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Bariatric Surgery Indication — RACP Adult Medicine MCQ

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ModerateEndocrinologyBariatric Surgery IndicationRACP Adult Medicine

A 50-year-old woman with BMI 42, type 2 diabetes (HbA1c 69 mmol/mol on metformin + empagliflozin), hypertension, and OSA has failed multiple weight loss attempts with lifestyle modification and pharmacotherapy over 5 years. What is the most effective long-term weight loss intervention?

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Correct answer: E — Bariatric surgery (sleeve gastrectomy or Roux-en-Y)

For patients with BMI ≥40 (or ≥35 with comorbidities) who have failed non-surgical weight loss, bariatric surgery is the most effective intervention for sustained weight loss AND improvement/remission of comorbidities (T2DM remission rates 60-80% with RYGB). RYGB and sleeve gastrectomy both produce durable weight loss (25-35% TBWL at 5 years). Metabolic surgery reduces cardiovascular mortality. GLP-1 RAs (semaglutide 2.4 mg) are effective but produce less weight loss than surgery (~15% vs 25-35%).

Reference: IFSO – 2024; ANZMOSS 2024; STAMPEDE Trial