This retrospective cohort study examined predictors of recurrence of obesity-related medical conditions (T2D, HTN, HLD, OSA) in 1,323 adults who had initial remission after primary sleeve gastrectomy (SG), Roux-en-Y gastric bypass (RYGB), or duodenal switch (DS) between 2008 and 2022, with ≥36 months of follow-up.
Recurrence rates were 16.2% for T2D, 21.3% for HTN, 19.0% for HLD, and 5.4% for OSA. Severe recurrent weight gain (>50%) independently predicted only HLD recurrence. RYGB and DS carried lower T2D and HLD recurrence risk vs. SG. T2D recurrence was driven by pre-op insulin use and higher HbA1c; HTN recurrence by greater antihypertensive burden and older age. White race was protective against HTN recurrence.
- Retrospective single-institution design limits generalizability. - OSA recurrence may be underestimated due to reliance on symptom-based or clinical criteria rather than repeat polysomnography. - Dataset is not publicly available; full multivariate model details require journal access.
Baseline disease severity (insulin dependence, HbA1c, antihypertensive burden) is a stronger predictor of ORMC recurrence than weight regain alone — so screen and manage underlying disease intensity closely before and after bariatric surgery. RYGB or DS may offer more durable metabolic protection than SG for T2D and HLD, which should factor into procedure selection.
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