Context: The number of patients who undergo Roux-en-Y gastric bypass (RYGB) and gastric banding (GB) surgeries has increased dramatically over the past decade yet the long-term impact of these surgeries on body weight, co-morbidities, and nutritional status remain unclear, as do the mechanisms of weight regain.

Evidence Acquisition: The articles were found via PubMed searches. To review the impact of bariatric surgery on weight maintenance and co-morbidities, only articles with a postoperative follow-up of 3 yr were included. The articles on nutritional status had a follow-up of 12 months.

Conclusions: RYGB and GB surgeries lead to substantial weight loss in individuals with morbid obesity. However, significant weight regain occurs over the long-term, and according to the only well designed prospective controlled study, the improvement in comorbidities associated with weight loss mitigates in the long-term upon weight regain. There is some evidence from a retrospective study that RYGB surgery is associated with a modest decrease in long-term mortality. These results remain to be substantiated by well designed long-term randomized and prospective controlled studies. The mechanisms that lead to weight regain need to be further examined and may include increase in energy intake due to enlargement of stoma and adaptive changes in the levels of gut and adipocyte hormones such as ghrelin and leptin which regulate energy intake; decrease in physical activity; changes in energy expenditure; and other factors. In addition to weight regain RYGB surgery is associated with frequent incidence of iron, vitamin B12, folate, calcium, and vitamin D deficiency, which requires regular supplementation and monitoring.