Eating behavior encompasses the psychological, physiological, and environmental factors influencing food intake. Dysregulation in eating behavior, such as emotional eating, binge eating, or loss of satiety signals, contributes to excessive caloric intake and weight gain. These behaviors are often linked to hormonal imbalances, stress, or genetic predisposition. Obesity is a chronic, multifactorial disease characterized by excessive body fat accumulation, with a body mass index (BMI) ≥ 30 kg/m² often used for diagnosis. It is associated with significant morbidity, including type 2 diabetes, cardiovascular disease, and obstructive sleep apnea. Pathophysiological mechanisms underlying obesity include insulin resistance, leptin dysregulation, and altered gut microbiota, which perpetuate metabolic derangements. Lifestyle interventions remain first-line treatment, but sustained weight loss is challenging for many patients. Bariatric surgery is a therapeutic option for individuals with severe obesity (BMI ≥ 40 kg/m² or ≥35 kg/m² with comorbidities) who have failed conservative management. Procedures such as Roux-en-Y gastric bypass and sleeve gastrectomy alter gastrointestinal anatomy, promoting weight loss through restriction, malabsorption, and hormonal modulation (e.g., increased GLP-1 secretion). Bariatric surgery improves obesity-related comorbidities and enhances quality of life. However, it requires lifelong medical follow-up to address potential nutritional deficiencies and ensure sustainable outcomes.

Obesity is a major public health problem that puts pressure on healthcare systems globally. The purpose of this narrative review is to summarize and analyse recent research on the bidirectional link between obesity and mental health, focusing on the biological, behavioural, dietary, emotional, and metabolic mechanisms arising from gut microbiota interactions. Epidemiological association between obesity and mental health disorders, especially depression and anxiety, often occurs bidirectionally, reinforcing each other. Low-grade systemic inflammation is a condition typically found in obesity, being a fundamental element of neuropsychiatric disorders. Considered the main energy substrate for colon cells, SCFAs are synthesized in the intestine and exert important local effects by reducing both local and systemic inflammation. The intestinal microbiota maintains this homeostasis through the SCFAs it produces. The combined impact of the increased intestinal permeability, immune activation, and disrupted metabolism of SCFAs and tryptophan contributes to the onset and progression of depression and anxiety, as well as to significant cognitive dysfunction, especially in obese individuals. Understanding the mechanisms by which microbiota metabolites influence brain development, neuroplasticity, and behaviour could pave the way for new and innovative therapeutic strategies for the treatment of obesity and depression. Conclusions: The association of these pathologies is not coincidental, as they coexist through overlapping biological pathways that they partially or completely share. The main pathway involved is formed by the brain–gut axis and its mediators (SCFAs).

Background and Objectives: Up until now, behavioral interventions and pharmacological therapies were the main approach available for the management of obesity. Diet and exercise, when used as a singular therapeutic method, are inadequate for a successful outcome. Research shows promising results for the surgical treatment of obesity, especially in the area of bariatric surgery (BaS). The relevance of this study is the valuable analysis of the evolution of obese patients with increased cardiovascular risk. Materials and Methods: The patients eligible for BaS commonly suffer from multiple chronic conditions, including type 2 diabetes, obstructive sleep apnea, cardiovascular diseases, and non-alcoholic fatty liver disease. Additionally, obesity contributes to an increased probability of developing certain types of cancer, osteoarthritis, urinary incontinence, and chronic kidney disease. In this review, we focused especially on the cardiovascular status of obese patients who underwent bariatric procedures. Results: BaS has been found to be strongly associated with a reduced incidence of severe complications in individuals with a history of myocardial infarction (MI) and severe obesity. Specifically, this procedure is linked to a lower occurrence of major adverse cardiovascular events and a decrease in overall mortality. Also, BaS is correlated with a reduced risk of recurrent MI and the development of new-onset heart failure. Conclusions: The results of BaS involve a significant amelioration of the BMI, contributing to a considerable decrease in cardiovascular risk factors and to a notable refinement in the cardiovascular structure and function.

Artificial intelligence (AI) is having a major impact in the field of bariatric surgery (BS) as it helps improve outcomes for patients with severe obesity. This advanced technology optimises clinical decision-making processes and helps reduce the risks associated with surgery. In the context of bariatrics, AI is used to identify suitable patients, and monitor postoperative recovery but also to predict complications that may occur. BS is an effective solution for treating severe obesity, a condition characterised by the excessive accumulation of body fat, which can lead to serious health problems. However, this surgical field faces challenges in terms of patient selection and follow-up. By implementing machine learning (ML) algorithms and advanced imaging technologies, AI offers advantages to surgeons in performing interventions with increased precision and efficiency. The integration of AI into BS brings significant benefits to both patients and healthcare professionals, thereby facilitating the development of a personalised and safe approach to obesity management. Through this review, we aim to explore the potential, benefits, and risks of using AI in the context of BS.

Background/Objectives: Obesity imposes a significant and growing burden on healthcare systems worldwide. Bariatric surgery remains the most effective long-term treatment for morbid obesity, but its success depends heavily on the quality of perioperative management and institutional expertise. This study presents a comprehensive analysis of 14 years of bariatric surgical activity in a university-based Center of Excellence, emphasizing complication rates and safety outcomes. Methods: A cohort analysis was performed on a prospectively collected database including all bariatric procedures conducted between June 2012 and June 2025 in an Obesity Center, located in ‘Saint Spiridon’ Hospital’ in Iasi, Romania. Eligibility was determined according to the American Society for Metabolic and Bariatric Surgery (ASMBS) and International Federation for the Surgery of Obesity and Metabolic Disorders (IFSO) guidelines. All patients underwent standardized preoperative evaluation by a multidisciplinary team. Results: Over a 14-year period, 1010 patients underwent surgery and had a mean age of 39 years and 72% of them were females. A total of 68 patients (6.73%) experienced complications, including 28 (2.77%) within 30 days and 40 (3.96%) after first month. No postoperative fistulas or deaths were recorded during the entire study period. Conclusions: The long-term data from over one thousand consecutive bariatric cases confirm the high safety and effectiveness of a multidisciplinary, protocol-driven approach. The absence of postoperative fistulas and mortality underscores the value of institutional experience and standardized perioperative care.

Metabolic and bariatric surgery (MBS) represents the most effective therapeutic approach for achieving substantial and sustained weight loss and improving obesity-related comorbidities. However, the role of routine preoperative esophagogastroduodenoscopy (EGD) remains controversial, and current recommendations vary among international professional societies. Obesity is associated with a high prevalence of upper gastrointestinal disorders, including gastroesophageal reflux disease, erosive esophagitis, hiatal hernia, Barrett’s esophagus, gastritis, Helicobacter pylori infection, gastric intestinal metaplasia, and peptic ulcer disease. Importantly, clinically relevant endoscopic abnormalities may occur in asymptomatic patients, limiting the reliability of symptom-based strategies for selecting candidates for EGD. Preoperative endoscopic findings may require medical treatment, additional diagnostic investigations, endoscopic surveillance, or modification of the planned bariatric procedure. This is particularly relevant when considering sleeve gastrectomy in patients with significant reflux-related disease or Barrett’s esophagus, as well as gastric bypass procedures that may limit subsequent endoscopic access to the excluded stomach. This narrative review summarizes current evidence regarding the clinical value of preoperative EGD in MBS, with particular emphasis on relevant gastroesophageal and gastric findings, standardized endoscopic assessment, their implications for surgical decision-making, and current international recommendations.