OBJECTIVES: Bariatric surgery is the most effective weight loss method compared to non-surgical strategies, however, post-surgery weight regain is common. We aimed to assess sustained weight loss over a five-year follow-up period across race, insurance payer type, and exposure to nutrition counseling.

METHODS: De-identified patient records were extracted from a US electronic health records database. Utilizing ICD-9 and ICD-10 codes, we selected patients >18 years old who received bariatric surgery (01/01/2011–12/31/2016, index date), had ≥1 postoperative nutrition consultation, and ≥1 BMI recording each year over a five-year follow-up period. Patients with any gastric cancer diagnosis were excluded. Change in BMI was observed across racial and insurance payer groups.

RESULTS: A total of 657 patients met study criteria (mean age 48.3 ± 12.6, 84.4% female, 87.0% white, 60.4% commercial insurance). Patients attended a mean of 2.9 ± 3 nutrition visits during five-year follow up. Compared to baseline BMI measurements (within preoperative 6 months), white patients lost more weight within the first year (25%±12% BMI loss) and experienced least weight regain at five years (23% ± 15% BMI loss). Black patients lost 19%(± 16%) BMI at year 1 and 15% (± 13%) by year 5. When weight loss was examined by payer, self-pay patients showed the greatest change from baseline BMI in the first year (31% ± 11%), though the loss was diminished to 27%(± 12%) by year 5. Medicaid subscribers were the only payer group that did not reveal overall weight regain (21% ± 21% BMI loss at year 1 and 23% ± 15% at year 5). Number of nutrition counseling visits was not suggestive of differences in sustained weight loss.

CONCLUSIONS: These results suggest that further research is needed to determine if patient characteristics such as race, payer type, and access to nutrition consultations affect long-term sustained weight loss post-bariatric surgery.