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TOPLINE:

Weight bias, stigma, and discrimination were associated with poorer mental health, less favorable weight outcomes, and lower quality of life (QOL) after metabolic and bariatric surgery, although evidence on long‑term physical effects remained limited.

METHODOLOGY:

• Researchers conducted a systematic review of English-language studies identified through comprehensive database searches to evaluate the effects of pre- and postoperative weight bias, stigma, and discrimination on outcomes after metabolic and bariatric surgery.
• Eligible studies included randomized controlled trials, clinical trials, longitudinal studies, cross-sectional studies, and qualitative studies, which were assessed for risk for bias and quality using validated tools.
• Surgical procedures included Roux-en-Y gastric bypass, sleeve gastrectomy, gastric banding, single anastomosis duodenal-ileal bypass with sleeve gastrectomy, one-anastomosis gastric bypass, and biliopancreatic diversion.
• Outcomes included physical health measures (weight loss or BMI), mental health outcomes (depressive symptoms or disordered eating behaviors), and QoL metrics such as social interactions, occupational settings, sexual health, educational experiences, and postsurgical health management.

TAKEAWAY:

• Eleven studies were included, comprising 2231 adults with obesity (75%-100% women; BMI ≥ 25 at time surgery), with sample sizes ranging from 14 to 564.
• Six studies evaluated weight- or BMI-related outcomes and found that higher pre‑ or postoperative internalized or experienced weight stigma was linked to poorer weight outcomes.
• Greater preoperative internalized bias predicted less weight loss at 1-year, unresolved preoperative shame was linked to substantially smaller weight loss, and higher postoperative internalized bias correlated with smaller BMI change and higher current BMI.
• Nine studies assessed mental health outcomes and found that higher pre‑ or postoperative internalized or experienced weight stigma was linked to greater depression, anxiety, binge eating, and disordered eating.
• Across six studies evaluating QOL domains, postoperative internalized weight stigma was associated with lower supplementation adherence, more barriers to physical activity, lower exercise self-efficacy, reduced moderate-to-vigorous physical activity, and poorer mental health-related QOL.
• No studies directly measured physiologic metrics (eg, hormonal or cardiovascular markers), highlighting substantial underreporting of the potential systemic effects of stigma.

IN PRACTICE:

“These findings underline an urgent need to recognize and address weight-related psychosocial determinants as integral components of metabolic and bariatric care,” the authors wrote.

SOURCE:

This study was led by Eugenia Romano, King’s College London, London, England. It was published online in Obesity Surgery.

LIMITATIONS:

The review included only English-language studies. Some studies relied on recalled experiences rather than direct measures of weight bias, stigma, and discrimination, potentially limiting assessment accuracy.

DISCLOSURES:

Funding information was not explicitly reported. The authors declared having no competing interests.

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