,"allowDirectSubmit":false,"externalIdentity":"obsu","sideBox":"Learn more about [Obesity Surgery](https://link.springer.com/journal/11695)","snPcode":"11695","submissionUrl":"https://submission.springernature.com/new-submission/11695/3","title":"Obesity Surgery","twitterHandle":"","acdcEnabled":true,"dfaEnabled":true,"editorialSystem":"stoa","reportingPortfolio":"Springer Hybrid","inReviewEnabled":true,"inReviewRevisionsEnabled":false},"keywords":"","lastPublishedDoi":"10.21203/rs.3.rs-9313191/v1","lastPublishedDoiUrl":"https://doi.org/10.21203/rs.3.rs-9313191/v1","license":{"name":"CC BY 4.0","url":"https://creativecommons.org/licenses/by/4.0/"},"manuscriptAbstract":"\u003cp\u003eBackground and objectives:\u003c/p\u003e\n\u003cp\u003ePreoperative weight loss remains controversial before metabolic and bariatric surgery, and its impact on postoperative outcomes is not clearly established. Most studies focus exclusively on preoperative weight loss, with limited evaluation of preoperative weight gain and objective thresholds for clinically meaningful weight variation. This study aimed to evaluate the association between preoperative weight variation—maintenance, loss, or gain—and postoperative outcomes, and to identify clinically relevant cutoffs for both minimum beneficial weight loss and maximum tolerable weight gain.\u003c/p\u003e\n\u003cp\u003eMaterials and Methods:\u003c/p\u003e\n\u003cp\u003eWe conducted a retrospective cohort study including patients who underwent Roux-en-Y gastric bypass (RYGB) or sleeve gastrectomy (SG), with follow-up to two years. Patients were stratified according to preoperative weight variation. Primary outcomes were total weight loss (TWL) \u0026gt;20% and excess weight loss (EWL) \u0026gt;50% at 1 and 2 years. Secondary outcomes included remission of obesity-related comorbidities and determination of optimal thresholds for preoperative weight change using receiver operating characteristic (ROC) analysis and the Youden index.\u003c/p\u003e\n\u003cp\u003eResults:\u003c/p\u003e\n\u003cp\u003eA total of 1,094 patients were included, of whom 82.2% were female. The median presurgical body mass index was 41.6 kg/m², and 71.8% underwent RYGB. At two years, patients who maintained their weight preoperatively had the highest success rates (97% achieved TWL \u0026gt;20%, p=0.025). Preoperative weight gain was independently associated with a lower likelihood of achieving both TWL \u0026gt;20% (adjusted OR 0.41; 95% CI 0.18–0.93) and EWL \u0026gt;50% (adjusted OR 0.41; 95% CI 0.18–0.95). Although preoperative weight loss was not associated with superior long-term weight outcomes in the overall cohort, stratified analyses demonstrated significant early benefits at 1 year, particularly after RYGB, as well as higher rates of diabetes remission. ROC analysis identified minimum beneficial preoperative weight loss thresholds of 10.91% (for TWL) and 4.96% (for EWL), and maximum tolerable weight gain thresholds of 6.67% and 5.51%, respectively.\u003c/p\u003e\n\u003cp\u003eConclusion:\u003c/p\u003e\n\u003cp\u003ePreoperative weight gain is an independent predictor of poorer postoperative weight outcomes, while modest preoperative weight loss (approximately 5–10%) may confer selective early benefits, particularly in patients undergoing RYGB and in those with type 2 diabetes (T2D). The identification of objective, clinically applicable thresholds for both beneficial weight loss and harmful weight gain supports an individualized preoperative optimization strategy focused on preventing weight gain and encouraging achievable, targeted weight reduction rather than enforcing universal mandates.\u003c/p\u003e","manuscriptTitle":"Preoperative Weight Change and Outcomes After Bariatric Surgery","msid":"","msnumber":"","nonDraftVersions":[{"code":1,"date":"2026-04-30 08:23:15","doi":"10.21203/rs.3.rs-9313191/v1","editorialEvents":[{"type":"communityComments","content":0},{"type":"reviewerAgreed","content":"115304153330477381712138637518358121510","date":"2026-05-14T11:54:51+00:00","index":"hide","fulltext":""},{"type":"reviewerAgreed","content":"229409180845881822880851459040554783211","date":"2026-05-13T21:13:24+00:00","index":"hide","fulltext":""},{"type":"reviewerAgreed","content":"336747491729239363957541207627751152611","date":"2026-04-22T00:12:34+00:00","index":"hide","fulltext":""},{"type":"reviewersInvited","content":"","date":"2026-04-21T23:11:21+00:00","index":"","fulltext":""},{"type":"editorAssigned","content":"","date":"2026-04-10T03:17:03+00:00","index":"","fulltext":""},{"type":"checksComplete","content":"","date":"2026-04-10T03:14:47+00:00","index":"","fulltext":""},{"type":"submitted","content":"Obesity Surgery","date":"2026-04-03T13:04:03+00:00","index":"","fulltext":""}],"status":"published","journal":{"display":true,"email":"[email protected]","identity":"obesity-surgery","isNatureJournal":false,"hasQc":true,"allowDirectSubmit":false,"externalIdentity":"obsu","sideBox":"Learn more about [Obesity Surgery](https://link.springer.com/journal/11695)","snPcode":"11695","submissionUrl":"https://submission.springernature.com/new-submission/11695/3","title":"Obesity Surgery","twitterHandle":"","acdcEnabled":true,"dfaEnabled":true,"editorialSystem":"stoa","reportingPortfolio":"Springer Hybrid","inReviewEnabled":true,"inReviewRevisionsEnabled":false}}],"origin":"","ownerIdentity":"f26c09a5-2c21-465b-be81-ceb8ceccb27c","owner":[],"postedDate":"April 30th, 2026","published":true,"recentEditorialEvents":[{"type":"reviewerAgreed","content":"115304153330477381712138637518358121510","date":"2026-05-14T11:54:51+00:00","index":49,"fulltext":""},{"type":"reviewerAgreed","content":"229409180845881822880851459040554783211","date":"2026-05-13T21:13:24+00:00","index":48,"fulltext":""}],"rejectedJournal":[],"revision":"","amendment":"","status":"under-review","subjectAreas":[],"tags":[],"updatedAt":"2026-04-30T08:23:15+00:00","versionOfRecord":[],"versionCreatedAt":"2026-04-30 08:23:15","video":"","vorDoi":"","vorDoiUrl":"","workflowStages":[]},"version":"v1","identity":"rs-9313191","journalConfig":"researchsquare"},"__N_SSP":true},"page":"/article/[identity]/[[...version]]","query":{"redirect":"/article/rs-9313191","identity":"rs-9313191","version":["v1"]},"buildId":"XKTyCvWXoU3ODBz1xrDgd","isFallback":false,"isExperimentalCompile":false,"dynamicIds":[84888],"gssp":true,"scriptLoader":[]}