Editorial: Women’s nutrition and bariatric surgery

Obesity is a progressive, chronic and stigmatising disease characterised by abnormal or excessive fat accumulation that can adversely affect health. With an estimated 4.7 million deaths worldwide, obesity is the fourth leading cause of premature death. Bariatric surgery (BS) is considered the most effective therapeutic intervention for achieving and maintaining long-term weight loss and improving obesity-related comorbidities (1).Research shows that women are more likely than men to seek clinical intervention (2), and the majority of patients undergoing bariatric surgery are female, according to recent global reports. Although the underlying causes of this gender disparity are unclear, it has been suggested that stigma, the prevalence of psychological problems and poor body image are more common in women than in men (3). Similarly, the outcomes of BS often differ between men and women. These differences are typically attributed to variations in hormonal profiles, body composition, and social and behavioural factors (4)(5)(6). Studies shows that women tend to lose a higher percentage of excess weight compared to men (4). However, men may experience greater absolute weight loss due to their higher initial body weight (4,5). Women are more likely to report greater improvements in quality of life post-surgery, while men may experience less psychological benefit despite similar physical health improvements (6).It has been suggested that men may find it difficult to consider BS due to a lack of knowledge about surgical complications and postoperative outcomes (7). Qualitative research has shown that after BS, men begin a complex and prolonged life-changing process involving both increased agency and health-related experiences. Much remains to be learned about the impact of gender as a biological variable but also behavioural and social. The analysis of gender differences in routinely performed procedures is therefore crucial, as data suggest the existence of a gender gap in the quality and experience of BS. As the causes and effects of these gender differences on long-term outcomes are not fully understood, it is important to study the outcomes of bariatric surgery by gender.Evidence suggests that obesity has a negative impact on overall quality of life, particularly in women, as obesity is a cause of stigma, menstrual disorders, sexual dysfunction, infertility, changes in bone metabolism, urinary incontinence, sarcopenia, miscarriage, psychological problems and increases the risk of almost all pregnancy complications (8).For these reasons, BS has become a popular approach to weight loss for women with obesity. This research topic drew papers examining the unique nutritional challenges, health outcomes, and physiological changes faced by women undergoing BS, as well as interventions and strategies to optimize their long-term health and quality of life. And forms a collection that expands our knowledge on the intersection of women's nutrition and bariatric surgery, shedding light on gender-specific considerations, pre-and postoperative care, and the broader implications for women's health and well-being in the context of surgical weight management.One paper in this collection highlights how BS improves glucose metabolism by examining the changes in hormones secreted by the three major metabolic tissuespancreas, adipose tissue and gut -as well as the differences in inflammatory cytokines of multiple origins between the remission and non-remission groups. These findings were reported by Ran Kim et al (9), and can be considered important data for obtaining noninvasive markers of obesity and metabolic syndrome.A clearly important aspect of women's health post BS is the impact of both obesity and its BS on reproductive health. Women with obesity have higher rates of PCOS and irregular menses with reduced fertility. PCOS increases AMH levels, which is controversially interested as a marker of ovarian reserve. Studies show a significant drop in anti-Müllerian hormone (AMH) levels shortly after BS, but the cause remains unclear.It's uncertain whether the drop in AMH indicates a true loss of ovarian reserve due to a reduction in follicle count, or whether it's a temporary functional change in folliculogenesis that resolves after the peak weight loss phase, or whether it represents a "normalisation" of the elevated levels observed in PCOS. Adipokines and certain nutritional parameters (e.g. Vitamin D, Vitamin B12, ferritin, prealbumin, total cholesterol, etc.) may also affect AMH levels. While antral follicular count (AFC) is an important non-hormonal indicator of ovarian reserve, there is limited data on how obesity affects this measure. In this regard, another paper in this research topic by Andreu (10) observed a significant decrease in AMH levels and a decrease in AFC during the first 12 months of obesity, with both markers stabilising thereafter. AMH variations were associated with reproductive and metabolic parameters, particularly changes in androgen and insulin levels. It remains unclear whether these changes reflect an effect on follicular It is interesting to note that previous research has linked the presence of persistent organic pollutants (POPs) to obesity. Plasma levels of these pollutants were found to correlate with BMI, gender and rapid weight loss. This suggests that there may be a transfer between the circulatory system and adipose tissue. There is also a lack of knowledge about how these compounds are affected by weight loss through bariatric surgery. Thus, although previous research has linked the presence of persistent organic pollutants (POPs) to obesity, little is known about how these compounds are affected by weight loss after bariatric surgery. For the first time in this research topic, Díaz-González et al (11), analysed 353 compounds in sera from 59 women with obesity before and after surgery and found a significant increase in both detection rates and concentrations of several pollutants, including circulating POPs, after rapid weight loss. In addition, gender differences were observed in the correlation between concentrations of naphthalene, phenanthrene, PCB-138, weight loss, total lipids and time after surgery. These compounds are often lipid-soluble and stored in adipose tissue. With any lipid mobilisation (weight loss, lactation), these compounds mobilise into the serum.Therefore, the increased levels may be due to emptying adipose stores of the lifetime accumulation of these compounds for elimination. This was a well-known issue of lipidsoluble pesticides from Inuit's eating fish living in rivers that had agricultural pesticidesit was encouraged that those women do not breastfeed to prevent infant exposure (12).These contaminants can cause endocrine, metabolic and molecular disruptions that may lead to the development of multiple pathologies, including endometriosis, elevated inflammatory markers, cardiovascular disease, and prostate and breast cancer. In addition, some of the chemicals released during weight loss are thought to contribute to the development of cancer or neurotoxicity. This highlights the need for legislative and biomonitoring efforts to prevent the development of exposure-related diseases.Gender is an important factor for research excellence and parity of health outcomes.Attention to gender differences and the integration of the gender dimension in research has been shown to improve the quality, rigour, reproducibility and creativity of research, to increase the societal relevance of research and innovation, and to promote greater application of its results to the population. Differences in outcomes between men and women in BS have not been extensively studied. This special issue will highlight relevant scientific issues and make a significant contribution with new knowledge related to women's nutrition and bariatric surgery. It also aims to encourage further research in this area to help health care providers individualise the best therapeutic approach for women and optimise health-related outcomes associated with bariatric surgery.

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