Application of the SF-BARI Score for Evaluating long-term Metabolic and Clinical Outcomes after Bariatric Surgery

Bariatric surgery is an effective treatment for severe obesity, resulting in significant weight loss and remission of obesity-related diseases. However, weight gain remains a challenge, potentially impacting long-term outcomes. The Swiss-Finnish BARIatric metabolic outcome score (SF-BARI) is a composite tool that integrates percentage total weight loss (%TWL), obesity associated disease remission, and operative complications rates to evaluate surgical optimal clinical response. This study assessed the associations between SF-BARI scores, obesity associated diseases remission, and weight gain 5 years after bariatric surgery. This retrospective cohort study included 81 patients who underwent Roux-en-Y gastric bypass (RYGB) at a Portuguese hospital, with complete 5-year follow-up data. Data on weight, body mass index (BMI), %TWL, weight gain (> 5% of nadir weight), and remission of type 2 diabetes mellitus (T2DM), hypertension, dyslipidemia, and obstructive sleep apnea (OSA) were collected at baseline and at 1 year and 5 years post-surgery. SF-BARI scores were calculated to assess outcomes. Statistical analyses included t tests, chi-square tests, and regression models to explore associations between SF-BARI scores, weight gain, and obesity associated diseases remission. At 1 year, the mean BMI decreased from 44.8 ± 5.1 kg/m² to 27.7 ± 3.8 kg/m² (p < 0.001), with a mean SF-BARI score of 103 ± 20.3 (good). At 5 years, the BMI increased to 30.6 ± 4.7 kg/m², 57.1% of patients experienced > 5% weight gain, and the SF-BARI score decreased to 93.8 ± 25.3 (good). Obesity associated diseases remission was significant, with 60.7% of hypertensive patients, 66.7% of diabetic patients, 50% of dyslipidemic patients, and 66.7% of OSA patients having improved disease control. No significant association was found between weight gain and obesity associated diseases control (p > 0.05). Greater % excess weight loss was the strongest predictor of higher SF-BARI scores (r²=0.596, p < 0.001), whereas weight gain and higher BMI were associated with lower scores (p < 0.001). Bariatric surgery yields durable improvements in weight and obesity associated diseases control at 5 years, despite frequent weight gain. The SF-BARI score effectively captures multidimensional outcomes, and the lack of association between weight gain and obesity associated diseases remission suggests weight-independent mechanisms. However, further studies are needed to validate the prognostic value of the SF-BARI in larger cohorts.