Sex disparities in patients undergoing metabolic bariatric surgery: Data from a national registry

BACKGROUND AND AIMS: Sex and menopause status are associated with substantial differences in body composition and cardiometabolic risk, Men, premenopausal women, and postmenopausal women therefore exhibit distinct metabolic and clinical profiles. Current metabolic bariatric surgery (MBS) eligibility is largely based on BMI thresholds; moreover a substantial sex disparity exists in MBS utilization, with approximately 80 % of the treated patients being female. This may contribute to the undertreatment of patients with a high disease burden. Considering these biological and metabolic difference. We aimed to evaluate sex disparities and differences between premenopausal and postmenopausal women, in patient characteristics, obesity related comorbidities, complication rates and weight loss outcomes after surgery. METHODS: We analyzed data from a national registry on primary laparoscopic Roux-en-Y gastric bypass and sleeve gastrectomy cases between 2018 and 2019, with follow-up data up to 24 months post-surgery. RESULTS: Among 17,567 patients (21.8 % men, 61.9 % premenopausal women, 16.3 % postmenopausal women), men and postmenopausal women had lower pre-surgery BMI than premenopausal women but showed higher rates of type 2 diabetes (30.4 % and 31.7 % vs. 11.4 %, p < 0.001). Postmenopausal women experienced more severe complications than both premenopausal women and men (6.2 % vs. 1.7 % and 2.7 %, p < 0.001), and men and postmenopausal women had higher postoperative bleeding rates (1.9 % and 1.6 % vs. 1.0 %, p < 0.001). MBS-induced total weight loss (TWL) was lower in men (TWL 28.2 ± 8.5 % and 27.9 ± 9.4 % at respectively 12 and 24 months). The observed differences between men, premenopausal, and postmenopausal women were largely consistent across surgery types.. CONCLUSIONS: This is the first study providing insights in preoperative and postoperative differences between men and premenopausal and postmenopausal women. Our findings underscore the potential benefit of earlier obesity treatment and referral of men and postmenopausal women, and create awareness that these groups more often present with unfavorable body composition and a significant disease burden..