Predictors of Weight Regain after Sleeve Gastrectomy: an Integrative Review

Abstract Background Sleeve gastrectomy (SG) is one of the most effective treatments for severe obesity, but weight regain after surgery is a challenging issue. The mechanism of post-surgical weight relapse is barely understood due to the lack of long-term data. Objective To review and synthesize current evidence related to factors that contribute to weight regain after SG. Method Whittemore and Knafl's integrative method guided the research. The databases PubMed, EMBASE, and CINAHL, as well as two selected journals were searched through October 2018 to gather English-language journal articles on the potential predictors of post-SG weight regain among adult populations. Only articles with sample size ≥10 were included. A narrative synthesis was used to analyze the 17 studies included in the review. Results In recent years, there has been an upward trend in the published reports of SG on longer-term outcomes. After a review of 6863 records, 17 eligible studies were identified, reporting various definitions of weight regain and three main categories of predictors: surgical/anatomic factors, hormonal/metabolic imbalance and behavioral/mood factors. The 17 studies used quantitative (n= 16) and qualitative methods (n= 1). Conclusion There is a dearth of available literature addressing predictors of weight regain following SG and the inconsistency in the definition of regain limited the comparability between studies. Besides the surgical/anatomic factors that have been reported as significant predictors, other modifiable factors such as behavioral and psychosocial determinants need to be further investigated.