Assessment of Metabolic Improvement post- bariatric surgery across different follow-up periods: retrospective cohort study

Background Obesity is a significant public health challenge worldwide, including in Bahrain, where its prevalence continues to rise. It is a well-established risk factor for a spectrum of metabolic disorders, including type 2 diabetes mellitus (T2DM), hypertension and dyslipidemia. These conditions contribute to increased morbidity and mortality, as well as substantial healthcare burdens. Bariatric surgery is an effective intervention for managing obesity and its associated metabolic complications. This study evaluates the long-term metabolic outcomes of both restrictive and malabsorptive bariatric procedures in the Bahraini population, focusing on weight loss, metabolic improvement over an 8-year period. Methods A single-center retrospective cohort analysis was conducted on 1,291 patients who underwent bariatric surgery at King Hamad University Hospital between January 2016 and December 2023. Statistical analyses included paired t-tests, Chi-square tests, and logistic regression. Results Both restrictive and malabsorptive bariatric procedures resulted in significant weight loss (~ 26%) and excess weight loss (~ 63%). Diabetes remission occurred in 70.9%, with Sleeve gastrectomy (SG) achieving a higher remission rate (76.3%) than Gastric Bypass (63.6%), though the difference was not statistically significant. Predictors of remission included younger age, higher preoperative C-peptide, and absence of insulin therapy. Hypertension remission was observed in 69.4%, but declined to 48.8% after 5 years. Lipid profiles improved significantly, and MASLD regressed in 64.7% of patients. Conclusion Bariatric surgery, particularly SG, is an effective intervention for weight reduction and metabolic improvement in the Bahraini population. Despite comparable diabetes remission rates between SG and Gastric Bypass, SG’s procedural simplicity and lower complication risk may offer a favorable risk-benefit profile. Sustained metabolic benefits require long-term follow-up, adherence to lifestyle modifications, and individualized patient selection to optimize outcomes.