Objective To explore the relationship between omental adipocyte size and metabolic benefits after gastric bypass surgery (RYGB). Methods 113 obese patients undergoing RYGB surgery were recruited between December 2015 and October 2018 at Nanjing Drum Tower Hospital. Omental adipose tissues were obtained during the surgery. Preoperative and postoperative blood glucose, blood lipid, body weight, body mass index (BMI), waist circumference and other metabolic indexes were measured. The diameter and volume of adipocytes were calculated through pathological section HE staining. Spearman correlation analysis was used to analyze the correlation between clinical parameters and the omental adipocyte size. Result The Omental adipocyte size was positively correlated with preoperative fasting plasma glucose (FPG), fasting insulin, fasting C peptide, homeostasis model assessment of insulin resistance(HOMA‑IR) (r=0.231, 0.432, 0.397, 0.421,all P<0.05), and there was a positive correlation between low density lipoprotein cholesterol (LDL‑C), apolipoprotein B, body weight, BMI, waist circumference, and hip circumference (r=0.298, 0.325, 0.397, 0.231, 0.310, and 0.232, all P<0.05) while as apolipoprotein A and high‑density lipoprotein cholesterol (HDL‑C) showed a negative correlation (r=0.224, 0.278, all P<0.05). The omental adipocyte size and the change of postoperative glycosylated hemoglobin A1c(HbA1c), FPG, fasting insulin, HOMA‑IR were positively correlated (r=0.441, 0.301, 0.236, 0.341, all P<0.05) after 3 months., and also positive correlation between the change with 3 moths postoperative of triglyceride, total cholesterol, low‑density lipoprotein cholesterol, apolipoprotein B (r=0.204, 0.296, 0.196, 0.253, all P<0.05). 63 obese nondiabetic, 50 obese with type 2 diabetes mellitus(T2DM), the omental adipocyte size and the change of postoperative HbA1c, FPG were positively correlated(r= 0.309, 0.342, all P<0.05) in obesity T2DM patients, and the change of postoperative HOMA‑IR(r= 0.281, 0.333, all P<0.05), total cholesterol (r=0.254, 0.369, all P<0.05) were positively correlated in the two groups after 3 months. Conclusion The omental adipocyte size was significantly related to the change of the metabolic index in obese patients during the first 3 months after surgery. The larger omental adipocyte size was accompanied by the more obvious the improvement of blood glucose and lipid. This retrospective study may offer insights into a novel pathological target for the clinical treatment of obesity. [ABSTRACT FROM AUTHOR]