In Obesity Patients, Is the Goal to Lose Weight or to Fight Metabolic Syndrome Components? How Did Leptin and Perilipin 1 Guide US in the Choice of Surgical Procedure?

Background: Severe obesity is a growing global health issue and a significant risk factor for cardiovascular diseases. Bariatric and metabolic surgeries, such as sleeve gastrectomy (SG) and Roux-en-Y gastric bypass (RYGB), are effective interventions for managing cardiometabolic comorbidities associated with obesity. This study investigates early changes in leptin and perilipin-1 levels following SG and RYGB and their impact on cardiometabolic comorbidities. Methods: A total of 60 individuals with severe obesity (body mass index [BMI] >35 kg/m 2 with cardiometabolic comorbidities or BMI >40 kg/m 2 ) underwent bariatric and metabolic surgery at a single center. Demographic data, preoperative and postoperative (1st-month) laboratory values (leptin, perilipin-1, hemoglobin A1c [HbA1c], low-density lipoprotein [LDL] cholesterol, triglycerides), and weight loss were recorded. Statistical analyses compared changes between the groups. Results: Forty individuals underwent SG, and 20 underwent RYGB. Both SG and RYGB resulted in significant weight loss and improvements in metabolic parameters within the first 30 postoperative days. Perilipin-1, a lipid droplet-coating protein that regulates lipolysis and is implicated in atherosclerotic plaque formation, showed significantly different postoperative trajectories between the two groups. RYGB demonstrated greater reductions in leptin and perilipin-1 levels compared with SG ( P = .007 for perilipin-1). LDL cholesterol and HbA1c levels also decreased more significantly in the RYGB group. While SG showed no significant changes in perilipin-1 levels postoperatively, RYGB significantly reduced this marker, suggesting superior efficacy in addressing obesity-related cardiometabolic comorbidities. Conclusion: Within the first 30 postoperative days, RYGB produces earlier and more pronounced reductions in key metabolic markers, including leptin, perilipin-1, LDL cholesterol, and HbA1c, compared with SG. These early hormonal differences may help explain the long-term cardiometabolic advantages of RYGB reported in the literature and support prioritizing RYGB in patients with severe obesity with associated metabolic comorbidity components. Further prospective studies with long-term follow-up are warranted.