{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,9,15]],"date-time":"2026-09-15T02:56:28Z","timestamp":1789440988745,"version":"build-2803163510"},"reference-count":49,"publisher":"MDPI AG","issue":"12","license":[{"start":{"date-parts":[[2026,6,12]],"date-time":"2026-06-12T00:00:00Z","timestamp":1781222400000},"content-version":"vor","delay-in-days":0,"URL":"https:\/\/creativecommons.org\/licenses\/by\/4.0\/"}],"content-domain":{"domain":[],"crossmark-restriction":false},"short-container-title":["JCM"],"abstract":"<jats:p>Background\/Objectives: Bariatric surgery is an effective intervention for severe obesity; however, long-term outcomes may be influenced by postoperative dietary behaviors, nutritional status, and complications. In Saudi Arabia, longitudinal evidence on weight trajectories and postoperative diet quality remains limited. The present study aimed at evaluating three-year weight status trends; assessing sociodemographic factors, baseline BMI, and postoperative diet quality; and examining nutrition-related complications following bariatric surgery. Methods: This retrospective longitudinal study included 189 adults who underwent sleeve gastrectomy at two tertiary hospitals in Jeddah, Saudi Arabia. Anthropometric data were obtained from medical records at six time points: preoperative, two weeks, six months, one year, two years, and three years postoperatively. Diet quality and postoperative complications were assessed via structured telephone interviews. Weight outcomes were expressed as percentage of total body weight loss (%TBWL), excess body weight loss (%EWL), excess body mass index loss (%EBMIL), and weight regain. Statistical analyses included Friedman\u2019s test, Mann\u2013Whitney U test, and multiple linear regression. Results: Significant improvements in all weight loss indicators were observed over three years (p &lt; 0.001). Diet quality score was the only significant variable associated with weight loss at three years, with higher scores associated with greater %EWL and %EBMIL. Baseline BMI and DQS were significantly associated with %EWL (Beta = \u22120.17, 95% CI: \u22121.72 to \u22120.13 and Beta = 0.21, 95% CI: 1.37 to 7.12, respectively) and %EBMIL (Beta = \u22120.15, 95% CI: \u22121.68 to \u22120.07 and Beta = 0.24, 95% CI: 1.90 to 7.66, respectively). Age was significantly associated with weight regain (Beta = 0.20, 95% CI: 0.02 to 1.08). Conclusions: Bariatric surgery resulted in sustained weight reduction over three years. Postoperative baseline BMI and diet quality were significantly associated with %EWL and %EBMIL, underscoring the importance of structured nutritional follow-up and counseling.<\/jats:p>","DOI":"10.3390\/jcm15124571","type":"journal-article","created":{"date-parts":[[2026,6,15]],"date-time":"2026-06-15T08:57:58Z","timestamp":1781513878000},"page":"4571","update-policy":"https:\/\/doi.org\/10.3390\/mdpi_crossmark_policy","source":"Crossref","is-referenced-by-count":1,"title":["Long-Term Weight Loss Outcomes Following Sleeve Gastrectomy and Their Association with Diet Quality, Postoperative Complications, and Sociodemographic Factors: A Retrospective Cohort Study in Jeddah, Saudi Arabia"],"prefix":"10.3390","volume":"15","author":[{"given":"Khalid A.","family":"Khormi","sequence":"first","affiliation":[{"name":"Clinical Nutrition Services, Erada and Mental Health Complex, Jeddah Second Health Cluster, Jeddah 23622, Saudi Arabia"},{"name":"Department of Clinical Nutrition, Faculty of Applied Medical Sciences, King Abdulaziz University, Jeddah 21589, Saudi Arabia"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0003-4007-0006","authenticated-orcid":false,"given":"Walaa A.","family":"Mumena","sequence":"additional","affiliation":[{"name":"Clinical Nutrition Department, College of Applied Medical Sciences, Taibah University, Madinah 42353, Saudi Arabia"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0009-0000-0830-2079","authenticated-orcid":false,"given":"Ahmed K. M.","family":"Salman","sequence":"additional","affiliation":[{"name":"Prince Sultan Center for Bariatric Surgery, King Fahd General Hospital, Jeddah 23325, Saudi Arabia"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Ahmed A.","family":"Faden","sequence":"additional","affiliation":[{"name":"Department of General & Minimally Invasive Surgery, King Abdullah Medical Complex, Jeddah Second Health Cluster, Ministry of Health, Jeddah 23816, Saudi Arabia"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-5769-175X","authenticated-orcid":false,"given":"Maryam S.","family":"Hafiz","sequence":"additional","affiliation":[{"name":"Department of Clinical Nutrition, Faculty of Applied Medical Sciences, King Abdulaziz University, Jeddah 21589, Saudi Arabia"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-2687-2515","authenticated-orcid":false,"given":"Hebah A.","family":"Kutbi","sequence":"additional","affiliation":[{"name":"Department of Clinical Nutrition, Faculty of Applied Medical Sciences, King Abdulaziz University, Jeddah 21589, Saudi Arabia"}],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"1968","published-online":{"date-parts":[[2026,6,12]]},"reference":[{"key":"ref_1","doi-asserted-by":"crossref","unstructured":"Ullah, M.I., and Tamanna, S. (2025). Obesity: Clinical Impact, Pathophysiology, Complications, and Modern Innovations in Therapeutic Strategies. Medicines, 12.","DOI":"10.3390\/medicines12030019"},{"key":"ref_2","doi-asserted-by":"crossref","first-page":"1027","DOI":"10.1016\/S0140-6736(23)02750-2","article-title":"Worldwide trends in underweight and obesity from 1990 to 2022: A pooled analysis of 3663 population-representative studies with 222 million children, adolescents, and adults","volume":"403","author":"Phelps","year":"2024","journal-title":"Lancet"},{"key":"ref_3","unstructured":"General Authority for Statistics (2026, March 13). Health Determinants Statistics Publication 2023, Available online: https:\/\/www.stats.gov.sa\/documents\/20117\/2435259\/Health-Determinants-Statistics-Publication-2023-EN_1.pdf\/461913b1-5636-e2cf-d10a-8185ab70488d?t=1734054115983."},{"key":"ref_4","doi-asserted-by":"crossref","unstructured":"Althumiri, N.A., Basyouni, M.H., AlMousa, N., AlJuwaysim, M.F., Almubark, R.A., BinDhim, N.F., Alkhamaali, Z., and Alqahtani, S.A. (2021). Obesity in Saudi Arabia in 2020: Prevalence, Distribution, and Its Current Association with Various Health Conditions. Healthcare, 9.","DOI":"10.3390\/healthcare9030311"},{"key":"ref_5","doi-asserted-by":"crossref","unstructured":"Alsulami, S., Baig, M., Ahmad, T., Althagafi, N., Hazzazi, E., Alsayed, R., Alghamdi, M., and Almohammadi, T. (2023). Obesity prevalence, physical activity, and dietary practices among adults in Saudi Arabia. Front. Public Health, 11.","DOI":"10.3389\/fpubh.2023.1124051"},{"key":"ref_6","doi-asserted-by":"crossref","first-page":"100375","DOI":"10.1016\/j.metop.2025.100375","article-title":"Obesity: Prevalence, causes, consequences, management, preventive strategies and future research directions","volume":"27","author":"Ahmed","year":"2025","journal-title":"Metab. Open"},{"key":"ref_7","doi-asserted-by":"crossref","first-page":"1477","DOI":"10.1161\/CIRCRESAHA.120.316101","article-title":"Obesity Phenotypes, Diabetes, and Cardiovascular Diseases","volume":"126","author":"Tchernof","year":"2020","journal-title":"Circ. Res."},{"key":"ref_8","doi-asserted-by":"crossref","first-page":"288","DOI":"10.1038\/s41574-019-0176-8","article-title":"Obesity: Global epidemiology and pathogenesis","volume":"15","year":"2019","journal-title":"Nat. Rev. Endocrinol."},{"key":"ref_9","first-page":"e984","article-title":"Obesity and Cardiovascular Disease: A Scientific Statement From the American Heart Association","volume":"143","author":"Poirier","year":"2021","journal-title":"Circulation"},{"key":"ref_10","doi-asserted-by":"crossref","first-page":"100027","DOI":"10.1016\/j.obpill.2022.100027","article-title":"Nonalcoholic fatty liver disease and obesity: An Obesity Medicine Association (OMA) Clinical Practice Statement (CPS) 2022","volume":"3","author":"Karjoo","year":"2022","journal-title":"Obes. Pillars"},{"key":"ref_11","first-page":"19","article-title":"Obstructive Sleep Apnea and Obesity: Implications for Public Health","volume":"1","author":"Jehan","year":"2017","journal-title":"Sleep. Med. Disord."},{"key":"ref_12","doi-asserted-by":"crossref","first-page":"103221","DOI":"10.1016\/j.eclinm.2025.103221","article-title":"The relationship between obesity and obstructive sleep apnea in four community-based cohorts: An individual participant data meta-analysis of 12,860 adults","volume":"83","author":"Esmaeili","year":"2025","journal-title":"eClinicalMedicine"},{"key":"ref_13","doi-asserted-by":"crossref","unstructured":"Nedunchezhiyan, U., Varughese, I., Sun, A.R., Wu, X., Crawford, R., and Prasadam, I. (2022). Obesity, Inflammation, and Immune System in Osteoarthritis. Front. Immunol., 13.","DOI":"10.3389\/fimmu.2022.907750"},{"key":"ref_14","doi-asserted-by":"crossref","unstructured":"Pati, S., Irfan, W., Jameel, A., Ahmed, S., and Shahid, R.K. (2023). Obesity and Cancer: A Current Overview of Epidemiology, Pathogenesis, Outcomes, and Management. Cancers, 15.","DOI":"10.3390\/cancers15020485"},{"key":"ref_15","doi-asserted-by":"crossref","first-page":"235","DOI":"10.1037\/amp0000517","article-title":"Lifestyle modification approaches for the treatment of obesity in adults","volume":"75","author":"Wadden","year":"2020","journal-title":"Am. Psychol."},{"key":"ref_16","doi-asserted-by":"crossref","unstructured":"Sannidhi, D., Abeles, R., Andrew, W., Bonnet, J.P., Vitale, K., Niranjan, V., Gulati, M., Pauly, K., Moran, R., and Alexander, L. (2025). Lifestyle Medicine for Obesity in the Era of Highly Effective Anti-Obesity Treatment. Nutrients, 17.","DOI":"10.3390\/nu17142382"},{"key":"ref_17","doi-asserted-by":"crossref","first-page":"E875","DOI":"10.1503\/cmaj.191707","article-title":"Obesity in adults: A clinical practice guideline","volume":"192","author":"Wharton","year":"2020","journal-title":"Can. Med. Assoc. J."},{"key":"ref_18","doi-asserted-by":"crossref","first-page":"1188","DOI":"10.1038\/ijo.2015.59","article-title":"Physiological adaptations to weight loss and factors favouring weight regain","volume":"39","author":"Greenway","year":"2015","journal-title":"Int. J. Obes."},{"key":"ref_19","doi-asserted-by":"crossref","first-page":"183","DOI":"10.1016\/j.mcna.2017.08.012","article-title":"Maintenance of Lost Weight and Long-Term Management of Obesity","volume":"102","author":"Hall","year":"2018","journal-title":"Med. Clin. N. Am."},{"key":"ref_20","first-page":"e66500","article-title":"Long-Term Effectiveness and Outcomes of Bariatric Surgery: A Comprehensive Review of Current Evidence and Emerging Trends","volume":"16","author":"Mahakalkar","year":"2024","journal-title":"Cureus"},{"key":"ref_21","doi-asserted-by":"crossref","unstructured":"Xiao, H., Du, Y., Tan, Y., and Ren, Y. (2024). Prognosticating post-bariatric surgery outcomes and management of postoperative recurrent weight gain and diabetes recurrence. Front. Nutr., 11.","DOI":"10.3389\/fnut.2024.1510403"},{"key":"ref_22","doi-asserted-by":"crossref","first-page":"879","DOI":"10.1001\/jama.2020.12567","article-title":"Benefits and Risks of Bariatric Surgery in Adults: A Review","volume":"324","author":"Arterburn","year":"2020","journal-title":"JAMA"},{"key":"ref_23","doi-asserted-by":"crossref","unstructured":"Alqahtani, S.J., Alfawaz, H.A., Moubayed, N.M.S., Hassan, W.M., Almnaizel, A.T., Alshiban, N.M.S., Abuhaimed, J.M., Alahmed, M.F., AL-Dagal, M.M., and El-Ansary, A. (2023). Bariatric Surgery as Treatment Strategy of Obesity in Saudi People: Effects of Gut Microbiota. Nutrients, 15.","DOI":"10.3390\/nu15020361"},{"key":"ref_24","doi-asserted-by":"crossref","first-page":"740","DOI":"10.1007\/s11695-012-0622-3","article-title":"Metabolic and Hormonal Changes After Laparoscopic Roux-en-Y Gastric Bypass and Sleeve Gastrectomy: A Randomized, Prospective Trial","volume":"22","author":"Peterli","year":"2012","journal-title":"Obes. Surg."},{"key":"ref_25","doi-asserted-by":"crossref","first-page":"164","DOI":"10.1038\/s41574-022-00757-5","article-title":"Glucose metabolism after bariatric surgery: Implications for T2DM remission and hypoglycaemia","volume":"19","author":"Sandoval","year":"2023","journal-title":"Nat. Rev. Endocrinol."},{"key":"ref_26","doi-asserted-by":"crossref","first-page":"229","DOI":"10.1007\/s13679-019-00351-3","article-title":"Gut Microbiota Dysbiosis in Human Obesity: Impact of Bariatric Surgery","volume":"8","year":"2019","journal-title":"Curr. Obes. Rep."},{"key":"ref_27","doi-asserted-by":"crossref","unstructured":"Tu, J., Wang, Y., Jin, L., and Huang, W. (2022). Bile acids, gut microbiota and metabolic surgery. Front. Endocrinol., 13.","DOI":"10.3389\/fendo.2022.929530"},{"key":"ref_28","doi-asserted-by":"crossref","first-page":"3","DOI":"10.1007\/s11695-018-3525-0","article-title":"Long-Term Outcomes After Bariatric Surgery: A Systematic Review and Meta-analysis of Weight Loss at 10 or More Years for All Bariatric Procedures and a Single-Centre Review of 20-Year Outcomes After Adjustable Gastric Banding","volume":"29","author":"Hindle","year":"2019","journal-title":"Obes. Surg."},{"key":"ref_29","doi-asserted-by":"crossref","first-page":"1560","DOI":"10.1001\/jama.2018.14433","article-title":"Comparison of the Performance of Common Measures of Weight Regain After Bariatric Surgery for Association With Clinical Outcomes","volume":"320","author":"King","year":"2018","journal-title":"JAMA"},{"key":"ref_30","doi-asserted-by":"crossref","unstructured":"Althumiri, N.A., Bindhim, N.F., Turki, A., Al-Rayes, S.A., and Alumran, A. (2025). Long-Term Weight Regain Following Bariatric Surgery: The Role of Diet and Eating Behaviors in Saudi Arabia. Nutrients, 17.","DOI":"10.3390\/nu17193080"},{"key":"ref_31","doi-asserted-by":"crossref","first-page":"e000219","DOI":"10.1136\/tsaco-2018-000219","article-title":"Early and late complications of bariatric operation","volume":"3","author":"Lim","year":"2018","journal-title":"Trauma Surg. Acute Care Open"},{"key":"ref_32","doi-asserted-by":"crossref","first-page":"2915","DOI":"10.1017\/S1368980016001099","article-title":"Can a dietary quality score derived from a short-form FFQ assess dietary quality in UK adult population surveys?","volume":"19","author":"Cleghorn","year":"2016","journal-title":"Public Health Nutr."},{"key":"ref_33","doi-asserted-by":"crossref","unstructured":"Mumena, W.A., Ateek, A.A., Alamri, R.K., Alobaid, S.A., Alshallali, S.H., Afifi, S.Y., Aljohani, G.A., and Kutbi, H.A. (2022). Fast-Food Consumption, Dietary Quality, and Dietary Intake of Adolescents in Saudi Arabia. Int. J. Environ. Res. Public Health, 19.","DOI":"10.3390\/ijerph192215083"},{"key":"ref_34","doi-asserted-by":"crossref","first-page":"e344","DOI":"10.18295\/squmj.2020.20.03.015","article-title":"Effect of Bariatric Surgery on Weight Loss, Nutritional Deficiencies, Postoperative Complications and Adherence to Dietary and Lifestyle Recommendations: A retrospective cohort study from Bahrain","volume":"20","author":"Hasan","year":"2020","journal-title":"Sultan Qaboos Univ. Med. J."},{"key":"ref_35","doi-asserted-by":"crossref","first-page":"2206","DOI":"10.1111\/dom.16219","article-title":"Actual weight loss trajectories after bariatric surgery compared with the SOPHIA prediction tool: An observational comparison study","volume":"27","author":"Sankar","year":"2025","journal-title":"Diabetes Obes. Metab."},{"key":"ref_36","doi-asserted-by":"crossref","unstructured":"Budny, A., Janczy, A., Szymanski, M., and Mika, A. (2024). Long-Term Follow-Up After Bariatric Surgery: Key to Successful Outcomes in Obesity Management. Nutrients, 16.","DOI":"10.3390\/nu16244399"},{"key":"ref_37","doi-asserted-by":"crossref","first-page":"2994","DOI":"10.1007\/s11695-021-05341-w","article-title":"Is It Possible to Predict Weight Loss After Bariatric Surgery?-External Validation of Predictive Models","volume":"31","author":"Kulawik","year":"2021","journal-title":"Obes. Surg."},{"key":"ref_38","first-page":"e69349","article-title":"The Impact of Bariatric Surgery on Weight Reduction and the Resolution of Comorbidities in Older Geriatric Populations of Saudi Arabia: A Retrospective Study","volume":"16","author":"Alamri","year":"2024","journal-title":"Cureus"},{"key":"ref_39","doi-asserted-by":"crossref","unstructured":"Alfadda, A.A., Al-Naami, M.Y., Masood, A., Elawad, R., Isnani, A., Ahamed, S.S., and Alfadda, N.A. (2021). Long-Term Weight Outcomes after Bariatric Surgery: A Single Center Saudi Arabian Cohort Experience. J. Clin. Med., 10.","DOI":"10.3390\/jcm10214922"},{"key":"ref_40","doi-asserted-by":"crossref","first-page":"4087","DOI":"10.1007\/s11695-025-08168-x","article-title":"GLP-1 and GIP Changes after Sleeve Gastrectomy and Weight Regain in Adolescents. Do we need a Boost?","volume":"35","author":"Shehata","year":"2025","journal-title":"Obes. Surg."},{"key":"ref_41","doi-asserted-by":"crossref","first-page":"255","DOI":"10.1001\/jama.2017.20897","article-title":"Effect of Laparoscopic Sleeve Gastrectomy vs Laparoscopic Roux-en-Y Gastric Bypass on Weight Loss in Patients With Morbid Obesity: The SM-BOSS Randomized Clinical Trial","volume":"319","author":"Peterli","year":"2018","journal-title":"JAMA"},{"key":"ref_42","doi-asserted-by":"crossref","first-page":"1577","DOI":"10.1038\/s41366-024-01585-5","article-title":"Metabolic adaptation following gastric bypass surgery: Results from a 2-year observational study","volume":"48","author":"Naseer","year":"2024","journal-title":"Int. J. Obes."},{"key":"ref_43","doi-asserted-by":"crossref","first-page":"911","DOI":"10.1016\/j.soard.2022.03.020","article-title":"Five-year weight loss, physical activity, and eating style trajectories after bariatric surgery","volume":"18","author":"Voorwinde","year":"2022","journal-title":"Surg. Obes. Relat. Dis."},{"key":"ref_44","doi-asserted-by":"crossref","first-page":"1768","DOI":"10.1007\/s11695-020-04392-9","article-title":"The Relationship Between Bariatric Surgery and Diet Quality: A Systematic Review","volume":"30","author":"Zarshenas","year":"2020","journal-title":"Obes. Surg."},{"key":"ref_45","doi-asserted-by":"crossref","unstructured":"Hosseini-Esfahani, F., Kazemi-Aliakbar, M., Koochakpoor, G., Barzin, M., Khalaj, A., Valizadeh, M., and Mirmiran, P. (2023). Diet quality and anthropometric indices of patients undergone bariatric surgery: The prospective Tehran obesity treatment study. BMC Surg., 23.","DOI":"10.1186\/s12893-023-02032-4"},{"key":"ref_46","doi-asserted-by":"crossref","first-page":"2930","DOI":"10.1007\/s11695-024-07359-2","article-title":"Adherence to Dietary Behavior Recommendations Moderates the Effect Between Time Since Metabolic and Bariatric Surgery and Percentage Total Weight Loss","volume":"34","author":"Marsall","year":"2024","journal-title":"Obes. Surg."},{"key":"ref_47","first-page":"162","article-title":"Post bariatric surgery complications, nutritional and psychological status","volume":"33","author":"Vanoh","year":"2024","journal-title":"Asia Pac. J. Clin. Nutr."},{"key":"ref_48","doi-asserted-by":"crossref","first-page":"2649","DOI":"10.1007\/s11695-021-05311-2","article-title":"Hair Loss After Metabolic and Bariatric Surgery: A Systematic Review and Meta-analysis","volume":"31","author":"Zhang","year":"2021","journal-title":"Obes. Surg."},{"key":"ref_49","doi-asserted-by":"crossref","first-page":"119232","DOI":"10.1016\/j.atherosclerosis.2025.119232","article-title":"Long-term trends in cardiovascular risk factors and cardiovascular risk following bariatric surgery: A 10-year prospective cohort study","volume":"405","author":"Sawicka","year":"2025","journal-title":"Atherosclerosis"}],"container-title":["Journal of Clinical Medicine"],"original-title":[],"language":"en","link":[{"URL":"https:\/\/www.mdpi.com\/2077-0383\/15\/12\/4571\/pdf","content-type":"unspecified","content-version":"vor","intended-application":"similarity-checking"}],"deposited":{"date-parts":[[2026,6,15]],"date-time":"2026-06-15T09:38:01Z","timestamp":1781516281000},"score":1,"resource":{"primary":{"URL":"https:\/\/www.mdpi.com\/2077-0383\/15\/12\/4571"}},"subtitle":[],"short-title":[],"issued":{"date-parts":[[2026,6,12]]},"references-count":49,"journal-issue":{"issue":"12","published-online":{"date-parts":[[2026,6]]}},"alternative-id":["jcm15124571"],"URL":"https:\/\/doi.org\/10.3390\/jcm15124571","relation":{},"ISSN":["2077-0383"],"issn-type":[{"value":"2077-0383","type":"electronic"}],"subject":[],"published":{"date-parts":[[2026,6,12]]}}}