Vance L. Albaugh

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.

Objective: Approximately 41% of the US population has obesity, though the prevalence of the highest BMI populations (e.g., ≥ 60 kg/m ² ) is increasing most rapidly. Given the association between obesity and surgical disease burden, we hypothesized that higher BMI groups would account for a growing proportion of operative volume over time. This study examined whether individuals with higher BMI have been receiving proportionally more surgical care over time. Methods: All multispecialty National Surgical Quality Improvement Program (NSQIP) cases from 2005 to 2022 were analyzed ( n = 11,634,075). Multinomial logistic regression was performed to analyze trends among BMI categories (< 30.0, 30.0–39.9, 40.0–49.9, 50.0–59.9, 60.0–69.9, and ≥ 70 kg/m ² ), while adjusting for demographics and comorbidities. Results: Regression models demonstrated decreased odds of patients with BMI ≥ 50 kg/m ² undergoing surgery over consecutive years, with increasingly higher BMI groups representing greater declines. Patients with BMI 30.0–39.9 kg/m ² demonstrated increased proportional operative volume. Conclusions: Despite increased growth in higher BMI populations, individuals in these categories undergo fewer surgical operations annually. These findings demonstrate a critical need to understand these inequalities, which are underscored by rising obesity prevalence that may be contributing to poor access to surgical care as well as increased morbidity/mortality of presentation with more advanced disease.

Introduction: As the field of metabolic surgery (MS), also known as bariatric surgery, continues to grow and change, especially in light of emerging anti‐obesity medications, the need to identify seminal studies within this domain becomes increasingly crucial. This study aims to provide a comprehensive 10‐year update on the most frequently cited articles in MS. Method: Utilizing the SCOPUS database, we identified the top 100 most cited articles in MS as of July 2023. Beyond assessing the most frequently cited works, this study also examines articles with the most citations per year and explores the citation trends. Results: The average number of citations per article increased from 383.5 in 2014 to 889.5. Forty‐four papers from the original top 50 list in 2014 were included in the current list. The year 2004 had the most number in the top 100 ( n = 10). While Roux‐en‐Y gastric bypass (RYGB) had the highest representation (48%), sleeve gastrectomy (SG) has rapidly risen in interest. Conclusions: As the landscape of MS expands, the reassessment of top‐cited scientific articles becomes imperative for obesity physicians and scientists, metabolic surgeons, fellows, and residents. Many of the articles listed in 2014 persisted in the 10‐year update, reflecting the significant growth observed in the MS field during the early 2000s. The increased citation count likely indicates the expanding influence of MS research. Despite RYGB maintaining its status as the most studied procedure, a noticeable uptick in interest in sleeve gastrectomy post‐2009 is evident as demonstrated by its increased representation within highly cited publications.