**3.1 The elderly (>60 years)**

Most elderly patients have multiple comorbidities, which are aggravated when severe obesity coexists. Obesity increases their risk of developing cancer, heart disease, diabetes, lower extremity arthritis, sleep apnea, and stroke, with higher mortality risks from cardiovascular disease [51]. LSG is effective for patients older than 65 years resulting in significant WL, comorbidities remission, and improved QoL [52, 53]. LSG for those older than 65 years (median BMI 43 kg/m2 ) showed low complications, where only 3.7% had gastric leak with no reported mortality and a median hospital stay of 5 days [52], BMI decreased to 35, 32.9 and 30.7 kg/m2 at 6, 12 and 24 months after LSG and the mean EWL was 76.3% at 2 years [52]. Moreover, T2DM, hypertension, dyslipidemia, OSA, and arthralgia showed significant remission at 1 and 2 years following LSG [52]. As for QoL, there was also significant improvement in the scales that represent physical health, mental health (social function), general health perception and vitality scores [52].
