Bariatric Surgery Cuts Risk of Diabetes, Hypertension, and Other Metabolic Diseases: JAMA
USA: A major US-based cohort study has found that bariatric surgery substantially reduces the likelihood of developing obesity-related metabolic conditions compared with standard medical weight management programs. The findings highlight the value of bariatric surgery as a long-term strategy for lowering the burden of chronic diseases associated with obesity.
The study, published in JAMA Network Open, was led by Amanda L. Bader and colleagues from the Department of Surgery, University of Pennsylvania Health System, Philadelphia. Using data from the Veterans Health Administration (VHA), the researchers evaluated outcomes in patients with obesity who underwent either bariatric surgery or participated in a structured weight management program.
The investigation drew on records from 269,470 veterans across 128 VHA centers between 2008 and 2023. Of these, 5,813 patients underwent bariatric surgery—either Roux-en-Y gastric bypass or sleeve gastrectomy—while 263,657 enrolled in the MOVE! medical weight management program. Participants were adults with a BMI of 30 or higher, plus at least one metabolic comorbidity, or a BMI of 35 or higher. Patients already diagnosed with all five comorbidities at baseline were excluded.
The study revealed the following findings:
- Over a median follow-up of nearly 10 years, bariatric surgery patients showed significantly lower incidence rates of key metabolic conditions compared with those in the weight management group.
- At five years, the surgery group recorded 3.35 cases of hypertension, 4.85 of hyperlipidemia, 1.06 of type 2 diabetes, 3.43 of obstructive sleep apnea (OSA), and 2.01 of metabolic dysfunction–associated steatotic liver disease (MASLD) per 1,000 person-years.
- In the weight management group, incidence rates were higher: 8.89 for hypertension, 9.67 for hyperlipidemia, 4.29 for type 2 diabetes, 3.99 for OSA, and 2.44 for MASLD per 1,000 person-years.
- Bariatric surgery was associated with a 79.2% lower risk of type 2 diabetes (HR, 0.21), a 58.8% lower risk of hypertension (HR, 0.41), a 50.5% lower risk of hyperlipidemia (HR, 0.49), a 56.9% lower risk of OSA (HR, 0.43), and a 40.4% lower risk of MASLD (HR, 0.60).
- Similar protective effects of bariatric surgery were observed in a subgroup analysis of female veterans, despite the cohort being largely male (87.1%).
The authors emphasized that as obesity rates continue to climb in the United States, the prevention of secondary metabolic complications is crucial for reducing the long-term strain on the healthcare system. Bariatric surgery, beyond its established role in managing existing obesity-related conditions, appears to play a strong role in preventing new comorbidities from arising.
While the results are promising, the study has limitations. Possible misclassification of exposures and outcomes, incomplete capture of surgeries performed outside the VHA, and variability in engagement with the medical weight management program may have influenced outcomes. Additionally, the veteran population studied was older and predominantly male, which may affect the generalizability of the findings to broader populations. The researchers also noted that the role of emerging anti-obesity medications was not accounted for in their analysis.
"Despite these caveats, the findings strongly support bariatric surgery as a durable and effective intervention for risk reduction in obesity. By significantly lowering the chances of developing chronic metabolic diseases, bariatric surgery may offer patients not only weight loss benefits but also long-term protection against conditions that pose a major public health burden," the authors concluded.
Reference:
Bader AL, Hsu JY, Altieri MS, et al. Bariatric Surgery and Incident Development of Obesity-Related Comorbidities. JAMA Netw Open. 2025;8(9):e2530787. doi:10.1001/jamanetworkopen.2025.30787
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