Michael Kachmar

1 Introduction The field of bariatric surgery, now regarded as metabolic surgery (MS), began in the early 1950s and is currently at the forefront of medical research as the prevalence of obesity and its host of comorbidities continues to rise. Highly impactful clinical and basic science studies since the 1950s form the basis of our understanding of the role of MS in treating chronic obesity and related disease.

What is already known? ○ Obesity increases the risk of diabetes, hypertension, and heart disease, but most studies group all obesity together or stop at Class III (BMI ≥ 40 kg/m2), failing to capture the unique risks faced by those with more severe obesity. What does this study add? ○ A clear, stepwise increase in cardiometabolic and kidney disease risk is associated with higher BMI, starting as early as Class I.

Abstract Optimizing patients with a body mass index (BMI) ≥ 70 kg/m² for metabolic surgery (MS) is challenging. However, pre-operative weight loss may be important for improving the safety of MS for these high-risk patients. Multi-modal anti-obesity medications (mmAOM) may enhance preoperative weight loss compared to non-pharmacologic medically supervised weight loss (NP-MSWL) or glucagon-like peptide-1 receptor agonist monotherapy (Mono-GLP-1) alone.