Obesity compresses healthspan, accelerating cardiometabolic disease, mobility loss, and cognitive and psychosocial decline. These effects intensify with age. Bariatric and metabolic surgery can reverse many risks by delivering durable weight loss, better glycemic control, and fewer cardiovascular events. However, translating weight loss into real gains in independence and resilience depends on who the patient is, how they are prepared, which procedure is chosen, how pharmacotherapy is integrated preoperatively, perioperatively, and long term, and how lifelong care is delivered. Preoperative optimization and sustained nutritional and functional stewardship are essential to convert short-term success into healthy longevity.

Aging physiology shapes every step of the bariatric journey. Frailty, sarcopenic obesity, bone health, micronutrient stores, sleep and circadian rhythms, and polypharmacy influence safety and recovery. Postoperatively, shifts in bile acids, incretins, the microbiome, and absorption alter metabolic set points while raising risks for deficiencies and musculoskeletal decline. The rapid rise of anti-obesity pharmacotherapy, such as GLP-1 and GLP-1/GIP receptor agonists, introduces new opportunities for sequencing and combination strategies with surgery. These medications may modify indications, optimize prehabilitation and perioperative risk, support postoperative weight maintenance, and inform relapse prevention. They also strengthen the need to compare surgery alone with medication alone and with combined or sequenced approaches. At the same time, they raise new questions about adherence and long-term outcomes. To extend healthspan, we need integrated evidence that links preoperative readiness, procedure choice, pharmacotherapy–surgery integration, and enduring nutritional care with function, cognition, quality of life, and biological aging.

Scope and Key Themes

Target audience and study types. This Research Topic is intended for clinicians and researchers in bariatric and metabolic surgery, endocrinology and obesity medicine, geriatrics and geroscience, nutrition, rehabilitation, primary care, and behavioral health, as well as methodologists and implementation scientists. We welcome randomized and pragmatic clinical trials, prospective and retrospective cohorts and registry-based studies, mechanistic translational and preclinical studies, implementation and equity research and cost-effectiveness analyses, and systematic reviews and meta-analyses.

Preoperative stratification and optimization. We invite work on frailty and body composition phenotyping, diet quality and protein targets, activity and sleep prehabilitation, and psychosocial readiness.

Surgical strategies across the lifespan. We welcome studies on perioperative safety in older and multimorbid patients, enhanced recovery pathways, and the durability of metabolic benefits.

Lifelong nutritional care. We seek evidence on preventing sarcopenia and bone loss, monitoring and correcting micronutrient deficiencies such as iron, vitamin B12, folate, vitamin D, and thiamine, and tailoring supplementation.

Outcomes that matter. We encourage integration of functional measures with metabolic endpoints, including the use of wearables and remote monitoring to assess activity, sleep, adherence, and patient-reported quality of life and mental health.

Mechanisms and geroscience. We invite research on adipokines and myokines, bile acids and incretins, microbiome remodeling, and biological aging metrics such as epigenetic clocks, proteomics, and metabolomics.

Safety, equity, and implementation. We seek studies on complications and revisions, diabetes relapse, trajectories of NAFLD and NASH and chronic kidney disease, interactions with pharmacotherapy, disparities in access and outcomes, and real-world surveillance.

Impact. By aligning preoperative optimization, procedure selection, pharmacotherapy integration, and lifelong nutritional and functional care, this Research Topic aims to transform obesity treatment into sustained gains in strength, metabolic stability, cognitive and mental well-being, and independent living. The ultimate goal is to deliver healthy longevity across aging populations.

Are you interested in contributing a manuscript to this Research Topic?

From Obesity to Healthy Longevity: Preoperative Optimization, Bariatric/Metabolic Surgery, and Long-Term Nutritional Care