Preoperative educational interventions in bariatric surgery: a systematic review and meta-analysis
In brief
Preoperative education reduced 30-day complications after bariatric surgery
Across 13 randomized trials, preoperative education was associated with fewer complications within 30 days, and a lower preoperative body mass index. The weight finding was highly variable and driven mainly by one very-low-calorie-diet trial; exercise programs also improved walking capacity. Which program components deliver lasting clinical benefits remains unclear, supporting calls for more standardized interventions and longer follow-up.
- Journal
- Surgery for obesity and related diseases : official journal of the American Society for Bariatric Surgery (Q1)
- Published
- 21 September 2026
- Study design
- Systematic review / meta-analysis of RCTs
- Evidence level
- Level 1, High (CEBM 1a)
- Authors
- Greta Ghizzardi, Rosario Caruso, Irene Baroni, Ilaria Milani, Giardiello Cristiano, Martino Giovanni, et al.
- PMID
- 42907283
- DOI
- 10.1016/j.soard.2026.09.006
Why clinicians should know about it
- Picked for Bariatric and Metabolic Surgery (paper of the day, 23 October 2026): RCT meta-analysis informs preparation and outcomes before bariatric surgery
Abstract
Preoperative educational interventions in bariatric surgery are structured programs combining information, skills training, and behavioral support delivered before metabolic and bariatric surgery and are increasingly incorporated into surgical pathways. However, these interventions vary substantially in content, intensity, and mode of delivery, and their efficacy on clinically meaningful outcomes remains uncertain. Therefore, this study aimed to systematically evaluate the effects of preoperative educational interventions on weight-related, functional, metabolic, and surgical outcomes in patients undergoing bariatric surgery. A systematic review and meta-analysis was conducted in accordance with the Preferred Reporting Items for Systematic Reviews and Meta-Analyses guidelines. Randomized controlled trials evaluating structured preoperative educational interventions were included. Meta-analyses using random-effects models were performed where appropriate. Outcomes unsuitable for quantitative pooling were synthesized narratively. Risk of bias was assessed using Risk of Bias 2, and intervention reporting was evaluated using the Template for Intervention Description and Replication checklist. Thirteen randomized controlled trials were included. A meta-analysis showed that preoperative educational interventions were associated with a clinically meaningful reduction in preoperative body mass index compared with standard care. However, this pooled estimate was highly heterogeneous, driven primarily by a single very-low-calorie-diet trial. A significant absolute reduction in 30-day postoperative complications was also observed. Exercise-based interventions improved functional capacity, as measured by the 6-minute walk test, although heterogeneity was substantial. Dietary interventions did not consistently improve postoperative anthropometric outcomes, whereas cognitive-behavioral interventions primarily influenced behavioral rather than weight outcomes. Eating behavior measures demonstrated consistent directional improvements, whereas evidence on metabolic outcomes was limited and fragmented. Because such interventions are already embedded in many state-of-the-art bariatric programs, the priority is not broad adoption but standardization of intervention content, identification of the specific components that drive clinically meaningful benefit, and evaluation of longer-term outcomes.
Abstract as published, via PubMed.
For healthcare professionals. The summary is generated by AI from the published abstract, and the evidence level is assigned automatically from the study design on the Oxford CEBM hierarchy. Neither is medical advice. Read the full paper before changing practice.