Dr. Ahmed
Gastric Sleeve 10 Years Later: How much weight regain is expected after 10 years?
With time the small banana-shaped stomach adjusts itself and expands to accommodate more food. This is especially concerning in people who are non-compliant with the diet they have been advised.
As the stomach tries to accommodate more food, people start gaining weight rapidly.
Gastric sleeve 10 years later has been estimated to cause 43.5% excess weight loss vs 51% with gastric bypass.
How Fast Are You Going to Lose Weight After Gastric Sleeve?
Sleeve gastrectomy is a weight loss surgery. The main aim is weight reduction and resolution of obesity-associated medical conditions such as diabetes and sleep apnea.
It is indicated in individuals with a BMI of 35 kg/m² or more with at least one obesity-associated medical condition or a BMI of more than 40 kg/m² without co-morbid medical conditions.
Individuals who undergo gastric sleeve tend to lose weight at a rapid speed. The weight loss can be noticed within the first month of the surgery.
The weight loss continues and the maximum weight loss is expected between 1 – 2 years after surgery.
After the second year, people start gaining weight again. The weight gain can range from 5% after the second year to 75% after 6 to 10 years.
Weight regain is mostly a problem that occurs in people who are not compliant with dietary advice.
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Gastric Sleeve 10 Years Later:
The primary concern after 10 years of gastric sleeve is weight regain. Weight regain can start after the second year.
Although weight regain is an issue, most people who regain weight still have markedly less weight than their pre-operative weight.
Different clinical trials have documented variable results. The results of some of the studies are presented here:
Half of the patients had weight regain after gastric sleeve:
In a study, 103 patients who had Gastric Sleeve surgery were followed for up to 10 years. Initial weight loss was significant.
However, about half of the patients regained weight after 10 years.
- 24% of the individuals regained 50% or more of the excess weight,
- 18% regained 25% to 49%, while
- 6% of the individuals had 25% or less weight regain after 10 years of gastric sleeve surgery.
Weight Re-Gain after 10 years of Gastric Sleeve Surgery |
|
| Weight re-gain of >50% | 24% |
| Weight re-gain of 25 – 50% | 18% |
| Weight re-gain of less than 25% | 6% |
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Weight regain after 10 years with Gastric Sleeve Vs Gastric Bypass:
Another study compared sleeve gastrectomy and laparoscopic Roux-en Y gastric bypass [Ref]. Out of a total of 65 patients, 34 patients underwent sleeve gastrectomy and 31 underwent gastric bypass.
The average weight of the study patients was 130 kgs (range: 120 to 140 kgs). After one year, the average weight reduced to 86 kgs (range: 81 to 95 kgs). Patients in the gastric sleeve group lost 44 kgs (34% of the baseline body weight).
After 10 years of gastric sleeve, weight regain was noted. The average weight after 10 years of the gastric sleeve was 95.5 kgs (26.5% weight loss from the baseline weight 10 years before)
No significant difference in weight loss or weight regain was noted when the gastric sleeve was compared with gastric bypass.
Weight loss after 1 and 10 years of gastric sleeve surgery
Parameters |
Baseline |
After 1 year |
After 10 years |
| Weight | 130 (120-140kg) | 86kg (81-95kg) | 95.5kg (90-110kg) |
| BMI | 47.4+/- | 33.2+/-5.9kg/m2 | 34.8+/-6.9 |
| %EWL | 61.7+/-11.9 | 52.1+/-19.9 |
%EWL: Percent estimated weight loss
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Significant Weight loss after 10 years of Gastric Sleeve:
In a study that included a total of 240 patients who had either a gastric sleeve surgery or gastric bypass were followed for up to 10 years.
Substantial weight loss was observed after 10 years in both groups of patients who had gastric sleeve or gastric bypass surgery done.
The percentage of EWL (excess body weight loss) was 43.5% ( 2.1 – 109.9%) over 10 years in the LSG group (gastric sleeve group) and 50.7% in the gastric bypass group.
Diabetes remission was 26% and 33% in the gastric sleeve group and gastric bypass groups respectively [Ref]
Other parameters are tabulated below:
Gastric Sleeve |
Gastric Bypass |
|
| Percent EWL | 43.5% | 50.7% |
| Diabetes remission | 26% | 33% |
| Dyslipidemia | 19% | 35% |
| Sleep apnea | 16% | 31% |
| Hypertension | 8% | 24% |
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30% weight loss after 10 years of gastric sleeve:
The effect of Gastric Sleeve Surgery was studied in a total of 182 patients who were followed for a minimum of 10 years.
The mean percentage of weight loss was 30.9% while the mean EWL (excess weight loss) was 52.5%.
Diabetes remission was noted in 64.7% of the patients. 10.4% of patients had weight regain of >25% of the maximum weight loss in the first year [Ref]
Gastric sleeve 10 years later: Weight Regain?
In this study, the long-term effects of sleeve gastrectomy on weight loss were done. In this study total of 40 patients were enrolled in the study.
In the first year of the post-op period, optimal weight loss in patients was recorded, but later on, weight regain was seen.
After 1 year of the post-op period, the average percentage of excess weight loss of 70+/-2% was recorded.
However, patients regained weight over the 10 years and the percentage of EWL (excess weight loss) was 42%.
BMI dropped to 31 at one year and rose again to 36 after 10 years.
| BMI | % EWL | |
| Baseline | 44 | 0 |
| at 1 year | 31 | 70 |
| at 10 years | 36 | 42 |
Because patients regained weight, 18% of patients had to undergo conversion to bypass procedures after 10 years [Ref].
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Weight regain over time after gastric sleeve surgery:
Another study was done to see the progression of weight loss in patients undergoing sleeve gastrectomy. In this study weight loss at different intervals was recorded.
The % of excess weight loss over time is given in the table below:
| %EWL (estimated weight loss) 5 years | 62.3% |
| %EWL (estimated weight loss) 6 years | 53.8% |
| %EWL (estimated weight loss) 7 years | 43% |
| %EWL (estimated weight loss) 8 years | 54.8% |
In this study factors resulting in weight regain were also noted. It was found that patients who were non-compliant with diet and those who lost to follow had the most weight regain [Ref].
Weight loss exceeding 50% with gastric sleeve 10 years later:
Another study was done on 307 patients with a follow-up of 11 years. In this study, the mean percentage of BMI was 43.7%.
The percentage of excess BMI loss (EBMIL) recorded at 5, 10, and 13 years was recorded as:
| BMI 5years | 62.3 +/- 23.1 |
| BMI 10years | 53.6 +/- 24.6 |
| BMI 13years | 51.2 +/- 20.3 |
Weight regain occurred after 10 years necessitating re-surgery. Every 5th patient required re-surgery.
7.8 % of patients underwent re-surgery because of Insufficient weight loss, 3.9% required re-surgery due to GERD, and 7.5% due to GERD + insufficient weight loss [Ref].
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In Conclusion:
Gastric sleeve surgery is associated with significant weight loss. The maximum weight loss is documented between 6 months and 2 years.
After 2 years some weight gain is possible because the stomach gets adapted and the food may stretch the stomach distending it back.
However, compared to most medical weight loss interventions such as Semaglutide and Tirzepatide, people who have undergone weight loss surgery would still remain lean and not regain significant weight.
