Long‐Term Metabolic Effects and Weight Loss Outcomes of Bariatric Surgery in Patients With Super‐Super Obesity

Objective To evaluate long‐term weight trajectories and metabolic outcomes after bariatric surgery in patients with extreme obesity (BMI ≥ 60 kg/m 2 ). Background Patients with BMI ≥ 60 kg/m 2 represent a high‐risk subgroup with a substantial cardiometabolic burden, yet long‐term outcome data remain limited, particularly beyond 5 years and in cohorts including revisional surgery. Methods A retrospective cohort study included patients with BMI ≥ 60 kg/m 2 who underwent bariatric surgery between April 2008 and August 2019. Outcomes included percentage total weight loss (%TWL), BMI change, and remission or improvement of metabolic comorbidities derived from structured medical records, with follow‐up of up to 10 years. Early postoperative complications and mortality were also assessed. Results Sixty patients were included (mean age 41.5 years; mean baseline BMI 63.8 kg/m 2 ; 67% female), 80% had obesity‐related comorbidities and 23% underwent revisional surgery. Mean %TWL declined from 37.99% at ≤ 2 years to 37.36% at 2–5 years, 22.37% at 5–10 years, and 19.38% at > 10 years ( p = 0.054). At the last follow‐up (mean 72 months), mean BMI decreased to 45.11 kg/m 2 and mean %TWL was 29.4%. Remission or improvement occurred in NAFLD (73.9%), type 2 diabetes (77.8%), obstructive sleep apnoea (85.7%), and hyperlipidaemia (70.0%), whereas hypertension improved in 29.1%. Two deaths occurred (3.33%): one perioperative death due to an anastomotic leak after revisional surgery and one late death unrelated to surgery. Conclusions In BMI ≥ 60 kg/m 2 , bariatric surgery delivers durable metabolic benefits despite frequent long‐term weight regain, supporting its role as a metabolic intervention beyond weight loss and underscoring the need for strategies that preserve metabolic health over time.