Comprehensive Overview - Outcomes and Challenges of Bariatric Surgery - Physical, Psychological and Nutritional Considerations
DOI:
https://doi.org/10.12775/JEHS.2025.78.57662Keywords
obesity, bariatric surgery, postoperative outcomesAbstract
Obesity, defined by excessive and abnormal body fat accumulation, leads to various health conditions such as diabetes, cardiovascular diseases, and certain cancers, significantly affecting the health and increasing the risk of mortality. Bariatric surgery offers a treatment for severe obesity, with restrictive and malabsorptive methods like sleeve gastrectomy (SG), adjustable gastric banding (AGB), Roux-en-Y gastric bypass (RYGB), biliopancreatic diversion (BPD). While bariatric surgery is effective for weight loss and health improvement, it is not without complications. Postoperative challenges include surgical complications, bone loss, nutritional deficiencies and changes in metabolism. Post-bariatric surgery patients may face psychological challenges such as emotional dysregulation, eating disorders like loss of control eating or binge eating, and body image concerns related to excess skin. This article explores the various impacts of bariatric surgery, addressing both physical and psychological challenges. It emphasizes the importance of holistic patient care, considering both physical outcomes and mental health post-surgery, to ensure long-term success.
Materials and methods
The article is a result of the review of the scientific literature searched by keywords “bariatric surgery”, “negative outcomes”, “obesity’’ available in Pubmed database. This overview does not cover all possible postoperative complications in bariatric surgery, but focuses on selected issues important for a comprehensive strategy for managing obesity.
Aim of the study
The aim of the study is to review the various complications and long-term effects of bariatric surgery, with a particular focus on specific issues that are important for a holistic approach to obesity treatment.
References
1. Mayoral LP, Andrade GM, Mayoral EP, et al. Obesity subtypes, related biomarkers & heterogeneity. Indian J Med Res. 2020;151(1):11-21. https://doi.org/10.4103/ijmr.IJMR_1768_17
2. Bray GA. Evaluation of obesity. Who are the obese?. Postgrad Med. 2003;114(6):19-38. https://doi.org/10.3810/pgm.2003.12.1544
3. Romero-Corral A, Somers VK, Sierra-Johnson J, et al. Accuracy of body mass index in diagnosing obesity in the adult general population. Int J Obes (Lond). 2008;32(6):959-966. https://doi.org/10.1038/ijo.2008.11
4. Kloock S, Ziegler CG, Dischinger U. Obesity and its comorbidities, current treatment options and future perspectives: Challenging bariatric surgery?. Pharmacol Ther. 2023;251:108549. https://doi.org/10.1016/j.pharmthera.2023.108549
5. Arterburn DE, Courcoulas AP. Bariatric surgery for obesity and metabolic conditions in adults. BMJ. 2014;349:g3961. Published 2014 Aug 27. https://doi.org/10.1136/bmj.g3961
6. Fink J, Seifert G, Blüher M, Fichtner-Feigl S, Marjanovic G. Obesity Surgery. Dtsch Arztebl Int. 2022;119(5):70-80. https://doi.org/10.3238/arztebl.m2021.0359
7. Kassir R, Debs T, Blanc P, et al. Complications of bariatric surgery: Presentation and emergency management. Int J Surg. 2016;27:77-81. https://doi.org/10.1016/j.ijsu.2016.01.067
8. Burgos AM, Braghetto I, Csendes A, et al. Gastric leak after laparoscopic-sleeve gastrectomy for obesity. Obes Surg. 2009;19(12):1672-1677. https://doi.org/10.1007/s11695-009-9884-9
9. Kassir R, Gugenheim J, Debs T, Tiffet O, Amor IB, Boutet C. Staple Line Bleeding in Sleeve Gastrectomy: a Simple and Cost-Effective Solution. Obes Surg. 2016;26(12):3021-3022. https://doi.org/10.1007/s11695-016-2394-7
10. Kassir R, Debs T, Ben Amor I, et al. Management of complications following bariatric surgery: summary. Int J Surg. 2014;12(12):1462-1464. https://doi.org/10.1016/j.ijsu.2014.11.009
11. Yu EW. Re: Bone Metabolism After Bariatric Surgery. J Bone Miner Res. 2018;33(5):959. https://doi.org/10.1002/jbmr.3430
12. De Prisco C, Levine SN. Metabolic bone disease after gastric bypass surgery for obesity. Am J Med Sci. 2005;329(2):57-61. https://doi.org/10.1097/00000441-200502000-00001
13. Nascimento IMCD, Padilha BM, Araujo MLD, et al. VITAMIN D LEVELS AND LIPID PROFILE IN PATIENTS UNDERGOING BARIATRIC SURGERY. Arq Bras Cir Dig. 2023;36:e1753. Published 2023 Jul 28. https://doi.org/10.1590/0102-672020230035e1753
14. Lespessailles E, Hammoud E, Toumi H, Ibrahim-Nasser N. Consequences of bariatric surgery on outcomes in rheumatic diseases. Arthritis Res Ther. 2019;21(1):83. Published 2019 Mar 28. https://doi.org/10.1186/s13075-019-1869-z
15. Lupoli R, Lembo E, Saldalamacchia G, Avola CK, Angrisani L, Capaldo B. Bariatric surgery and long-term nutritional issues. World J Diabetes. 2017;8(11):464-474. https://doi.org/10.4239/wjd.v8.i11.464
16. Antozzi P, Soto F, Arias F, et al. Development of acute gouty attack in the morbidly obese population after bariatric surgery. Obes Surg. 2005;15(3):405-407. https://doi.org/10.1381/0960892053576802
17. Delamere JP, Baddeley RM, Walton KW. Jejuno-ileal bypass arthropathy: its clinical features and associations. Ann Rheum Dis. 1983;42(5):553-557. doi:10.1136/ard.42.5.553 https://doi.org/10.1136/ard.42.5.553
18. Tu J, Chan JJ, Yu LL. Bowel bypass syndrome/bowel-associated dermatosis arthritis syndrome post laparoscopic gastric bypass surgery. Australas J Dermatol. 2011;52(1):e5-e7. https://doi.org/10.1111/j.1440-0960.2009.00614.x
19. Callen JP. Neutrophilic dermatoses. Dermatol Clin. 2002;20(3):409-419. https://doi.org/10.1016/s0733-8635(02)00006-2
20. Gowanlock Z, Lezhanska A, Conroy M, et al. Iron deficiency following bariatric surgery: a retrospective cohort study. Blood Adv. 2020;4(15):3639-3647. https://doi.org/10.1182/bloodadvances.2020001880
21. 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. Obesity (Silver Spring). 2013;21 Suppl 1(0 1):S1-S27. https://doi.org/10.1002/oby.20461
22. Sherf-Dagan S, Goldenshluger A, Azran C, Sakran N, Sinai T, Ben-Porat T. Vitamin K-what is known regarding bariatric surgery patients: a systematic review. Surg Obes Relat Dis. 2019;15(8):1402-1413. https://doi.org/10.1016/j.soard.2019.05.031
23. Handzlik-Orlik G, Holecki M, Orlik B, Wyleżoł M, Duława J. Nutrition management of the post-bariatric surgery patient. Nutr Clin Pract. 2015;30(3):383-392. https://doi.org/10.1177/0884533614564995
24. Clements RH, Katasani VG, Palepu R, et al. Incidence of vitamin deficiency after laparoscopic Roux-en-Y gastric bypass in a university hospital setting. Am Surg. 2006;72(12):1196-1204. https://doi.org/10.1177/000313480607201209
25. Stein J, Stier C, Raab H, Weiner R. Review article: The nutritional and pharmacological consequences of obesity surgery. Aliment Pharmacol Ther. 2014;40(6):582-609. https://doi.org/10.1111/apt.12872
26. Long AN, Atwell CL, Yoo W, Solomon SS. Vitamin B(12) deficiency associated with concomitant metformin and proton pump inhibitor use. Diabetes Care. 2012;35(12):e84. https://doi.org/10.2337/dc12-0980
27. Mallory GN, Macgregor AM. Folate Status Following Gastric Bypass Surgery (The Great Folate Mystery). Obes Surg. 1991;1(1):69-72. https://doi.org/10.1381/096089291765561493
28. Riess KP, Farnen JP, Lambert PJ, Mathiason MA, Kothari SN. Ascorbic acid deficiency in bariatric surgical population. Surg Obes Relat Dis. 2009;5(1):81-86. https://doi.org/10.1016/j.soard.2008.06.007
29. Sherf-Dagan S, Buch A, Ben-Porat T, Sakran N, Sinai T. Vitamin E status among bariatric surgery patients: a systematic review. Surg Obes Relat Dis. 2021;17(4):816-830. https://doi.org/10.1016/j.soard.2020.10.029
30. Bhakhri R, Ridder WH 3rd, Adrean S. Case Report: Delayed Vitamin A Retinopathy Secondary to Bariatric Surgery. Optom Vis Sci. 2019;96(3):227-232. https://doi.org/10.1097/OPX.0000000000001346
31. Lima de Carvalho JR Jr, Tsang SH, Sparrow JR. VITAMIN A DEFICIENCY MONITORED BY QUANTITATIVE SHORT WAVELENGTH FUNDUS AUTOFLUORESCENCE IN A CASE OF BARIATRIC SURGERY. Retin Cases Brief Rep. 2022;16(2):218-221. https://doi.org/10.1097/ICB.0000000000000931
32. Bjørklund G, Peana M, Pivina L, et al. Iron Deficiency in Obesity and after Bariatric Surgery. Biomolecules. 2021;11(5):613. Published 2021 Apr 21. https://doi.org/10.3390/biom11050613
33. Khanbhai M, Dubb S, Patel K, Ahmed A, Richards T. The prevalence of iron deficiency anaemia in patients undergoing bariatric surgery. Obes Res Clin Pract. 2015;9(1):45-49. https://doi.org/10.1016/j.orcp.2013.12.004
34. Sallé A, Demarsy D, Poirier AL, et al. Zinc deficiency: a frequent and underestimated complication after bariatric surgery. Obes Surg. 2010;20(12):1660-1670. https://doi.org/10.1007/s11695-010-0237-5
35. Cominetti C, Garrido AB Jr, Cozzolino SM. Zinc nutritional status of morbidly obese patients before and after Roux-en-Y gastric bypass: a preliminary report. Obes Surg. 2006;16(4):448-453. https://doi.org/10.1381/096089206776327305
36. Yanagisawa H. Zinc deficiency and clinical practice--validity of zinc preparations. Yakugaku Zasshi. 2008;128(3):333-339. https://doi.org/10.1248/yakushi.128.333
37. Krzizek EC, Brix JM, Stöckl A, Parzer V, Ludvik B. Prevalence of Micronutrient Deficiency after Bariatric Surgery. Obes Facts. 2021;14(2):197-204. https://doi.org/10.1159/000514847
38. Griffith DP, Liff DA, Ziegler TR, Esper GJ, Winton EF. Acquired copper deficiency: a potentially serious and preventable complication following gastric bypass surgery. Obesity (Silver Spring). 2009;17(4):827-831. https://doi.org/10.1038/oby.2008.614
39. Gasmi A, Bjørklund G, Mujawdiya PK, et al. Micronutrients deficiences in patients after bariatric surgery. Eur J Nutr. 2022;61(1):55-67. https://doi.org/10.1007/s00394-021-02619-8
40. Tobón GJ, Ospina FE, Suso JP, et al. Autoantibodies production and immunological abnormalities after bariatric surgery. J Transl Autoimmun. 2019;2:100024. Published 2019 Nov 9. https://doi.org/10.1016/j.jtauto.2019.100024
41. Cañas CA, Echeverri AF, Ospina FE, et al. Is Bariatric Surgery a Trigger Factor for Systemic Autoimmune Diseases?. J Clin Rheumatol. 2016;22(2):89-91. https://doi.org/10.1097/RHU.0000000000000363
42. Smolarczyk K, Meczekalski B, Rudnicka E, Suchta K, Szeliga A. Association of Obesity and Bariatric Surgery on Hair Health. Medicina (Kaunas). 2024;60(2):325. Published 2024 Feb 14. https://doi.org/10.3390/medicina60020325
43. Rojas P, Gosch M, Basfi-fer K, et al. Alopecia en mujeres con obesidad severa y mórbida sometidas a cirugía bariátrica [Alopecia in women with severe and morbid obesity who undergo bariatric surgery]. Nutr Hosp. 2011;26(4):856-862. https://doi.org/10.3305/nh.2011.26.4.5199
44. Cohen-Kurzrock RA, Cohen PR. Bariatric Surgery-Induced Telogen Effluvium (Bar SITE): Case Report and a Review of Hair Loss Following Weight Loss Surgery. Cureus. 2021;13(4):e14617. Published 2021 Apr 21. https://doi.org/10.7759/cureus.14617
45. Barbuti M, D'Alessandro G, Weiss F, et al. The Impact of Negative Emotional Dysregulation on the Outcome of Bariatric Surgery in Patients with Severe Obesity: An Observational One-Year Follow-Up Study. J Clin Med. 2024;13(17):5158. Published 2024 Aug 30. https://doi.org/10.3390/jcm13175158
46. Barbuti M, Carignani G, Weiss F, et al. Eating disorders and emotional dysregulation are associated with insufficient weight loss after bariatric surgery: a 1-year observational follow-up study. Eat Weight Disord. 2023;28(1):49. Published 2023 Jun 2. https://doi.org/10.1007/s40519-023-01574-z
47. Williams-Kerver GA, Steffen KJ, Mitchell JE. Eating Pathology After Bariatric Surgery: an Updated Review of the Recent Literature. Curr Psychiatry Rep. 2019;21(9):86. Published 2019 Aug 13. https://doi.org/10.1007/s11920-019-1071-7
48. Ivezaj V, Lawson JL, Lydecker JA, Duffy AJ, Grilo CM. Examination of night eating and loss-of-control eating following bariatric surgery. Eat Weight Disord. 2022;27(1):207-213. https://doi.org/10.1007/s40519-021-01156-x
49. Williams-Kerver GA, Steffen KJ, Mitchell JE. Eating Pathology After Bariatric Surgery: an Updated Review of the Recent Literature. Curr Psychiatry Rep. 2019;21(9):86. Published 2019 Aug 13. https://doi.org/10.1007/s11920-019-1071-7
50. de Lourdes M, Cerqueira L, Pinto-Bastos A, et al. Understanding Uncontrolled Eating after Bariatric Surgery: The Role of Excessive Skin and Body Image Shame. J Clin Med. 2021;10(13):2967. Published 2021 Jul 1. https://doi.org/10.3390/jcm10132967
Downloads
Published
How to Cite
Issue
Section
License
Copyright (c) 2025 Katarzyna Doman, Dawid Komada, Kamil Hermanowicz, Daria Oleksy, Agnieszka Najdek, Urszula Kaczmarska, Aleksandra Woźniak, Marcin Mycyk, Julia Nowak, Michał Jakub Cioch

This work is licensed under a Creative Commons Attribution-NonCommercial-ShareAlike 4.0 International License.
The periodical offers access to content in the Open Access system under the Creative Commons Attribution-NonCommercial-ShareAlike 4.0
Stats
Number of views and downloads: 86
Number of citations: 0