Battle of the super obese sexes: female versus male variation in pre-operative clinical characteristics among 1,673 surgical patients undergoing bilio-pancreatic bypass/duodenal switch (BPD/DS)

Morbid obesity has risen steadily over the last three decades with Body Mass Index (BMI) increasing at 0.4 kg/m2 per decade worldwide.1 Obese patients have become integral to every surgical practice, not just bariatric surgeons. Every clinical insight helps manage these medically fragile individuals. In this context, understanding differences between sexes in clinical characteristics and in weight-related medical problems between women and men with the most extreme levels of obesity would be important to surgeons. Some medical problems vary between normal weight males and females. Cardiomyopathies occur more commonly in men and more women are affected by asthma and autoimmune disorders.2 In chronic obstructive pulmonary disease (COPD), females suffer more metabolic disorders, gastrointestinal diseases, gallstones and osteoporosis, and males higher cardiopulmonary co-morbidities such as pneumonia, pleural effusions and respiratory failure.3 Whether or not these sex differences in co-morbid conditions translate to super-obese patients is unknown. Previously we have reported clinical variation by sex in patients who were pre-operative for laparoscopic Roux-en-Y gastric bypass.4 Nevertheless, whether or not these variations by sex affect also the most severely obese, high-risk surgical patients is unknown. Therefore, the objective of this study was to identify variation in weight, demographics, and the distribution of pre-operative clinical characteristics between super obese females versus males who chose to undego BPD/DS.