Effects of bariatric surgery in different obesity phenotypes: Tehran Obesity Treatment Study (TOTS)



Not all morbid obese patients suffer from metabolic co-morbidities; thus, a sub-group of metabolically healthy morbid obese (MHMO) individuals are identified. However, the role of bariatric surgery is not well understood in this subgroup.


A total of 2244 morbid obese individuals aged 18–65 years undergoing bariatric surgery were selected. Patients were considered MHMO according to the joint interim statement (JIS) definition, as having two or less abnormalities in these five parameters: waist circumference (WC), triglyceride (TG), high density lipoprotein cholesterol (HDL-C), systolic or diastolic blood pressure (SBP or DBP), and fasting plasma glucose (FPG). Otherwise, they were considered metabolically unhealthy morbid obese (MUMO). Follow-up data were collected at 6, 12, and 24 months post-surgery.


Prior to surgery, 36.2% of participants were MHMO and had significantly lower BMI, WC, TG, FPG, SBP, and DBP and higher HDL-C compared to MUMO. Both MHMO and MUMO participants showed a significant decrease in BMI, WC, TG, SBP, DBP, and FPG and increase in HDL-C and the percentage of excess weight loss (%EWL). Two-year post-operative changes (from baseline) of BMI, WC, and %EWL were greater in MHMO subjects and changes of TG, HDL-C, DBP, SBP, and FPG were greater in MUMO subjects. Further multivariate regression analysis for delta (∆) change in these characteristics revealed that only the delta (∆) changes of WC and %EWL were statistically different between the two phenotypes and were greater in MHMO subjects, 2 years after the surgery (− 3.077 cm decrease in WC and + 3.612% higher %EWL compared to MUMO subjects).


Bariatric surgery is an effective method for reduction of metabolic abnormalities and weight loss in both MUMO and MHMO phenotypes. Benefits of this intervention are comparable between patients with these two obesity phenotypes.

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The authors would like to thank the hospital staff, study assistants, and coordinators that took part in this research. The authors would also like to thank Dr. Forough Ghanbari for critically editing English grammar and syntax of the manuscript.

Funding information

This work was funded by the Research Institute for Endocrine Sciences, Shahid Beheshti University of Medical Sciences, Tehran, Iran.

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Correspondence to Farhad Hosseinpanah.

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The authors declare that they have no conflict of interest.

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Informed consent was obtained from all individual participants included in the study.

Human Rights/Ethical Approval

This study has been approved by the Human Research Review Committee of the Endocrine Research Center, Shahid Beheshti University of Medical Sciences, No. 2ECRIES 93/03/13.

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Barzin, M., Aryannezhad, S., Khalaj, A. et al. Effects of bariatric surgery in different obesity phenotypes: Tehran Obesity Treatment Study (TOTS). OBES SURG 30, 461–469 (2020) doi:10.1007/s11695-019-04182-y

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  • Bariatric surgery
  • Morbid obesity
  • Obesity phenotype