Exploring the impact of metabolic and bariatric surgery on the risk of idiopathic intracranial hypertension risk in obesity: insights from a nationwide French study.

Authors

Julie Bulsei, Eric Fontas, Sergio Carandina, Antonio Iannelli

Published in

Surgery for obesity and related diseases : official journal of the American Society for Bariatric Surgery. Jun 20, 2026. Epub Jun 20, 2026.

Abstract

Idiopathic intracranial hypertension (IIH) predominantly affects individuals with obesity, and weight loss represents the only disease-modifying therapy. While bariatric surgery (BS) effectively treats established IIH, its preventive effect on IIH development in the general population with obesity remains unexplored. This study assessed whether BS is associated with a lower risk of developing IIH in individuals with obesity.
This nationwide retrospective cohort study utilized data from the French national healthcare database (Système National des Données de Santé [SNDS]) covering 99% of the population. We included adults aged ≥18 years with obesity (body mass index [BMI] ≥30 kg/m²) diagnosed between January 2016 and December 2021, with follow-up through December 2024. The metabolic and bariatric surgery group included patients who underwent Roux-en-Y gastric bypass (RYGB) or sleeve gastrectomy (SG). The primary outcome was incident IIH. Propensity score matching (1:1) was performed using age, sex, obesity degree, and socioeconomic status. Fine and Gray subdistribution hazard models accounting for competing risk of death were used to assess the association between metabolic and bariatric surgery and IIH risk.
After propensity score matching, 187,791 individuals in each group were analyzed. During a median follow-up of 5.2 years, the incidence of IIH was significantly lower in the BS group (126 cases, .13 per 1000 person-years) compared to controls (375 cases, .38 per 1000 person-years). BS was associated with a 66% reduction in IIH risk (subdistribution hazard ratio .339, 95% CI .280-.411, P < .0001). The protective effect was consistent across subgroups: age ≤50 years (SHR .305, P < .0001), age >50 years (SHR .550, P = .0077), females (SHR .309, P < .0001), males (SHR .579, P = .0246), BMI 30-40 (SHR .423, P < .0001), and BMI >40 (SHR .316, P < .0001). Both RYGB and SG demonstrated comparable protective effects (SHR .306, P < .0001 and SHR .346, P < .0001, respectively).
BS was associated with a significantly lower the risk of developing IIH in individuals with obesity, with a consistent protective effect across age, sex, and obesity severity subgroups. Both RYGB and SG provided substantial risk reduction with no significant difference between procedures. These findings expand the recognized benefits of BS to include important neurological protection and should inform clinical counseling for patients with severe obesity.

PMID:
42624710
Bibliographic data and abstract were imported from PubMed on 21 Aug 2026.

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