{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,9,22]],"date-time":"2026-09-22T00:25:56Z","timestamp":1790036756284,"version":"4.0.1"},"reference-count":43,"publisher":"American Medical Association (AMA)","issue":"9","content-domain":{"domain":[],"crossmark-restriction":false},"short-container-title":["JAMA Netw Open"],"abstract":"Importance<\/jats:title>As obesity rates rise in the US, managing associated metabolic comorbidities presents a growing burden to the health care system. While bariatric surgery has shown promise in mitigating established metabolic conditions, no large studies have quantified the risk of developing major obesity-related comorbidities after bariatric surgery.<\/jats:p><\/jats:sec>Objective<\/jats:title>To identify common metabolic phenotypes for patients eligible for bariatric surgery and to estimate crude and adjusted incidence rates of additional metabolic comorbidities associated with bariatric surgery compared with weight management program (WMP) alone.<\/jats:p><\/jats:sec>Design, Setting, and Participants<\/jats:title>This retrospective, multicenter cohort study used data from the Veterans Health Administration (VHA) Corporate Data Warehouse, which incorporates data from 128 VHA centers. Participants were adults 18 years or older with a body mass index (BMI; calculated as weight in kilograms divided by height in meters squared) of 30 or higher and at least 1 of 5 metabolic comorbidities or with a BMI of 35 or higher who underwent bariatric surgery (Roux-en-Y gastric bypass or sleeve gastrectomy) or enrolled in the WMP (called MOVE!) between January 1, 2008, and December 31, 2023. Patients with all 5 comorbidities at baseline or missing key data were excluded.<\/jats:p><\/jats:sec>Exposure<\/jats:title>Bariatric surgery vs WMP.<\/jats:p><\/jats:sec>Main Outcome and Measures<\/jats:title>Incident diagnosis of any of 5 metabolic comorbidities: type 2 diabetes (T2D), hypertension, hyperlipidemia, obstructive sleep apnea (OSA), and metabolic dysfunction\u2013associated steatotic liver disease (MASLD).<\/jats:p><\/jats:sec>Results<\/jats:title>Among 269\u202f470 veterans, 263\u202f657 were enrolled in the WMP and 5813 underwent bariatric surgery. Patients included 232\u202f196 males (87.1%) and had a median (IQR) age of 57 (47-64) years. Median (IQR) follow-up time was 112.9 (79.5-145.4) months. At 5 years, incidence rates per 1000 person-years were 8.89 for hypertension, 9.67 for hyperlipidemia, 4.29 for T2D, 3.99 for OSA, and 2.44 for MASLD in the WMP group. For the bariatric surgery group, incidence rates per 1000 person-years were 3.35 for hypertension, 4.85 for hyperlipidemia, 1.06 for T2D, 3.43 for OSA, and 2.01 for MASLD. Bariatric surgery was associated with a statistically significant lower risk of incident T2D (79.2% lower; hazard ratio [HR], 0.21 [95% CI, 0.18-0.26]), hypertension (58.8% lower; HR, 0.41 [95% CI, 0.33-0.51]), hyperlipidemia (50.5% lower; HR, 0.49 [95% CI, 0.42-0.58]), OSA (56.9% lower; HR, 0.43 [95% CI, 0.35-0.52]), and MASLD (40.4% lower; HR, 0.60 [95% CI, 0.49-0.73]) compared with the WMP. Results were consistent in a subgroup analysis of only female veterans.<\/jats:p><\/jats:sec>Conclusions and Relevance<\/jats:title>In this cohort study, bariatric surgery was associated with a significantly lower risk of developing major metabolic comorbidities compared with the medical WMP. This finding supports the relevance of bariatric surgery as a durable approach for obesity-related risk mitigation.<\/jats:p><\/jats:sec>","DOI":"10.1001\/jamanetworkopen.2025.30787","type":"journal-article","created":{"date-parts":[[2025,9,9]],"date-time":"2025-09-09T15:00:23Z","timestamp":1757430023000},"page":"e2530787","source":"Crossref","is-referenced-by-count":7,"title":["Bariatric Surgery and Incident Development of Obesity-Related Comorbidities"],"prefix":"10.1001","volume":"8","author":[{"given":"Amanda L.","family":"Bader","sequence":"first","affiliation":[{"name":"Department of Surgery, University of Pennsylvania Health System, Philadelphia"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Jesse Y.","family":"Hsu","sequence":"additional","affiliation":[{"name":"Department of Biostatistics, Epidemiology and Informatics, University of Pennsylvania, Philadelphia"},{"name":"Perelman School of Medicine, University of Pennsylvania, Philadelphia"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Maria S.","family":"Altieri","sequence":"additional","affiliation":[{"name":"Department of Surgery, University of Pennsylvania Health System, Philadelphia"},{"name":"Perelman School of Medicine, University of Pennsylvania, Philadelphia"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Charles M.","family":"Vollmer","sequence":"additional","affiliation":[{"name":"Department of Surgery, University of Pennsylvania Health System, Philadelphia"},{"name":"Perelman School of Medicine, University of Pennsylvania, Philadelphia"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"James D.","family":"Lewis","sequence":"additional","affiliation":[{"name":"Perelman School of Medicine, University of Pennsylvania, Philadelphia"},{"name":"Division of Gastroenterology, University of Pennsylvania Health System, Philadelphia"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"David E.","family":"Kaplan","sequence":"additional","affiliation":[{"name":"Perelman School of Medicine, University of Pennsylvania, Philadelphia"},{"name":"Division of Gastroenterology, University of Pennsylvania Health System, Philadelphia"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Nadim","family":"Mahmud","sequence":"additional","affiliation":[{"name":"Perelman School of Medicine, University of Pennsylvania, Philadelphia"},{"name":"Division of Gastroenterology, University of Pennsylvania Health System, Philadelphia"}],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"10","published-online":{"date-parts":[[2025,9,9]]},"reference":[{"issue":"10","key":"zoi250866r1","doi-asserted-by":"publisher","first-page":"1895","DOI":"10.2105\/AJPH.2013.301379","article-title":"The impact of obesity on US mortality levels: the importance of age and cohort factors in population estimates.","volume":"103","author":"Masters","year":"2013","journal-title":"Am J Public Health"},{"issue":"4","key":"zoi250866r2","doi-asserted-by":"publisher","first-page":"1290","DOI":"10.1053\/j.gastro.2020.06.006","article-title":"Bariatric surgery provides long-term resolution of nonalcoholic steatohepatitis and regression of fibrosis.","volume":"159","author":"Lassailly","year":"2020","journal-title":"Gastroenterology"},{"key":"zoi250866r3","doi-asserted-by":"publisher","first-page":"88","DOI":"10.1186\/1471-2458-9-88","article-title":"The incidence of co-morbidities related to obesity and overweight: a systematic review and meta-analysis.","volume":"9","author":"Guh","year":"2009","journal-title":"BMC Public Health"},{"issue":"1","key":"zoi250866r5","doi-asserted-by":"publisher","first-page":"3","DOI":"10.1007\/s11695-022-06332-1","article-title":"2022 American Society of Metabolic and Bariatric Surgery (ASMBS) and International Federation for the Surgery of Obesity and Metabolic Disorders (IFSO) indications for metabolic and bariatric surgery.","volume":"33","author":"Eisenberg","year":"2023","journal-title":"Obes Surg"},{"issue":"20","key":"zoi250866r6","doi-asserted-by":"publisher","first-page":"2031","DOI":"10.1001\/jama.2021.19569","article-title":"Association of bariatric surgery with major adverse liver and cardiovascular outcomes in patients with biopsy-proven nonalcoholic steatohepatitis.","volume":"326","author":"Aminian","year":"2021","journal-title":"JAMA"},{"issue":"6","key":"zoi250866r7","doi-asserted-by":"publisher","first-page":"1163","DOI":"10.1016\/j.soard.2016.05.007","article-title":"A nationwide safety analysis of bariatric surgery in nonseverely obese patients with type 2 diabetes.","volume":"12","author":"Aminian","year":"2016","journal-title":"Surg Obes Relat Dis"},{"issue":"4","key":"zoi250866r8","doi-asserted-by":"publisher","first-page":"457","DOI":"10.1016\/j.soard.2019.12.022","article-title":"American Society for Metabolic and Bariatric Surgery 2018 estimate of metabolic and bariatric procedures performed in the United States.","volume":"16","author":"English","year":"2020","journal-title":"Surg Obes Relat Dis"},{"issue":"10","key":"zoi250866r9","doi-asserted-by":"publisher","first-page":"999","DOI":"10.1001\/jamasurg.2015.1250","article-title":"Patient and referring practitioner characteristics associated with the likelihood of undergoing bariatric surgery: a systematic review.","volume":"150","author":"Funk","year":"2015","journal-title":"JAMA Surg"},{"issue":"1","key":"zoi250866r10","doi-asserted-by":"publisher","first-page":"8","DOI":"10.1016\/j.soard.2009.07.003","article-title":"Socioeconomic disparities in eligibility and access to bariatric surgery: a national population-based analysis.","volume":"6","author":"Martin","year":"2010","journal-title":"Surg Obes Relat Dis"},{"issue":"2","key":"zoi250866r12","doi-asserted-by":"publisher","first-page":"162","DOI":"10.1001\/jamasurg.2022.6410","article-title":"Association between bariatric surgery and alcohol use-related hospitalization and all-cause mortality in a Veterans Affairs cohort.","volume":"158","author":"Mahmud","year":"2023","journal-title":"JAMA Surg"},{"key":"zoi250866r13","doi-asserted-by":"publisher","DOI":"10.14309\/ajg.0000000000002785","article-title":"The impact of weight loss programs on BMI trajectory in patients with metabolic dysfunction-associated steatotic liver disease: a Veterans Health Administration Study.","author":"Tang","year":"2024","journal-title":"Am J Gastroenterol"},{"issue":"12","key":"zoi250866r14","doi-asserted-by":"publisher","first-page":"1345","DOI":"10.1016\/j.soard.2022.08.013","article-title":"2022 American Society for Metabolic and Bariatric Surgery (ASMBS) and International Federation for the Surgery of Obesity and Metabolic Disorders (IFSO): indications for metabolic and bariatric surgery.","volume":"18","author":"Eisenberg","year":"2022","journal-title":"Surg Obes Relat Dis"},{"issue":"8","key":"zoi250866r15","doi-asserted-by":"publisher","first-page":"737","DOI":"10.1176\/appi.ps.201200314","article-title":"\u201cMOVE!\u201d Outcomes of a weight loss program modified for veterans with serious mental illness.","volume":"64","author":"Goldberg","year":"2013","journal-title":"Psychiatr Serv"},{"issue":"6","key":"zoi250866r17","doi-asserted-by":"publisher","first-page":"645","DOI":"10.1001\/jamasurg.2025.0490","article-title":"Survival and cost-effectiveness of bariatric surgery among patients with obesity and cirrhosis.","volume":"160","author":"Bansal","year":"2025","journal-title":"JAMA Surg"},{"issue":"1","key":"zoi250866r18","doi-asserted-by":"publisher","first-page":"220","DOI":"10.1016\/j.jamcollsurg.2015.02.018","article-title":"Predictors of hospital readmission after bariatric surgery.","volume":"221","author":"Abraham","year":"2015","journal-title":"J Am Coll Surg"},{"issue":"16","key":"zoi250866r19","doi-asserted-by":"publisher","first-page":"1789","DOI":"10.1001\/archinte.158.16.1789","article-title":"The AUDIT Alcohol Consumption Questions (AUDIT-C): an effective brief screening test for problem drinking. Ambulatory Care Quality Improvement Project (ACQUIP). Alcohol use disorders identification test.","volume":"158","author":"Bush","year":"1998","journal-title":"Arch Intern Med"},{"issue":"6","key":"zoi250866r20","doi-asserted-by":"publisher","first-page":"995","DOI":"10.1097\/HJH.0000000000003424","article-title":"The prevalence and treatment of hypertension in Veterans Health Administration, assessing the impact of the updated clinical guidelines.","volume":"41","author":"Yamada","year":"2023","journal-title":"J Hypertens"},{"issue":"3","key":"zoi250866r21","doi-asserted-by":"publisher","first-page":"170","DOI":"10.1111\/j.1751-7176.2010.00408.x","article-title":"25-hydroxyvitamin D levels and hypertension rates.","volume":"13","author":"Bhandari","year":"2011","journal-title":"J Clin Hypertens (Greenwich)"},{"issue":"5","key":"zoi250866r22","doi-asserted-by":"publisher","first-page":"201","DOI":"10.1177\/106286060401900504","article-title":"Identifying hypertension-related comorbidities from administrative data: what\u2019s the optimal approach?","volume":"19","author":"Borzecki","year":"2004","journal-title":"Am J Med Qual"},{"key":"zoi250866r23","doi-asserted-by":"publisher","first-page":"B10","DOI":"10.2337\/diacare.27.suppl_2.B10","article-title":"Who has diabetes? Best estimates of diabetes prevalence in the Department of Veterans Affairs based on computerized patient data.","volume":"27","author":"Miller","year":"2004","journal-title":"Diabetes Care"},{"issue":"2","key":"zoi250866r24","doi-asserted-by":"publisher","first-page":"175","DOI":"10.5664\/jcsm.8160","article-title":"Multisite validation of a simple electronic health record algorithm for identifying diagnosed obstructive sleep apnea.","volume":"16","author":"Keenan","year":"2020","journal-title":"J Clin Sleep Med"},{"issue":"8","key":"zoi250866r25","doi-asserted-by":"publisher","DOI":"10.1371\/journal.pone.0237430","article-title":"Validating a non-invasive, ALT-based non-alcoholic fatty liver phenotype in the million veteran program.","volume":"15","author":"Serper","year":"2020","journal-title":"PLoS One"},{"issue":"25","key":"zoi250866r26","doi-asserted-by":"publisher","first-page":"3083","DOI":"10.1002\/sim.3697","article-title":"Balance diagnostics for comparing the distribution of baseline covariates between treatment groups in propensity-score matched samples.","volume":"28","author":"Austin","year":"2009","journal-title":"Stat Med"},{"issue":"1","key":"zoi250866r27","doi-asserted-by":"publisher","first-page":"22","DOI":"10.1177\/1536867X0200200102","article-title":"Parametric frailty and shared frailty survival models.","volume":"2","author":"Gutierrez","year":"2002","journal-title":"Stata J"},{"issue":"3","key":"zoi250866r28","doi-asserted-by":"publisher","first-page":"266","DOI":"10.1001\/jama.2017.20813","article-title":"Lifestyle intervention and medical management with vs without Roux-en-Y gastric bypass and control of hemoglobin A1c, LDL cholesterol, and systolic blood pressure at 5 years in the Diabetes Surgery Study.","volume":"319","author":"Ikramuddin","year":"2018","journal-title":"JAMA"},{"issue":"9997","key":"zoi250866r29","doi-asserted-by":"publisher","first-page":"964","DOI":"10.1016\/S0140-6736(15)00075-6","article-title":"Bariatric-metabolic surgery versus conventional medical treatment in obese patients with type 2 diabetes: 5 year follow-up of an open-label, single-centre, randomised controlled trial.","volume":"386","author":"Mingrone","year":"2015","journal-title":"Lancet"},{"issue":"7","key":"zoi250866r30","doi-asserted-by":"publisher","first-page":"641","DOI":"10.1056\/NEJMoa1600869","article-title":"Bariatric surgery versus intensive medical therapy for diabetes: 5-year outcomes.","volume":"376","author":"Schauer","year":"2017","journal-title":"N Engl J Med"},{"issue":"13","key":"zoi250866r31","doi-asserted-by":"publisher","first-page":"1271","DOI":"10.1001\/jama.2019.14231","article-title":"Association of metabolic surgery with major adverse cardiovascular outcomes in patients with type 2 diabetes and obesity.","volume":"322","author":"Aminian","year":"2019","journal-title":"JAMA"},{"issue":"15","key":"zoi250866r32","doi-asserted-by":"publisher","first-page":"1429","DOI":"10.1016\/j.jacc.2022.01.047","article-title":"Long-term cardiovascular outcomes after bariatric surgery in the Medicare population.","volume":"79","author":"Mentias","year":"2022","journal-title":"J Am Coll Cardiol"},{"issue":"8","key":"zoi250866r33","doi-asserted-by":"publisher","first-page":"654","DOI":"10.1001\/jama.2024.0318","article-title":"Long-term outcomes of medical management vs bariatric surgery in type 2 diabetes.","volume":"331","author":"Courcoulas","year":"2024","journal-title":"JAMA"},{"issue":"2","key":"zoi250866r34","doi-asserted-by":"publisher","DOI":"10.1097\/AS9.0000000000000158","article-title":"Remission and relapse of hypertension after bariatric surgery: a retrospective study on long-term outcomes.","volume":"3","author":"Fisher","year":"2022","journal-title":"Ann Surg Open"},{"issue":"4","key":"zoi250866r35","doi-asserted-by":"publisher","first-page":"522","DOI":"10.1007\/s11695-013-1121-x","article-title":"Early impact of bariatric surgery on type II diabetes, hypertension, and hyperlipidemia: a systematic review, meta-analysis and meta-regression on 6,587 patients.","volume":"24","author":"Ricci","year":"2014","journal-title":"Obes Surg"},{"issue":"7","key":"zoi250866r36","doi-asserted-by":"publisher","DOI":"10.1136\/bmjopen-2022-070431","article-title":"Effect of bariatric surgery on NAFLD\/NASH: a single-centre observational prospective cohort study.","volume":"13","author":"Theel","year":"2023","journal-title":"BMJ Open"},{"issue":"15","key":"zoi250866r37","doi-asserted-by":"publisher","first-page":"9078","DOI":"10.3390\/ijerph19159078","article-title":"Quality of life after bariatric surgery-a systematic review.","volume":"19","author":"Sierzantowicz","year":"2022","journal-title":"Int J Environ Res Public Health"},{"issue":"5","key":"zoi250866r38","doi-asserted-by":"publisher","first-page":"477","DOI":"10.1002\/j.1550-8528.1999.tb00436.x","article-title":"Reduction in incidence of diabetes, hypertension and lipid disturbances after intentional weight loss induced by bariatric surgery: the SOS Intervention Study.","volume":"7","author":"Sj\u00f6str\u00f6m","year":"1999","journal-title":"Obes Res"},{"issue":"26","key":"zoi250866r39","doi-asserted-by":"publisher","first-page":"2683","DOI":"10.1056\/NEJMoa035622","article-title":"Lifestyle, diabetes, and cardiovascular risk factors 10 years after bariatric surgery.","volume":"351","author":"Sj\u00f6str\u00f6m","year":"2004","journal-title":"N Engl J Med"},{"issue":"1","key":"zoi250866r40","doi-asserted-by":"publisher","first-page":"15","DOI":"10.1016\/j.orcp.2023.12.001","article-title":"Incidence of type 2 diabetes after gastric by-pass surgery in a Swedish controlled cohort study.","volume":"18","author":"Jamaly","year":"2024","journal-title":"Obes Res Clin Pract"},{"issue":"2","key":"zoi250866r41","doi-asserted-by":"publisher","DOI":"10.7759\/cureus.34723","article-title":"The effects of bariatric surgery on cardiovascular outcomes and cardiovascular mortality: a systematic review and meta-analysis.","volume":"15","author":"Chandrakumar","year":"2023","journal-title":"Cureus"},{"issue":"12","key":"zoi250866r42","doi-asserted-by":"publisher","first-page":"4449","DOI":"10.1007\/s00464-013-3127-9","article-title":"Effect of bariatric surgery on oncologic outcomes: a systematic review and meta-analysis.","volume":"27","author":"Tee","year":"2013","journal-title":"Surg Endosc"},{"issue":"24","key":"zoi250866r43","doi-asserted-by":"publisher","first-page":"2423","DOI":"10.1001\/jama.2022.9009","article-title":"Association of bariatric surgery with cancer risk and mortality in adults with obesity.","volume":"327","author":"Aminian","year":"2022","journal-title":"JAMA"},{"key":"zoi250866r4","unstructured":"Stierman? B, Afful? J, Carroll? MD, . National Health and Nutrition Examination Survey 2017\u2013March 2020 prepandemic data files\u2013development of files and prevalence estimates for selected health outcomes. National Health Statistics Reports. June 14, 2021. Accessed December 2, 2023. https:\/\/stacks.cdc.gov\/view\/cdc\/106273"},{"key":"zoi250866r11","unstructured":"FDA approves new drug treatment for chronic weight management, first since 2014. US Food and Drug Administration. Accessed July 30, 2025. https:\/\/content.govdelivery.com\/accounts\/USFDA\/bulletins\/2e2adc7"},{"key":"zoi250866r16","unstructured":"List of CPT\/HCPCS codes. Centers for Medicare & Medicaid Services. Accessed June 21, 2024. https:\/\/www.cms.gov\/medicare\/regulations-guidance\/physician-self-referral\/list-cpt-hcpcs-codes"}],"container-title":["JAMA Network Open"],"original-title":[],"language":"en","link":[{"URL":"https:\/\/jamanetwork.com\/journals\/jamanetworkopen\/articlepdf\/2838651\/bader_2025_oi_250866_1756840248.299.pdf","content-type":"unspecified","content-version":"vor","intended-application":"similarity-checking"}],"deposited":{"date-parts":[[2025,9,9]],"date-time":"2025-09-09T15:00:27Z","timestamp":1757430027000},"score":1,"resource":{"primary":{"URL":"https:\/\/jamanetwork.com\/journals\/jamanetworkopen\/fullarticle\/2838651"}},"subtitle":[],"short-title":[],"issued":{"date-parts":[[2025,9,9]]},"references-count":43,"journal-issue":{"issue":"9","published-print":{"date-parts":[[2025,9,2]]}},"URL":"https:\/\/doi.org\/10.1001\/jamanetworkopen.2025.30787","relation":{},"ISSN":["2574-3805"],"issn-type":[{"value":"2574-3805","type":"electronic"}],"subject":[],"published":{"date-parts":[[2025,9,9]]}}}