Trends in Immunotherapy

Review Article

Bariatric Surgery as Immunometabolic Therapy: A Narrative Review of Mechanisms, Clinical Outcomes, and Future Precision Approaches

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https://doi.org/10.54963/ti.v10i2.2373
Baygashkaev, E., Mamasaliev, Z., Atykanov, A., & Alymkulov, A. (2026). Bariatric Surgery as Immunometabolic Therapy: A Narrative Review of Mechanisms, Clinical Outcomes, and Future Precision Approaches. Trends in Immunotherapy, 10(2), 118–136. https://doi.org/10.54963/ti.v10i2.2373
Volume 10, Issue 2 (June 2026): In Progress
Copyright (c) 2026 Ertegin Baygashkaev, Zhumabek Mamasaliev, Arystanbek Atykanov, Argen Alymkulov
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Authors

  • Ertegin Baygashkaev

    Department of Anatomy, Histology and Normal Physiology, Osh State University, Bishkek 723500, Kyrgyzstan
  • Zhumabek Mamasaliev

    Department of Anatomy, Histology and Normal Physiology, Osh State University, Bishkek 723500, Kyrgyzstan
  • Arystanbek Atykanov

    Department of Morphophysiological Disciplines, Salymbekov University, Bishkek 720054, Kyrgyzstan
  • Argen Alymkulov

    Research and Analytical Department, International Higher School of Medicine, Bishkek 720054, Kyrgyzstan

Received: 20 April 2026; Revised: 18 May 2026; Accepted: 10 June 2026; Published: 16 June 2026

Obesity is a global health and economic burden that affects disadvantaged groups and increases healthcare use. It involves adipocyte hypertrophy/hypoxia, adipokine imbalance, immune cell recruitment, pro-inflammatory polarization, signaling activation, systemic inflammation, oxidative stress, insulin resistance, and a higher cardiometabolic risk. This review synthesizes bariatric surgery as an immunometabolic intervention, integrating mechanistic, clinical, and translational findings. A literature search of PubMed/MEDLINE, Scopus, and Web of Science (through 2025), supplemented by Google Scholar, included peer-reviewed human and animal studies on metabolic or immunological mechanisms; technical surgical reports and non-peer-reviewed sources were excluded. Bariatric surgery consistently achieves broader metabolic and immunomodulatory, sustained weight loss and improved glycemic control and comorbidity profiles. Diabetes improvements partially preceded major weight loss via enhanced enteroinsular signaling, altered bile acid pathways, and microbiome remodeling. Surgery reduces systemic inflammation, reprograms cytokines, improves immune cell phenotypes, and lowers oxidative stress, leading to antioxidant status recovery. Comparative evidence indicates an efficacy–risk gradient: laparoscopic adjustable gastric banding is least effective; laparoscopic sleeve gastrectomy offers intermediate benefits with favorable safety; Roux-en-Y gastric bypass is widely supported with strong outcomes and manageable risks; and biliopancreatic diversion with duodenal switch yields maximal benefit but higher adverse-event and malabsorption burden. Bariatric surgery is an immunometabolic intervention that induces immune and metabolic remodeling, disrupting the obesity–inflammation–insulin resistance cycle via multi-system remodeling.

Keywords:

Obesity Public Health Chronic Disease Lifestyle Changes Pharmacotherapy Inflammation

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