Impact of laparoscopic sleeve gastrectomy on obesity-related comorbidities in patients over 65 years: a prospective comparative study

Obesity in adults over 65 years is increasingly prevalent and linked to comorbidities like type 2 diabetes (T2D), hypertension (HTN), osteoarthritis (OA), and obstructive sleep apnea (OSA), where conservative treatments often fail. Laparoscopic sleeve gastrectomy (LSG) effectively treats severe obesity, but prospective comparisons with non-surgical management in this age group are limited. This prospective, non-randomized, patient-preference cohort study enrolled 60 patients aged ≥ 65 years with BMI ≥ 40 kg/m² and ≥ 1 comorbidity (T2D, HTN, OA, or OSA). Group A (n = 30) underwent LSG; Group B (n = 30) received conservative management (diet counseling, pharmacotherapy), with 12‑month follow‑up. The prespecified primary endpoint was reduction or discontinuation of pharmacologic treatment for at least one baseline weight‑related comorbidity; secondary endpoints included weight loss, comorbidity‑specific outcomes, and postoperative complications.​. Baseline characteristics were balanced between groups. At 12 months, medication reduction or discontinuation for at least one obesity-related comorbidity occurred in 100% of patients after LSG versus 10% with conservative management (adjusted absolute risk difference 0.91, 95% CI 0.79–1.00, p < 0.001). LSG achieved 30.7% total body weight loss and 63.1% excess weight loss compared with 2.9% and 6.2%, respectively, in the conservative group (both p < 0.001). Multivariable-adjusted analyses showed that LSG was associated with greater reductions in weight (− 37.9 kg, 95% CI − 40.5 to − 35.2, p < 0.001), BMI (− 13.6 kg/m², 95% CI − 14.6 to − 12.6, p < 0.001), HbA1c (− 1.36%, 95% CI − 1.74 to − 0.96, p < 0.001), systolic blood pressure (− 4.5 mmHg, 95% CI − 8.0 to − 1.0, p = 0.02), and AHI (− 14.8 events/hour, 95% CI − 17.1 to − 12.4, p < 0.001), and with increased right knee joint space width (+ 0.33 mm, 95% CI 0.17–0.49, p < 0.001) at 12 months. In carefully selected patients over 65 years, LSG was associated with greater medication reduction, comorbidity improvement, and weight loss compared with conservative management, with an acceptable safety profile and no mortality. LSG may be actively considered for elderly patients with severe obesity and multiple weight-related comorbidities.​