Bariatric-metabolic interventions are intended to be durable yet we have very little quality data on most long-term outcomes. Meanwhile, the surgical procedure development cycle is short, and largely unregulated, in contrast with that of pharmacotherapy. In addition, there is surgical optimism that tends to focus on the benefits of surgery and short-term procedural associated risks, but many of the potential long-term effects of surgery lie outside the surgical domain and present clinically elsewhere. The risks of long-term unexpected detrimental effects on health outcomes are high and largely unexplored.
Emerging examples include nutritional, anatomical, and neuro-hormonal changes that are generated by surgical interventions and increase the risk of long-term complications. The focus for all patients should be healthy aging, but there are clear signals of neurological, bone, body composition, gastrointestinal, and mental health risks.
As bariatric-metabolic surgery evolves as a recommended therapy for many clinically severely obese patients we need to better understand the powerful mechanisms of action of surgery and reduce the off-target effects. In addition we need to provide appropriate clinical pathways that can identify and reduce the risk of adverse longer term events.