# The Impact of Preoperative Weight Loss on Long-term Success: 5-year Outcomes After Metabolic Bariatric Surgery

## TL;DR

This study finds that preoperative weight loss is linked to better short-term but not long-term weight loss outcomes after metabolic bariatric surgery.

## Contribution

The study provides five-year follow-up data on the impact of preoperative weight loss after metabolic bariatric surgery.

## Key findings

- Greater preoperative weight loss is associated with higher total weight loss up to two and four years post-surgery.
- No significant differences in weight loss were observed after five years of follow-up.
- Female sex, RYGB procedure, and younger age predict greater total weight loss.

## Abstract

Preoperative weight loss has been suggested as a predictor of postoperative weight loss outcomes after Metabolic Bariatric Surgery (MBS). While previous studies focused on outcomes up to 3 years, longer-term results remain limited. This study evaluates the association between preoperative weight loss and total weight loss (%TWL) up to five years postoperatively.

This single-center retrospective study included 765 patients who underwent primary MBS between June 2017 and august 2019. Patients were stratified into quartiles based on preoperative weight loss. Follow-up data on %TWL were analyzed at 3 and 6 months and 1 through 5 years postoperatively.

The median age was 45 (35-52) and the majority were female (76.6%). Most patients underwent ring augmented Roux-en-Y Gastric Bypass (91.1%). Follow-up was 99.6% at 1 year and 65.9% at 5 years. Quartiles were defined as Q1: <4.4%, Q2:4.4-6.2%, Q3: 6.2-8.2% and Q4: > 8.2% preoperative weight loss. After 5 years %TWL was 32.4 (Q1), 32 (Q2), 32 (Q3) and 31.6 (Q4).

Greater preoperative weight loss was associated with significant higher %TWL up to two years (quartiles) and four years (low vs high) after MBS, but no significant differences were found after five years of follow up. The impact of preoperative weight loss on long-term outcomes was consistent across subgroups. Female sex, RYGB procedure and younger age were general predictors for greater %TWL.

The online version contains supplementary material available at 10.1007/s11695-025-08476-2.