What Really Matters in Weight Loss After Bariatric Surgery – 10 Years Follow-Up (BARI-10-POL Study)

What Really Matters in Weight Loss After Bariatric Surgery – 10 Years Follow-Up (BARI-10-POL Study) | 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 What Really Matters in Weight Loss After Bariatric Surgery – 10 Years Follow-Up (BARI-10-POL Study) Agata Czerwińska, Izabela Karpińska, Piotr Zarzycki, Maciej Matyja, and 3 more This is a preprint; it has not been peer reviewed by a journal. https://doi.org/ 10.21203/rs.3.rs-6319526/v1 This work is licensed under a CC BY 4.0 License Status: Published Journal Publication published 17 Nov, 2025 Read the published version in Obesity Surgery → Version 1 posted 7 You are reading this latest preprint version Abstract Introduction Currently, metabolic bariatric surgery (MBS) is considered the most effective method for achieving substantial and long-term weight-loss in severely obese patients. However, 4 to 40% of bariatric patients do not accomplish optimal results. The study aimed to identify factors contributing to maintain >50% EWL after MBS at the 10- years observation. Materials and methods This is a retrospective, multicenter cohort study of patients with obesity who completed 10-years follow-up, undergoing primary laparoscopic MBS surgery in 2007–2014. Data came from 5 bariatric centers. Patients were divided into two groups: patients who achieved more than 50% EWL and those who achieved less than 50% EWL. Uni- and multivariable logistic regression were used to identify predictors of optimal results. Results Out of 368 analyzed patients the median BMI before the surgery was 42.73 kg/m2. The most common obesity-related diseases were hypertension (HT) (52.72%) and type 2 diabetes mellitus (T2DM) (30.98%). Sleeve gastrectomy was the most frequently performed procedure (65.22%). The median follow-up was 10.90 years. 59,24% patients achieved >50% EWL. Uni- and multivariable logistic regression analysis confirmed preoperative weigh loss (OR=1.04; P=0.03), T2DM (OR=0.45; P=0.003), psychiatric history (OR=0.38; P=0.01) and one anastomosis gastric bypass (OAGB) (OR=4.64; P<0.0001) to have a significant impact on weight loss outcome 10-years after MBS. Conclusions In a 10-year follow-up, patients with greater preoperative weight loss may have a better response to surgery. OAGB emerged as the most beneficial type of surgery in terms of weight loss. T2DM and psychiatric history are independent predictors of lower %EWL. Figures Figure 1 INTRODUCTION Obesity become one of the major problems for the global health system with alarming increase 1 . It is a chronic disease which is hard to treat and has high index of recurrence 2 . Only surgical treatment results in substantial and long- term weight loss in very obese patients 3,4 . Although surgery technique is still evolving and several surgical techniques are available, sleeve gastrectomy (SG) and roux-en-Y gastric bypass (RYGB) are most commonly performed metabolic bariatric surgeries (MBS) 5 . Another frequently carried out procedure nowadays is one anastomosis gastric bypass (OAGB) 6 . The benefits of MBS have been unequivocally proven 7 . However, it is a common observation in clinical practice that postoperative weight reduction shows great disparities from one individual to another and 4–40% of bariatric patients fail to accomplish optimal results 8 . Due to the complexity of the problem of obesity, there are many factors including age, initial BMI, comorbidity rate, physical activity, eating behavior, mental status, economical status which may modify the effects of bariatric treatment 9–12 . Despite numerous studies exploring this topic, differences between individuals are not completely understood. Most authors focus on the short and mid-time results of operations, and there is still need of longer follow up (exceeding 5 years). Success in bariatric treatment regard to weight reduction is defined as ≥ 50% excess body weight loss (EWL). The maximal weight loss is observed 1–2 years after surgery 13 . But considering invasiveness of surgical treatment, the proposed method should ensure long-term effectiveness. Identification specific factors contributing to weight loss success in long-term observation could optimize selection of candidates more likely to benefit from the surgery and adjust them appropriate procedure, resulting in better long-term effects on sustained weight loss and obesity-related comorbidities with acceptable perioperative safety. The aim of this study is to identify factors affecting the weight loss maintenance 10 years after MBS. MATERIALS AND METHODS Study design In this retrospective cohort study, we investigated patients with obesity who underwent MBS in 5 Bariatric Centers in Poland. It is part of the Bariatric Ten Years Outcomes in Poland (BARI-10-POL) project under the patronage of the Metabolic and Bariatric Surgery Chapter of The Association of Polish Surgeons. Patients were categorized into two groups, those who achieved (≥ 50%EWL group) or did not achieve anticipated weight loss (< 50%EWL group). Finally, the relationship between preoperative variables and weight loss outcome was analysed, to identify contributing factors. Ethics The data were completely anonymized. Informed consent for surgical treatment and anonymous usage of patient data was obtained from all patients prior to surgery. All procedures performed in the study involving human participants were in accordance with the 1964 Helsinki Declaration and its later amendments. The study protocol gained approval from The Bioethics Committee. Study population Study population comprised patients with obesity aged between 18 to 65 years who underwent primary bariatric procedure between February 2007 and December 2014 and completed 10 years of postoperative follow-up. Patients with incomplete data and those who underwent revision procedure were excluded from the analysis. Subsequently, we excluded patients due to lost to follow- up. Surgical techniques and perioperative care Participants underwent three types of bariatric procedures performed laparoscopically: SG, RYGB, and OAGB. Each patient was qualified for the appropriate type of procedure in accordance with the Polish Guidelines for Metabolic and Bariatric Surgery 14 . The surgical techniques used have been described in detail in previous publications 15–17 . During SG a 36-French gastric bougie inserted into the stomach along the lesser curvature was used to calibrate the gastric sleeve. The length of alimentary and enzymatic limb during RYGB was standardized 150 and 100 cm respectively. This procedure consists of creating a 20 mL proximal gastric pouch. During OAGB the gastric pouch is created with a linear stapler against a 36-French bougie. The gastroenterostomy is fashioned approximately 200 cm distal to the ligament of Treitz. Perioperative care is based on 15-item Enhanced Recovery After Surgery (ERAS) guidelines 18 . Candidates for MBS were evaluated by a multidisciplinary team of surgeons, dieticians, psychologists, clinical nurse specialists and anesthetists. Each patient was advised to lose weight, cease smoking or drinking alcohol and begin physical activity prior to surgery. Implemented fast track care program aims also no routine placement of tubing and lining, antithrombotic and antibiotic prophylaxis, quick mobilization and early oral intake. Data collection All necessary information for calculations like: demographic, clinical data along with comorbidities, surgical history, medications, habits and outcomes were collected pre- and postoperatively by a trained research team from medical records. Demographic data included: sex, age (calculated as the difference between the date of birth and the date of surgery) and BMI (calculated from the weight in kilograms divided by the square of height in meters). The definitions for most comorbidities included documentation of the condition and its treatment. Chronic conditions assessed in our study were: type 2 diabetes (T2DM) and its duration (defined as the difference between the date of T2DM diagnosis and date of surgery), obstructive sleep apnea (OSA), pulmonary diseases (including asthma and chronic obstructive pulmonary disease), hypertension (HT) and its duration (defined as the difference between the date of HT diagnosis and date of surgery), gastroesophageal reflux disease (GERD), cardiovascular diseases (including: coronary artery disease (CAD), history of myocardial infarction (MI) requiring percutaneous intervention or cardiac surgery, arrhythmia requiring implantation of a pacemaker or oral medications), dyslipidemia (including: hypercholesterolemia, mixed hyperlipidemia, hypertriglyceridemia), autoimmunological disorders ( rheumatoid arthritis, scleroderma, psoriasis, psoriatic arthritis, leukoplakia, condition after kidney transplantation – requiring immunosuppressive drugs, ulcerative colitis, Quincke's edema), neurological diseases (cortical-subcortical atrophy, multiple sclerosis, mental retardation due to brain injury, stroke, lower limb paresis, epilepsy, vertigo syndrome, myodystrophy), hepatic steatosis, polycystic ovary syndrome (PCOS), hypothyroidism, osteoarthritis, renal insufficiency and psychiatric history (including depression, neurosis, WAGR syndrome, bipolar disorder, schizophrenia, anxiety disorders, autism, fragile chromosome syndrome) The usage of medication comprised antihypertensives, oral anti-diabetic drugs, and insulin. Investigated habits were smoking on the day of surgery and the history of alcohol abuse. The outcomes of interest included weight 10 years after the operation. Outcome measurement Evaluated outcome of bariatric treatment was defined as patient’s weight at 10 years after initial procedure, assessed by postoperative BMI. Weight change was expressed using percentage total weight loss (%TWL) and percentage EWL (%EWL) obtained according to the previously described formulas 19 . Ideal body weight was calculated as equivalent to BMI 25 kg/m 2 . Weight loss success after intervention was defined as ≥ 50% EWL 20 . Statistical analysis Continuous variables are presented as mean and standard deviation (SD) or median and interquartile range (IQR) for normally and non-normally distributed variables respectively. Categorical variables are presented as numbers and percentages. To confirm the normality of the distribution of the continuous variables we used the Shapiro-Wilk and the Kolmogorov-Smirnov with the Lilliefors correction tests. To assess factors influencing sustained weight loss success uni- and multivariable logistic regression analysis were performed. The relationship between each parameter and weight loss outcome was established by an univariable logistic regression. The association was considered significant when p < 0.01. Finally, variables that had an impact on weight loss success were used to build a multivariable logistic regression model. Additionally, variables: age, BMI, hypothyroidism, and osteoarthritis were added into multivariable analysis based on published literature and clinical observations 20,21 . For each variable, the odds ratio (OR) with a 95% confidence interval (CI) was calculated. Results were considered statistically significant when p ≤ 0.05. The data were analyzed using Statistica 13.3 software (StatSoft, Tulsa, Oklahoma, US). RESULTS Patients recruitment Total population included 1703 patients. 1218 patients were excluded due to loss to follow-up and missing data, 117 patients were excluded due to revision procedure. The follow-up rate was 28.5%. Figure 1 . Subjects characteristics 368 patients entered the study: 253 women (68.75%) and 115 men (31.25%) with the median age of 42.50 years. The median BMI on the day of qualification for surgery was 42.73 kg/m2 and the median preoperative weight loss was 4.0 kg. Preoperative data on comorbidities revealed that two most common comorbidities were HT in 194 (52.72%) patients and T2DM in 114 (30.98%) patients. The SG was a bariatric procedure in 240 patients (65.22%), 65 (17.66%) patients underwent RYGB, whereas OAGB was performed in 63 (17.12%) patients. The median follow-up for analyzed group was 10.90 years. The patients baseline characteristics are summarized in Table 1 . Weight loss The median BMI at the data of 10 years follow-up was 32,30 kg/m2 and median TWL was 22,81% ( Table 2 ). More than half of the patients (59,24%) achieved the EWL ≥ 50% with median %EWL of 59,17% . Table 2 Weight loss outcomes in the study population Variable All (n = 368) Weight, kg 92.25 (80.00-109.50) BMI, kg/m2 32.30 (27.95–37.38) TWL, % 22.81 (11.95–32.58) EWL, % 59.17 (29.33–81.26) ≥ 50% EWL (n, %) 218 (59.24) Predictive factors In the univariable analysis the weight loss success during follow up was significantly associated with: preoperative weight loss (OR = 1.05; P = 0,003), T2DM (OR = 0.55; P = 0.005) and psychiatric history (OR = 0.41; P = 0.01). Regard to type of surgery only OAGB have a significant association with achieving 50% EWL (OR = 4.0; P = 0.0001). Since the above-mentioned factors were individually found to be significantly associated with the success weight loss 10 years postoperatively, these variables in addition with age, BMI, hypothyroidism, and osteoarthritis were examined together in a multivariable analysis which confirmed that preoperative weight loss (OR = 1.04; P = 0.03), T2DM (OR = 0.45; P = 0.003), psychiatric history (OR = 0.38; P = 0.01) and performing OAGB (OR = 4.64; P < 0,0001) were identified as independent predictive factors of satisfactory final outcome. The detailed results of uni- and multivariable logistic regression analysis is shown in Table 3 . Table 3 Results of uni- and multivariable logistic regression Variable Univariable regression Multivariable OR Cl p-value OR Cl p-value Age 0.999 0.98–1.02 0.92 1.00 0.98–1.02 0.97 Sex: male female ref. 0.77 0.49–1.22 0.27 Preoperative weight loss 1.05 1.02–1.09 0.003 1.04 1.004–1.08 0.03 BMI 0.99 0.96–1.03 0.72 1.02 0.98–1.07 0.32 Type of surgery: SG RYGB OAGB ref. 1.05 4.00 0.61–1.82 1.99–8.04 0.86 0.0001 1.007 4.64 0.53–1.92 2.05–10.49 0.98 `12W < 0.0001 HT 1.15 0.76–1.74 0.51 T2DM 0.55 0.36–0.84 0.005 0.45 0.26–0.76 0.003 GERD 1.24 0.71–2.18 0.45 OSA 1.60 0.68–3.78 0.29 Pulmonary diseases 0.74 0.32–1.72 0.48 Cardiovascular diseases 0.82 0.34–1.94 0.64 Dyslipidemia 1.09 0.41–2.87 0.87 PCOS 2.08 0.21–20.18 0.53 Hipothyroidism 1.10 0.61–1.98 0.76 1.54 0.75–3.18 0.24 Hepatic steatosis 0.54 0.14–2.05 0.37 Osteoarthritis 1.60 0.86–2.96 0.14 2.07 0.996–4.31 0.051 Renal insufficiency 0.86 0.23–3.25 0.82 Autoimmunological disorders 1.21 0.35–4.21 0.76 Neurological Diseases 1.21 0.35–4.21 0.76 Psychiatric history 0.41 0.21–0.81 0.01 0.38 0.18–0.82 0.01 Smoking 1.39 0.47–4.17 0.55 Alcohol abuse history 0.69 0.10–4.92 0.71 DISCUSSION Our study is a retrospective, multicenter analysis examining preoperative factors influencing weight loss outcomes in a 10-year follow-up of 368 patients undergoing MBS in Poland. To our knowledge, this is one of the few studies to analyze preoperative factors contributing surgical outcomes after such a long follow-up. Maintaining completeness of follow-up will always be a major challenge for long-term follow-up studies. Given the chronic nature of obesity and obesity-related diseases, long-term monitoring of patients after MBS is particularly important. Current IFSO recommendations enjoin control visits at least once a year after 1 year after MBS 22 . The number of patients who continue to follow-up visits decrease year by year. In meta-analysis regarding 10- years observation follow-up ranges from 23–99% 23 . In our study the follow-up rate is 28.5% which is the limitation of this study. The association between adherence to follow-up visits after MBS and weight loss remains unclear 24–28 . Interestingly, in the literature there is a lack of consensus on the definition of long-term follow-up 29 . According to different authors, 'long-term’ follow-up can range from even 2 to 10 years, some researchers considering it as 5 to 10 years, and others extending it to beyond 10 years. Oochit et al in analysis of the length of observation in the literature showed that the number of articles reporting long-term outcomes increased from 14% in 2015 to 25% in 2021, but the majority has remained short-term. Of the articles reporting long-term outcomes in 2021, 70% of the included patients respectively had > 5 years follow-up 30 . A great minority of recent studies describe follow-up longer than 10 years, with the longest reported observation period being 26 years 23,31–34 . Taking this into account, it is concluded that our study regarding 10-year follow-up remains very valuable. Despite satisfactory effects of MBS in general, there are part of patients that will struggle to get to the goal weight and some of them will regain some of the weight. Numerous studies are being conducted to identify factors affecting outcomes of MBS, among others preoperative factors, to better distinguish patients who may require a special approach already at the stage of qualification for the procedure 35 . These patients should be an area of particular interest as a group requiring exceptional care in the selection of the surgical technique used as well as non-standard postoperative monitoring. Their treatment will likely require use of other methods in addition to operation to achieve better results. However, most studies to date evaluating the influence of preoperative factors of weight loss after MBS have considered 1–2 year outcomes, with a few reporting outcomes up to 5 years 36–38 . According to the literature, long term outcomes of %EWL after RYGB range from 27–69%, 70–84% after OAGB, and 53–62% after SG 23 . In the analysed population 65% patients underwent SG, the rest of patients underwent OAGB and RYGB in equal percentages. More than a half of the patients achieved the goal of ≥ 50% EWL. The medium %EWL for the whole group in general was 59.17% (% TWL 22.81%). In our analysis, we presented an overall outcome of the weight loss, as a detailed breakdown exceeded the scope of this study. We found no association between preoperative BMI and weight loss success. Multiple studies reported that higher baseline BMI was a significant predictor of poorer weight loss 39,40 . These include a big study of 73,989 patients (BOLD database) which stated that baseline weight accounted for 18.5% of the total variability in 12-month absolute weight loss outcomes 41 . However, in other research with the longer observation (≥ 36 months of follow-up), the relationship between weight loss and initial BMI was no longer significant 36,37 . The guidelines by IFSO indicate that there is no upper age limit for MBS 22 . However, it is well known that the effect of weight loss is better in younger patients. Contreras et al. found that patients with age below 45 had better results in 1 year observation 42 . Scozzari et al. Revealed that patients aged > = 52 years, showed a significantly lower BMI decrease, with a more consistent weight regain in the follow-up range between 12 and 72 months 43 . In work from Chang et al. analysis showed that age is negatively correlated with BMI change at 3 and 5 years 20 . In contradiction with these reports our findings demonstrate that age alone does not significantly influence weight loss outcome after MBS and they are consistent with recent study that analyzed a cohort of patients over 65 years of age. 44 In summary, these results may indicate that during long-term follow-up the influence of age and baseline BMI is outweighed by other factors, probably those presented in postoperative period. Interestingly, our analysis suggests that appropriate preoperative preparation may hold greater importance than the demographic characteristics of patients. Due to our findings preoperative weight loss is positively correlated with weight loss. While it may seem intuitive that patients who lose weight before surgery are likely to be more successful at losing weight after MBS, data from published studies on this topic are inconsistent and ambiguous 9,45–47 . Giordano et al. stated that preoperative weight loss > 10% may improve weight loss outcomes at 1-year follow-up 48 . This finding, in connection with our results may indicate that the relationship between preoperative and postoperative weight loss applies to the most motivated patients: those who lost the most weight before surgery and who were willing to continue long-term follow-up visits. According to our findings, OAGB increased the likelihood of achieving more than 50% EWL by over 4 times compared to other procedures in the multivariable logistic regression. The advantage of OAGB over other procedures was confirmed in the results of Cadena-Obando et al 49 . In addition, SG was shown to be a factor of worse outcome of %TWL in 3- and 5-year follow-up 20,50 . Therefore, the choice of surgical procedure in a patient with multiple factors of failure to lose weight should be cautious. T2DM was related to worse prognosis of %EWL, which is in agreement with the literature. In a study of over 400 patients who underwent MBS, T2DM was a significant predictor of reduced %EBWL in 1-year observation 21 . Also, in two big retrospective studies T2DM was found to be a strong predictor of poorer %EWL 5 years after surgery 51,52 . Interestingly, in a study of RYGB with a median follow-up of 9.3 years, Wood et al. found preoperative insulin use to be associated with greater long-term postoperative percent weight loss 53 . In our study at least 41 patients were treated with insulin what constitutes significant minority (35%) of the group. Mental health conditions are common among bariatric surgery patients 54 . Polish preliminary data on the prevalence of mental disorders in patients qualified for the nationwide multi-center pilot of bariatric obesity treatment program (KOS-BAR) showed that 12.1% patients were in psychiatric treatment but there were additional 11.7% with de novo diagnosis 55 . There is inconsistent evidence regarding the association between preoperative mental health conditions and postoperative weight loss 54,56,57 . In a study by Vermeer et al. in bariatric patients, in whom 163 had preoperative diagnosis of psychiatric disease and 2362 had no such diagnosis, total weight loss 1 to 4 years after surgery was significantly lower in the psychiatric group 58 . Our study showed a negative association between preoperative psychiatric history and achieving ≥ 50% EWL. However, analysed population consisted of 4% patients with this factor which can cause bias. The study has several limitations. The retrospective design of the study may introduce potential biases, especially in data collection and reporting. Another bias is introduced by the low follow-up rate achieved. Since all data were reported from 5 different bariatric centers, there is a potential for inconsistency in the collected data. The study lacks partial data on outcomes, and the results presented are the endpoint of the follow-up. In addition, the majority of patients were operated on using one method. Nevertheless, we believe that this study provides valuable data on MBS in long-term follow-up, and its results can certainly be clinically applied. CONCLUSIONS T2DM, and history of psychiatric treatment may lead to lower %EWL in the postoperative period. At the same time preoperative weight loss was positively related to weight loss success. OAGB emerged as the most efficacious type of surgery in terms of weight loss. Our data regard to preoperative factors affecting outcomes of MBS differ significantly from those concerning shorter observations. Additional studies especially those with long-term observation and proper percentage of follow-up rate are needed to change clinical practice of bariatric procedures. Declarations Author Contribution PM and NDG conceived this research.IK, NDG and MM gathered data.AC, IK, PM participated in the design and interpretation of the data.IK performed statistical analysis and modelling.AC and IK wrote the main manuscript text.AC performed tables and graphs.PM participated in the revisions of manuscript. References Swinburn BA, Kraak VI, Allender S, et al. The Global Syndemic of Obesity, Undernutrition, and Climate Change: The Lancet Commission report. Lancet . 2019;393(10173):791-846. doi:10.1016/S0140-6736(18)32822-8 Heymsfield SB, Bourgeois B, Thomas DM. Why is it Difficult to Lose and Maintain Large Amounts of Weight with Lifestyle and Pharmacologic Treatments? 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Reoperations After Bariatric Surgery in 26 Years of Follow-up of the Swedish Obese Subjects Study. JAMA Surg . 2019;154(4):319-326. doi:10.1001/JAMASURG.2018.5084 Kehagias I, Bellou A, Kehagias D, et al. Long-term (11 + years) efficacy of sleeve gastrectomy as a stand-alone bariatric procedure: a single-center retrospective observational study. Langenbeck’s Arch Surg . 2022;408(1). doi:10.1007/S00423-022-02734-Y Iljin A, Antoszewski B, Szewczyk T, Sitek A. Selected factors affecting the rate of reduction of body weight components during the first six months after bariatric surgery: A cohort study. Polish J Surg . 2023;96(1):34-41. doi:10.5604/01.3001.0053.8609 Angrisani L, Di Lorenzo N, Favretti F, et al. The Italian Group for LAP-BAND: Predictive value of initial body mass index for weight loss after 5 years of follow-up. Surg Endosc Other Interv Tech . 2004;18(10):1524-1527. doi:10.1007/s00464-003-9149-y Kinzl JF, Schrattenecker M, Traweger C, Mattesich M, Fiala M, Biebl W. Psychosocial predictors of weight loss after bariatric surgery. Obes Surg . 2006;16(12):1609-1614. doi:10.1381/096089206779319301 Bakr AA, Fahmy MH, Elward AS, Balamoun HA, Ibrahim MY, Eldahdoh RM. Analysis of Medium-Term Weight Regain 5 Years After Laparoscopic Sleeve Gastrectomy. Obes Surg . 2019;29(11):3508-3513. doi:10.1007/s11695-019-04009-w Campos GM, Rabl C, Mulligan K, et al. Factors associated with weight loss after gastric bypass. Arch Surg . 2008;143(9):877-883. doi:10.1001/ARCHSURG.143.9.877 Melton GB, Steele KE, Schweitzer MA, Lidor AO, Magnuson TH. Suboptimal weight loss after gastric bypass surgery: Correlation of demographics, comorbidities, and insurance status with outcomes. J Gastrointest Surg . 2008;12(2):250-255. doi:10.1007/s11605-007-0427-1 Benoit SC, Hunter TD, Francis DM, De La Cruz-Munoz N. Use of Bariatric outcomes longitudinal database (BOLD) to study variability in patient success after Bariatric surgery. Obes Surg . 2014;24(6):936-943. doi:10.1007/s11695-014-1197-y Contreras JE, Santander C, Court I, Bravo J. Correlation between age and weight loss after bariatric surgery. Obes Surg . 2013;23(8):1286-1289. doi:10.1007/s11695-013-0905-3 Scozzari G, Passera R, Benvenga R, Toppino M, Morino M. Age as a long-term prognostic factor in bariatric surgery. Ann Surg . 2012;256(5):724-729. doi:10.1097/sla.0b013e3182734113 Karpińska I, Dowgiałło-Gornowicz N, Franczak P, et al. Factors contributing to weight loss success after bariatric procedures in patient over 65 years old: a multicenter retrospective cohort study. Int J Surg . 2024;110(8):4893. doi:10.1097/JS9.0000000000001588 Stefura T, Droś J, Kacprzyk A, et al. Influence of Preoperative Weight Loss on Outcomes of Bariatric Surgery for Patients Under the Enhanced Recovery After Surgery Protocol. Obes Surg . 2019;29(4):1134-1141. doi:10.1007/s11695-018-03660-z Samaan JS, Zhao J, Qian E, et al. Preoperative Weight Loss as a Predictor of Bariatric Surgery Postoperative Weight Loss and Complications. J Gastrointest Surg . 2022;26(1):86-93. doi:10.1007/s11605-021-05055-5 M.S. RA, Hsu G, Safadi BY, et al. Impact of preoperative weight loss in patients undergoing Laparoscopic Roux-en-Y Gastric Bypass (LRYGB). Surg Obes Relat Dis . 2005;1(3):256. doi:10.1016/j.soard.2005.03.098 Giordano S, Victorzon M. The impact of preoperative weight loss before laparoscopic gastric bypass. Obes Surg . 2014;24(5):669-674. doi:10.1007/s11695-013-1165-y Cadena-Obando D, Ramírez-Rentería C, Ferreira-Hermosillo A, et al. Are there really any predictive factors for a successful weight loss after bariatric surgery? BMC Endocr Disord . 2020;20(1):1-8. doi:10.1186/s12902-020-0499-4 Voglino C, Badalucco S, Tirone A, et al. Follow-up after bariatric surgery: is it time to tailor it? Analysis of early predictive factors of 3-year weight loss predictors of unsuccess in bariatric patients. Updates Surg . 2022;74(4):1389-1398. doi:10.1007/s13304-022-01314-5 Barhouch AS, Padoin A V., Casagrande DS, et al. Predictors of Excess Weight Loss in Obese Patients After Gastric Bypass: a 60-Month Follow-up. Obes Surg . 2016;26(6):1178-1185. doi:10.1007/s11695-015-1911-4 Luo Y, Haddad RA, Ontan MS, et al. Impact of diabetes on weight loss outcomes after bariatric surgery: Experience from 5-year follow-up of Michigan Bariatric Surgery Cohort. Clin Endocrinol (Oxf) . 2023;99(3):285-295. doi:10.1111/cen.14922 Wood GC, Benotti PN, Lee CJ, et al. Evaluation of the association between preoperative clinical factors and long-term weight loss after Roux-en-Y gastric bypass. JAMA Surg . 2016;151(11):1056-1062. doi:10.1001/jamasurg.2016.2334 Dawes AJ, Maggard-Gibbons M, Maher AR, et al. Mental health conditions among patients seeking and undergoing bariatric surgery a meta-analysis. JAMA - J Am Med Assoc . 2016;315(2):150-163. doi:10.1001/jama.2015.18118 Herstowska M, Przygocka-Pieniążek A, Grabowski K, Kaska Ł. Prevalence of mental disorders in patients with pathological obesity selected for bariatric surgery in the KOS-BAR nationwide multi-centre pilot programme – a preliminary report. Wideochirurgia I Inne Tech Maloinwazyjne . 2023;18(3):502-509. doi:10.5114/wiitm.2023.128910 Kozela M, Stepaniak U, Koziara K, Karpińska I, Major P, Matyja M. No association between history of psychiatric treatment and postoperative weight reduction after bariatric surgery. Eat Weight Disord . 2024;29(1):4-11. doi:10.1007/s40519-024-01645-9 Lüscher A, Vionnet N, Amiguet M, et al. Impact of Preoperative Psychiatric Profile in Bariatric Surgery on Long-term Weight Outcome. Obes Surg . 2023;33(7):2072-2082. doi:10.1007/s11695-023-06595-2 Vermeer KJ, Monpellier VM, Cahn W, Janssen IMC. Bariatric surgery in patients with psychiatric comorbidity: Significant weight loss and improvement of physical quality of life. Clin Obes . 2020;10(4):1-8. doi:10.1111/cob.12373 Table 1 Table 1 is available in the Supplementary Files section. Additional Declarations No competing interests reported. Supplementary Files Table1.docx Cite Share Download PDF Status: Published Journal Publication published 17 Nov, 2025 Read the published version in Obesity Surgery → Version 1 posted Editorial decision: Revision requested 02 Jul, 2025 Reviews received at journal 02 Jun, 2025 Reviewers agreed at journal 02 Jun, 2025 Reviewers invited by journal 02 Jun, 2025 Editor assigned by journal 08 Apr, 2025 Submission checks completed at journal 07 Apr, 2025 First submitted to journal 27 Mar, 2025 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. 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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-6319526","acceptedTermsAndConditions":true,"allowDirectSubmit":false,"archivedVersions":[],"articleType":"Research Article","associatedPublications":[],"authors":[{"id":465400245,"identity":"8df96b39-abab-4c34-8070-5584cb7068ac","order_by":0,"name":"Agata Czerwińska","email":"","orcid":"","institution":"Jagiellonian University","correspondingAuthor":false,"prefix":"","firstName":"Agata","middleName":"","lastName":"Czerwińska","suffix":""},{"id":465400246,"identity":"5dfddf55-396c-4eef-8d94-6a3241fa85af","order_by":1,"name":"Izabela Karpińska","email":"data:image/png;base64,iVBORw0KGgoAAAANSUhEUgAAAZAAAAAyAQMAAABI0h/eAAAABlBMVEX///8AAABVwtN+AAAACXBIWXMAAA7EAAAOxAGVKw4bAAABDklEQVRIiWNgGAWjYBACNiBmbIAwmBkYKiTAogeAWIZILWckGHigWnjw2QTWwgDSwtiGUIpTCx//4QeMM2ru5fFJtz82+DnPIs+evffhgR8Md3BqYWM4ZsC44VhxMZvMGePE3m0SxTw8xw0O9jA8w62FscGA8QFbQmKbRA7zAd5tEok9EmkMB3gYDuPWwsz+gfHBP5CW9McH/84BapF/xnDwDz4tbDwGjBvbQFoSjJN5G0C2sIHU49HCw1NwcGZfQjGbRI6xscwxoJYzaQyHZQxw+0W+//jGhz3fEvLkZ6Q/lnxTU5fY3n6M+eObijtyuLSAwAEgTkATMziATwcYoGthIKxlFIyCUTAKRgwAALOaUuG8ebLRAAAAAElFTkSuQmCC","orcid":"","institution":"Jagiellonian University","correspondingAuthor":true,"prefix":"","firstName":"Izabela","middleName":"","lastName":"Karpińska","suffix":""},{"id":465400247,"identity":"98ad559a-0833-412b-ad67-37c67dd10c94","order_by":2,"name":"Piotr Zarzycki","email":"","orcid":"","institution":"Jagiellonian University","correspondingAuthor":false,"prefix":"","firstName":"Piotr","middleName":"","lastName":"Zarzycki","suffix":""},{"id":465400248,"identity":"f8011b1a-0e40-408c-a033-3c80c0760ac7","order_by":3,"name":"Maciej Matyja","email":"","orcid":"","institution":"Jagiellonian University","correspondingAuthor":false,"prefix":"","firstName":"Maciej","middleName":"","lastName":"Matyja","suffix":""},{"id":465400249,"identity":"e31da3ae-541a-47e5-97c8-aefeadc1758c","order_by":4,"name":"Natalia Dowgiałło-Gornowicz","email":"","orcid":"","institution":"University of Warmia and Mazury in Olsztyn","correspondingAuthor":false,"prefix":"","firstName":"Natalia","middleName":"","lastName":"Dowgiałło-Gornowicz","suffix":""},{"id":465400250,"identity":"f9b80792-0059-46bd-beae-15cb24f30831","order_by":5,"name":"Paweł Jaworski","email":"","orcid":"","institution":"Samodzielny Publiczny Szpital Kliniczny im. prof. 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Orłowskiego CMKP","correspondingAuthor":false,"prefix":"","firstName":"Paweł","middleName":"","lastName":"Jaworski","suffix":""},{"id":465400251,"identity":"fef0cf80-4074-4984-a9c6-a77706ce1956","order_by":6,"name":"Piotr Major","email":"","orcid":"","institution":"Jagiellonian University","correspondingAuthor":false,"prefix":"","firstName":"Piotr","middleName":"","lastName":"Major","suffix":""}],"badges":[],"createdAt":"2025-03-27 10:23:06","currentVersionCode":1,"declarations":"","doi":"10.21203/rs.3.rs-6319526/v1","doiUrl":"https://doi.org/10.21203/rs.3.rs-6319526/v1","draftVersion":[],"editorialEvents":[{"content":"https://doi.org/10.1007/s11695-025-08385-4","type":"published","date":"2025-11-17T15:57:00+00:00"}],"editorialNote":"","failedWorkflow":false,"files":[{"id":84187948,"identity":"accb436b-5914-4c1c-b8ef-ad49424c3c24","added_by":"auto","created_at":"2025-06-09 06:04:16","extension":"png","order_by":1,"title":"Figure 1","display":"","copyAsset":false,"role":"figure","size":141399,"visible":true,"origin":"","legend":"\u003cp\u003ePatients recruitment\u003c/p\u003e","description":"","filename":"floatimage1.png","url":"https://assets-eu.researchsquare.com/files/rs-6319526/v1/3b533cfcd8b1840002408927.png"},{"id":96650175,"identity":"961d1d77-a00e-46cb-be45-30df9ab45217","added_by":"auto","created_at":"2025-11-24 16:09:14","extension":"pdf","order_by":0,"title":"","display":"","copyAsset":false,"role":"manuscript-pdf","size":875399,"visible":true,"origin":"","legend":"","description":"","filename":"manuscript.pdf","url":"https://assets-eu.researchsquare.com/files/rs-6319526/v1/0b258d5a-7109-435a-b6a3-a9100baecb1d.pdf"},{"id":84186730,"identity":"139398dc-3821-4ae1-9dc8-0abcc1f54b7c","added_by":"auto","created_at":"2025-06-09 05:40:16","extension":"docx","order_by":1,"title":"","display":"","copyAsset":false,"role":"supplement","size":16598,"visible":true,"origin":"","legend":"","description":"","filename":"Table1.docx","url":"https://assets-eu.researchsquare.com/files/rs-6319526/v1/3f52479f8d3cc88c6ee01aa8.docx"}],"financialInterests":"No competing interests reported.","formattedTitle":"\u003cp\u003eWhat Really Matters in Weight Loss After Bariatric Surgery – 10 Years Follow-Up (BARI-10-POL Study)\u003c/p\u003e","fulltext":[{"header":"INTRODUCTION","content":"\u003cp\u003eObesity become one of the major problems for the global health system with alarming increase \u003csup\u003e1\u003c/sup\u003e. It is a chronic disease which is hard to treat and has high index of recurrence \u003csup\u003e2\u003c/sup\u003e. Only surgical treatment results in substantial and long- term weight loss in very obese patients \u003csup\u003e3,4\u003c/sup\u003e. Although surgery technique is still evolving and several surgical techniques are available, sleeve gastrectomy (SG) and roux-en-Y gastric bypass (RYGB) are most commonly performed metabolic bariatric surgeries (MBS)\u003csup\u003e5\u003c/sup\u003e. Another frequently carried out procedure nowadays is one anastomosis gastric bypass (OAGB)\u003csup\u003e6\u003c/sup\u003e.\u003c/p\u003e \u003cp\u003eThe benefits of MBS have been unequivocally proven \u003csup\u003e7\u003c/sup\u003e. However, it is a common observation in clinical practice that postoperative weight reduction shows great disparities from one individual to another and 4\u0026ndash;40% of bariatric patients fail to accomplish optimal results \u003csup\u003e8\u003c/sup\u003e. Due to the complexity of the problem of obesity, there are many factors including age, initial BMI, comorbidity rate, physical activity, eating behavior, mental status, economical status which may modify the effects of bariatric treatment \u003csup\u003e9\u0026ndash;12\u003c/sup\u003e. Despite numerous studies exploring this topic, differences between individuals are not completely understood. Most authors focus on the short and mid-time results of operations, and there is still need of longer follow up (exceeding 5 years).\u003c/p\u003e \u003cp\u003eSuccess in bariatric treatment regard to weight reduction is defined as \u0026ge;\u0026thinsp;50% excess body weight loss (EWL). The maximal weight loss is observed 1\u0026ndash;2 years after surgery \u003csup\u003e13\u003c/sup\u003e. But considering invasiveness of surgical treatment, the proposed method should ensure long-term effectiveness. Identification specific factors contributing to weight loss success in long-term observation could optimize selection of candidates more likely to benefit from the surgery and adjust them appropriate procedure, resulting in better long-term effects on sustained weight loss and obesity-related comorbidities with acceptable perioperative safety.\u003c/p\u003e \u003cp\u003eThe aim of this study is to identify factors affecting the weight loss maintenance 10 years after MBS.\u003c/p\u003e"},{"header":"MATERIALS AND METHODS","content":"\u003cdiv id=\"Sec3\" class=\"Section2\"\u003e \u003ch2\u003eStudy design\u003c/h2\u003e \u003cp\u003eIn this retrospective cohort study, we investigated patients with obesity who underwent MBS in 5 Bariatric Centers in Poland. It is part of the Bariatric Ten Years Outcomes in Poland (BARI-10-POL) project under the patronage of the Metabolic and Bariatric Surgery Chapter of The Association of Polish Surgeons. Patients were categorized into two groups, those who achieved (\u0026ge;\u0026thinsp;50%EWL group) or did not achieve anticipated weight loss (\u0026lt;\u0026thinsp;50%EWL group). Finally, the relationship between preoperative variables and weight loss outcome was analysed, to identify contributing factors.\u003c/p\u003e \u003c/div\u003e\n\u003ch3\u003eEthics\u003c/h3\u003e\n\u003cp\u003eThe data were completely anonymized. Informed consent for surgical treatment and anonymous usage of patient data was obtained from all patients prior to surgery. All procedures performed in the study involving human participants were in accordance with the 1964 Helsinki Declaration and its later amendments. The study protocol gained approval from The Bioethics Committee.\u003c/p\u003e\n\u003ch3\u003eStudy population\u003c/h3\u003e\n\u003cp\u003eStudy population comprised patients with obesity aged between 18 to 65 years who underwent primary bariatric procedure between February 2007 and December 2014 and completed 10 years of postoperative follow-up. Patients with incomplete data and those who underwent revision procedure were excluded from the analysis. Subsequently, we excluded patients due to lost to follow- up.\u003c/p\u003e\n\u003ch3\u003eSurgical techniques and perioperative care\u003c/h3\u003e\n\u003cp\u003eParticipants underwent three types of bariatric procedures performed laparoscopically: SG, RYGB, and OAGB. Each patient was qualified for the appropriate type of procedure in accordance with the Polish Guidelines for Metabolic and Bariatric Surgery \u003csup\u003e14\u003c/sup\u003e. The surgical techniques used have been described in detail in previous publications \u003csup\u003e15\u0026ndash;17\u003c/sup\u003e. During SG a 36-French gastric bougie inserted into the stomach along the lesser curvature was used to calibrate the gastric sleeve. The length of alimentary and enzymatic limb during RYGB was standardized 150 and 100 cm respectively. This procedure consists of creating a 20 mL proximal gastric pouch. During OAGB the gastric pouch is created with a linear stapler against a 36-French bougie. The gastroenterostomy is fashioned approximately 200 cm distal to the ligament of Treitz.\u003c/p\u003e \u003cp\u003ePerioperative care is based on 15-item Enhanced Recovery After Surgery (ERAS) guidelines \u003csup\u003e18\u003c/sup\u003e. Candidates for MBS were evaluated by a multidisciplinary team of surgeons, dieticians, psychologists, clinical nurse specialists and anesthetists. Each patient was advised to lose weight, cease smoking or drinking alcohol and begin physical activity prior to surgery. Implemented fast track care program aims also no routine placement of tubing and lining, antithrombotic and antibiotic prophylaxis, quick mobilization and early oral intake.\u003c/p\u003e\n\u003ch3\u003eData collection\u003c/h3\u003e\n\u003cp\u003eAll necessary information for calculations like: demographic, clinical data along with comorbidities, surgical history, medications, habits and outcomes were collected pre- and postoperatively by a trained research team from medical records. Demographic data included: sex, age (calculated as the difference between the date of birth and the date of surgery) and BMI (calculated from the weight in kilograms divided by the square of height in meters). The definitions for most comorbidities included documentation of the condition and its treatment. Chronic conditions assessed in our study were: type 2 diabetes (T2DM) and its duration (defined as the difference between the date of T2DM diagnosis and date of surgery), obstructive sleep apnea (OSA), pulmonary diseases (including asthma and chronic obstructive pulmonary disease), hypertension (HT) and its duration (defined as the difference between the date of HT diagnosis and date of surgery), gastroesophageal reflux disease (GERD), cardiovascular diseases (including: coronary artery disease (CAD), history of myocardial infarction (MI) requiring percutaneous intervention or cardiac surgery, arrhythmia requiring implantation of a pacemaker or oral medications), dyslipidemia (including: hypercholesterolemia, mixed hyperlipidemia, hypertriglyceridemia), autoimmunological disorders ( rheumatoid arthritis, scleroderma, psoriasis, psoriatic arthritis, leukoplakia, condition after kidney transplantation \u0026ndash; requiring immunosuppressive drugs, ulcerative colitis, Quincke's edema), neurological diseases (cortical-subcortical atrophy, multiple sclerosis, mental retardation due to brain injury, stroke, lower limb paresis, epilepsy, vertigo syndrome, myodystrophy), hepatic steatosis, polycystic ovary syndrome (PCOS), hypothyroidism, osteoarthritis, renal insufficiency and psychiatric history (including depression, neurosis, WAGR syndrome, bipolar disorder, schizophrenia, anxiety disorders, autism, fragile chromosome syndrome) The usage of medication comprised antihypertensives, oral anti-diabetic drugs, and insulin. Investigated habits were smoking on the day of surgery and the history of alcohol abuse. The outcomes of interest included weight 10 years after the operation.\u003c/p\u003e \u003cdiv id=\"Sec8\" class=\"Section2\"\u003e \u003ch2\u003eOutcome measurement\u003c/h2\u003e \u003cp\u003eEvaluated outcome of bariatric treatment was defined as patient\u0026rsquo;s weight at 10 years after initial procedure, assessed by postoperative BMI. Weight change was expressed using percentage total weight loss (%TWL) and percentage EWL (%EWL) obtained according to the previously described formulas \u003csup\u003e19\u003c/sup\u003e. Ideal body weight was calculated as equivalent to BMI 25 kg/m\u003csup\u003e2\u003c/sup\u003e. Weight loss success after intervention was defined as \u0026ge;\u0026thinsp;50% EWL \u003csup\u003e20\u003c/sup\u003e.\u003c/p\u003e \u003c/div\u003e \u003cdiv id=\"Sec9\" class=\"Section2\"\u003e \u003ch2\u003eStatistical analysis\u003c/h2\u003e \u003cp\u003eContinuous variables are presented as mean and standard deviation (SD) or median and interquartile range (IQR) for normally and non-normally distributed variables respectively. Categorical variables are presented as numbers and percentages. To confirm the normality of the distribution of the continuous variables we used the Shapiro-Wilk and the Kolmogorov-Smirnov with the Lilliefors correction tests.\u003c/p\u003e \u003cp\u003eTo assess factors influencing sustained weight loss success uni- and multivariable logistic regression analysis were performed. The relationship between each parameter and weight loss outcome was established by an univariable logistic regression. The association was considered significant when p\u0026thinsp;\u0026lt;\u0026thinsp;0.01. Finally, variables that had an impact on weight loss success were used to build a multivariable logistic regression model. Additionally, variables: age, BMI, hypothyroidism, and osteoarthritis were added into multivariable analysis based on published literature and clinical observations \u003csup\u003e20,21\u003c/sup\u003e. For each variable, the odds ratio (OR) with a 95% confidence interval (CI) was calculated. Results were considered statistically significant when p\u0026thinsp;\u0026le;\u0026thinsp;0.05.\u003c/p\u003e \u003cp\u003eThe data were analyzed using Statistica 13.3 software (StatSoft, Tulsa, Oklahoma, US).\u003c/p\u003e \u003c/div\u003e"},{"header":"RESULTS","content":"\u003cdiv id=\"Sec11\" class=\"Section2\"\u003e\n \u003ch2\u003ePatients recruitment\u003c/h2\u003e\n \u003cp\u003eTotal population included 1703 patients. 1218 patients were excluded due to loss to follow-up and missing data, 117 patients were excluded due to revision procedure. The follow-up rate was 28.5%. Figure \u003cspan class=\"InternalRef\"\u003e1\u003c/span\u003e.\u003c/p\u003e\n\u003c/div\u003e\n\u003cdiv id=\"Sec12\" class=\"Section2\"\u003e\n \u003ch2\u003eSubjects characteristics\u003c/h2\u003e\n \u003cp\u003e368 patients entered the study: 253 women (68.75%) and 115 men (31.25%) with the median age of 42.50 years. The median BMI on the day of qualification for surgery was 42.73 kg/m2 and the median preoperative weight loss was 4.0 kg.\u003c/p\u003e\n \u003cp\u003ePreoperative data on comorbidities revealed that two most common comorbidities were HT in 194 (52.72%) patients and T2DM in 114 (30.98%) patients. The SG was a bariatric procedure in 240 patients (65.22%), 65 (17.66%) patients underwent RYGB, whereas OAGB was performed in 63 (17.12%) patients. The median follow-up for analyzed group was 10.90 years. The patients baseline characteristics are summarized in Table \u003cspan class=\"InternalRef\"\u003e1\u003c/span\u003e.\u003c/p\u003e\n\u003c/div\u003e\n\u003cdiv id=\"Sec13\" class=\"Section2\"\u003e\n \u003ch2\u003eWeight loss\u003c/h2\u003e\n \u003cp\u003eThe median BMI at the data of 10 years follow-up was 32,30 kg/m2 and median TWL was 22,81% ( Table \u003cspan class=\"InternalRef\"\u003e2\u003c/span\u003e). More than half of the patients (59,24%) achieved the EWL\u0026thinsp;\u0026ge;\u0026thinsp;50% with median %EWL of 59,17% .\u0026nbsp;\u003c/p\u003e\u0026nbsp;\u003ctable id=\"Tab2\" border=\"1\"\u003e\n \u003ccaption language=\"En\"\u003e\n \u003cdiv class=\"CaptionNumber\"\u003eTable 2\u003c/div\u003e\n \u003cdiv class=\"CaptionContent\"\u003e\n \u003cp\u003eWeight loss outcomes in the study population\u003c/p\u003e\n \u003c/div\u003e\n \u003c/caption\u003e\n \u003cthead\u003e\n \u003ctr\u003e\n \u003cth align=\"left\"\u003e\n \u003cp\u003eVariable\u003c/p\u003e\n \u003c/th\u003e\n \u003cth align=\"left\"\u003e\n \u003cp\u003eAll (n\u0026thinsp;=\u0026thinsp;368)\u003c/p\u003e\n \u003c/th\u003e\n \u003c/tr\u003e\n \u003c/thead\u003e\n \u003ctbody\u003e\n \u003ctr\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003eWeight, kg\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e92.25 (80.00-109.50)\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003eBMI, kg/m2\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e32.30 (27.95\u0026ndash;37.38)\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003eTWL, %\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e22.81 (11.95\u0026ndash;32.58)\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003eEWL, %\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e59.17 (29.33\u0026ndash;81.26)\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e\u0026ge;\u0026thinsp;50% EWL (n, %)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e218 (59.24)\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003c/tbody\u003e\n \u003c/table\u003e\n \u003cp\u003e\u003c/p\u003e\n\u003c/div\u003e\n\u003cdiv id=\"Sec14\" class=\"Section2\"\u003e\n \u003ch2\u003ePredictive factors\u003c/h2\u003e\n \u003cp\u003eIn the univariable analysis the weight loss success during follow up was significantly associated with: preoperative weight loss (OR\u0026thinsp;=\u0026thinsp;1.05; P\u0026thinsp;=\u0026thinsp;0,003), T2DM (OR\u0026thinsp;=\u0026thinsp;0.55; P\u0026thinsp;=\u0026thinsp;0.005) and psychiatric history (OR\u0026thinsp;=\u0026thinsp;0.41; P\u0026thinsp;=\u0026thinsp;0.01). Regard to type of surgery only OAGB have a significant association with achieving 50% EWL (OR\u0026thinsp;=\u0026thinsp;4.0; P\u0026thinsp;=\u0026thinsp;0.0001).\u003c/p\u003e\n \u003cp\u003eSince the above-mentioned factors were individually found to be significantly associated with the success weight loss 10 years postoperatively, these variables in addition with age, BMI, hypothyroidism, and osteoarthritis were examined together in a multivariable analysis which confirmed that preoperative weight loss (OR\u0026thinsp;=\u0026thinsp;1.04; P\u0026thinsp;=\u0026thinsp;0.03), T2DM (OR\u0026thinsp;=\u0026thinsp;0.45; P\u0026thinsp;=\u0026thinsp;0.003), psychiatric history (OR\u0026thinsp;=\u0026thinsp;0.38; P\u0026thinsp;=\u0026thinsp;0.01) and performing OAGB (OR\u0026thinsp;=\u0026thinsp;4.64; P\u0026thinsp;\u0026lt;\u0026thinsp;0,0001) were identified as independent predictive factors of satisfactory final outcome. The detailed results of uni- and multivariable logistic regression analysis is shown in Table \u003cspan class=\"InternalRef\"\u003e3\u003c/span\u003e.\u0026nbsp;\u003c/p\u003e\u0026nbsp;\u003ctable id=\"Tab3\" border=\"1\"\u003e\n \u003ccaption language=\"En\"\u003e\n \u003cdiv class=\"CaptionNumber\"\u003eTable 3\u003c/div\u003e\n \u003cdiv class=\"CaptionContent\"\u003e\n \u003cp\u003eResults of uni- and multivariable logistic regression\u003c/p\u003e\n \u003c/div\u003e\n \u003c/caption\u003e\n \u003cthead\u003e\n \u003ctr\u003e\n \u003cth align=\"left\" rowspan=\"2\"\u003e\n \u003cp\u003eVariable\u003c/p\u003e\n \u003c/th\u003e\n \u003cth align=\"left\" colspan=\"3\"\u003e\n \u003cp\u003eUnivariable regression\u003c/p\u003e\n \u003c/th\u003e\n \u003cth align=\"left\" colspan=\"3\"\u003e\n \u003cp\u003eMultivariable\u003c/p\u003e\n \u003c/th\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003cth align=\"left\"\u003e\n \u003cp\u003eOR\u003c/p\u003e\n \u003c/th\u003e\n \u003cth align=\"left\"\u003e\n \u003cp\u003eCl\u003c/p\u003e\n \u003c/th\u003e\n \u003cth align=\"left\"\u003e\n \u003cp\u003ep-value\u003c/p\u003e\n \u003c/th\u003e\n \u003cth align=\"left\"\u003e\n \u003cp\u003eOR\u003c/p\u003e\n \u003c/th\u003e\n \u003cth align=\"left\"\u003e\n \u003cp\u003eCl\u003c/p\u003e\n \u003c/th\u003e\n \u003cth align=\"left\"\u003e\n \u003cp\u003ep-value\u003c/p\u003e\n \u003c/th\u003e\n \u003c/tr\u003e\n \u003c/thead\u003e\n \u003ctbody\u003e\n \u003ctr\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003eAge\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"char\"\u003e\n \u003cp\u003e0.999\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"char\"\u003e\n \u003cp\u003e0.98\u0026ndash;1.02\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"char\"\u003e\n \u003cp\u003e0.92\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"char\"\u003e\n \u003cp\u003e1.00\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"char\"\u003e\n \u003cp\u003e0.98\u0026ndash;1.02\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"char\"\u003e\n \u003cp\u003e0.97\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003eSex:\u003c/p\u003e\n \u003cp\u003emale\u003c/p\u003e\n \u003cp\u003efemale\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003eref.\u003c/p\u003e\n \u003cp\u003e0.77\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e0.49\u0026ndash;1.22\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e0.27\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\u0026nbsp;\u003c/td\u003e\n \u003ctd align=\"left\"\u003e\u0026nbsp;\u003c/td\u003e\n \u003ctd align=\"left\"\u003e\u0026nbsp;\u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003ePreoperative weight loss\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"char\"\u003e\n \u003cp\u003e1.05\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"char\"\u003e\n \u003cp\u003e1.02\u0026ndash;1.09\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"char\"\u003e\n \u003cp\u003e\u003cstrong\u003e0.003\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"char\"\u003e\n \u003cp\u003e1.04\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"char\"\u003e\n \u003cp\u003e1.004\u0026ndash;1.08\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"char\"\u003e\n \u003cp\u003e\u003cstrong\u003e0.03\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003eBMI\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"char\"\u003e\n \u003cp\u003e0.99\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"char\"\u003e\n \u003cp\u003e0.96\u0026ndash;1.03\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"char\"\u003e\n \u003cp\u003e0.72\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"char\"\u003e\n \u003cp\u003e1.02\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"char\"\u003e\n \u003cp\u003e0.98\u0026ndash;1.07\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"char\"\u003e\n \u003cp\u003e0.32\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003eType of surgery:\u003c/p\u003e\n \u003cp\u003eSG\u003c/p\u003e\n \u003cp\u003eRYGB\u003c/p\u003e\n \u003cp\u003eOAGB\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003eref.\u003c/p\u003e\n \u003cp\u003e1.05\u003c/p\u003e\n \u003cp\u003e4.00\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e0.61\u0026ndash;1.82\u003c/p\u003e\n \u003cp\u003e1.99\u0026ndash;8.04\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e0.86\u003c/p\u003e\n \u003cp\u003e\u003cstrong\u003e0.0001\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e1.007\u003c/p\u003e\n \u003cp\u003e4.64\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e0.53\u0026ndash;1.92\u003c/p\u003e\n \u003cp\u003e2.05\u0026ndash;10.49\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e0.98\u003c/p\u003e\n \u003cp\u003e\u003cstrong\u003e`12W\u0026thinsp;\u0026lt;\u0026thinsp;0.0001\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003eHT\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"char\"\u003e\n \u003cp\u003e1.15\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"char\"\u003e\n \u003cp\u003e0.76\u0026ndash;1.74\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"char\"\u003e\n \u003cp\u003e0.51\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\u0026nbsp;\u003c/td\u003e\n \u003ctd align=\"left\"\u003e\u0026nbsp;\u003c/td\u003e\n \u003ctd align=\"left\"\u003e\u0026nbsp;\u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003eT2DM\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"char\"\u003e\n \u003cp\u003e0.55\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"char\"\u003e\n \u003cp\u003e0.36\u0026ndash;0.84\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"char\"\u003e\n \u003cp\u003e\u003cstrong\u003e0.005\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"char\"\u003e\n \u003cp\u003e0.45\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"char\"\u003e\n \u003cp\u003e0.26\u0026ndash;0.76\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"char\"\u003e\n \u003cp\u003e\u003cstrong\u003e0.003\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003eGERD\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"char\"\u003e\n \u003cp\u003e1.24\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"char\"\u003e\n \u003cp\u003e0.71\u0026ndash;2.18\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"char\"\u003e\n \u003cp\u003e0.45\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\u0026nbsp;\u003c/td\u003e\n \u003ctd align=\"left\"\u003e\u0026nbsp;\u003c/td\u003e\n \u003ctd align=\"left\"\u003e\u0026nbsp;\u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003eOSA\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"char\"\u003e\n \u003cp\u003e1.60\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"char\"\u003e\n \u003cp\u003e0.68\u0026ndash;3.78\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"char\"\u003e\n \u003cp\u003e0.29\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\u0026nbsp;\u003c/td\u003e\n \u003ctd align=\"left\"\u003e\u0026nbsp;\u003c/td\u003e\n \u003ctd align=\"left\"\u003e\u0026nbsp;\u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003ePulmonary diseases\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"char\"\u003e\n \u003cp\u003e0.74\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"char\"\u003e\n \u003cp\u003e0.32\u0026ndash;1.72\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"char\"\u003e\n \u003cp\u003e0.48\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\u0026nbsp;\u003c/td\u003e\n \u003ctd align=\"left\"\u003e\u0026nbsp;\u003c/td\u003e\n \u003ctd align=\"left\"\u003e\u0026nbsp;\u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003eCardiovascular diseases\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"char\"\u003e\n \u003cp\u003e0.82\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"char\"\u003e\n \u003cp\u003e0.34\u0026ndash;1.94\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"char\"\u003e\n \u003cp\u003e0.64\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\u0026nbsp;\u003c/td\u003e\n \u003ctd align=\"left\"\u003e\u0026nbsp;\u003c/td\u003e\n \u003ctd align=\"left\"\u003e\u0026nbsp;\u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003eDyslipidemia\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"char\"\u003e\n \u003cp\u003e1.09\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"char\"\u003e\n \u003cp\u003e0.41\u0026ndash;2.87\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"char\"\u003e\n \u003cp\u003e0.87\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\u0026nbsp;\u003c/td\u003e\n \u003ctd align=\"left\"\u003e\u0026nbsp;\u003c/td\u003e\n \u003ctd align=\"left\"\u003e\u0026nbsp;\u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003ePCOS\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"char\"\u003e\n \u003cp\u003e2.08\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"char\"\u003e\n \u003cp\u003e0.21\u0026ndash;20.18\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"char\"\u003e\n \u003cp\u003e0.53\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\u0026nbsp;\u003c/td\u003e\n \u003ctd align=\"left\"\u003e\u0026nbsp;\u003c/td\u003e\n \u003ctd align=\"left\"\u003e\u0026nbsp;\u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003eHipothyroidism\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"char\"\u003e\n \u003cp\u003e1.10\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"char\"\u003e\n \u003cp\u003e0.61\u0026ndash;1.98\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"char\"\u003e\n \u003cp\u003e0.76\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"char\"\u003e\n \u003cp\u003e1.54\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"char\"\u003e\n \u003cp\u003e0.75\u0026ndash;3.18\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"char\"\u003e\n \u003cp\u003e0.24\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003eHepatic steatosis\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"char\"\u003e\n \u003cp\u003e0.54\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"char\"\u003e\n \u003cp\u003e0.14\u0026ndash;2.05\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"char\"\u003e\n \u003cp\u003e0.37\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\u0026nbsp;\u003c/td\u003e\n \u003ctd align=\"left\"\u003e\u0026nbsp;\u003c/td\u003e\n \u003ctd align=\"left\"\u003e\u0026nbsp;\u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003eOsteoarthritis\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"char\"\u003e\n \u003cp\u003e1.60\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"char\"\u003e\n \u003cp\u003e0.86\u0026ndash;2.96\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"char\"\u003e\n \u003cp\u003e0.14\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"char\"\u003e\n \u003cp\u003e2.07\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"char\"\u003e\n \u003cp\u003e0.996\u0026ndash;4.31\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"char\"\u003e\n \u003cp\u003e0.051\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003eRenal insufficiency\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"char\"\u003e\n \u003cp\u003e0.86\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"char\"\u003e\n \u003cp\u003e0.23\u0026ndash;3.25\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"char\"\u003e\n \u003cp\u003e0.82\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\u0026nbsp;\u003c/td\u003e\n \u003ctd align=\"left\"\u003e\u0026nbsp;\u003c/td\u003e\n \u003ctd align=\"left\"\u003e\u0026nbsp;\u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003eAutoimmunological disorders\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"char\"\u003e\n \u003cp\u003e1.21\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"char\"\u003e\n \u003cp\u003e0.35\u0026ndash;4.21\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"char\"\u003e\n \u003cp\u003e0.76\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\u0026nbsp;\u003c/td\u003e\n \u003ctd align=\"left\"\u003e\u0026nbsp;\u003c/td\u003e\n \u003ctd align=\"left\"\u003e\u0026nbsp;\u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003eNeurological Diseases\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"char\"\u003e\n \u003cp\u003e1.21\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"char\"\u003e\n \u003cp\u003e0.35\u0026ndash;4.21\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"char\"\u003e\n \u003cp\u003e0.76\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\u0026nbsp;\u003c/td\u003e\n \u003ctd align=\"left\"\u003e\u0026nbsp;\u003c/td\u003e\n \u003ctd align=\"left\"\u003e\u0026nbsp;\u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003ePsychiatric history\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"char\"\u003e\n \u003cp\u003e0.41\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"char\"\u003e\n \u003cp\u003e0.21\u0026ndash;0.81\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"char\"\u003e\n \u003cp\u003e\u003cstrong\u003e0.01\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"char\"\u003e\n \u003cp\u003e0.38\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"char\"\u003e\n \u003cp\u003e0.18\u0026ndash;0.82\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"char\"\u003e\n \u003cp\u003e\u003cstrong\u003e0.01\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003eSmoking\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"char\"\u003e\n \u003cp\u003e1.39\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"char\"\u003e\n \u003cp\u003e0.47\u0026ndash;4.17\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"char\"\u003e\n \u003cp\u003e0.55\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\u0026nbsp;\u003c/td\u003e\n \u003ctd align=\"left\"\u003e\u0026nbsp;\u003c/td\u003e\n \u003ctd align=\"left\"\u003e\u0026nbsp;\u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003eAlcohol abuse history\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"char\"\u003e\n \u003cp\u003e0.69\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"char\"\u003e\n \u003cp\u003e0.10\u0026ndash;4.92\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"char\"\u003e\n \u003cp\u003e0.71\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\u0026nbsp;\u003c/td\u003e\n \u003ctd align=\"left\"\u003e\u0026nbsp;\u003c/td\u003e\n \u003ctd align=\"left\"\u003e\u0026nbsp;\u003c/td\u003e\n \u003c/tr\u003e\n \u003c/tbody\u003e\n \u003c/table\u003e\n\n\u003c/div\u003e"},{"header":"DISCUSSION","content":"\u003cp\u003eOur study is a retrospective, multicenter analysis examining preoperative factors influencing weight loss outcomes in a 10-year follow-up of 368 patients undergoing MBS in Poland. To our knowledge, this is one of the few studies to analyze preoperative factors contributing surgical outcomes after such a long follow-up.\u003c/p\u003e \u003cp\u003eMaintaining completeness of follow-up will always be a major challenge for long-term follow-up studies. Given the chronic nature of obesity and obesity-related diseases, long-term monitoring of patients after MBS is particularly important. Current IFSO recommendations enjoin control visits at least once a year after 1 year after MBS \u003csup\u003e22\u003c/sup\u003e. The number of patients who continue to follow-up visits decrease year by year. In meta-analysis regarding 10- years observation follow-up ranges from 23–99%\u003csup\u003e23\u003c/sup\u003e. In our study the follow-up rate is 28.5% which is the limitation of this study. The association between adherence to follow-up visits after MBS and weight loss remains unclear \u003csup\u003e24–28\u003c/sup\u003e.\u003c/p\u003e \u003cp\u003eInterestingly, in the literature there is a lack of consensus on the definition of long-term follow-up \u003csup\u003e29\u003c/sup\u003e. According to different authors, 'long-term’ follow-up can range from even 2 to 10 years, some researchers considering it as 5 to 10 years, and others extending it to beyond 10 years. Oochit et al in analysis of the length of observation in the literature showed that the number of articles reporting long-term outcomes increased from 14% in 2015 to 25% in 2021, but the majority has remained short-term. Of the articles reporting long-term outcomes in 2021, 70% of the included patients respectively had \u0026gt; 5 years follow-up \u003csup\u003e30\u003c/sup\u003e. A great minority of recent studies describe follow-up longer than 10 years, with the longest reported observation period being 26 years \u003csup\u003e23,31–34\u003c/sup\u003e. Taking this into account, it is concluded that our study regarding 10-year follow-up remains very valuable.\u003c/p\u003e \u003cp\u003eDespite satisfactory effects of MBS in general, there are part of patients that will struggle to get to the goal weight and some of them will regain some of the weight. Numerous studies are being conducted to identify factors affecting outcomes of MBS, among others preoperative factors, to better distinguish patients who may require a special approach already at the stage of qualification for the procedure \u003csup\u003e35\u003c/sup\u003e. These patients should be an area of particular interest as a group requiring exceptional care in the selection of the surgical technique used as well as non-standard postoperative monitoring. Their treatment will likely require use of other methods in addition to operation to achieve better results. However, most studies to date evaluating the influence of preoperative factors of weight loss after MBS have considered 1–2 year outcomes, with a few reporting outcomes up to 5 years \u003csup\u003e36–38\u003c/sup\u003e.\u003c/p\u003e \u003cp\u003eAccording to the literature, long term outcomes of %EWL after RYGB range from 27–69%, 70–84% after OAGB, and 53–62% after SG \u003csup\u003e23\u003c/sup\u003e. In the analysed population 65% patients underwent SG, the rest of patients underwent OAGB and RYGB in equal percentages. More than a half of the patients achieved the goal of ≥ 50% EWL. The medium %EWL for the whole group in general was 59.17% (% TWL 22.81%). In our analysis, we presented an overall outcome of the weight loss, as a detailed breakdown exceeded the scope of this study.\u003c/p\u003e \u003cp\u003eWe found no association between preoperative BMI and weight loss success. Multiple studies reported that higher baseline BMI was a significant predictor of poorer weight loss \u003csup\u003e39,40\u003c/sup\u003e. These include a big study of 73,989 patients (BOLD database) which stated that baseline weight accounted for 18.5% of the total variability in 12-month absolute weight loss outcomes \u003csup\u003e41\u003c/sup\u003e. However, in other research with the longer observation (≥ 36 months of follow-up), the relationship between weight loss and initial BMI was no longer significant \u003csup\u003e36,37\u003c/sup\u003e.\u003c/p\u003e \u003cp\u003eThe guidelines by IFSO indicate that there is no upper age limit for MBS \u003csup\u003e22\u003c/sup\u003e. However, it is well known that the effect of weight loss is better in younger patients. Contreras et al. found that patients with age below 45 had better results in 1 year observation \u003csup\u003e42\u003c/sup\u003e. Scozzari et al. Revealed that patients aged \u0026gt; = 52 years, showed a significantly lower BMI decrease, with a more consistent weight regain in the follow-up range between 12 and 72 months \u003csup\u003e43\u003c/sup\u003e. In work from Chang et al. analysis showed that age is negatively correlated with BMI change at 3 and 5 years \u003csup\u003e20\u003c/sup\u003e. In contradiction with these reports our findings demonstrate that age alone does not significantly influence weight loss outcome after MBS and they are consistent with recent study that analyzed a cohort of patients over 65 years of age.\u003csup\u003e44\u003c/sup\u003e\u003c/p\u003e \u003cp\u003eIn summary, these results may indicate that during long-term follow-up the influence of age and baseline BMI is outweighed by other factors, probably those presented in postoperative period.\u003c/p\u003e \u003cp\u003eInterestingly, our analysis suggests that appropriate preoperative preparation may hold greater importance than the demographic characteristics of patients. Due to our findings preoperative weight loss is positively correlated with weight loss. While it may seem intuitive that patients who lose weight before surgery are likely to be more successful at losing weight after MBS, data from published studies on this topic are inconsistent and ambiguous \u003csup\u003e9,45–47\u003c/sup\u003e. Giordano et al. stated that preoperative weight loss \u0026gt; 10% may improve weight loss outcomes at 1-year follow-up \u003csup\u003e48\u003c/sup\u003e. This finding, in connection with our results may indicate that the relationship between preoperative and postoperative weight loss applies to the most motivated patients: those who lost the most weight before surgery and who were willing to continue long-term follow-up visits.\u003c/p\u003e \u003cp\u003eAccording to our findings, OAGB increased the likelihood of achieving more than 50% EWL by over 4 times compared to other procedures in the multivariable logistic regression. The advantage of OAGB over other procedures was confirmed in the results of Cadena-Obando et al \u003csup\u003e49\u003c/sup\u003e. In addition, SG was shown to be a factor of worse outcome of %TWL in 3- and 5-year follow-up \u003csup\u003e20,50\u003c/sup\u003e. Therefore, the choice of surgical procedure in a patient with multiple factors of failure to lose weight should be cautious.\u003c/p\u003e \u003cp\u003eT2DM was related to worse prognosis of %EWL, which is in agreement with the literature. In a study of over 400 patients who underwent MBS, T2DM was a significant predictor of reduced %EBWL in 1-year observation \u003csup\u003e21\u003c/sup\u003e. Also, in two big retrospective studies T2DM was found to be a strong predictor of poorer %EWL 5 years after surgery \u003csup\u003e51,52\u003c/sup\u003e. Interestingly, in a study of RYGB with a median follow-up of 9.3 years, Wood et al. found preoperative insulin use to be associated with greater long-term postoperative percent weight loss \u003csup\u003e53\u003c/sup\u003e. In our study at least 41 patients were treated with insulin what constitutes significant minority (35%) of the group.\u003c/p\u003e \u003cp\u003eMental health conditions are common among bariatric surgery patients \u003csup\u003e54\u003c/sup\u003e. Polish preliminary data on the prevalence of mental disorders in patients qualified for the nationwide multi-center pilot of bariatric obesity treatment program (KOS-BAR) showed that 12.1% patients were in psychiatric treatment but there were additional 11.7% with de novo diagnosis \u003csup\u003e55\u003c/sup\u003e. There is inconsistent evidence regarding the association between preoperative mental health conditions and postoperative weight loss \u003csup\u003e54,56,57\u003c/sup\u003e. In a study by Vermeer et al. in bariatric patients, in whom 163 had preoperative diagnosis of psychiatric disease and 2362 had no such diagnosis, total weight loss 1 to 4 years after surgery was significantly lower in the psychiatric group \u003csup\u003e58\u003c/sup\u003e. Our study showed a negative association between preoperative psychiatric history and achieving ≥ 50% EWL. However, analysed population consisted of 4% patients with this factor which can cause bias.\u003c/p\u003e \u003cp\u003eThe study has several limitations. The retrospective design of the study may introduce potential biases, especially in data collection and reporting. Another bias is introduced by the low follow-up rate achieved. Since all data were reported from 5 different bariatric centers, there is a potential for inconsistency in the collected data. The study lacks partial data on outcomes, and the results presented are the endpoint of the follow-up. In addition, the majority of patients were operated on using one method. Nevertheless, we believe that this study provides valuable data on MBS in long-term follow-up, and its results can certainly be clinically applied.\u003c/p\u003e"},{"header":"CONCLUSIONS","content":"\u003cp\u003eT2DM, and history of psychiatric treatment may lead to lower %EWL in the postoperative period. At the same time preoperative weight loss was positively related to weight loss success. OAGB emerged as the most efficacious type of surgery in terms of weight loss. Our data regard to preoperative factors affecting outcomes of MBS differ significantly from those concerning shorter observations. Additional studies especially those with long-term observation and proper percentage of follow-up rate are needed to change clinical practice of bariatric procedures.\u003c/p\u003e"},{"header":"Declarations","content":"\u003ch2\u003eAuthor Contribution\u003c/h2\u003e\u003cp\u003ePM and NDG conceived this research.IK, NDG and MM gathered data.AC, IK, PM participated in the design and interpretation of the data.IK performed statistical analysis and modelling.AC and IK wrote the main manuscript text.AC performed tables and graphs.PM participated in the revisions of manuscript.\u003c/p\u003e"},{"header":"References","content":"\u003col\u003e\n\u003cli\u003eSwinburn BA, Kraak VI, Allender S, et al. The Global Syndemic of Obesity, Undernutrition, and Climate Change: The Lancet Commission report. \u003cem\u003eLancet\u003c/em\u003e. 2019;393(10173):791-846. doi:10.1016/S0140-6736(18)32822-8\u003c/li\u003e\n\u003cli\u003eHeymsfield SB, Bourgeois B, Thomas DM. 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Bariatric surgery in patients with psychiatric comorbidity: Significant weight loss and improvement of physical quality of life. \u003cem\u003eClin Obes\u003c/em\u003e. 2020;10(4):1-8. doi:10.1111/cob.12373\u003c/li\u003e\n\u003c/ol\u003e"},{"header":"Table 1","content":"\u003cp\u003eTable 1 is available in the Supplementary Files section.\u003c/p\u003e\n"}],"fulltextSource":"","fullText":"","funders":[],"hasAdminPriorityOnWorkflow":false,"hasManuscriptDocX":true,"hasOptedInToPreprint":true,"hasPassedJournalQc":"","hasAnyPriority":false,"hideJournal":false,"highlight":"","institution":"","isAcceptedByJournal":true,"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-6319526/v1","lastPublishedDoiUrl":"https://doi.org/10.21203/rs.3.rs-6319526/v1","license":{"name":"CC BY 4.0","url":"https://creativecommons.org/licenses/by/4.0/"},"manuscriptAbstract":"\u003cp\u003e\u003cstrong\u003eIntroduction\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eCurrently, metabolic bariatric surgery (MBS) is considered the most effective method for achieving substantial and long-term weight-loss in severely obese patients. However, 4 to 40% of bariatric patients do not accomplish optimal results. The study aimed to identify factors contributing to maintain \u0026gt;50% EWL after MBS at the 10- years observation.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eMaterials and methods\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eThis is a retrospective, multicenter cohort study of patients with obesity who completed 10-years follow-up, undergoing primary laparoscopic MBS surgery in 2007–2014. Data came from 5 bariatric centers. Patients were divided into two groups: patients who achieved more than 50% EWL and those who achieved less than 50% EWL. Uni- and multivariable logistic regression were used to identify predictors of optimal results.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eResults\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eOut of 368 analyzed patients the median BMI before the surgery was 42.73 kg/m2. The most common obesity-related diseases were hypertension (HT) (52.72%) and type 2 diabetes mellitus (T2DM) (30.98%). Sleeve gastrectomy was the most frequently performed procedure (65.22%). The median follow-up was 10.90 years. 59,24% patients achieved \u0026gt;50% EWL. Uni- and multivariable logistic regression analysis confirmed preoperative weigh loss (OR=1.04; P=0.03), T2DM (OR=0.45; P=0.003), psychiatric history (OR=0.38; P=0.01) and one anastomosis gastric bypass (OAGB) \u0026nbsp;(OR=4.64; P\u0026lt;0.0001) to have a significant impact on weight loss outcome 10-years after MBS.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eConclusions\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eIn a 10-year follow-up, patients with greater preoperative weight loss may have a better response to surgery. OAGB emerged as the most beneficial type of surgery in terms of weight loss. T2DM and psychiatric history are independent predictors of lower %EWL.\u003c/p\u003e","manuscriptTitle":"What Really Matters in Weight Loss After Bariatric Surgery – 10 Years Follow-Up (BARI-10-POL Study)","msid":"","msnumber":"","nonDraftVersions":[{"code":1,"date":"2025-06-09 05:40:11","doi":"10.21203/rs.3.rs-6319526/v1","editorialEvents":[{"type":"communityComments","content":0},{"type":"decision","content":"Revision requested","date":"2025-07-02T22:55:39+00:00","index":"","fulltext":""},{"type":"editorInvitedReview","content":"","date":"2025-06-02T16:49:10+00:00","index":"hide","fulltext":""},{"type":"reviewerAgreed","content":"20028809721055585553772705566884974687","date":"2025-06-02T16:17:59+00:00","index":"hide","fulltext":""},{"type":"reviewersInvited","content":"","date":"2025-06-02T16:11:04+00:00","index":"","fulltext":""},{"type":"editorAssigned","content":"","date":"2025-04-08T23:52:14+00:00","index":"","fulltext":""},{"type":"checksComplete","content":"","date":"2025-04-08T01:02:40+00:00","index":"","fulltext":""},{"type":"submitted","content":"Obesity Surgery","date":"2025-03-27T10:07:38+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":"15ba99ba-10b4-48c1-af07-a058a6ebad8a","owner":[],"postedDate":"June 9th, 2025","published":true,"recentEditorialEvents":[],"rejectedJournal":[],"revision":"","amendment":"","status":"published-in-journal","subjectAreas":[],"tags":[],"updatedAt":"2025-11-24T16:03:15+00:00","versionOfRecord":{"articleIdentity":"rs-6319526","link":"https://doi.org/10.1007/s11695-025-08385-4","journal":{"identity":"obesity-surgery","isVorOnly":false,"title":"Obesity Surgery"},"publishedOn":"2025-11-17 15:57:00","publishedOnDateReadable":"November 17th, 2025"},"versionCreatedAt":"2025-06-09 05:40:11","video":"","vorDoi":"10.1007/s11695-025-08385-4","vorDoiUrl":"https://doi.org/10.1007/s11695-025-08385-4","workflowStages":[]},"version":"v1","identity":"rs-6319526","journalConfig":"researchsquare"},"__N_SSP":true},"page":"/article/[identity]/[[...version]]","query":{"redirect":"/article/rs-6319526","identity":"rs-6319526","version":["v1"]},"buildId":"8U1c8b4HqxoKbykW_rLl7","isFallback":false,"isExperimentalCompile":false,"dynamicIds":[84888],"gssp":true,"scriptLoader":[]}