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Impact of smoking on weight loss outcomes after bariatric surgery: a literature review

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Abstract

Background

The association between smoking and surgical complications after bariatric surgery has been well-established. However, given that this patient population is inherently weight-concerned, understanding the effects of tobacco use on postoperative weight loss is essential to guiding clinicians in counseling patients. We aimed to summarize the current literature examining the effects of preoperative and postoperative smoking, as well as changes in smoking status, on bariatric surgery weight loss outcomes.

Methods

Ovid MEDLINE, PubMed, and SCOPUS databases were queried to identify relevant published studies.

Results

Overall, 20 studies were included. Preoperative and postoperative smoking rates varied widely across studies, as did requirements for smoking cessation prior to bariatric surgery. Reported preoperative smoking prevalence ranged from 1 to 62%, and postoperative smoking prevalence ranged from 6 to 43%. The majority of studies which examined preoperative and/or postoperative smoking habits found no association between smoking habits and postoperative weight loss outcomes. A minority of studies found relatively small differences in postoperative weight loss between smokers and nonsmokers; these often became nonsignificant with longer follow-up. No studies found significant associations between changes in smoking status and weight loss outcomes.

Conclusion

While smoking has been associated with weight loss in the general population, most current evidence demonstrates that smoking habits are not associated with weight loss outcomes after bariatric surgery. However, due to the heterogeneity in study design and analysis, no definitive conclusions can be made, and more robust studies are needed to investigate any relationship between smoking and long-term weight loss outcomes. Given the established increased risk of surgical complications and mortality in smokers, smoking cessation should be encouraged.

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Authors and Affiliations

  1. Division of Upper GI and General Surgery, Department of Surgery, Keck School of Medicine of USC, 1510 San Pablo St., Suite 514, Los Angeles, CA, 90033, USA

    Sukriti Mohan & Kamran Samakar

  2. Department of Medicine, Cedars Sinai Medical Center, Los Angeles, CA, USA

    Jamil S. Samaan

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  1. Sukriti Mohan
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  2. Jamil S. Samaan
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  3. Kamran Samakar
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Correspondence to Kamran Samakar.

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Ms. Sukriti Mohan, Dr. Jamil S. Samaan, and Dr. Kamran Samakar have no conflicts of interest or financial ties to disclose.

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Mohan, S., Samaan, J.S. & Samakar, K. Impact of smoking on weight loss outcomes after bariatric surgery: a literature review. Surg Endosc 35, 5936–5952 (2021). https://doi.org/10.1007/s00464-021-08654-0

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