Rapid Recurrent Weight Gain Within Two Years of Sleeve Gastrectomy: Clinical Predictors and Metabolic Consequences

This study aimed to identify risk factors for rapid recurrent weight gain (RRWG), defined as ≥ 20% regain from the weight loss 1 year postoperatively within 2 years after laparoscopic sleeve gastrectomy (LSG). In this retrospective cohort study, we analyzed 201 consecutive adults who underwent LSG, with weight recorded preoperatively and at 3, 6, 12, and 24 months postoperatively, and with extended follow-up to 5 years. Laboratory parameters, comorbidities, psychological evaluations, and medication use were also assessed. The median preoperative body mass index (BMI) was 39.4 kg/m². The median total body weight loss (TBWL) was 28.6% at 6 months, 34.4% at 1 year, and 32.9% at 2 years. Although weight loss outcomes were comparable between groups at 1 year, by 2 years the RRWG group showed significantly lower excess body weight loss (EBWL) and TBWL, as well as fewer patients achieving EBWL ≥ 50% (P < 0.001). Mid-term follow-up revealed persistently higher recurrence rates in the RRWG group at 3-4 years, with a continuing trend at 5 years. Compared with the maintained weight loss (MW) group, RRWG patients demonstrated a higher prevalence of diabetes (26.3% vs. 7.1%, P = 0.017), greater worsening of dyslipidemia (57.9% vs. 25.3%, P = 0.006), and lower rates of hypertension remission (46.2% vs. 62.5%, P = 0.002) at 24 months. Multivariable analysis identified preoperative BMI < 37.4 (aOR = 5.036, P = 0.001), and TBWL at 12 months < 25% (aOR = 4.930, P = 0.036) as independent predictors of RRWG. Lower preoperative BMI, and suboptimal 12-month weight loss independently predicted RRWG after LSG. Early identification of high-risk patients is essential to optimize long-term outcomes after LSG.