Treatment pathways and outcomes in patients with BMI≥50 kg/m²: Conservative treatment, immediate surgery or stepwise surgical approach

Introduction: Bariatric surgery is the most effective treatment for patients with a BMI≥50 kg/m², yet preoperative conservative therapy is often mandated. This study aimed to compare outcomes of conservative treatment alone, immediate surgery, and surgery following failed conservative therapy in patients with BMI≥50 kg/m².

Methods: All patients with BMI≥50 kg/m² presenting to a German bariatric center between 2015–2021 were retrospectively categorised into three therapy groups. Primary outcomes were assessed at 6, 12, and 24 months and included weight loss, resolution of obesity-associated comorbidities, and overall outcome measured by the SF-BARI score.

Results: Of 918 patients, 538 met inclusion criteria and were allocated to Non-Surgical (n=203), Surgery-First (n=225), and Stepwise-Treatment (n=110). After 6 months, median%TWL and%EWL were significantly higher in the Surgery-First group compared to Non-Surgical management. Compared to Surgery-First, the Stepwise-Treatment group showed comparable short-term weight loss, but significantly lower%TWL and%EWL at 12 and 24 months. SF-BARI scores were significantly higher in Surgery-First, whereas severe postoperative complications were more common in Stepwise-Treatment.

Conclusion: In patients with BMI≥50 kg/m², immediate bariatric surgery was associated with superior weight loss, improved comorbidity resolution, and fewer complications. These findings support direct surgical treatment in this population.

Publikationsverlauf

Artikel online veröffentlicht:
15. September 2025