TOPLINE:

Bariatric surgery is associated with short-term improvements in employment and work productivity among patients with obesity; however, employment rates followed a reverse U-shaped trajectory, returning to baseline levels after about 5 years. 

METHODOLOGY:

• Most economic evaluations of bariatric surgery focus on healthcare costs and overlook productivity or other societal costs (eg, absenteeism). Prior studies on occupational outcomes have reported mixed findings.
• Researchers conducted a systematic review of three biomedical and two economic databases through April 2024 to assess employment status and productivity in adults with obesity (BMI ≥ 30) who underwent any bariatric surgery.
• Occupational outcomes were compared before and after surgery and, when available, between surgical and nonsurgical cohorts.
• Primary outcomes included employment status, return to work/unemployment, disability pension, and productivity measures (absenteeism/sick leave, presenteeism, work hours).

TAKEAWAY:

• Forty-two studies (159,678 patients; mean age, 32.4-49.9 years; 54.9%-100% female; follow-up, 0.6-20 years ) were included; 38 reported pre- and post-surgical outcomes, and 13 included surgical vs nonsurgical comparisons. Most studies examined Roux-en-Y gastric bypass and were conducted in high-income countries.
• Employment rates rose from 54.4% to 66.4% at year 1, remained stable through year 4, and decreased by year 5 after surgery; unemployment rates showed a similar reversed U-shaped trend, decreasing initially but returning to baseline levels at year 5 (pooled data from 27 studies).
• After surgery, absenteeism/sick leave decreased (5/10 comparisons), work capacity improved (4/4), and work hours increased (4/5). Studies comparing surgical with nonsurgical patients showed short-term gains in employment and return-to-work, but long-term benefits were inconsistent.
• Barriers to improved occupational outcomes included insufficient weight loss, female sex, older age, preoperative comorbidities, lower quality of life, and limited prior work experience.

IN PRACTICE:

"This project highlights the critical need for long-term strategies to maintain and amplify the occupational benefits post-surgery and to develop targeted interventions for at-risk populations," the authors wrote.

SOURCE:

This study was led by Qing Xia, PhD, Queensland University of Technology, Brisbane, Australia. It was published online in JAMA Surgery.

LIMITATIONS: 

There was substantial heterogeneity in outcomes, procedures, and settings. Many studies were small with limited follow-up. Labeling missed work hours as "short-term work loss" obscured whether some absences reflected longer-term disability or early retirement.

DISCLOSURES:

This study received funding through a grant from the 2023 Queensland University of Technology Centre for Healthcare Transformation. The authors reported no conflicts of interest.

This article was created using several editorial tools, including AI, as part of the process. Human editors reviewed this content before publication.