BackgroundBariatric surgery is often the preferred method to resolve obesity and diabetes, with ~800,000 cases worldwide yearly and high outcome variability. The ability to predict the long-term Body Mass Index (BMI) change following surgery has important implications on individuals and the health care system in general. Given the tight connection between eating habits, sugar consumption, BMI, and the gut microbiome, we tested whether the microbiome before any treatment is associated with different treatment outcomes, as well as other intakes (high-density lipoproteins (HDL), Triglycerides, etc.).ResultsA projection of the gut microbiome composition of obese (sampled before and after bariatric surgery) and slim patients into principal components was performed and the relation between this projection and surgery outcome was studied. The projection reveals 3 different microbiome profiles belonging to slim, obese, and obese who underwent bariatric surgery, with post-surgery more different from the slim than the obese. The same projection allowed for a prediction of BMI loss following bariatric surgery, using only the pre-surgery microbiome.ConclusionsThe gut microbiome can be decomposed into main components depicting the patient’s development and predicting in advance the outcome. Those may be translated into better clinical management of obese individuals planning to undergo metabolic surgery.ImportanceBMI and diabetes can affect the gut microbiome composition.Bariatric surgery has large variabilities in outcome.The microbiome was previously shown to be a good predictor for multiple diseases.We analyzed here the gut microbiome before and after bariatric surgery and show that: The microbiome before surgery can be used to predict surgery outcome.Post-surgery microbiome drifts further away from the slim microbiome than pre-surgery obese patients.These results can lead to a microbiome-based pre-surgery decision whether to perform surgery.

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