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Male patients are underrepresented in bariatric surgery (BS) despite a relatively equal proportion of men and women experiencing obesity. Differences in frequency and severity of obesity-associated medical problems (OAMPs) between men and women undergoing BS or in a control group (HELIUS [HEalthy Life In an Urban Setting]) were evaluated. The hypothesis was that men undergoing BS are less healthy than women. A cross-sectional study of 2 cohorts undergoing BS in 2013 (BS2013) and 2019 (BS2019) and a control group of patients with severe obesity from a general population (HELIUS). Characteristics concerning weight and OAMPs, medication usage, intoxications, postoperative complications (for BS2019) were compared between men and women. Members of the HELIUS cohort were tested for eligibility for BS. Of 3244 patients included, the majority were female (>78.4%). Median (interquartile range) age and body mass index (kg/m2) in male versus female patients were 47.0 (41.0–53.8) versus 43.0 (36.0–51.0) years and 41.5 (38.4–45.2) versus 42.3 (40.2–45.9), respectively, in BS2013, and 52.0 (39.8–57.0) versus 45.0 (35.0–53.0) years and 40.4 (37.4–43.8) versus 41.3 (39.0–44.1) in BS2019 (P <.05). The rates of men with OAMPs were 71.4% and 82.0% compared with 50.2% and 56.9% of women in BS2013 and BS2019, respectively. Overall medication usage was higher in male patients (P =.014). In BS2019, male patients exhibited a higher median HbA1C (P <.001) and blood pressure (P =.003) and used more antihypertensives and antidiabetics (P =.004). Postoperative complications did not differ between men and women. In the control cohort, 66.5% of men and 66.6% of women were eligible for BS. Men undergoing BS more often experience OAMPs than women, and OAMPs are more advanced in men. [Display omitted] ‑ Males are severely underrepresented in bariatric surgery. ‑ Male patients undergoing bariatric surgery are of older age and have a lower BMI ‑ Male patients undergoing bariatric surgery exhibit more and also more advanced obesity associated medical problems [ABSTRACT FROM AUTHOR]