Metabolic surgery results in greater metabolic benefits in patients who achieve healthy weight.

Background: A percentage of total weight loss (%TWL) >20% as the expected weight loss target after metabolic surgery might be insufficient to produce adequate metabolic benefits.

Objectives: This study identified the optimal weight loss target to achieve substantial benefits from metabolic surgery.

Setting: University-affiliated tertiary care center.

Methods: In this retrospective study, participants were categorized into healthy weight (18.5 kg/m ≤ body mass index [BMI] < 24 kg/m), overweight (24 kg/m ≤ BMI < 28 kg/m), and obesity groups (BMI ≥28 kg/m) according to their BMI 1 year after metabolic surgery. The weight loss and remission of obesity-related comorbidities were evaluated. Ordinal logistic regression analysis was used to identify predictors for achieving healthy weight 1 year postoperatively.

Results: Overall, 125 patients (112 sleeve gastrectomies, 13 Roux-en-Y gastric bypasses) were recruited in this study. Forty-two participants achieved healthy weight, 38 were overweight, and 45 had obesity. Type 2 diabetes mellitus and obstructive sleep apnea were relieved in all groups. Individuals who achieved healthy weight showed more improvements in nonalcoholic fatty liver disease, hypertension, and hyperuricemia than those who did not. Preoperative BMI was an independent predictor for the BMI achieved postoperatively, and the optimal cut-off point for achieving healthy weight was 34.9 kg/m.

Conclusions: Healthy weight was a more stringent target for patients who underwent metabolic surgery than the %TWL. Populations with a preoperative BMI of <34.9 kg/m were prone to realize the goal. Additional weight loss interventions could be considered for those with higher preoperative BMIs and enforced within 1 year postoperatively.