Skip to main content

Preoperative Medical Weight Management in Bariatric Surgery: a Review and Reconsideration


Bariatric surgery is the most robust treatment for extreme obesity. The impact of preoperative medical weight management sessions designed, in theory, with the primary goal of promoting preoperative weight loss, is unclear. This paper reviews studies that have investigated the relationship between preoperative weight loss and bariatric surgical outcomes, both with respect to postoperative weight loss and complications. We conclude that the most robust of preoperative interventions has not been implemented or evaluated in a manner which would conclusively assess the value of this element of care. We offer a reconsideration of the role of preoperative medical weight management and provide recommendations for future research in this area.

This is a preview of subscription content, access via your institution.


  1. Mechanick JI, Youdim A, Jones DB, et al. Clinical practice guidelines for the perioperative nutritional, metabolic, and nonsurgical support of the bariatric surgery patient—2013 update: cosponsored by American Association of Clinical Endocrinologists, the Obesity Society, and American Society for Metabolic & Bariatric Surgery. Surg Obes Relat Dis. 2013;9(2):159–91. doi:10.1016/j.soard.2012.12.010.

    Article  PubMed  Google Scholar 

  2. Sjostrom L. Review of the key results from the Swedish Obese Subjects (SOS) trial—a prospective controlled intervention study of bariatric surgery. J Intern Med. 2013;273(3):219–34. doi:10.1111/joim.12012.

    CAS  Article  PubMed  Google Scholar 

  3. Adams TD, Davidson LE, Litwin SE, et al. Health benefits of gastric bypass surgery after 6 years. JAMA. 2012;308(11):1122–31. doi:10.1001/2012.jama.11164.

    CAS  Article  PubMed  PubMed Central  Google Scholar 

  4. Courcoulas AP, Christian NJ, Belle SH, et al. Weight change and health outcomes at 3 years after bariatric surgery among individuals with severe obesity. JAMA. 2013;310(22):2416–25. doi:10.1001/jama.2013.280928.

    CAS  PubMed  PubMed Central  Google Scholar 

  5. Nguyen NT, Blackstone RP, Morton JM, et al. Patient safety. The ASMBS textbook of bariatric surgery. Volume 1: Bariatric Surgery. 2015. p. 115–37.

  6. Jensen MD, Ryan DH, Apovian CM, et al. 2013 AHA/ACC/TOS guideline for the management of overweight and obesity in adults: a report of the American College of Cardiology/American Heart Association Task Force on Practice Guidelines and The Obesity Society. J Am Coll Cardiol. 2014;63(25 Pt B):2985–3023. doi:10.1016/j.jacc.2013.11.004.

    Article  PubMed  Google Scholar 

  7. About: American College of Surgeons; [cited 2016 May 16]. Available from:

  8. Sadhasivam S, Larson CJ, Lambert PJ, et al. Refusals, denials, and patient choice: reasons prospective patients do not undergo bariatric surgery. Surg Obes Relat Dis. 2007;3(5):531–5. discussion 5-6 doi:10.1016/j.soard.2007.07.004.

    Article  PubMed  Google Scholar 

  9. Jamal MK, DeMaria EJ, Johnson JM, et al. Insurance-mandated preoperative dietary counseling does not improve outcome and increases dropout rates in patients considering gastric bypass surgery for morbid obesity. Surg Obes Relat Dis. 2006;2(2):122–7. doi:10.1016/j.soard.2006.01.009.

    Article  PubMed  Google Scholar 

  10. Gastrointestinal surgery for severe obesity. NIH consensus development conference, March 25-7,1991. Nutrition. 1996;12(6):397–404.

  11. Clinical guidelines on the identification, evaluation, and treatment of overweight and obesity in adults—the evidence report. National Institutes of Health. Obes Res. 1998;6 Suppl 2:51S–209S.

  12. Gibbons LM, Sarwer DB, Crerand CE, et al. Previous weight loss experiences of bariatric surgery candidates: how much have patients dieted prior to surgery? Surg Obes Relat Dis. 2006;2(2):159–64. doi:10.1016/j.soard.2006.03.013.

    Article  PubMed  Google Scholar 

  13. Buchwald H, Panel CC. Consensus conference statement bariatric surgery for morbid obesity: health implications for patients, health professionals, and third-party payers. Surg Obes Relat Dis. 2005;1(3):371–81. doi:10.1016/j.soard.2005.04.002.

    Article  PubMed  Google Scholar 

  14. Martin LF, Tan TL, Holmes PA, et al. Can morbidly obese patients safely lose weight preoperatively? Am J Surg. 1995;169(2):245–53.

    CAS  Article  PubMed  Google Scholar 

  15. van de Weijgert EJ, Ruseler CH, Elte JW. Long-term follow-up after gastric surgery for morbid obesity: preoperative weight loss improves the long-term control of morbid obesity after vertical banded gastroplasty. Obes Surg. 1999;9(5):426–32. doi:10.1381/096089299765552693.

    Article  PubMed  Google Scholar 

  16. Brethauer S. ASMBS position statement on preoperative supervised weight loss requirements. Surg Obes Relat Dis. 2011;7(3):257–60. doi:10.1016/j.soard.2011.03.003.

    Article  PubMed  Google Scholar 

  17. Kadeli DK, Sczepaniak JP, Kumar K, et al. The effect of preoperative weight loss before gastric bypass: a systematic review. J Obes. 2012;2012:867540. doi:10.1155/2012/867540.

    Article  PubMed  PubMed Central  Google Scholar 

  18. Mechanick JI, Kushner RF, Sugerman HJ, et al. American Association of Clinical Endocrinologists, The Obesity Society, and American Society for Metabolic & Bariatric Surgery Medical Guidelines for Clinical Practice for the perioperative nutritional, metabolic, and nonsurgical support of the bariatric surgery patient. Surg Obes Relat Dis. 2008;4(5 Suppl):S109–84. doi:10.1016/j.soard.2008.08.009.

    Article  PubMed  Google Scholar 

  19. Alami RS, Morton JM, Schuster R, et al. Is there a benefit to preoperative weight loss in gastric bypass patients? A prospective randomized trial. Surg Obes Relat Dis. 2007;3(2):141–5. discussion 5-6 doi:10.1016/j.soard.2006.11.006.

    Article  PubMed  Google Scholar 

  20. Harnisch MC, Portenier DD, Pryor AD, et al. Preoperative weight gain does not predict failure of weight loss or co-morbidity resolution of laparoscopic Roux-en-Y gastric bypass for morbid obesity. Surg Obes Relat Dis. 2008;4(3):445–50. doi:10.1016/j.soard.2007.09.016.

    Article  PubMed  Google Scholar 

  21. Huerta S, Dredar S, Hayden E, et al. Preoperative weight loss decreases the operative time of gastric bypass at a Veterans Administration hospital. Obes Surg. 2008;18(5):508–12. doi:10.1007/s11695-007-9334-5.

    Article  PubMed  Google Scholar 

  22. Cassie S, Menezes C, Birch DW, et al. Effect of preoperative weight loss in bariatric surgical patients: a systematic review. Surg Obes Relat Dis. 2011;7(6):760–7. discussion 7 doi:10.1016/j.soard.2011.08.011.

    Article  PubMed  Google Scholar 

  23. Colameco C, Weiner J. Essential health benefits: 50-state variations on a theme. Penn Leonard Davis Institute of Health Economics and Robert Wood Johnson Foundation. 2014.

  24. Glenn NM, Raine KD, Spence JC. Mandatory weight loss during the wait for bariatric surgery. Qual Health Res. 2015;25(1):51–61. doi:10.1177/1049732314549478.

    Article  PubMed  Google Scholar 

  25. Livhits M, Mercado C, Yermilov I, et al. Does weight loss immediately before bariatric surgery improve outcomes: a systematic review. Surg Obes Relat Dis. 2009;5(6):713–21. doi:10.1016/j.soard.2009.08.014.

    Article  PubMed  Google Scholar 

  26. Ochner CN, Dambkowski CL, Yeomans BL, et al. Pre-bariatric surgery weight loss requirements and the effect of preoperative weight loss on postoperative outcome. Int J Obes. 2012;36(11):1380–7. doi:10.1038/ijo.2012.60.

    CAS  Article  Google Scholar 

  27. Ochner CN, Puma LM, Raevuori A, et al. Effectiveness of a prebariatric surgery insurance-required weight loss regimen and relation to postsurgical weight loss. Obesity (Silver Spring). 2010;18(2):287–92. doi:10.1038/oby.2009.230.

    Article  Google Scholar 

  28. Gerber P, Anderin C, Thorell A. Weight loss prior to bariatric surgery: an updated review of the literature. Scand J Surg. 2015;104(1):33–9. doi:10.1177/1457496914553149.

    CAS  Article  PubMed  Google Scholar 

  29. Gerber P, Anderin C, Gustafsson UO, et al. Weight loss before gastric bypass and postoperative weight change: data from the Scandinavian Obesity Registry (SOReg). Surg Obes Relat Dis. 2016;12(3):556–62. doi:10.1016/j.soard.2015.08.519.

    Article  PubMed  Google Scholar 

  30. Horwitz D, Saunders JK, Ude-Welcome A, et al. Insurance-mandated medical weight management before bariatric surgery. Surg Obes Relat Dis. 2016;12(3):496–9. doi:10.1016/j.soard.2015.09.004.

    Article  PubMed  Google Scholar 

  31. Van Nieuwenhove Y, Dambrauskas Z, Campillo-Soto A, et al. Preoperative very low-calorie diet and operative outcome after laparoscopic gastric bypass: a randomized multicenter study. Arch Surg. 2011;146(11):1300–5. doi:10.1001/archsurg.2011.273.

    Article  PubMed  Google Scholar 

  32. Kalarchian MA, Marcus MD, Courcoulas AP, et al. Preoperative lifestyle intervention in bariatric surgery: a randomized clinical trial. Surg Obes Relat Dis. 2016;12(1):180–7. doi:10.1016/j.soard.2015.05.004.

    Article  PubMed  Google Scholar 

  33. Khorgami Z, Andalib A, Corcelles R, et al. Recent national trends in the surgical treatment of obesity: sleeve gastrectomy dominates. Surg Obes Relat Dis. 11(6):S6–8. doi:10.1016/j.soard.2015.10.012.

  34. Ruiz-Tovar J, Boix E, Bonete JM, et al. Effect of preoperative eating patterns and preoperative weight loss on the short- and mid-term weight loss results of sleeve gastrectomy. Cir Esp. 2015;93(4):241–7. doi:10.1016/j.ciresp.2014.04.010.

    Article  PubMed  Google Scholar 

  35. Pekkarinen T, Mustonen H, Sane T, et al. Long-term effect of gastric bypass and sleeve gastrectomy on severe obesity: do preoperative weight loss and binge eating behavior predict the outcome of bariatric surgery? Obes Surg. 2016; doi:10.1007/s11695-016-2090-7.

    PubMed  Google Scholar 

  36. Ogden CL, Lamb MM, Carroll MD, et al. Obesity and socioeconomic status in adults:United States, 2005–2008. NCHS Data Brief. 2010.

  37. Wadden TA, Sarwer DB. Behavioral assessment of candidates for bariatric surgery: a patient-oriented approach. Surg Obes Relat Dis. 2006;2(2):171–9. doi:10.1016/j.soard.2006.03.011.

    Article  PubMed  Google Scholar 

  38. Wadden TA, Volger S, Sarwer DB, et al. A two-year randomized trial of obesity treatment in primary care practice. N Engl J Med. 2011;365(21):1969–79. doi:10.1056/NEJMoa1109220.

    CAS  Article  PubMed  PubMed Central  Google Scholar 

  39. Thomas JG, Bond DS, Sarwer DB, et al. Technology for behavioral assessment and intervention in bariatric surgery. Surg Obes Relat Dis. 2011;7(4):548–57. doi:10.1016/j.soard.2011.02.009.

    Article  PubMed  PubMed Central  Google Scholar 

  40. Mitchell JE, Christian NJ, Flum DR, et al. Postoperative behavioral variables and weight change 3 years after bariatric surgery. JAMA Surg. 2016; doi:10.1001/jamasurg.2016.0395.

    Google Scholar 

Download references

Author information

Authors and Affiliations


Corresponding author

Correspondence to Colleen Tewksbury.

Ethics declarations

This article does not contain any studies with human participants or animals performed by any of the authors. Informed consent does not apply.

Conflict of Interest

CT is a full-time employee for Penn Metabolic and Bariatric Surgery Program and a part time student in Temple University College of Public Health.

CT, NNW, and KD have no financial conflicts of interest to disclose. DBS has consulting relationships with Baronova, Covidien, and Ethicon.

Rights and permissions

Reprints and Permissions

About this article

Verify currency and authenticity via CrossMark

Cite this article

Tewksbury, C., Williams, N.N., Dumon, K.R. et al. Preoperative Medical Weight Management in Bariatric Surgery: a Review and Reconsideration. OBES SURG 27, 208–214 (2017).

Download citation

  • Published:

  • Issue Date:

  • DOI:


  • Preoperative weight loss
  • Medical weight management
  • Bariatric surgery
  • Obesity