A study investigated the long-term effects of bariatric surgery (BS) on cognition, brain structure, and perfusion in individuals with severe obesity. The study included 133 participants who underwent Roux-en-Y gastric bypass, with assessments conducted before and at 6 and 24 months post-surgery. Results showed that 42.9% of participants experienced at least a 20% improvement in global cognitive function 24 months after surgery. Inflammatory markers, such as high-sensitivity C-reactive protein, were significantly lower, and depressive symptoms were reduced. Physical activity levels increased, while medication use for comorbidities decreased. Brain imaging revealed that most brain regions showed reduced volumes and perfusion after BS, except for the hippocampus, white matter, and temporal cortex. The temporal cortex exhibited increased cortical thickness and lower spatial coefficient of variation (sCOV), indicating improved vascular efficiency. Cerebral blood flow (CBF) was lower in several regions, but remained stable in the nucleus accumbens and parietal cortex. Adipokine and cytokine levels also changed, with some markers showing significant reductions. The study suggests that BS is associated with long-term health benefits, including improvements in cognition, inflammation, and comorbidities. These findings highlight the potential of BS to improve brain structure and function, particularly in the temporal cortex. However, the study acknowledges limitations, including the absence of a control group and potential confounding factors such as aging. Future research should include control groups and explore underlying mechanisms to better understand the long-term effects of BS on brain health.A study investigated the long-term effects of bariatric surgery (BS) on cognition, brain structure, and perfusion in individuals with severe obesity. The study included 133 participants who underwent Roux-en-Y gastric bypass, with assessments conducted before and at 6 and 24 months post-surgery. Results showed that 42.9% of participants experienced at least a 20% improvement in global cognitive function 24 months after surgery. Inflammatory markers, such as high-sensitivity C-reactive protein, were significantly lower, and depressive symptoms were reduced. Physical activity levels increased, while medication use for comorbidities decreased. Brain imaging revealed that most brain regions showed reduced volumes and perfusion after BS, except for the hippocampus, white matter, and temporal cortex. The temporal cortex exhibited increased cortical thickness and lower spatial coefficient of variation (sCOV), indicating improved vascular efficiency. Cerebral blood flow (CBF) was lower in several regions, but remained stable in the nucleus accumbens and parietal cortex. Adipokine and cytokine levels also changed, with some markers showing significant reductions. The study suggests that BS is associated with long-term health benefits, including improvements in cognition, inflammation, and comorbidities. These findings highlight the potential of BS to improve brain structure and function, particularly in the temporal cortex. However, the study acknowledges limitations, including the absence of a control group and potential confounding factors such as aging. Future research should include control groups and explore underlying mechanisms to better understand the long-term effects of BS on brain health.