The role of metabolic and bariatric surgery for obesity management in endometrial intraepithelial neoplasia and endometrial cancer: A Society of Gynecologic Oncology and Society of American Gastrointestinal and Endoscopic Surgeons clinical practice statement.

OBJECTIVE: To provide evidence-based guidance on the role of metabolic and bariatric surgery (MBS) and other weight loss interventions in the management of obesity among women with endometrial intraepithelial neoplasia (EIN) and endometrial cancer (EC). METHODS: This clinical practice statement, developed collaboratively by the Society of Gynecologic Oncology (SGO) and the Society of American Gastrointestinal and Endoscopic Surgeons (SAGES), synthesizes current literature on obesity, EC outcomes, and weight loss interventions, including lifestyle modification, anti-obesity medications, endoscopic bariatric therapies, and MBS. RESULTS: Obesity is a major modifiable risk factor for EC and is associated with worse oncologic and overall outcomes, with cardiovascular disease representing the leading cause of mortality in this population. Lifestyle and pharmacologic interventions can achieve modest weight loss but are often limited by sustainability. In contrast, MBS produces substantial and durable weight loss, improves obesity-related comorbidities, and is associated with reduced risk of hormone-related cancers, including EC. Emerging evidence supports the feasibility of incorporating MBS at various time points in cancer care, including as a bridge to definitive surgery or as an adjunct to conservative management, with early weight loss contributing to improved surgical candidacy and metabolic health. CONCLUSIONS: MBS represents the most effective and durable treatment for obesity in women with EIN and EC and may reduce cancer risk and improve overall health outcomes. Early multidisciplinary evaluation and integration of obesity treatment into oncologic care are essential to optimize patient outcomes.