ArticleObesity surgery2026
Comparative Outcomes of Bariatric Surgery in Individuals with Class 2-3 and Class 4 Obesity : A Retrospective Cohort Study.
Article in Obesity surgery, 2026. The graph could read no effect estimate from its abstract, so it casts no vote on the map. Not yet cited in PubMed.
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Abstract
objectivesTo compare perioperative and postoperative outcomes of bariatric surgery between individuals with Class 2-3 and Class 4 obesity and to evaluate procedure-specific differences within the Class 4 group. PATIENTS AND
methodsThis retrospective study included 570 patients who underwent sleeve gastrectomy, roux-en-y gastric bypass, or one-anastomosis gastric bypass between 2013 and 2022. Primary outcome was total weight loss percentage (%TWL). Secondary outcomes included remission of diabetes, hypertension, and dyslipidemia, postoperative complications, mortality, suboptimal clinical response and weight-regain rates.
resultsIndividuals with Class 4 obesity had significantly higher %TWL (38.0% vs. 36.4%, p < 0.05) than patients with Class 2 and 3 obesity. Suboptimal clinical response (3.% vs. 2.5%) and weight regain (11.9% vs. 17.4%) were comparable between groups. Remission of diabetes, hypertension, and dyslipidemia did not significantly differ. Overall complication rates were similar; however, mortality was significantly higher among individuals with Class 4 obesity (2.5% vs. 0.2%, p < 0.05). Among the Class 4 obesity group, OAGB and RYGB resulted in the highest %TWL and lowest postoperative BMI, outperforming SG.
conclusionsBoth individuals with Class 2-3 and Class 4 obesity achieved significant and durable weight loss, though relative weight reduction remained lower in the Class 4 group. In patients with Class 4 obesity, OAGB and RYGB were associated with greater weight loss than SG during follow-up. However, these findings should be interpreted cautiously given the retrospective design, non-randomized procedure selection, and limited subgroup sample sizes. Bariatric surgery remains effective and generally safe, but individuals with Class 4 obesity require meticulous perioperative management given increased mortality risk.
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