Background: Until now, no detailed long-term data regarding patients with declining quality of life or occupational status after laparoscopic Roux-en-Y gastric bypass surgery have been presented. The aim of this study was to evaluate the long-term effect of laparoscopic Roux-en-Y gastric bypass surgery on quality of life and occupational status. Methods: The study was a single-center register-based cohort study including all patients who underwent laparoscopic Roux-en-Y gastric bypass surgery from 2010 through 2014. Quality of life was based on the validated Moorehead-Ardelt questionnaire, measured preoperatively and postoperatively after 12, 24, and median 63 months. Longitudinal trends of occupational status were created and compared with overall trends in the Danish population. Subgroup analyses were conducted, investigating associations between declining quality of life, declining occupational status, and postoperative chronic abdominal pain. Results: In total, 749 patients were included in the study. All aspects of quality of life improved after laparoscopic Roux-en-Y gastric bypass surgery. After a median follow-up of 63 months, quality of life was significantly reduced in 14% of the patients compared with the preoperative baseline. Lower quality of life was associated with a decline in occupational status (P = .008) and postoperative chronic abdominal pain (P < .0001). Overall, occupational status was unchanged compared with before surgery. Throughout the study period occupational status declined in 21% of the patients. Declining occupational status was associated with declining quality of life (P = .008) and development of chronic abdominal pain (P = .009). Conclusion: In general, quality of life and occupational status improved after laparoscopic Roux-en-Y gastric bypass surgery. Subgroups of patients had declining quality of life and declining occupational status both being associated with postoperative chronic abdominal pain.