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Background <p>Bariatric surgery is the most effective treatment for patients with BMI ≥ 50 kg/m<sup>2</sup>, yet preoperative conservative therapy is often mandated. The benefit remains controversial. This study compared outcomes of conservative treatment, immediate surgery, and surgery after conservative therapy in patients with BMI ≥ 50 kg/m<sup>2</sup>.</p> Methods <p>All patients with BMI ≥ 50 kg/m<sup>2</sup> at a German bariatric center (2015–2021) were retrospectively categorized into: Non-Surg (conservative therapy only), Surg-First (immediate surgery), and Step-Treat (initial conservative therapy followed by surgery). Primary outcomes at 6, 12, and 24 months included weight loss, resolution of comorbidities (hypertension, type 2 diabetes, dyslipidemia, obstructive sleep apnea), Quality of Life and overall outcome (SF-BARI QOL score).</p> Results <p>Of 918 screened patients, 538 met inclusion criteria: Non-Surg (<i>n</i> = 203), Surg-First (<i>n</i> = 225), Step-Treat (<i>n</i> = 110). After 6&#xa0;months, median % total weight loss (%TWL) and % excess weight loss (%EWL) were significantly higher in Surg-First (%TWL: 23.6% vs. 0%; %EWL: 42% vs. 0%; both <i>P</i> &lt; .001) vs. Non-Surg. Surg-First showed higher diabetes remission (54.1% vs. 21.2%; <i>P</i> &lt; .001) and fewer de novo diabetes cases. Compared to Surg-First, Step-Treat showed similar short-term weight loss but lower %TWL and %EWL at 12 and 24&#xa0;months. Severe postoperative complications (Grade IIIb) were more common in Step-Treat (11.8% vs. 3.6%; <i>P</i> &lt; .001), and SF-BARI QOL scores were higher in Surg-First.</p> Conclusion <p>In patients with BMI ≥ 50 kg/m<sup>2</sup>, immediate bariatric surgery resulted in superior weight loss, improved comorbidity resolution, and fewer complications compared to conservative therapy alone or a stepwise approach, supporting direct surgical treatment in this population.</p>

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Treatment Pathways and Outcomes in Patients with BMI ≥ 50 kg/m2: Conservative Treatment, Immediate Surgery or Stepwise Surgical Approach

  • 期刊论文

  • 出版模式：

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  • 发表日期：

    2025年7月18日

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  • Sara Notz,
  • Rainer Grotelueschen,
  • Julia Pape,
  • Bjoern-Ole Stueben,
  • Louisa Stern,
  • Julia Gerullies,
  • Jonas Wagner,
  • Anne Lautenbach,
  • Jakob Robert Izbicki,
  • Thilo Hackert,
  • Philipp Busch,
  • Anna Dupree,
  • Dieter Weber,
  • Oliver Mann,
  • Gabriel Plitzko

摘要

Background

Bariatric surgery is the most effective treatment for patients with BMI ≥ 50 kg/m2, yet preoperative conservative therapy is often mandated. The benefit remains controversial. This study compared outcomes of conservative treatment, immediate surgery, and surgery after conservative therapy in patients with BMI ≥ 50 kg/m2.

Methods

All patients with BMI ≥ 50 kg/m2 at a German bariatric center (2015–2021) were retrospectively categorized into: Non-Surg (conservative therapy only), Surg-First (immediate surgery), and Step-Treat (initial conservative therapy followed by surgery). Primary outcomes at 6, 12, and 24 months included weight loss, resolution of comorbidities (hypertension, type 2 diabetes, dyslipidemia, obstructive sleep apnea), Quality of Life and overall outcome (SF-BARI QOL score).

Results

Of 918 screened patients, 538 met inclusion criteria: Non-Surg (n = 203), Surg-First (n = 225), Step-Treat (n = 110). After 6 months, median % total weight loss (%TWL) and % excess weight loss (%EWL) were significantly higher in Surg-First (%TWL: 23.6% vs. 0%; %EWL: 42% vs. 0%; both P < .001) vs. Non-Surg. Surg-First showed higher diabetes remission (54.1% vs. 21.2%; P < .001) and fewer de novo diabetes cases. Compared to Surg-First, Step-Treat showed similar short-term weight loss but lower %TWL and %EWL at 12 and 24 months. Severe postoperative complications (Grade IIIb) were more common in Step-Treat (11.8% vs. 3.6%; P < .001), and SF-BARI QOL scores were higher in Surg-First.

Conclusion

In patients with BMI ≥ 50 kg/m2, immediate bariatric surgery resulted in superior weight loss, improved comorbidity resolution, and fewer complications compared to conservative therapy alone or a stepwise approach, supporting direct surgical treatment in this population.