MSS860: CLINICAL AND BEHAVIORAL PREDICTORS OF SHORT-TERM WEIGHT RECIDIVISM FOLLOWING BARIATRIC SURGERY AT A MILITARY TREATMENT FACILITY
Michael T Olson, MD; Yun Beom Lee, MD; Brian Layton, DO; Pamela Masella, DO; Department of Minimally Invasive and Bariatric Surgery, Brooke Army Medical Center, Fort Sam Houston, Texas, USA
Objectives: Weight recidivism after bariatric surgery is a recognized challenge that may undermine the benefits of the procedure. This study aimed to evaluate the incidence and predictors of short-term weight recidivism following bariatric surgery and secondarily assess its impact on metabolic outcomes.
Methods: We performed a retrospective analysis of patients undergoing bariatric surgery between 01/01/2023 and 01/01/2024 at a tertiary military treatment facility. Patients were categorized into weight recidivism versus no recidivism, defined as an increase in weight ≥10 kg from nadir or regaining >20% of initial excess weight loss (EWL). Demographics, preoperative comorbidities, cardiometabolic parameters, operative characteristics, and postoperative behavioral factors were collected. Adherence to national exercise and protein intake recommendations, defined as ≥150 minutes/week of moderate-intensity aerobic exercise and ≥60 g/day of protein, was assessed at 12-month follow-up. Statistical analyses included Firth’s logistic regression for predictors of recidivism and t-tests for weight loss and metabolic outcomes.
Results: 122 patients underwent bariatric surgery during the study period, with comprehensive 24-month follow-up data available for 75 patients: 23 (30.7%) with weight recidivism and 52 (69.3%) without recidivism. Patients with recidivism were younger (43.3 ± 10.7 vs 47.9 ± 9.3 years, p=0.08) and less likely to be married (69.6% vs 90.4%, p=0.038). Preoperative BMI was higher in recidivism patients (42.4 ± 7.4 vs 39.5 ± 5.3; p=0.099). Preoperative comorbidities, beneficiary status, procedure type, postoperative complications, and healthcare utilization did not differ between groups. At 24 months, total weight loss (TWL) and EWL was non-significantly higher in patients with no recidivism (TWL: 27.4 ± 13.4 vs 23.9 ± 9.6, p=0.265; EWL: 75.4 ± 40.4 vs 71.2 ± 40.4, p=0.674). On Firth’s logistic regression, younger age (OR 0.958, 95% CI 0.904–1.010), being married (OR 0.272, 95% CI 0.068–1.025), adherence to exercise recommendations (OR 5.52, 95% CI 1.70–20.4, p=0.002), and adequate protein intake (OR 5.35, 95% CI 1.676–18.81, p=0.001) at 12 months were significant predictors of 2-year weight recidivism. Patients with recidivism demonstrated lower mean reduction in LDL cholesterol at 12 months compared to non-recidivism patients (9.8% vs 22.8%, p=0.026).
Conclusion: Short-term weight recidivism after bariatric surgery in the military health system is predicted by younger age, marital status, and poor adherence to behavioral recommendations at 12 months. Social support and lifestyle adherence may have the strongest influence on weight recidivism, suggesting that patients with low exercise or protein intake should be targeted for closer follow-up than standard annual visits.