Research progress on metabolic and bariatric surgery in older obese patients_CHINESE JOURNAL OF BASES AND CLINICS IN GENERAL SURGERY

Authors：

HU Yi ^1,2 , GAO Zhiguang ¹ , WU Zhenpeng ¹ , LI Weige ¹ , WU Li’na ¹ ,  YANG Jingge ¹

1. Department of Gastrointestinal Surgery & Bariatric and Metabolic Surgery, The First Affiliated Hospital of Jinan University, Guangzhou 510630, P. R. China;
2. The First School of Clinical Medicine, Jinan University, Guangzhou 510630, P. R. China;

Corresponding author：

YANG Jingge, Email: duke.yjg@126.com

Keywords：

obesity; advanced age; bariatric surgery; gastric bypass; sleeve gastrectomy

DOI：

10.7507/1007-9424.202508121

Video：

Export PDF Favorites Scan Get Citation

Abstract Full text Figures/Tables Video References Cited by

Objective To systematically review the research progress in the selection of metabolic bariatric procedures, efficacy, safety, complication prevention, and long-term management for elderly patients, so as to provide references for surgical decision-making and perioperative management in future metabolic and bariatric surgery for elderly obese patients. Method A review of recent domestic and international literature on metabolic and bariatric surgery in elderly patients was conducted. Results With the intensification of societal aging, the incidence of obesity and related metabolic diseases among the elderly population has significantly increased. Metabolic and bariatric surgery has been proven to effectively reduce weight and improve obesity-related metabolic diseases in elderly patients. Current guidelines no longer consider age an absolute contraindication for surgery. Sleeve gastrectomy (SG) and Roux-en-Y gastric bypass (RYGB) are the most commonly used procedures internationally. SG is superior to RYGB in terms of surgical safety, while RYGB has greater advantages in improving metabolic diseases. Although the postoperative mortality and complications risks in elderly obese patients are higher than those in younger obese patients, strict preoperative assessment and individualized procedure selection can significantly reduce these risks. Conclusions Metabolic and bariatric surgery can serve as an effective treatment for elderly obese patients, offering comprehensive benefits in weight loss and metabolic improvement. Procedure selection requires individualized assessment, balancing the patient’s baseline condition and metabolic needs. Postoperative success hinges on systematic long-term follow-up and management to ensure sustained benefits and safety. Future efforts should focus on clarifying the definitions or standards of “elderly” and “obesity,” followed by more large-sample, long-term follow-up randomized controlled studies to validate the safety and efficacy of metabolic and bariatric surgery.

Citation： HU Yi, GAO Zhiguang, WU Zhenpeng, LI Weige, WU Li’na, YANG Jingge. Research progress on metabolic and bariatric surgery in older obese patients. CHINESE JOURNAL OF BASES AND CLINICS IN GENERAL SURGERY, 2025, 32(9): 1148-1153. doi: 10.7507/1007-9424.202508121 Copy

1.	Sørensen TIA, Martinez AR, Jørgensen TSH. Epidemiology of obesity. Handb Exp Pharmacol, 2022, 274: 3-27.
2.	Fakhouri TH, Ogden CL, Carroll MD, et al. Prevalence of obesity among older adults in the United States, 2007–2010. NCHS Data Brief, 2012, (106): 1-8.
3.	Kloock S, Ziegler CG, Dischinger U. Obesity and its comorbidities, current treatment options and future perspectives: challenging bariatric surgery?. Pharmacol Ther, 2023, 251: 108549. doi: 10.1016/j.pharmthera.2023.108549.
4.	Lynch DH, Petersen CL, Fanous MM, et al. The relationship between multimorbidity, obesity and functional impairment in older adults. J Am Geriatr Soc, 2022, 70(5): 1442-1449.
5.	Villareal DT. Editorial: obesity and accelerated aging. J Nutr Health Aging, 2023, 27(5): 312-313.
6.	GBD 2021 Adult BMI Collaborators. Global, regional, and national prevalence of adult overweight and obesity, 1990–2021, with forecasts to 2050: a forecasting study for the Global Burden of Disease Study 2021. Lancet, 2025, 405(10481): 813-838.
7.	Fried M, Yumuk V, Oppert JM, et al. Interdisciplinary European guidelines on metabolic and bariatric surgery. Obes Surg, 2014, 24(1): 42-55.
8.	Kapała J, Maroszczuk T, Dowgiałło-Gornowicz N. Efficacy and safety of laparoscopic bariatric surgery in patients of 70 years and older: a systematic review and meta-analysis. Obes Rev, 2025, 26(3): e13867. doi: 10.1111/obr.13867.
9.	Kermansaravi M, Vitiello A, Valizadeh R, et al. Comparing the safety and efficacy of sleeve gastrectomy versus Roux-en-Y gastric bypass in elderly (>60 years) with severe obesity: an umbrella systematic review and meta-analysis. Int J Surg, 2023, 109(11): 3541-3554.
10.	De Luca M, Shikora S, Eisenberg D, et al. Scientific evidence for the updated guidelines on indications for metabolic and bariatric surgery (IFSO/ASMBS). Obes Surg, 2024, 34(11): 3963-4096.
11.	Giordano S, Salminen P. Laparoscopic sleeve gastrectomy is safe for patients over 60 years of age: a meta-analysis of comparative studies. J Laparoendosc Adv Surg Tech A, 2020, 30(1): 12-19.
12.	Marczuk P, Kubisa MJ, Święch M, et al. Effectiveness and safety of Roux-en-Y gastric bypass in elderly patients—systematic review and meta-analysis. Obes Surg, 2019, 29(2): 361-368.
13.	Dowgiałło-Gornowicz N, Wityk M, Jaworski P, et al. Obesity solutions for patients over 65 years of age: surgeon perspectives on anti-obesity medications and metabolic bariatric surgery—international survey study. Obes Surg, 2025, 35(8): 3182-3189.
14.	Wang Y, Yi X, Li Q, et al. The effectiveness and safety of sleeve gastrectomy in the obese elderly patients: a systematic review and meta-analysis. Obes Surg, 2016, 26(12): 3023-3030.
15.	Giordano S, Victorzon M. Laparoscopic Roux-en-Y gastric bypass in elderly patients (60 years or older): a meta-analysis of comparative studies. Scand J Surg, 2018, 107(1): 6-13.
16.	Dayan D, Bendayan A, Nizri E, et al. One anastomosis gastric bypass compared with sleeve gastrectomy in elderly patients: safety and long-term outcomes. Obes Surg, 2023, 33(2): 570-576.
17.	Gholizadeh B, Makhsosi BR, Valizadeh R, et al. Safety and efficacy of one anastomosis gastric bypass on patients with severe obesity aged 65 years and above. Obes Surg, 2022, 32(5): 1610-1616.
18.	Musella M, Milone M, Maietta P, et al. Bariatric surgery in elderly patients. A comparison between gastric banding and sleeve gastrectomy with five years of follow up. Int J Surg, 2014: 12 Suppl 2: S69-S72. doi: 10.1016/j.ijsu.2014.08.377.
19.	Matteo MV, Bove V, Pontecorvi V, et al. Outcomes of endoscopic sleeve gastroplasty in the elder population. Obes Surg, 2022, 32(10): 3390-3397.
20.	Gerber P, Gustafsson UO, Anderin C, et al. Effect of age on quality of life after gastric bypass: data from the Scandinavian Obesity Surgery Registry. Surg Obes Relat Dis, 2022, 18(11): 1313-1322.
21.	Iranmanesh P, Boudreau V, Ramji K, et al. Outcomes of bariatric surgery in elderly patients: a registry-based cohort study with 3-year follow-up. Int J Obes (Lond), 2022, 46(3): 574-580.
22.	O’Keefe KL, Kemmeter PR, Kemmeter KD. Bariatric surgery outcomes in patients aged 65 years and older at an American Society for Metabolic and Bariatric Surgery Center of Excellence. Obes Surg, 2010, 20(9): 1199-1205.
23.	Lainas P, Dammaro C, Gaillard M, et al. Safety and short-term outcomes of laparoscopic sleeve gastrectomy for patients over 65 years old with severe obesity. Surg Obes Relat Dis, 2018, 14(7): 952-959.
24.	Susmallian S, Raziel A, Barnea R, et al. Bariatric surgery in older adults: should there be an age limit?. Medicine (Baltimore), 2019, 98(3): e13824. doi: 10.1097/MD.0000000000013824.
25.	Rezapanah A, Ebrahimi P, Sherafati H, et al. Comparative analysis of metabolic and bariatric surgery outcomes and complications in patients under and over 50 years of age. Langenbecks Arch Surg, 2025, 410(1): 71. doi: 10.1007/s00423-025-03644-5.
26.	Moon RC, Kreimer F, Teixeira AF, et al. Morbidity rates and weight loss after Roux-en-Y gastric bypass, sleeve gastrectomy, and adjustable gastric banding in patients older than 60 years old: which procedure to choose?. Obes Surg, 2016, 26(4): 730-736.
27.	Pajecki D, Dos Anjos Pinheiro MC, Dantas ACB, et al. Sleeve gastrectomy versus Roux-en-Y gastric bypass for treating obesity in patients > 65 years old: 3-year outcomes of a randomized trial. J Gastrointest Surg, 2023, 27(4): 780-782.
28.	Qin C, Luo B, Aggarwal A, et al. Advanced age as an independent predictor of perioperative risk after laparoscopic sleeve gastrectomy (LSG). Obes Surg, 2015, 25(3): 406-412.
29.	Mabeza RM, Mao Y, Maynard K, et al. Bariatric surgery outcomes in geriatric patients: a contemporary, nationwide analysis. Surg Obes Relat Dis, 2022, 18(8): 1005-1011.
30.	Casillas RA, Kim B, Fischer H, et al. Comparative effectiveness of sleeve gastrectomy versus Roux-en-Y gastric bypass for weight loss and safety outcomes in older adults. Surg Obes Relat Dis, 2017, 13(9): 1476-1483.
31.	Albacete S, Verhoeff K, Mocanu V, et al. A 5-year characterization of trends and outcomes in elderly patients undergoing elective bariatric surgery. Surg Endosc, 2023, 37(7): 5397-5404.
32.	Goldenberg A, Farah JFM, Lacerda MR, et al. Sleeve gastrectomy in septuagenarians: a case-control study. Obes Surg, 2022, 32(9): 2846-2852.
33.	Arolfo S, Salzano A, Dogliotti S, et al. Bariatric surgery in over 60 years old patients: is it worth it?. Updates Surg, 2021, 73(4): 1501-1507.
34.	Belluzzi A, Hage K, Abi Mosleh K, et al. Long-term safety and efficacy of bariatric surgery in septuagenarians. Obes Surg, 2023, 33(12): 3778-3785.
35.	Dowgiałło-Gornowicz N, Lech P, Major P, et al. Bariatric and metabolic surgery in patients older than 65 years—a multicenter study. Obes Surg, 2023, 33(10): 3106-3111.
36.	Hage K, Cornejo J, Allotey JK, et al. Feasibility and outcomes of simultaneous gastric bypass with paraesophageal hernia repair in elderly patients. Obes Surg, 2023, 33(9): 2734-2741.
37.	Dang JT, Mocanu V, Verhoeff K, et al. Predicting serious complications following bariatric surgery in geriatric patients: development of the GeriBari scoring tool using the MBSAQIP database. Surg Obes Relat Dis, 2023, 19(3): 195-202.
38.	Sebastian R, Ghanem OM, Cornejo J, et al. Validation of the cumulative deficit theory in bariatric surgery: new bariatric frailty score is associated with non-home discharge, prolonged hospital stay and mortality in the era of fast-track bariatric surgery. Surg Obes Relat Dis, 2022, 18(6): 779-788.

1. Sørensen TIA, Martinez AR, Jørgensen TSH. Epidemiology of obesity. Handb Exp Pharmacol, 2022, 274: 3-27.
2. Fakhouri TH, Ogden CL, Carroll MD, et al. Prevalence of obesity among older adults in the United States, 2007–2010. NCHS Data Brief, 2012, (106): 1-8.
3. Kloock S, Ziegler CG, Dischinger U. Obesity and its comorbidities, current treatment options and future perspectives: challenging bariatric surgery?. Pharmacol Ther, 2023, 251: 108549. doi: 10.1016/j.pharmthera.2023.108549.
4. Lynch DH, Petersen CL, Fanous MM, et al. The relationship between multimorbidity, obesity and functional impairment in older adults. J Am Geriatr Soc, 2022, 70(5): 1442-1449.
5. Villareal DT. Editorial: obesity and accelerated aging. J Nutr Health Aging, 2023, 27(5): 312-313.
6. GBD 2021 Adult BMI Collaborators. Global, regional, and national prevalence of adult overweight and obesity, 1990–2021, with forecasts to 2050: a forecasting study for the Global Burden of Disease Study 2021. Lancet, 2025, 405(10481): 813-838.
7. Fried M, Yumuk V, Oppert JM, et al. Interdisciplinary European guidelines on metabolic and bariatric surgery. Obes Surg, 2014, 24(1): 42-55.
8. Kapała J, Maroszczuk T, Dowgiałło-Gornowicz N. Efficacy and safety of laparoscopic bariatric surgery in patients of 70 years and older: a systematic review and meta-analysis. Obes Rev, 2025, 26(3): e13867. doi: 10.1111/obr.13867.
9. Kermansaravi M, Vitiello A, Valizadeh R, et al. Comparing the safety and efficacy of sleeve gastrectomy versus Roux-en-Y gastric bypass in elderly (>60 years) with severe obesity: an umbrella systematic review and meta-analysis. Int J Surg, 2023, 109(11): 3541-3554.
10. De Luca M, Shikora S, Eisenberg D, et al. Scientific evidence for the updated guidelines on indications for metabolic and bariatric surgery (IFSO/ASMBS). Obes Surg, 2024, 34(11): 3963-4096.
11. Giordano S, Salminen P. Laparoscopic sleeve gastrectomy is safe for patients over 60 years of age: a meta-analysis of comparative studies. J Laparoendosc Adv Surg Tech A, 2020, 30(1): 12-19.
12. Marczuk P, Kubisa MJ, Święch M, et al. Effectiveness and safety of Roux-en-Y gastric bypass in elderly patients—systematic review and meta-analysis. Obes Surg, 2019, 29(2): 361-368.
13. Dowgiałło-Gornowicz N, Wityk M, Jaworski P, et al. Obesity solutions for patients over 65 years of age: surgeon perspectives on anti-obesity medications and metabolic bariatric surgery—international survey study. Obes Surg, 2025, 35(8): 3182-3189.
14. Wang Y, Yi X, Li Q, et al. The effectiveness and safety of sleeve gastrectomy in the obese elderly patients: a systematic review and meta-analysis. Obes Surg, 2016, 26(12): 3023-3030.
15. Giordano S, Victorzon M. Laparoscopic Roux-en-Y gastric bypass in elderly patients (60 years or older): a meta-analysis of comparative studies. Scand J Surg, 2018, 107(1): 6-13.
16. Dayan D, Bendayan A, Nizri E, et al. One anastomosis gastric bypass compared with sleeve gastrectomy in elderly patients: safety and long-term outcomes. Obes Surg, 2023, 33(2): 570-576.
17. Gholizadeh B, Makhsosi BR, Valizadeh R, et al. Safety and efficacy of one anastomosis gastric bypass on patients with severe obesity aged 65 years and above. Obes Surg, 2022, 32(5): 1610-1616.
18. Musella M, Milone M, Maietta P, et al. Bariatric surgery in elderly patients. A comparison between gastric banding and sleeve gastrectomy with five years of follow up. Int J Surg, 2014: 12 Suppl 2: S69-S72. doi: 10.1016/j.ijsu.2014.08.377.
19. Matteo MV, Bove V, Pontecorvi V, et al. Outcomes of endoscopic sleeve gastroplasty in the elder population. Obes Surg, 2022, 32(10): 3390-3397.
20. Gerber P, Gustafsson UO, Anderin C, et al. Effect of age on quality of life after gastric bypass: data from the Scandinavian Obesity Surgery Registry. Surg Obes Relat Dis, 2022, 18(11): 1313-1322.
21. Iranmanesh P, Boudreau V, Ramji K, et al. Outcomes of bariatric surgery in elderly patients: a registry-based cohort study with 3-year follow-up. Int J Obes (Lond), 2022, 46(3): 574-580.
22. O’Keefe KL, Kemmeter PR, Kemmeter KD. Bariatric surgery outcomes in patients aged 65 years and older at an American Society for Metabolic and Bariatric Surgery Center of Excellence. Obes Surg, 2010, 20(9): 1199-1205.
23. Lainas P, Dammaro C, Gaillard M, et al. Safety and short-term outcomes of laparoscopic sleeve gastrectomy for patients over 65 years old with severe obesity. Surg Obes Relat Dis, 2018, 14(7): 952-959.
24. Susmallian S, Raziel A, Barnea R, et al. Bariatric surgery in older adults: should there be an age limit?. Medicine (Baltimore), 2019, 98(3): e13824. doi: 10.1097/MD.0000000000013824.
25. Rezapanah A, Ebrahimi P, Sherafati H, et al. Comparative analysis of metabolic and bariatric surgery outcomes and complications in patients under and over 50 years of age. Langenbecks Arch Surg, 2025, 410(1): 71. doi: 10.1007/s00423-025-03644-5.
26. Moon RC, Kreimer F, Teixeira AF, et al. Morbidity rates and weight loss after Roux-en-Y gastric bypass, sleeve gastrectomy, and adjustable gastric banding in patients older than 60 years old: which procedure to choose?. Obes Surg, 2016, 26(4): 730-736.
27. Pajecki D, Dos Anjos Pinheiro MC, Dantas ACB, et al. Sleeve gastrectomy versus Roux-en-Y gastric bypass for treating obesity in patients > 65 years old: 3-year outcomes of a randomized trial. J Gastrointest Surg, 2023, 27(4): 780-782.
28. Qin C, Luo B, Aggarwal A, et al. Advanced age as an independent predictor of perioperative risk after laparoscopic sleeve gastrectomy (LSG). Obes Surg, 2015, 25(3): 406-412.
29. Mabeza RM, Mao Y, Maynard K, et al. Bariatric surgery outcomes in geriatric patients: a contemporary, nationwide analysis. Surg Obes Relat Dis, 2022, 18(8): 1005-1011.
30. Casillas RA, Kim B, Fischer H, et al. Comparative effectiveness of sleeve gastrectomy versus Roux-en-Y gastric bypass for weight loss and safety outcomes in older adults. Surg Obes Relat Dis, 2017, 13(9): 1476-1483.
31. Albacete S, Verhoeff K, Mocanu V, et al. A 5-year characterization of trends and outcomes in elderly patients undergoing elective bariatric surgery. Surg Endosc, 2023, 37(7): 5397-5404.
32. Goldenberg A, Farah JFM, Lacerda MR, et al. Sleeve gastrectomy in septuagenarians: a case-control study. Obes Surg, 2022, 32(9): 2846-2852.
33. Arolfo S, Salzano A, Dogliotti S, et al. Bariatric surgery in over 60 years old patients: is it worth it?. Updates Surg, 2021, 73(4): 1501-1507.
34. Belluzzi A, Hage K, Abi Mosleh K, et al. Long-term safety and efficacy of bariatric surgery in septuagenarians. Obes Surg, 2023, 33(12): 3778-3785.
35. Dowgiałło-Gornowicz N, Lech P, Major P, et al. Bariatric and metabolic surgery in patients older than 65 years—a multicenter study. Obes Surg, 2023, 33(10): 3106-3111.
36. Hage K, Cornejo J, Allotey JK, et al. Feasibility and outcomes of simultaneous gastric bypass with paraesophageal hernia repair in elderly patients. Obes Surg, 2023, 33(9): 2734-2741.
37. Dang JT, Mocanu V, Verhoeff K, et al. Predicting serious complications following bariatric surgery in geriatric patients: development of the GeriBari scoring tool using the MBSAQIP database. Surg Obes Relat Dis, 2023, 19(3): 195-202.
38. Sebastian R, Ghanem OM, Cornejo J, et al. Validation of the cumulative deficit theory in bariatric surgery: new bariatric frailty score is associated with non-home discharge, prolonged hospital stay and mortality in the era of fast-track bariatric surgery. Surg Obes Relat Dis, 2022, 18(6): 779-788.

Previous Article
Child and adolescent obesity: challenges and responses in China
Next Article
Effects of weight loss interventions on hormone levels and sexual function

CHINESE JOURNAL OF BASES AND CLINICS IN GENERAL SURGERY

Research progress on metabolic and bariatric surgery in older obese patients

Abstract Full text Figures/Tables Video References Cited by

Previous Article

Next Article

Format

Content