Impact of multidisciplinary steatotic liver disease management on bariatric surgery referral and clinical outcomes: A retrospective cohort study

doi:10.4254/wjh.v18.i1.113753

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Jan 27, 2026 (publication date) through Jan 27, 2026

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World Journal of Hepatology

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1948-5182

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Baishideng Publishing Group Inc, 7041 Koll Center Parkway, Suite 160, Pleasanton, CA 94566, USA

Retrospective Cohort Study

World J Hepatol. Jan 27, 2026; 18(1): 113753
Published online Jan 27, 2026. doi: 10.4254/wjh.v18.i1.113753

Impact of multidisciplinary steatotic liver disease management on bariatric surgery referral and clinical outcomes: A retrospective cohort study

Andrew W Schwartz, Emily Y Park, Ysabel C Ilagan-Ying, Zoe E Zimmerman, Bryan Bollinger, Lee D Ying, Yanhong D Deng, Andrew J Duffy, John M Morton, Wajahat Z Mehal, Albert Do, Bubu A Banini

Andrew W Schwartz, Emily Y Park, Zoe E Zimmerman, Bryan Bollinger, Department of Internal Medicine, Yale School of Medicine, New Haven, CT 06510, United States

Ysabel C Ilagan-Ying, Wajahat Z Mehal, Albert Do, Bubu A Banini, Section of Digestive Diseases, Department of Internal Medicine, Yale School of Medicine, New Haven, CT 06510, United States

Lee D Ying, Andrew J Duffy, John M Morton, Department of Surgery, Yale School of Medicine, New Haven, CT 06510, United States

Yanhong D Deng, Yale Center for Analytical Sciences, Yale School of Public Health, New Haven, CT 06510, United States

Co-first authors: Andrew W Schwartz and Emily Y Park.

Author contributions: Schwartz AW, Park EY, Zimmerman ZE, and Bollinger B contributed to manuscript drafting; Schwartz A and Park EY contributed equally to this manuscript as co-first authors; Schwartz AW, Park EY, Ilagan-Ying YC, Zimmerman ZE, and Bollinger B contributed to data collection; Schwartz A, Park EY, Zimmerman ZE, and Bollinger B contributions to data analysis; Ilagan-Ying YC, Do A and Banini BA contributed to study formulation; Ilagan-Ying YC, Ying LD, Deng Y, Duffy AJ, Morton JM, and Mehal WZ assisted with critical revision; Do A and Banini BA contributed equally to supervision, data interpretation, and critical revision as co-senior authors. All authors have read and approved the final manuscript.

Supported by the National Institute of Diabetes and Digestive and Kidney Diseases, No. 5R01DK134624-02 and No. 5P30DK034989-40 8073.

Institutional review board statement: The study was approved by Human Research Protection Program Institutional Review Boards (approval No. 2000027433).

Informed consent statement: The informed consent was waived by the Institutional Review Board.

Conflict-of-interest statement: Banini BA reports work related to being advisory board member for Novo Nordisk and Boehringer Ingelheim, and research grant from Merck & Co., outside the submitted work.

STROBE statement: The authors have read the STROBE Statement-checklist of items, and the manuscript was prepared and revised according to the STROBE Statement-checklist of items.

Data sharing statement: No additional data are available.

Open Access: This article is an open-access article that was selected by an in-house editor and fully peer-reviewed by external reviewers. It is distributed in accordance with the Creative Commons Attribution NonCommercial (CC BY-NC 4.0) license, which permits others to distribute, remix, adapt, build upon this work non-commercially, and license their derivative works on different terms, provided the original work is properly cited and the use is non-commercial. See: https://creativecommons.org/Licenses/by-nc/4.0/

Corresponding author: Bubu A Banini, MD, PhD, Assistant Professor, Section of Digestive Diseases, Department of Internal Medicine, Yale School of Medicine, 40 Temple St, Suite 1A, New Haven, CT 06510, United States. bubu.banini@yale.edu

Received: September 2, 2025
Revised: September 18, 2025
Accepted: December 1, 2025
Published online: January 27, 2026
Processing time: 147 Days and 7.7 Hours

Abstract

BACKGROUND

Lifestyle modifications aimed at weight loss are key to improving metabolic dysfunction-associated steatotic liver disease (MASLD); however, achieving substantial and sustained weight loss through non-surgical approaches may be difficult for some patients. Bariatric surgery should be considered as a therapeutic option in select patients with MASLD, but the national referral rate for eligible patients is low (< 1%).

AIM

To examine referral rates and one-year outcomes among adults with MASLD in a multidisciplinary clinic integrating hepatology and obesity medicine.

METHODS

We performed a retrospective cohort study of 965 patients seen in a MASLD-specific clinic over a three-year period (2018-2022). Patients were categorized as bariatric surgery eligible or non-eligible based on standard referral criteria. We assessed bariatric surgery referral rates, weight, and liver-related outcomes, including change in nonalcoholic fatty liver disease fibrosis score. Categorical variables were compared with χ² tests, and continuous variables were analyzed with two-tailed t-tests. P value < 0.05 was considered significant.

RESULTS

Among 491 patients eligible for bariatric surgery, 127 patients (26%) were referred for surgical evaluation, with 31 patients (24%) ultimately undergoing bariatric surgery (21 sleeve gastrectomy and 10 Roux-en-Y gastric bypass). The remaining 96 patients continued with medication and/or lifestyle management. Individuals who underwent bariatric surgery achieved greater one-year total body weight loss than those who utilized medication and/or lifestyle management alone (20.6% vs 2.5%, P < 0.001). Average nonalcoholic fatty liver disease fibrosis score at one year was -0.91 in surgery patients vs -0.008 in non-surgery patients (P = 0.005).

CONCLUSION

Integration of weight management with hepatology care in patients with MASLD resulted in bariatric surgery referral rates that substantially exceed the national average, leading to improved weight and liver-related outcomes.

Keywords: Bariatric surgery; Metabolic dysfunction-associated steatotic liver disease; Metabolic dysfunction-associated steatohepatitis; Fatty liver disease; Obesity medicine; Weight loss; Multidisciplinary care; Transient elastography

Core Tip: Bariatric surgery should be considered as a therapeutic option in eligible patients with metabolic dysfunction-associated steatotic liver disease (MASLD). Integration of weight management into a tertiary care center’s MASLD-specific clinic led to substantial improvement in referral rates for bariatric surgery when compared with the national average, with improved weight loss and liver-related outcomes one-year post surgery. Multidisciplinary obesity medicine and hepatology co-management is an effective model for MASLD care and promotes access to bariatric surgery.