Bariatric Surgery Significantly Increases Survival in Patients with Obesity-Related Liver Disease

Bansal S, Bader A, Mahmud N, Kaplan DE. Survival and Cost-Effectiveness of Bariatric Surgery Among Patients with Obesity and Cirrhosis. JAMA Surg. 2025; in press.

Obesity can be accompanied by liver diseases such as metabolic dysfunction-associated steatotic liver disease (MASLD) and steatohepatitis (MASH); these conditions increase risk of mortality, hospitalization, healthcare utilization, and costs.

Most obese patients have MASLD and 30%–40% have MASH. This retrospective cohort study of obese patients cared for in the US Veterans Healthcare System sought to determine the effects of bariatric surgery on obesity-related liver disease and costs of care.

The study compared outcomes of patients treated with structured lifestyle modification (n = 31,055), sleeve gastrectomy (n = 4,301), or Roux-en-Y gastric bypass (n = 1,906).

Although a relatively small proportion of each group had documented cirrhosis, the data showed that sleeve gastrectomy and Roux-en-Y gastric bypass were associated with significant increases in survival; surgical treatment also met the defined requirements for cost effectiveness.