Long-Term Metabolic Effects and Weight Loss Outcomes of Bariatric Surgery in Patients With Super-Super Obesity

Objective: To evaluate long-term weight trajectories and metabolic outcomes after bariatric surgery in patients with extreme obesity (BMI ≥ 60 kg/m²). Background: Patients with BMI ≥ 60 kg/m² represent a high-risk subgroup with a substantial cardiometabolic burden, yet long-term outcome data remain limited, particularly beyond 5 years and in cohorts including revisional surgery. Methods: A retrospective cohort study included patients with BMI ≥ 60 kg/m² who underwent bariatric surgery between April 2008 and August 2019. Outcomes included percentage total weight loss (%TWL), BMI change, and remission or improvement of metabolic comorbidities derived from structured medical records, with follow-up of up to 10 years. Early postoperative complications and mortality were also assessed. Results: Sixty patients were included (mean age 41.5 years; mean baseline BMI 63.8 kg/m²; 67% female), 80% had obesity-related comorbidities and 23% underwent revisional surgery. Mean %TWL declined from 37.99% at ≤ 2 years to 37.36% at 2–5 years, 22.37% at 5–10 years, and 19.38% at > 10 years (p = 0.054). At the last follow-up (mean 72 months), mean BMI decreased to 45.11 kg/m² and mean %TWL was 29.4%. Remission or improvement occurred in NAFLD (73.9%), type 2 diabetes (77.8%), obstructive sleep apnoea (85.7%), and hyperlipidaemia (70.0%), whereas hypertension improved in 29.1%. Two deaths occurred (3.33%): one perioperative death due to an anastomotic leak after revisional surgery and one late death unrelated to surgery. Conclusions: In BMI ≥ 60 kg/m², bariatric surgery delivers durable metabolic benefits despite frequent long-term weight regain, supporting its role as a metabolic intervention beyond weight loss and underscoring the need for strategies that preserve metabolic health over time.