Objective To explore the predictive factors of successful weight loss after laparoscopic sleeve gastrectomy (LSG) for patients with obesity complicated with nonalcoholic fatty liver disease (NAFLD). Methods 130 obese patients with NAFLD who received LSG in the hospital were selected from October 2022 to October 2023 as the study subjects. All patients were followed up for 1 year. The percentage of excess weight loss (EWL) ≥50% was used as the criteria for successful weight loss after LSG, and the patients were divided into successful weight loss group and unsuccessful weight loss group. The factors affecting the success of weight loss after LSG and predictive efficiency were analyzed. Results There were 93 cases (71.54%) of successful weight loss and 37 cases (28.46%) of unsuccessful weight loss among 130 obese patients with NAFLD. There were significant differences in waist-to-hip ratio (WHR), body mass index (BMI), insulin resistance index (HOMA-IR), triglyceride (TG), alanine aminotransferase (ALT), aspartate aminotransferase (AST) and NAFLD fibrosis score (NFS) between groups (P＜0.05). Logistic regression analysis and ROC curve indicated that BMI, HOMA-IR and NFS were the influencing factors of unsuccessful weight loss in obese patients with NAFLD (P＜0.05), and the AUCs of BMI, HOMA-IR and NFS for predicting successful weight loss were 0.831, 0.808 and 0.830 respectively. Conclusion LSG has a significant weight loss effect in the treatment of patients with obesity complicated with NAFLD, and BMI, HOMA-IR and NFS are important indicators for the success of postoperative weight loss