Sleeve Gastrectomy Versus Banded Roux-en-Y Gastric Bypass for Obesity and Diabetes Mellitus: Psychology and Quality of Life Outcomes at 10 Years.

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Learn more: PMC Disclaimer | PMC Copyright Notice Obes Surg . 2026 Apr 8;36(5):2317–2327. doi: 10.1007/s11695-026-08623-3 Sleeve Gastrectomy Versus Banded Roux-en-Y Gastric Bypass for Obesity and Diabetes Mellitus: Psychology and Quality of Life Outcomes at 10 Years Preekesh Suresh Patel 1, 2, ✉ , Megan Grinlinton 1 , Anamitra Nair 1 , Jack Pullman 1 , Lindsay D Plank 2 , Rinki Murphy 2, 3 , Michael Booth 1 Author information Article notes Copyright and License information 1 Department of General Surgery - Upper Gastrointestinal/Bariatric Unit, Te Whatu Ora Health New Zealand - Waitemata, Auckland, New Zealand 2 Faculty of Medical and Health Sciences, University of Auckland, Auckland, New Zealand 3 Department of Endocrinology, Te Whatu Ora Health New Zealand - Counties Manukau, Auckland, New Zealand ✉ Corresponding author. Received 2025 Dec 12; Revised 2026 Feb 3; Accepted 2026 Mar 20; Issue date 2026. © Crown 2026 Open Access This article is licensed under a Creative Commons Attribution 4.0 International License, which permits use, sharing, adaptation, distribution and reproduction in any medium or format, as long as you give appropriate credit to the original author(s) and the source, provide a link to the Creative Commons licence, and indicate if changes were made. The images or other third party material in this article are included in the article’s Creative Commons licence, unless indicated otherwise in a credit line to the material. If material is not included in the article’s Creative Commons licence and your intended use is not permitted by statutory regulation or exceeds the permitted use, you will need to obtain permission directly from the copyright holder. To view a copy of this licence, visit http://creativecommons.org/licenses/by/4.0/ . PMC Copyright notice PMCID: PMC13222162  PMID: 41951955 Abstract Background Obesity impacts physical, physiological and psychological domains of life. The long-term effects of metabolic bariatric surgery (MBS) on patient-centred outcomes such as mental health and quality of life (QOL) may enhance the management of obesity and the application of MBS. Methods A prospective, blinded, double arm, parallel, randomised trial was carried out at a single bariatric centre in Waitemata, New Zealand. Adults with type 2 diabetes mellitus and obesity were randomised 1:1 to undergo laparoscopic sleeve gastrectomy (SG) or silastic ring Roux-en-Y gastric bypass (SR-RYGB). After unblinding at 5 years, patients were followed up at 10 years. This analysis focuses on secondary outcomes: Hospital Anxiety and Depression Scale (HADS) scores and RAND-36 QOL scores. Results Of 114 patients randomised, 80 patients (70.2%) completed 10-year follow up (39 SG; 41 SR-RYGB). SR-RYGB was associated with greater weight loss (33.3 kg vs. 25.8 kg, p = 0.031) and trended towards higher diabetes remission (31.7% vs. 23.1%, adjusted OR 2.07, 95% CI 0.70, 6,10, p = 0.186). Mean HADS anxiety score for SG decreased by 1.59 units over 10-years ( p = 0.027). Improvements in RAND-36 scores were significantly greater after 10 years for SR-RYGB than SG for physical function (19 vs. 12 points, p = 0.026) and general health (17 vs. 10 points, p = 0.036). Role limitation due to emotional problems worsened significantly by 16 points for the SG group ( p = 0.032). Conclusion SR-RYGB demonstrated superior long-term improvements in physical function and general health QOL domains of RAND-36 compared to SG. Anxiety symptoms may be reduced long-term following SG. Key Points SG led to improved long-term anxiety symptom scores. SG and SR-RYGB both had improved physical function and general health QOL scores. SR-RYGB is superior to SG for improvement in long-term QOL scores. Introduction As our understanding of obesity grows, it becomes clearer that the interplay between obesity, its treatments and its impact on every organ system is complex. Psychological health and quality of life (QOL) are patient-centred factors that are impacted by obesity and metabolic bariatric surgery (MBS) [ 1 – 3 ]. MBS has the potential to improve psychological health and QOL with weight loss and resolution of obesity associated medical problems [ 2 , 4 – 6 ]. On the contrary, the adverse outcomes of MBS such as complications, altered gastrointestinal function and psychosocial implications can negatively impact psychology and QOL [ 7 – 9 ]. The type of MBS performed may also impact psychology and QOL differentially [ 10 ]. Funding for MBS varies globally and, in New Zealand (NZ), despite consensus guidelines recommending improved public funding/access, it is predominantly privately funded [ 11 , 12 ]. Given MBS in the public sector is a finite resource, it should be reserved for those that will derive the most benefit. Psychological health and QOL are parameters that are currently underutilised in determining access to public MBS. Psychological health has strong emphasis in the preoperative multidisciplinary work-up for MBS. Preoperative psychological screening is recommended by the International Federation for Surgery of Obesity (IFSO) to identify optimisable psychosocial factors to improve patient’s ability to both cope with and achieve maximal benefit from MBS [ 13 ]. Furthermore, symptoms of some psychological disorders can overlap with those experienced after MBS (e.g. changes in appetite and bowel habit). The long-term interplay between psychological symptoms and MBS outcomes are poorly understood. There has been a stronger focus on patient-centred QOL outcomes following MBS to provide insights into surgical efficacy that are reflective of patient’s goals of obesity treatment [ 5 , 14 ]. Questionnaire based surveys (e.g. RAND-36) allow this to be performed and reported in a standardised and comparable fashion [ 15 ]. QOL information could guide a more individualised approach to MBS selection. QOL and psychology outcomes have previously been reported for this randomised trial comparing sleeve gastrectomy (SG) and silastic-ring Roux-en-Y gastric bypass (SR-RYGB) in patients with obesity and type 2 diabetes mellitus (T2DM) in NZ [ 16 , 17 ]. Depressive and anxiety symptoms improved significantly within the first year after both types of surgery. At five years, only depressive symptoms were lower than baseline, while anxiety symptoms returned to baseline levels by year five. This study at 10 years adds to the existing high quality randomised studies that report long term outcomes comparing SG to Roux-en-Y gastric bypass (RYGB) given it considers silastic ring augmented RYGB (demonstrating greater weight loss and limited weight recidivism), and focuses on patient-centred outcomes [ 18 – 20 ]. The objectives of this paper were to compare SG and SR-RYGB in patients with obesity and T2DM; to identify long-term (10-year postoperative) changes in psychological health and quality of life; and to evaluate whether preoperative depression and anxiety symptoms influence long-term weight loss. Methods Ethics Local/regional ethics approval was obtained in 2011. The trial was registered with the appropriate national registry. Follow-up extension beyond five years was granted. Design This was a prospective, double-armed, parallel, randomised trial that was double-blinded (patient and assessor) to five-years. The full study protocol was published previously [ 21 ]. The setting was a single bariatric centre in Waitemata, NZ. Patients referred for consideration for MBS were screened based on their referral (from general practitioners and hospital specialists). Eligible patients attended an educational seminar including presentations on obesity and MBS delivered by our multidisciplinary team (surgical fellow, dietitian and clinical nurse specialist). Selection criteria application and measurement of baseline anthropometrics (height and weight) were performed at their first specialist appointment. Selection Criteria Inclusion criteria included: age 20–55, body mass index (BMI) 35–65 kg/m 2 (> 5-year duration), diagnosis of T2DM (made at least six-months prior), suitability to undergo SG or SR-RYGB, ability to provide informed consent and commitment to five-years of follow-up. Exclusion criteria included: type 1 diabetes, secondary diabetes, oral steroid use, cigarette smoking, history of chronic pancreatitis, pregnancy, post-prandial C-peptide < 350pmol/L and unable to safely receive general anaesthesia. Randomisation Computer generated randomisation was performed with allocation concealment and minimisation. Minimisation was based on age (20–30, 30–40, 40–50 years), ethnicity (Māori, Pacific, European or other), BMI (35-44.9, 45-54.9, 55–65 kg/m 2 ), time since T2DM diagnosis (< 5 years, 5–10 years, > 10 years) and insulin requirement (yes, no). Interventions Details of SG and SR-RYGB techniques used have been published [ 22 ]. Procedures were performed laparoscopically. Orogastric bougies were used to calibrate both SG (36 F) and the SR-RYGB gastric pouch (32 F). SR-RYGB limb lengths were 50 cm (biliopancreatic) and 100 cm (antecolic roux limb). The silastic ring for SR-RYGB was 6.5 cm and secured 2 cm proximal to the gastrojejunostomy. Outcomes This analysis focuses on secondary outcomes; psychological symptoms and QOL at 10 years postoperatively. The psychological symptoms were assessed using the hospital anxiety and depression scale (HADS) [ 23 ]. This is a validated screening tool based on 14 questions (7 for depression and 7 for anxiety), each scored from 0 to 3. A HADS depression score of ≥8 indicated mild to severe depressive symptoms. A HADS anxiety score of ≥8 indicated mild to severe anxiety symptoms. Scores of ≤7 indicated an absence of symptoms. QOL was evaluated using the validated RAND-36 score, based on 8 overarching domains: physical functioning (PF), role limitation (physical), bodily pain, general health (GH), role limitation (emotional) (RE), energy/fatigue, emotional well-being and social functioning [ 15 ]. Each domain is scored from 0 indicating poor health to 100 indicating good health. Sample Size and Statistical Analysis The original sample size was calculated to detect a 29% difference in T2DM remission between the SR-RYGB group (assumed 88% remission) and SG group (assumed 59% remission) using a 2-sided statistical test with 80% power and an alpha risk of 0.05. While this paper focuses on secondary outcomes, the same cohort was used for longitudinal analysis of psychological and QOL measures. Normally distributed continuous variables are reported as means and standard deviations (SD) and Student’s t-test was used for between-group comparisons. Categorical data were compared between groups using Fisher’s exact test. The difference in proportion of participants achieving diabetes remission was compared between SR-LRYGB and LSG using logistic regression with adjustment for stratification variables. Repeated measures mixed effects models with adjustment for stratification variables were used to analyse HADS, RAND-36 and weight changes from baseline. Least squares means with standard errors (SEs) were plotted graphically. A two-sided P value < 0.05 was considered to indicate statistical significance. Analyses were performed using SAS version 9.4 statistical software (SAS Institute, Cary, NC). Results A total of 114 patients were recruited and their progression through the study is summarised in Fig. 1 . At 10 years, 80 (41 SR-RYGB, 39 SG) patients had completed HADS and QOL questionnaires, giving a follow-up completion rate of 70.2%. Of those that did not complete 10-year follow-up, there were 22 patients that either declined further trial participation or were uncontactable and 12 deaths (four SR-RYGB, eight SG). Of the mortalities (all of which were not directly relatable to bariatric surgery): six were related to advanced malignancy (metastatic renal cell carcinoma (x2), glioblastoma multiforme, metastatic cholangiocarcinoma, malignant small bowel obstruction and metastatic endometrioid adenocarcinoma), two were cardiac in nature (cardiac arrest and heart failure) and one was a trauma (motor vehicle accident). The cause of death was unknown for three participants. The baseline characteristics are summarised in Table 1 , demonstrating no significant differences between those that did and did not complete 10 years of follow-up. Mild to moderate depressive symptoms (scores of ≥8) at 10 years were present for 4 (10.3%) SG patients and 6 (14.6%) SR-RYGB patients. Mild to moderate anxiety symptoms (scores of ≥8) at 10 years were present for 8 (20.5%) SG patients and 9 (22.0%) SR-RYGB patients. Baseline emotional wellbeing scores were significantly greater in the SR-RYGB by chance. All other baseline characteristics were balanced amongst both groups, with the whole cohort on average being predominantly NZ European, aged in their forties with a BMI in the forties and a similar number of patients with pre-existing psychological symptoms. Fig. 1. Open in a new tab Summary of participant flow and follow-up for psychological symptom and quality of life outcomes Table 1. Baseline characteristics for those that completed and those not completing HADS and QOL data questionnaires at 10 years follow-up. * Comparison of SG and SR-RYGB in completed group; ‡ Comparison of groups completing and not completing follow-up Completed Not completed Total ( n = 80) SG ( n = 39) SR-RYGB ( n = 41) p -value* Total ( n = 34) p -value ‡ Age (years), mean (SD) 47.5 (6.1) 46.9 (6.5) 47.9 (5.7) 0.466 45.4 (7.5) 0.130 Female, n (%) 38 (47.5) 15 (38.5) 23 (56.1) 0.125 21 (61.8) 0.219 Ethnicity, n (%) 0.246 0.590 New Zealand European 51 (63.8) 28 (71.7) 23 (56.1) 21 (61.8) Māori 12 (15.0) 5 (12.8) 7 (17.1) 8 (23.5) Pacific 7 (8.8) 1 (2.6) 6 (14.6) 3 (8.8) Other 10 (12.5) 5 (12.8) 5 (12.2) 2 (5.9) Duration of type 2 diabetes (y), mean (SD) 7.2 (5.5) 6.7 (5.1) 7.7 (5.8) 0.410 6.1 (4.7) 0.300 HbA1c (mmol/mol), mean (SD) 62.9 (14.6) 62.2 (11.1) 63.6 (17.4) 0.673 64.1 (17.7) 0.718 Weight (kg), mean (SD) 125.6 (22.9) 125.5 (22.9) 125.7 (23.2) 0.965 128.3 (26.2) 0.608 BMI (kg/m 2 ), mean (SD) 42.5 (6.6) 42.1 (6.3) 42.8 (6.8) 0.641 44.1 (6.4) 0.224 HADS scores Depression, mean (SD) 3.5 (3.0) 3.6 (3.2) 3.4 (2.9) 0.790 4.0 (3.9) 0.478 Anxiety, mean (SD) 5.5 (4.1) 6.1 (4.6) 4.8 (3.5) 0.155 5.9 (4.4) 0.633 HADS Depression Score ≥ 8, n (%) 11 (13.8) 6 (15.4) 5 (12.2) 0.753 7 (20.6) 0.404 HADS Anxiety Score ≥ 8, n (%) 22 (27.5) 12 (30.8) 10 (24.4) 0.619 11 (32.4) 0.654 RAND-36 scores, mean (SD) Physical functioning 70.0 (24.4) 73.8 (22.4) 66.4 (25.9) 0.179 66.9 (23.3) 0.534 Role limitations due to physical health 72.2 (36.0) 73.7 (35.8) 70.7 (36.6) 0.718 63.6 (44.7) 0.291 Role limitations due to emotional problems 86.1 (24.0) 84.2 (29.8) 87.8 (26.6) 0.572 78.8 (38.0) 0.264 Energy/fatigue 59.3 (19.6) 59.0 (19.1) 59.6 (20.4) 0.896 54.2 (21.3) 0.233 Emotional Well Being 80.9 (16.4) 77.0 (18.8) 84.6 (12.9) 0.041 78.4 (16.6) 0.465 Social Functioning 82.3 (21.8) 81.4 (21.0) 83.2 (22.6) 0.711 80.3 (25.0) 0.665 Bodily Pain 74.1 (22.7) 75.0 (22.4) 73.2 (23.2) 0.725 71.4 (24.9) 0.586 General Health 54.1 (24.0) 57.5 (23.3) 50.9 (24.6) 0.219 48.9 (25.3) 0.310 Open in a new tab Total weight loss over 10 years was superior for SR-RYGB over SG at 33.3 (SE 2.4) kg vs. 25.8 (2.5) kg ( p = 0.031). Diabetes remission at 10 years was seen in 31.7% (13 of 41 participants) in the SR-RYGB group compared with 23.1% (9 of 39 participants) in the SG group (adjusted OR 2.07; 95% CI 0.70, 6, 10; P = 0.186). HADS HADS depression symptom scores improved for both groups at 1 year (-1.68 (SE 0.47), P = 0.0005, for SG; -2.27 (0.45), P < 0.0001, for SR-RYGB) and 5 years follow-up (-1.26 (SE 0.53), P = 0.018, for SG; -1.20 (0.51), P = 0.020, for SR-RYGB) but there was no significant change from baseline by 10 years follow-up for either group (-0.77 (0.62), P = 0.215, for SG; -0.29 (0.60), P = 0.634, for SR-RYGB) (Fig. 2 ). Mean score for anxiety decreased at 1-year (-1.39 (0.60), P = 0.021) and 5-year follow-up in SG patients (-1.58 (SE 0.61), P = 0.011) and remained below baseline at 10 years (-1.59 (0.71), P = 0.027). For SR-RYGB patients, mean anxiety scores did not change from baseline at 1 year (-1.01 (0.57), P = 0.079), 5 years (-0.62 (0.59), P = 0.295) and 10 years (-0.54 (0.69), P = 0.435) (Fig. 2 ). There were no significant between-group differences. Fig. 2. Open in a new tab Change in depression ( A ) and anxiety ( B ) scores over 10 years in patients undergoing SG (open symbols) or SR-RYGB (closed symbols). Data are mean ± SE. P values relate to changes from baseline The relationships between psychological outcomes, surgery type and weight loss at 5 and 10 years are shown in Fig. 3 . Patients who underwent SG with baseline depressive or anxiety symptoms had similar total weight loss at 10 years to those without symptoms (32.7 (9.5) kg vs. 24.5 (2.4) kg, p = 0.437 and 31.8 (4.7) kg vs. 23.0 (2.8) kg, P = 0.128, respectively). Patients who underwent SR-RYGB with baseline depressive or anxiety symptoms had similar weight loss at 10 years to those without symptoms (25.6 (7.1) kg vs. 34.4 (2.5) kg, P = 0.229 and 33.2 (4.8) kg vs. 33.3 (2.8) kg, P = 0.981, respectively). Fig. 3. Open in a new tab Total weight change over 10 years based on operative type and the presence/absence of baseline depressive ( A and B ) and anxiety ( C and D ) symptoms. No symptoms (closed symbols); mild or severe symptoms (open symbols). Data are mean ± SE. * P = 0.044 RAND-36 RAND-36 scores are depicted in Fig. 4 . PF scores improved significantly for each group over time (SG: 12 points, P = 0.004 and SR-RYGB 19 points, P < 0.0001) with a significant between group difference ( P = 0.026). GH scores also improved significantly for each group over time (SG: 10 points, P = 0.018 and SR-RYGB: 17 points, P < 0.0001) with a significant difference between the groups ( P = 0.036). Although RE scores worsened significantly for the SG group (16 points, P = 0.032) long-term, those for SR-RYGB did not and there was no significant between-group difference. For all other RAND-36 domains there were no significant changes over time and no significant between-group differences. Fig. 4. Open in a new tab SG and SR-RYGB RAND-36 quality of life scores at baseline and 10 years Discussion The findings address the objectives of providing a comparison of SG and SR-RYGB focusing on psychological symptoms and QOL at 10 years postoperatively. They provide an extension to the published five-year results [ 17 ]. Depression symptom scores for SG and SR-RYGB were similar to baseline levels at 10 years, with a significant improvement noted at the one and five-year mark. Anxiety symptom scores significantly improved for SG at 10 years. Anxiety symptom scores remained similar for SR-RYGB across the follow-up period. There were no significant between-group differences. The short-term psychological symptom score improvement demonstrated by our cohort supports the existing literature with similar findings [ 2 , 17 , 24 , 25 ]. This likely is contributed to by weight loss, resolution of associated medical problems and improved body image. The long-term results demonstrate improved depression and anxiety symptom scores from baseline for both groups. Aside from SG anxiety scores having sustained improvement from years five to 10, most 10-year results either stagnate or worsen compared to five-year results. This may be contributed to by recurrent weight gain, relapse of associated medical issues, nutrient deficiencies and requirement for either long-term medications and/or further procedures. The long-term data that exists regarding psychological symptoms following MBS are heterogeneous (method of measurement, procedures included, definitions of “long-term”) and because psychological/QOL parameters are generally not the primary outcome, this has implications on study power and result generalisability [ 26 – 29 ]. The general trend is an improvement in depression and anxiety scores, which is echoed within our findings. The greatest overall improvement in psychological symptom scores was the 1.59-point reduction in anxiety scores for SG patients which may be related to the generally lower “side effect” profile of SG – such as nutritional deficiencies, dumping syndrome and increase in bowel frequency [ 30 ]. Although this improvement is positive, translating this result into guidance for selecting SG over SR-RYGB (i.e. clinical significance) is limited by two key factors: a 1–2-point HADS score improvement is unlikely to confer a clinically significant improvement (given symptoms are present for scores of 8–21) and HADS is a screening tool – it is not diagnostic [ 23 , 31 ]. Although the HADS score is objective and validated, monitoring (by a qualified practitioner) of formal psychological diagnoses, severity and treatment (type, dosage) may provide a more clinically relevant evaluation of perioperative mental health. The changes in HADS scores over time highlight that psychological symptoms should be considered perioperatively as recommended in the IFSO guidelines [ 13 ]. There are multiple other factors that can impact postoperative psychology which include but are not limited to: recurrent weight gain, body image, body contouring surgery and complications of MBS. Recurrent weight gain can be predicted by and follow psychological symptom scores after MBS [ 27 , 28 , 32 ]. Body contouring surgery is also a contributor to postoperative MBS psychology and intimately linked with body image [ 33 ]. At five years, SR-RYGB patients with no pre-existing depressive symptoms had greater weight loss (34.0 kg vs. 23.0 kg, P = 0.044). This did not persist to 10 years. Preoperative anxiety symptoms did not impact long-term weight loss either. The link between preoperative psychological symptoms and post-MBS weight loss is poorly understood and published data in this field are inconsistent and lack long-term follow-up beyond five years [ 34 – 36 ]. PF and GH RAND-36 QOL scores significantly improved for both groups over 10 years and were superior with SR-RYGB. Change in RAND-36 scores for each patient over time provides an individualized and objective measure of patient-centred overall health. PF and GH assess patient perceptions of their physical activities and health. Weight loss and resolution of associated medical issues would likely explain the enhanced QOL. Improvement in QOL parameters has been demonstrated in the short-term postoperative period [ 28 , 37 – 39 ]. Long term persistence post-MBS is less evident [ 4 , 5 , 40 ]. RE domain scores significantly reduced for the SG group over 10 years and this is in keeping with the published literature [ 38 , 40 ]. This domain assesses the emotional issues negatively impacting patients (affecting their home, work and daily activities). Recurrent weight gain and post-SG reflux could contribute to this. The pattern of post-MBS weight loss, regain then stability has been linked to corresponding changes within QOL parameters [ 41 , 42 ]. This highlights the importance of long-term follow-up for identification and treatment (behavioural, medical, surgical) of recurrent weight gain and reflux. The strengths of this study are that it is a randomised comparison of SG and SR-RYGB with a high follow-up rate (78.4%, excluding the 12 deaths). This paper provides a unique assessment of MBS outcomes by focusing specifically on psychological symptoms and QOL within an exclusive cohort of patients with T2DM and including the ring-augmented variation of RYGB. There are some limitations to consider. There was no control group thus limiting the comparative strength of the two groups. The study was underpowered for patient-centred outcomes as it was not designed to detect a difference in these at 10-years postoperative. This may particularly be relevant to the improved anxiety scores within the SG group whereby the relationship between a statistically significant result and clinical significance is not completely understood. The use of the HADS screening tool allowed comparison for the same patient over time but clinical relevance is not easily transferable – limiting the ability of these data to guide recommendations for specific MBS. Finally, information regarding bariatric-specific postoperative QOL (e.g. dysphagia, vomiting) would allow a more thorough patient-centred comparison of SG and SR-RYGB. Using a specific validated score (such as the bariatric analysis and reporting outcome system) would allow a more holistic assessment [ 43 , 44 ]. With suitably powered future studies focusing on psychological symptoms and QOL, the approach to MBS selection for global obesity management could be tailored to individual patients which may improve outcomes from a patient and disease perspective. Conclusion In the context of this study, SR-RYGB is superior to SG with regard to weight loss, diabetes remission and the physical components of QOL assessment. Pre-existing depression and anxiety symptoms do not clearly and meaningfully impact long-term weight loss. However, SG may result in reduced long-term anxiety symptoms (as well as improved QOL). Future research should be powered towards detecting differences in these patient-centred outcomes to offer an individualised approach to obesity management. Acknowledgements Sherry Nisbet is a specialist research nurse employed with Te Whatu Ora Health New Zealand – Waitemata in New Zealand who we acknowledge for assisting with initial database setup/maintenance and follow-up. The patients that completed 10-year follow up kindly agreed to extend follow-up (beyond five-years). Author Contributions MB, LP and RM contributed significantly to conceptualization, funding acquisition, investigation, methodology, project administration, supervision and writing - reviewing/editing. This included general guidance. Along with MG and JP, they were all involved with previous publications based on earlier follow-up periods. LP also contributed significantly to formal analysis and software. Specifically, he carried out statistical analysis and generated all of the figures. The tabulated information was curated by LP and PP. PP, MG, JP, AN contributed significantly to data curation, formal analysis, investigation, visualization, writing - original draft preparation and writing - review/editing. Specifically, this included patient consultations via phone or physically and data collection (physical and electronic).PP presented this data as an oral presentation at the 27th IFSO World Congress in Melbourne (2024). Funding Open Access funding enabled and organized by CAUL and its Member Institutions. The trial was initiated by the investigators and was primarily funded by Te Whatu Ora Health New Zealand – limited publicly funded metabolic bariatric surgeries annually. Additional financial support was provided by Johnson and Johnson (New Zealand), Covidien (New Zealand), Obex (New Zealand) and the Auckland Medical Research Foundation. Sponsors of the study were not involved in study design, data interpretation/analysis or manuscript preparation. Data Availability Datasets generated and analysed during the study can be requested directly from the publishing authors on reasonable request and would need to be approved at a local hospital level. Declarations Ethical Approval All procedures performed in studies involving human participants were in accordance with the ethical standards of the institutional and/or national research committee and with the 1964 Helsinki declaration and its later amendments or comparable ethical standards. Informed Consent Informed consent was obtained from all individual participants included in the study. Competing Interests The authors declare no competing interests. Footnotes Publisher’s Note Springer Nature remains neutral with regard to jurisdictional claims in published maps and institutional affiliations. References 1. Stephenson J, Smith CM, Kearns B, Haywood A, Bissell P. The association between obesity and quality of life: a retrospective analysis of a large-scale population-based cohort study. BMC Public Health. 2021;21(1):1990. 10.1186/s12889-021-12009-8. [ DOI ] [ PMC free article ] [ PubMed ] [ Google Scholar ] 2. Law S, Dong S, Zhou F, Zheng D, Wang C, Dong Z. Bariatric surgery and mental health outcomes: an umbrella review. Front Endocrinol (Lausanne). 2023;14:1283621. 10.3389/fendo.2023.1283621. [ DOI ] [ PMC free article ] [ PubMed ] [ Google Scholar ] 3. Becerra AZ, Khalid SI, Morgenstern AS, et al. The association between bariatric surgery and psychiatric disorders: a national cohort study. Obes Surg. 2022;32(4):1110–8. 10.1007/s11695-022-05896-2. [ DOI ] [ PubMed ] [ Google Scholar ] 4. Konttinen H, Sjöholm K, Carlsson LMS, Peltonen M, Svensson PA. Fifteen-year changes in health-related quality of life after bariatric surgery and non-surgical obesity treatment. Int J Obes (Lond). 2024;48(10):1447–56. 10.1038/s41366-024-01572-w. [ DOI ] [ PMC free article ] [ PubMed ] [ Google Scholar ] 5. Major P, Stefura T, Dziurowicz B, et al. Quality of life 10 years after bariatric surgery. Obes Surg. 2020;30(10):3675–84. 10.1007/s11695-020-04726-7. [ DOI ] [ PMC free article ] [ PubMed ] [ Google Scholar ] 6. Fu R, Zhang Y, Yu K, Mao D, Su H. Bariatric surgery alleviates depression in obese patients: A systematic review and meta-analysis. Obes Res Clin Pract. 2022;16(1):10–6. 10.1016/j.orcp.2021.11.002. [ DOI ] [ PubMed ] [ Google Scholar ] 7. Brown RM, Guerrero-Hreins E, Brown WA, le Roux CW, Sumithran P. Potential gut-brain mechanisms behind adverse mental health outcomes of bariatric surgery. Nat Rev Endocrinol. 2021;17(9):549–59. 10.1038/s41574-021-00520-2. [ DOI ] [ PubMed ] [ Google Scholar ] 8. Soroceanu RP, Timofte DV, Danila R, et al. The impact of bariatric surgery on quality of life in patients with obesity. J Clin Med. 2023;12(13):4225. 10.3390/jcm12134225. [ DOI ] [ PMC free article ] [ PubMed ] [ Google Scholar ] 9. Sierżantowicz R, Ładny JR, Lewko J. Quality of life after bariatric surgery-a systematic review. Int J Environ Res Public Health. 2022;19(15):9078. 10.3390/ijerph19159078. Published 2022 Jul 26. [ DOI ] [ PMC free article ] [ PubMed ] [ Google Scholar ] 10. Ramos-Bachiller B, López-Gómez JJ, García-Calvo S, et al. Quality of life and psychological changes in bariatric surgery: an observational study. Ann Nutr Metab. 2025;81(1):22–31. 10.1159/000540012. [ DOI ] [ PubMed ] [ Google Scholar ] 11. Australia and New Zealand bariatric surgery registry. Bariatric surgery registry 2023 annual report [Internet]. Melbourne, Australia. 2024 Aug [cited 2025 Oct 19]. Available from: https://www.monash.edu/__data/assets/pdf_file/0007/3757876/Bariatric_Surgery_Registry_-Annual_Report_2023.pdf 12. Aly A, Talbot ML, Brown WA. Bariatric surgery: a call for greater access to coordinated surgical and specialist care in the public health system. Med J Aust. 2022;217(5):228–31. 10.5694/mja2.51673. [ DOI ] [ PMC free article ] [ PubMed ] [ Google Scholar ] 13. Eisenberg D, Shikora SA, Aarts E, et al. 2022 American Society of Metabolic and Bariatric Surgery (ASMBS) and International Federation for the Surgery of Obesity and Metabolic Disorders (IFSO) indications for metabolic and bariatric surgery. Obes Surg. 2023;33(1):3–14. 10.1007/s11695-022-06332-1. [ DOI ] [ PMC free article ] [ PubMed ] [ Google Scholar ] 14. Billig JI, Sears ED, Travis BN, Waljee JF. Patient-reported outcomes: understanding surgical efficacy and quality from the patient’s perspective. Ann Surg Oncol. 2020;27(1):56–64. 10.1245/s10434-019-07748-3. [ DOI ] [ PMC free article ] [ PubMed ] [ Google Scholar ] 15. Hays RD, Sherbourne CD, Mazel RM. The RAND 36-Item Health Survey 1.0. Health Econ. 1993;2(3):217–27. 10.1002/hec.4730020305. [ DOI ] [ PubMed ] [ Google Scholar ] 16. Murphy R, Plank LD, Clarke MG, et al. Effect of banded Roux-en-Y gastric bypass versus sleeve gastrectomy on diabetes remission at 5 years among patients with obesity and type 2 diabetes: a blinded randomized clinical trial. Diabetes Care. 2022;45(7):1503–11. 10.2337/dc21-2498. [ DOI ] [ PMC free article ] [ PubMed ] [ Google Scholar ] 17. Murton LM, Plank LD, Cutfield R, et al. Bariatric surgery and psychological health: a randomised clinical trial in patients with obesity and type 2 diabetes. Obes Surg. 2023;33(5):1536–44. 10.1007/s11695-023-06537-y. [ DOI ] [ PMC free article ] [ PubMed ] [ Google Scholar ] 18. Salminen P, Grönroos S, Helmiö M, et al. Effect of laparoscopic sleeve gastrectomy vs Roux-en-Y gastric bypass on weight loss, comorbidities, and reflux at 10 years in adult patients with obesity: The SLEEVEPASS randomized clinical trial. JAMA Surg. 2022;157(8):656–66. 10.1001/jamasurg.2022.2229. [ DOI ] [ PMC free article ] [ PubMed ] [ Google Scholar ] 19. Kraljevic M, Süsstrunk J, Wölnerhanssen BK, et al. Long-term outcomes of laparoscopic Roux-en-Y gastric bypass vs laparoscopic sleeve gastrectomy for obesity: The SM-BOSS randomized clinical trial. JAMA Surg. 2025;160(4):369–77. 10.1001/jamasurg.2024.7052. [ DOI ] [ PMC free article ] [ PubMed ] [ Google Scholar ] 20. Rasera I Jr, Coelho TH, Ravelli MN, et al. A Comparative, prospective and randomized evaluation of Roux-en-Y gastric bypass with and without the silastic ring: a 2-year follow up preliminary report on weight loss and quality of life. Obes Surg. 2016;26(4):762–8. 10.1007/s11695-015-1851-z. [ DOI ] [ PubMed ] [ Google Scholar ] 21. Murphy R, Evennett NJ, Clarke MG, et al. Sleeve gastrectomy versus Roux-en-Y gastric bypass for type 2 diabetes and morbid obesity: double-blind randomised clinical trial protocol. BMJ Open. 2016;6(7):e011416. 10.1136/bmjopen-2016-011416. [ DOI ] [ PMC free article ] [ PubMed ] [ Google Scholar ] 22. Pullman JS, Plank LD, Nisbet S, Murphy R, Booth MWC. Seven-year results of a randomized trial comparing banded Roux-en-Y gastric bypass to sleeve gastrectomy for type 2 diabetes and weight loss. Obes Surg. 2023;33(7):1989–96. 10.1007/s11695-023-06635-x. [ DOI ] [ PMC free article ] [ PubMed ] [ Google Scholar ] 23. Zigmond AS, Snaith RP. The hospital anxiety and depression scale. Acta Psychiatr Scand. 1983;67(6):361–70. 10.1111/j.1600-0447.1983.tb09716.x. [ DOI ] [ PubMed ] [ Google Scholar ] 24. By-Band-Sleeve Collaborating Group. Prevalence and short-term change in symptoms of anxiety and depression following bariatric surgery: a prospective cohort study. BMJ Open. 2024;14(1):e071231. 10.1136/bmjopen-2022-071231. [ DOI ] [ PMC free article ] [ PubMed ] [ Google Scholar ] 25. Paczkowska A, Hoffmann K, Raakow J, et al. Impact of bariatric surgery on depression, anxiety and stress symptoms among patients with morbid obesity: international multicentre study in Poland and Germany. BJPsych Open. 2022;8(1):e32. 10.1192/bjo.2021.1084. [ DOI ] [ PMC free article ] [ PubMed ] [ Google Scholar ] 26. Sumithran P, Roberts L, Caterson ID, Brown RM, Spittal MJ, Brown WA. Incidence of adverse mental health outcomes after sleeve gastrectomy compared with gastric bypass and restrictive bariatric procedures: a retrospective cohort study. Obes (Silver Spring). 2023;31(7):1913–23. 10.1002/oby.23757. [ DOI ] [ PMC free article ] [ PubMed ] [ Google Scholar ] 27. Furtado TA, Girundi MG, Campolina COC, et al. Depressive and eating disorders in patients post-bariatric surgery with weight regain: a descriptive observational study. Arq Bras Cir Dig. 2023;36:e1725. 10.1590/0102-672020230002e1725. [ DOI ] [ PMC free article ] [ PubMed ] [ Google Scholar ] 28. Burgmer R, Legenbauer T, Müller A, de Zwaan M, Fischer C, Herpertz S. Psychological outcome 4 years after restrictive bariatric surgery. Obes Surg. 2014;24(10):1670–8. 10.1007/s11695-014-1226-x. [ DOI ] [ PubMed ] [ Google Scholar ] 29. Al-Kadi A, Al-Sulaim L. Role of bariatric surgery on psychological and social outcomes of patients: A systematic review. Pol Przegl Chir. 2022;95(4):1–5. 10.5604/01.3001.0016.1104. [ DOI ] [ PubMed ] [ Google Scholar ] 30. Howard R, Chao GF, Yang J, et al. Comparative safety of sleeve gastrectomy and gastric bypass up to 5 years after surgery in patients with severe obesity. JAMA Surg. 2021;156(12):1160–9. 10.1001/jamasurg.2021.4981. [ DOI ] [ PMC free article ] [ PubMed ] [ Google Scholar ] 31. Roberts MH, Fletcher RB, Merrick PL. The validity and clinical utility of the hospital anxiety and depression scale (HADS) with older adult New Zealanders. Int Psychogeriatr. 2014;26(2):325–33. 10.1017/S104161021300197X. [ DOI ] [ PubMed ] [ Google Scholar ] 32. Lüscher A, Vionnet N, Amiguet M, et al. Impact of preoperative psychiatric profile in bariatric surgery on long-term weight outcome. Obes Surg. 2023;33(7):2072–82. 10.1007/s11695-023-06595-2. [ DOI ] [ PMC free article ] [ PubMed ] [ Google Scholar ] 33. Pehlke B, Oliveira F, Varnava C, et al. Psychological well-being as a motive for and result of post-bariatric body contouring procedures. Obes Sci Pract. 2023;10(1):e719. 10.1002/osp4.719. [ DOI ] [ PMC free article ] [ PubMed ] [ Google Scholar ] 34. Dawes AJ, Maggard-Gibbons M, Maher AR, et al. Mental health conditions among patients seeking and undergoing bariatric surgery: a meta-analysis. JAMA. 2016;315(2):150–63. 10.1001/jama.2015.18118. [ DOI ] [ PubMed ] [ Google Scholar ] 35. Aylward L, Lilly C, Tabone L, Szoka N, Abunnaja S, Cox S. Anxiety predicts reduced weight loss 30 months after bariatric surgery. Surg Obes Relat Dis. 2022;18(7):919–27. 10.1016/j.soard.2022.04.007. [ DOI ] [ PMC free article ] [ PubMed ] [ Google Scholar ] 36. Versteegden DPA, Van Himbeeck MJJ, Nienhuijs SW. Improvement in quality of life after bariatric surgery: sleeve versus bypass. Surg Obes Relat Dis. 2018;14(2):170–4. 10.1016/j.soard.2017.10.008. [ DOI ] [ PubMed ] [ Google Scholar ] 37. White MA, Kalarchian MA, Levine MD, Masheb RM, Marcus MD, Grilo CM. Prognostic significance of depressive symptoms on weight loss and psychosocial outcomes following gastric bypass surgery: a prospective 24-month follow-up study. Obes Surg. 2015;25(10):1909–16. 10.1007/s11695-015-1631-9. [ DOI ] [ PMC free article ] [ PubMed ] [ Google Scholar ] 38. Macano CAW, Nyasavajjala SM, Brookes A, Lafaurie G, Riera M. Comparing quality of life outcomes between laparoscopic sleeve gastrectomy and laparoscopic Roux-en-Y gastric bypass using the RAND36 questionnaire. Int J Surg. 2017;42:138–42. 10.1016/j.ijsu.2017.04.061. [ DOI ] [ PubMed ] [ Google Scholar ] 39. Gunnarsson BK, Hansdottir I, Bjornsdottir E, Birgisdottir EB, Arnadottir AT, Magnusson B. The effects of multidisciplinary obesity treatment on body weight and mental well-being in the long and short term. Laeknabladid. 2016;102(2):83–8. 10.17992/lbl.2016.02.66. [ DOI ] [ PubMed ] [ Google Scholar ] 40. ’t Hart JWH, Noordman BJ, Birnie E, et al. Long-term quality of life after sleeve gastrectomy vs Roux-en-Y Gastric Bypass in patients with severe obesity: Results from the SleeveBypass multicentre randomised controlled trial. Eur J Intern Med. 2025;139:106377. 10.1016/j.ejim.2025.06.006. [ DOI ] [ PubMed ] [ Google Scholar ] 41. Karlsson J, Taft C, Rydén A, Sjöström L, Sullivan M. Ten-year trends in health-related quality of life after surgical and conventional treatment for severe obesity: the SOS intervention study. Int J Obes (Lond). 2007;31(8):1248–61. 10.1038/sj.ijo.0803573. [ DOI ] [ PubMed ] [ Google Scholar ] 42. Felsenreich DM, Prager G, Kefurt R, et al. Quality of life 10 years after sleeve gastrectomy: a multicenter study. Obes Facts. 2019;12(2):157–66. 10.1159/000496296. [ DOI ] [ PMC free article ] [ PubMed ] [ Google Scholar ] 43. Oria HE, Moorehead MK. Bariatric analysis and reporting outcome system (BAROS). Obes Surg. 1998;8(5):487–99. 10.1381/096089298765554043. [ DOI ] [ PubMed ] [ Google Scholar ] 44. Costa JM, Soares JB. Bariatric analysis and reporting outcome system (BAROS): toward the uniform assessment of bariatric surgery outcomes. GE Port J Gastroenterol. 2015;22(3):85–6. 10.1016/j.jpge.2015.04.004. [ DOI ] [ PMC free article ] [ PubMed ] [ Google Scholar ] Associated Data This section collects any data citations, data availability statements, or supplementary materials included in this article. Data Availability Statement Datasets generated and analysed during the study can be requested directly from the publishing authors on reasonable request and would need to be approved at a local hospital level. Articles from Obesity Surgery are provided here courtesy of Springer ACTIONS View on publisher site PDF (1.2 MB) Cite Collections Permalink RESOURCES Similar articles Cited by other articles Links to NCBI Databases Follow NCBI NCBI on X (formerly known as Twitter) NCBI on Facebook NCBI on LinkedIn NCBI on GitHub NCBI RSS feed Connect with NLM NLM on X (formerly known as Twitter) NLM on Facebook NLM on YouTube National Library of Medicine 8600 Rockville Pike Bethesda, MD 20894 Web Policies FOIA HHS Vulnerability Disclosure Help Accessibility Careers NLM NIH HHS USA.gov Back to Top

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