Results showed that 64% and 36% of the participants had severe and moderate anxiety symptoms, respectively. Similar results were obtained by Ribeiro et al  who observed between 24 and 59 months after surgery, 33% of patients had symptoms suggestive of anxiety, and 60 months after surgery, 40% of patients had some degree of anxiety. In addition, the authors pointed out that patients had improved anxiety levels in the first 23 months after surgery. Taken together, these results show that anxiety symptoms tend to be present in bariatric patients after 24 months of surgery. One hypothesis for this finding is that with the stabilization or recovery of body weight, anxiety symptoms may (re)appear, however, there is no way to establish a cause and effect relationship, that is, there is no way to assume whether patients present symptoms of anxiety caused by weight regain, or if anxiety symptoms may also contribute to weight gain.
In the present study, the domains with the best perception of QL were functional capacity and limitation due to physical aspects. These data complement the findings by Nickel et al.  who, when assessing the QL at 6 months and 24 months after surgery, concluded that bariatric surgery had a greater effect on QL due to physical aspects than on mental QL, which improved in the short term and began to decrease within 24 months after surgery. These data indicate that the increase in physical QL is related to the decrease in weight in the postoperative period, however, and as expected, if there is weight regain, the physical QL tends to decrease in these patients.
Also, considering that in our results the physical QL presented good scores, the study carried out by Major et al.  with the effect of bariatric surgery on the long-term QL in 65 patients. The authors found that the perception of physical health QL increased significantly after the 10-year period. It is important to consider that although the literature has already established short-term improvement in QL after bariatric surgery, as in the results found by Sánchez-Piedrahita, Castañeda-Avilés and Núñez-Gómez  and Nickel et al. , there is still a need for further studies evaluating very long-term outcomes.
Additionally, the present study observed an inverse correlation between the perception of the general emotional component of QL and anxiety, regardless of weight regain and surgery time. This result is convergent with the one composed by Kalarchian et al.  in which, regardless of weight change, mood and anxiety disorders are related to a smaller improvement in QL related to mental health in the long-term postoperative period. Together, these results obtained that are necessary aimed at a QL, in order to face anxiety and other aspects of the emotional component in the context of long-term postoperative bariatric surgery. In the same context, Al Khalifa and Al Ansari  observed that the postoperative QL assessments of patients undergoing the sleeve surgical technique showed significant improvements in all items, except in the mental health domain.
An correlation was also observed between anxiety and low general scores of physical components and functional capacity, indicating that moderate and severe degrees of anxiety can interfere with the ability and autonomy to be more independent in daily activities, as this dimension intends to measure how much the state of health interferes with simple activities such as taking a shower, walking, climbing stairs, running, sweeping the floor or carrying weight.
Unlike the data found in this study, Sockalingam et al.  when evaluating psychosocial predictors, such as anxiety and QL two years after bariatric surgery, found in their results that anxiety had no significant influence on health-related QL or weight, in addition, the study patients had a low rate of anxiety symptoms (15.1%). In this sense, Le Foll et al. (2020), highlight the importance of monitoring around 15 to 18 months after bariatric surgery, as this period can be identified as the first "critical" period where weight regain and decreased self-perception of QL may occur. A possible explanation for the divergence between the results of this research and those found by Sockalingam et al.  may be the different methods adopted in the two studies to assess symptoms of anxiety, and the fact that the sample in the study by Sockalingam et al.  include participants of both sexes.
It was also found that the worse the perception of the general physical component of QL, the greater the anxiety, regardless of weight regain and surgery time. This result differs from the one found by Freire et al.  who observed an association between anxiety symptoms and weight regain in about 86% of patients, between seven to 14 years after surgery. Considering these findings, it can be assumed that the increase in anxiety symptoms over the years may interfere with the individual's level of independence, affecting their basic activities and leaving them functionally dependent, which, consequently, will directly affect their QL
As for anthropometry, it was observed in this study mean preoperative BMI of 44.0±6.6kg/m² and current BMI of 29.7±5.4kg/m². Similar results were found by Reichmann et al.  who recorded very similar means of preoperative BMI (45.0±6.54kg/m²) and current BMI (31±6.84 kg/m²). Regarding the surgical technique, most participants in this study underwent gastric bypass (68%). Bardal, Ceccatto and Mezzomo  also found a prevalence of gastric bypass in their investigation, corroborating the Data from the International Federation for the Surgery of Obesity and Metabolic Diseases (IFSO), which claims that the gastric bypass is the most performed surgical technique in Brazil, with about 76.6% .
The present study has some limitations that should be taken into account, such as the small sample size and the lack of follow-up of the women studied. However, despite this, it is worth noting that this study was carried out only in with women, which helps to elucidate which variables have interfered with the QL of this profile of patients after 24 months of bariatric surgery, since most studies include both women and men, thus allowing to identify which aspects should be taken into account in the follow-up in the long term to prevent or treat symptoms of anxiety and occurrence of weight regain in order to preserve the improvement in QL achieved postoperatively for clinical practice. Furthermore, the variables used in this study, such as QL, anxiety, weight regain, used only in women, were not listed in other investigations, which points to the need for further research in this area and the non-generalization of these results.