Fig. 3　Weight and HbA1c transition from the first visit to pregnancy. At the first visit, the patient’s height, weight, BMI, and HbA1c were 164.4 cm, 105.5 kg, 39.0 kg/m², and 6.7%, respectively. After 6-month medical management, the patient was referred to surgery with a weight of 101.0 kg and HbA1c of 6.7%. A preoperative weight loss program was performed for 2 weeks during hospitalization, and preoperative weight and HbA1c were 95.9 kg and 6.6%, respectively. At 5 and 13 months postoperatively, the weight loss was 78.8 and 78.2 kg, respectively, and the percent of total weight loss from the time of surgery was 17% and 20%, respectively. Postoperative HbA1c remained below 6%. AIH was performed at 4 and 5 months postoperatively but did not achieve pregnancy, and pregnancy was achieved by IVF at 12 months postoperatively.