Early prediction of suboptimal clinical response after bariatric surgery using total weight loss percentiles

Individuals undergo bariatric surgery to achieve significant weight loss or improvement of comorbidities. Early identification of patients at risk for suboptimal clinical response is critical to enable timely intervention. This study evaluated the performance of TWL percentiles for predicting suboptimal clinical response after one-anastomosis gastric bypass (OAGB), Roux-en-Y gastric bypass (RYGB), and sleeve gastrectomy (SG). This retrospective cohort study included 5780 individuals undergoing bariatric surgery from 2008 to 2020. Suboptimal clinical response was defined as a %TWL < 20 at the first follow-up visit occurring between 24 and 36 months after surgery. The mean age of participants was 37 years for SG and 40 years for both OAGB and RYGB, with the majority being female (75-84%). From three months post-surgery, patients with suboptimal clinical response were consistently concentrated below the 25th percentile, suggesting this threshold may serve as a general early warning sign. Six months post-surgery, the 23rd percentile for SG, 29th for RYGB, and 33rd for OAGB emerged as the key predictive thresholds. TWL percentiles offer a valuable tool for predicting suboptimal clinical response. Incorporating TWL percentile monitoring into routine postoperative care may support timely detection, enabling earlier intervention with targeted strategies for better long-term outcomes.