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Religious Fasting of Muslim Patients After Metabolic and Bariatric Surgery: a Modified Delphi Consensus

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Abstract

Background

Fasting during Ramadan is one of the five pillars of the Muslim faith. Despite the positive effects of fasting on health, there are no guidelines or clear recommendations regarding fasting after metabolic/bariatric surgery (MBS). The current study reports the result of a modified Delphi consensus among expert metabolic/bariatric surgeons with experience in managing patients who fast after MBS.

Methods

A committee of 61 well-known metabolic and bariatric surgeons from 24 countries was created to participate in the Delphi consensus. The committee voted on 45 statements regarding recommendations and controversies around fasting after MBS. An agreement/disagreement ≥ of 70.0% was regarded as consensus.

Results

The experts reached a consensus on 40 out of 45 statements after two rounds of voting. One hundred percent of the experts believed that fasting needs special nutritional support in patients who underwent MBS. The decision regarding fasting must be coordinated among the surgeon, the nutritionist and the patient.

At any time after MBS, 96.7% advised stopping fasting in the presence of persistent symptoms of intolerance. Seventy percent of the experts recommended delaying fasting after MBS for 6 to 12 months after combined and malabsorptive procedures according to the patient’s situation and surgeon’s experience, and 90.1% felt that proton pump inhibitors should be continued in patients who start fasting less than 6 months after MBS.

There was consensus that fasting may help in weight loss, improvement/remission of non-alcoholic fatty liver disease, dyslipidemia, hypertension and type 2 diabetes mellitus among 88.5%, 90.2%, 88.5%, 85.2% and 85.2% of experts, respectively.

Conclusion

Experts voted and reached a consensus on 40 statements covering various aspects of fasting after MBS.

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Author information

Authors and Affiliations

  1. Department of Surgery, Minimally Invasive Surgery Research Center, Division of Minimally Invasive and Bariatric Surgery, Rasool-E Akram Hospital, Iran University of Medical Sciences, Tehran, Iran

    Mohammad Kermansaravi & Abdolreza Pazouki

  2. Wirral University Teaching Hospital, NHS Foundation Trust, Birkenhead, Wirral, UK

    Islam Omar

  3. Bariatric Unit, South Tyneside and Sunderland NHS Trust, Sunderland, SR4 7TP, UK

    Kamal Mahawar

  4. Minimally Invasive Surgery Research Center, Iran University of Medical Sciences, Tehran, Iran

    Shahab Shahabi & Amir Hossein Davarpanah Jazi

  5. Minimally Invasive and Bariatric Surgery, Gastrointestinal Bariatric and Metabolic Center (GBMC)-Jordan Hospital, Queen Noor Street, Amman, 11152, Jordan

    Ahmad Bashir & Ashraf Haddad

  6. Bariatric Surgery Unit, Faculty of Medicine, Ain Shams University, Cairo, 11591, Egypt

    Alaa Abbass, Tarek Abouzeid, Khaled Gawdat, Mohamed Qassem & Karim Sabry

  7. Iranian Hospital, Alwasl Road, Dubai, UAE

    Syed Imran Abbas

  8. University Hospitals Cleveland Medical Center, Cleveland, OH, USA

    Mujjahid Abbas

  9. Bariatric and Metabolic Surgery, Istanbul, Turkey

    Faki Akin

  10. Department of Surgery, Aleris Hospital, Fredrik Stangs gate 11-13, 0264, Oslo, Norway

    Ebrahim Aghajani

  11. Bariatric and Metabolic Institute, Cleveland Clinic, Cleveland, OH, USA

    Ali Aminian

  12. Robotic Surgery Academy, International Modern Hospital, Baghdad, Iraq

    Mohanad AlAnsari

  13. Capital Hospital, CDA, Islamabad, Pakistan

    Syed Tanseer Asghar

  14. Faculty of Health Sciences, Istanbul Rumeli University, Istanbul, Turkey

    Ahmet Ziya Balta

  15. International Medical Center, Jeddah, Saudi Arabia

    Waleed Bukhari

  16. Makassed General Hospital, Beirut, Lebanon

    Mohamad Hayssam Elfawal

  17. Endocrine and Bariatric Surgery Unit, Mansoura University, Mansoura, Egypt

    Waleed Gado

  18. Department of Medical Science, School of Healthcare and Medical Sciences, Sunway UniversityJalan UniversitySelangor Darul Ehsan, 47500, Bandar SunwayPetaling Jaya, Malaysia

    Tikfu Gee

  19. Vinet Lausanne, Switzerland

    Bijan Ghavami

  20. Wockhardt Hospitals, Mumbai, India

    Ramen Goel

  21. Healthpoint Hospital, Mubadala Health Care, Abu Dhabi, UAE

    Mohammed AlHadad

  22. Royal Hospital, Muscat, Oman

    Bader AlHadhrami

  23. Alhaifi Private Clinic, Kuwait, Kuwait

    Mohammad AlHaifi

  24. Wellington Hospital, Wellington, UK

    Ali AlHamdani

  25. Sidra Hospital, Kuwait, Kuwait

    Ibrahim Hassan

  26. International Center of Excellence in Bariatric and Metabolic Surgery, Hospital BC, Tijuana, Mexico

    Selim Jalil Illan

  27. In Charge Metabolic, Thoracic and General Surgery Unit III, Department of General Surgery, Pakistan Institute of Medical Sciences, Islamabad, Pakistan

    Atif Inam

  28. Faculty of Medicine, Aswan University, Aswan, Egypt

    Aiman Ismaeil

  29. Cork University Hospital, Cork, Ireland

    Yasser Kayyal

  30. Ministry of Health, Kuwait, Kuwait

    Khaleel Mohammad

  31. Walsall Healthcare NHS Trust, Walsall, UK

    Amir Ulhagh Khan & Salman Mirza

  32. Health Sciences Center, Department of Surgery, Kuwait, Kuwait

    Mousa khoursheed

  33. Chelsea and Westminster Hospital, London, UK

    Haris Khwaja

  34. Founding President MGB-OAGB Club, Kular Research Institute, Bija, India

    K. S. Kular

  35. HOD Surgical Bariatric Department, Dubai, UAE

    Laurent Abram Layani

  36. Shalimar Medical and Dental College, Lahore, Pakistan

    Maazulhassan

  37. Sharjah University Hospital, Mansoura Faculty of Medicine, Sharjah, UAE

    Tarek Mahdy

  38. South City Hospital, Karachi, Pakistan

    Mumtaz Maher

  39. Private Practice, Durban, South Africa

    Ebrahim Mansoor

  40. Faculty of Medicine, Brawijaya University, Dr Saiful Anwar General Hospital, Malang, Indonesia

    Muhammad S. Niam

  41. First Surgical Disease Department, Azerbaijan Medical University, Baku, Azerbaijan

    Taryel Omarov

  42. New You Medical Center, King Saud University, Obesity Chair, Riyadh, Saudi Arabia

    Aayed R. Alqahtani

  43. Inova Fair Oaks Hospital, COE Bariatric Center, 14904 Jefferson Davis Hwy, Suite 205, Woodbridge, VA, 22191, USA

    Masoud Rezvani

  44. Alsadir Teaching Hospital, Najaf, Iraq

    Safauldeen Salim

  45. Yong Loo Lin School of Medicine, National University of Singapore, Singapore; Department of Surgery, University Surgical Cluster, National University Health System, Singapore, Singapore

    Asim Shabbir

  46. CHU de Montpellier, Montpellier, France

    Mehdi Skalli

  47. Bariatric Unit, Plastic and Obesity Surgery Department, Assiut University Hospital, Assiut, Egypt

    Osama Taha

  48. Department of General Surgery, Sina Hospital, Tehran University of Medical Sciences, Tehran, Iran

    Mohammad Talebpour

  49. Cerrahpasa Medical Faculty, Department of Surgery, Istanbul University Cerrahpasa, Istanbul, Turkey

    Halit Eren Taskin & Mustafa Taskin

  50. Evercare Hospital, Lahore, Pakistan

    Tahir Yunus

  51. Department of Digestive Surgery, CHU Félix Guyon, Saint Denis, La Réunion, France

    Radwan Kassir

  52. Chief, Bariatric and Metabolic Surgery Carolinas Medical Center, Ballantyne and Gastonia Director, Atrium Health University of North Carolina-Charlotte Campus Director, Bariatric Fellowship Program Carolinas Medical Center-Mercy, Atrium Health Weight Management Charlotte, ConcordCharlotte, NC, USA

    Abdelrahman Nimeri

Authors
  1. Mohammad Kermansaravi
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  2. Islam Omar
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  3. Kamal Mahawar
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  61. Abdelrahman Nimeri
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Corresponding author

Correspondence to Abdelrahman Nimeri.

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Key Points

• Fasting is safe after metabolic and bariatric surgery [MBS].

• Fasting needs special nutritional support in patients after MBS.

• Patients after MBS should avoid fasting if they have food intolerance.

• Fasting after MBS helps in weight loss and improvement of obesity-related medical problems.

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Kermansaravi, M., Omar, I., Mahawar, K. et al. Religious Fasting of Muslim Patients After Metabolic and Bariatric Surgery: a Modified Delphi Consensus. OBES SURG 31, 5303–5311 (2021). https://doi.org/10.1007/s11695-021-05724-z

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