# Metabolic Outcomes in Bariatric/Metabolic Surgery Individuals: Impact of Metabolic Health Definition, Type of Surgery, and Follow-Up Duration—An Observational, Retrospective Study

## TL;DR

This study examines how different definitions of metabolic health affect outcomes in bariatric surgery patients, finding that Roux-en-Y gastric bypass has the strongest benefits.

## Contribution

The study evaluates multiple metabolic health definitions and their impact on post-surgery outcomes, revealing variability and the role of surgery type.

## Key findings

- Metabolic health classifications and metabolically unhealthy phenotype prevalence vary significantly by definition.
- RYGB leads to greater weight loss and more improvement in cardiometabolic markers compared to other procedures.
- Post-surgery metabolic phenotype is not solely determined by weight loss or the type of surgery performed.

## Abstract

Background: There is no standardized definition for metabolic health. Overweight and obesity are often linked to metabolic dysfunction. Bariatric surgery promotes body weight loss and cardiometabolic health improvement. Objective: We aim to characterize metabolic health using distinct definitions and evaluate anthropometric and cardiometabolic features, both before and after different surgery procedures. Methods: We studied 3313 individuals from CRI-O [Porto, PT; BMI 39.56 (42.60; 46.20) kg/m2; 36 (43; 51) y; 82.7% women] who underwent Roux-en-Y gastric bypass (RYGB; 61.7%), sleeve gastrectomy (30.9%), or gastric band (7.5%) surgery. Anthropometric and cardiometabolic features were assessed at baseline and at yearly follow-ups, up to 4 years; the same for cardiometabolic dysfunction characterization using NCEP ATP III, Karelis, Meigs, Khan, Pluemacher, and Schulze definitions. Results: Baseline metabolic health classification and metabolically unhealthy phenotype (MUH) post-surgery prevalence decrease show substantial variability depending on the definition used. Unlike relative body weight loss, the altered metabolic feature number in MUH remains unchanged. Changes in MUH prevalence do not reflect body weight loss, nor does the variation in MUH percentage fully align with changes in altered metabolic features. Blood pressure, C-reactive protein, antihypertensive medication, and HOMA-IR are key contributors to baseline MUH. Post-surgical changes in body weight, lipid profile, and C-reactive protein vary by procedure. RYGB yields greater weight loss and more often improves cardiometabolic markers. However, post-operative metabolic phenotype is independent of surgery type. Conclusions: Metabolic health phenotypes pre- and post-surgery vary by definition, and the latter are not solely driven by weight loss or surgery type. In this cohort, RYGB shows the strongest beneficial impact.