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categories, including sexual drive (3.9 ± 0.3 to 5.3 ± 0.3), erectile function (6.4 ± 0.5 to 8.9 ± 0.5), ejaculatory
function (4.9 ± 0.4 to 6.3 ± 0.4), problem assessment (7.4 ± 0.5 to 9.6 ± 0.5), and sexual satisfaction (1.6 ±
[38]
0.2 to 2.3 ± 0.2; all P < 0.01) . Other studies have also demonstrated improvements in sexual quality of
life after bariatric surgery, as well as favorable reproductive hormonal alterations in men [39,40] . The biologic
(improvement in sex hormone levels) and gender-related aspects of weight loss (in part body image-related)
likely work in symbiosis to create renewed vitality and a positive sense of identity for both men and women.

[41]
Vegel et al. further examined QOL outcomes after bariatric surgery at a single institution using the
Moorehead-Ardelt Quality of Life Questionnaire II (MAQoLII). In total, 209 patients underwent bariatric
surgery from 2010 to 2012, with 79% being women. There was a significant improvement in scores both
overall and across each category of QOL measures at one-year postoperatively compared to preoperatively,
including in physical functioning, self-esteem, and sexual function. Gender was not associated with a
change in outcome. In a prospective study of 32 men who underwent bariatric surgery conducted by
[42]
Sarwer et al. , participants reported significant improvements in physical quality of life measures, weight-
related quality of life, and body image. All this proposes that, although men may not initially view the
downsides of obesity on their health and functional capacity, bariatric surgery seems to significantly
improve quality of life measures in both genders equally.

CONCLUSION
Bariatric surgery has evolved to become a safe and effective treatment for morbid obesity with favorable
outcomes for both women and men. However, significant barriers exist between morbidly obese patients
and bariatric surgical treatment, and, although these barriers exist for both men and women, there is
clearly a gender disparity with far fewer eligible men receiving appropriate treatment. Thus, greater
efforts are needed to improve overall access to surgical care and narrow the gender gap. This can only be
accomplished through collaborations between bariatric surgical specialists and primary care providers
to ensure that eligible patients receive meaningful education about the risks and benefits of surgery with
attention to gendered concerns and expectations. Primary care providers, who continue to be the most
[11]
important source of patient referral , are in a frontline position to identify patients who may benefit
from surgery and to understand patients’ health-related and social values, working closely with those who
may be reticent to consider bariatric surgery and less likely to independently express interest in a surgical
evaluation when appropriate. Individualized multidisciplinary support remains vital throughout both the
evaluation and treatment process to ensure commitment to surgery and long-term success, as surgical
weight loss can truly result in profound positive changes across all aspects of life.

DECLARATIONS
Authors’ contributions
Conceived the original idea: Hachey K
Contributed to the drafting of the manuscript and critical revisions: Aly S, Hachey K, Pernar LIM

Availability of data and materials
Not applicable.

Financial support and sponsorship
None.

Conflicts of interest
All authors declared that there are no conflicts of interest.

Ethical approval and consent to participate
Not applicable.