Key result
Extreme obesity linked to ~271% higher serious complication risk in bariatric surgery vs BMI <40.
Why the study?
The study aimed to estimate the prevalence of extreme obesity and its association with disease burden and outcomes in patients undergoing metabolic and bariatric surgery.
Does extreme obesity increase the risk of preoperative disease burden and 30-day complications in patients undergoing metabolic and bariatric surgery compared to lower BMI categories?
Cross-Sectional (n=1,795,127)
Yes
Does extreme obesity increase the risk of preoperative disease burden and 30-day complications in patients undergoing metabolic and bariatric surgery compared to lower BMI categories?
Absolute Event Rate: 2.6% vs 0.7%
p-value: p=<0.001
Extreme obesity is common in bariatric surgery and is associated with progressively higher comorbidity burden and 30-day complications, though absolute event rates remain low enough to not contraindicate surgery.
Captured external expert commentary on this paper, strongest first. Original sources are linked where available.
“Extreme obesity presents substantial medical and surgical challenges, but it should not be viewed as a reason to deny patients effective treatment. Our findings show that, even at the highest levels of BMI, metabolic and bariatric surgery can be performed with relatively low rates of serious complications and mortality when patients are treated by experienced, multidisciplinary teams.”
“Extreme obesity represents one of the most medically complex and understudied forms of obesity, yet these patients have been largely overlooked for decades. This study brings much-needed attention to a growing population of patients who face substantial health risks and barriers to care, while also identifying important opportunities to improve treatment and outcomes.”
Supports heightened perioperative vigilance in extreme obesity; leaves open optimal BMI thresholds for bariatric candidacy.
Objective This study aimed to estimate extreme obesity prevalence and association with disease burden and outcomes in patients undergoing metabolic and bariatric surgery (MBS). Methods Cross‐sectional data from the Metabolic and Bariatric Surgery Accreditation and Quality Improvement Program (MBSAQIP, 2015–2023) were analyzed ( n = 1,795,127). Preoperative disease burden and 30‐day outcomes were compared across BMI categories (< 40, 40.0–49.9, 50.0–59.9, 60.0–69.9, 70.0–79.9, and ≥ 80 kg/m 2 ), emphasizing extreme obesity compared to lower BMI categories. Results Extreme obesity represented 5.3% of the eligible sample, though even higher BMI values (i.e., ≥ 70 kg/m 2 ) were consistently present in 1.1% of cases annually (13,677 cases/9 years). Relative to BMI < 40 kg/m 2 , patients with the highest BMI values (≥ 70 kg/m 2 ) had significantly greater frequency of hypertension (56.7% vs. 46.9%), sleep apnea (59.6% vs. 34.6%), COPD (2.6% vs. 1.1%), and functional dependence (4.5% vs. 0.5%). Increasing BMI category was associated with increased serious complications (2.6% vs. 0.7%; p < 0.001) and mortality (0.35% vs. 0.05%; p < 0.001). Conclusions Extreme obesity is common in MBS, and greater BMI is associated with progressively higher comorbidity burden and complications. Despite the higher frequency of complications, absolute events are low and do not contraindicate multidisciplinary obesity treatment. Strategies to reduce preoperative BMI among patients with the highest BMI values warrant evaluation.
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Albaugh et al. (2026) conducted a cross-sectional in Extreme obesity (n=1,795,127). Extreme obesity (BMI ≥ 70 kg/m2) vs. BMI < 40 kg/m2 was evaluated on Serious complications (p=<0.001). Compared to BMI <40 kg/m2, extreme obesity (≥70 kg/m2) in bariatric surgery patients was associated with higher rates of serious complications (2.6% vs 0.7%) and mortality (0.35% vs 0.05%; P<0.001).
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