Authors
Gonzalo Rivero, Amaia Rodríguez, Victoria Catalán, Beatriz Ramírez, Federico Carbone, Fabrizio Montecucco, Javier Gómez-Ambrosi, Gema Frühbeck, Sara Becerril
Published in
Current obesity reports. Volume 15. Issue 1. Jul 22, 2026. Epub Jul 22, 2026.
Abstract
Obesity is a multifactorial, chronic, and relapsing non-communicable disease characterized by excessive adipose tissue accumulation and metabolic dysfunction. Increasing evidence indicates that biological sex influences not only the development and distribution of adipose tissue but also responses to obesity treatments, including metabolic-bariatric surgery. This narrative review synthesizes current evidence on sex-related differences in metabolic outcomes after bariatric surgery.
Bariatric surgery induces substantial weight loss and marked improvement of obesity-related complications in both men and women along sex-specific differences in body composition changes, adipose tissue remodeling, adipokine secretion, inflammatory responses, and thermogenic adaptations. Estrogen signaling contributes to a more favorable adipose tissue phenotype through anti-inflammatory effects, enhanced adipokine profiles, preservation of lean mass, and stimulation of white adipose tissue beiging, a process by which an inducible form of thermogenic adipocytes within white adipose tissue (beige adipocytes) acquire thermogenic characteristics similar to brown adipose tissue. In women, menopausal status represents a key biological modifier of these responses. In contrast, androgen excess is associated with visceral fat accumulation and insulin resistance. Despite largely comparable rates of remission of major obesity-related complications between sexes, variances in adiposity, hormonal milieu, and postoperative metabolic outcomes suggest different underlying mechanisms. Although remission rates of obesity-related complications appear broadly comparable between sexes, the underlying metabolic and endocrine adaptations differ. Biological sex represents a determinant of post-bariatric metabolic remodeling. This review highlights the relevance of biological sex in obesity and its treatment, emphasizing the need for sex-stratified studies to elucidate underlying mechanisms and support the development of more precise, personalized strategies in obesity management.
PMID:
42484735
Bibliographic data and abstract were imported from PubMed on 22 Jul 2026.
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