Postoperative Management After Metabolic Surgery: Role of the Family Physician

Lindsay Green, MD
Christopher Dunlap, MD
Craig Glass, MD

American Family Physician. 2026;113(5):469-478.

Author disclosure: No relevant financial relationships.

This clinical content conforms to AAFP criteria for CME.

Obesity is associated with cardiometabolic risk factors and increased mortality. Treatment of obesity includes lifestyle modifications, pharmacotherapy, and surgical management with metabolic and bariatric surgery. In 2022, approximately 270,000 bariatric procedures were performed in the United States. Metabolic and bariatric surgery produces sustained weight loss and improvement in chronic conditions such as type 2 diabetes, hypertension, obstructive sleep apnea, and infertility. Family physicians are positioned to provide long-term care for patients seeking surgical attention for obesity and obesity-related complications, highlighting the importance of education regarding associated acute, subacute, and chronic complications, and changes in neurohormonal regulation that affect digestion and fertility. Improvements in obesity-related conditions should be monitored and medications adjusted as necessary. Understanding of common complications (eg, gastroesophageal reflux disease, dumping syndrome, changes in stool habits, nutritional deficiencies) and changes in cardiometabolic risk factors and fertility enables the family physician to provide comprehensive care for patients after metabolic and bariatric surgery.

LINDSAY GREEN, MD, is core faculty and director of the Obstetrics Fellowship at the University of Tennessee Health Science Center Family Medicine Residency Program, Murfreesboro.

CHRISTOPHER DUNLAP, MD, is the program director of the University of Tennessee Health Science Center Family Medicine Residency Program.

CRAIG GLASS, MD, is the associate program director of the University of Tennessee Health Science Center Family Medicine Residency Program.

Address correspondence to Lindsay Green, MD, at lindsay.green@ascension.org.

Author disclosure: No relevant financial relationships.

  1. 1.Eisenberg D, Shikora SA, Aarts E, et al. 2022 American Society for Metabolic and Bariatric Surgery (ASMBS) and International Federation for the Surgery of Obesity and Metabolic Disorders (IFSO): indications for metabolic and bariatric surgery. Surg Obes Relat Dis. 2022;18(12):1345-1356.
  2. 2.Emmerich SD, Fryar CD, Stierman B, et al. Obesity and severe obesity prevalence in adults: United States, August 2021–August 2023. NCHS Data Brief. 2024(508):10.15620/cdc/159281.
  3. 3.Heneghan HM, Meron-Eldar S, Brethauer SA, et al. Effect of bariatric surgery on cardiovascular risk profile. Am J Cardiol. 2011;108(10):1499-1507.
  4. 4.Stenberg E, Ottosson J, Näslund E. Remission of obesity-related sleep apnea and its effect on mortality and cardiovascular events after metabolic and bariatric surgery: a propensity-matched cohort study. J Am Coll Surg. 2024;239(2):77-84.
  5. 5.Aminian A, Al-Kurd A, Wilson R, et al. Association of bariatric surgery with major adverse liver and cardiovascular outcomes in patients with biopsy-proven nonalcoholic steatohepatitis. JAMA. 2021;326(20):2031-2042.
  6. 6.Clapp B, Ponce J, Corbett J, et al. American Society for Metabolic and Bariatric Surgery 2022 estimate of metabolic and bariatric procedures performed in the United States. Surg Obes Relat Dis. 2024;20(5):425-431.
  7. 7.Yanovski SZ, Yanovski JA. Approach to obesity treatment in primary care: a review. JAMA Intern Med. 2024;184(7):818-829.
  8. 8.Mechanick JI, Apovian C, Brethauer S, et al. Clinical practice guidelines for the perioperative nutrition, metabolic, and nonsurgical support of patients undergoing bariatric procedures - 2019 update: cosponsored by American Association of Clinical Endocrinologists/American College of Endocrinology, The Obesity Society, American Society for Metabolic & Bariatric Surgery, Obesity Medicine Association, and American Society of Anesthesiologists - executive summary. Endocr Pract. 2019;25(12):1346-1359.
  9. 9.McGlone ER, Carey I, Veličković V, et al. Bariatric surgery for patients with type 2 diabetes mellitus requiring insulin: clinical outcome and cost-effectiveness analyses. PLoS Med. 2020;17(12):e1003228.
  10. 10.Smith VA, Zepel L, Kawatkar AA, et al. Health expenditures after bariatric surgery: a retrospective cohort study. Ann Surg. 2024;280(6):e8-e16.
  11. 11.Sjöström L, Narbro K, Sjöström CD, et al.; Swedish Obese Subjects Study. Effects of bariatric surgery on mortality in Swedish obese subjects. N Engl J Med. 2007;357(8):741-752.
  12. 12.Adams TD, Gress RE, Smith SC, et al. Long-term mortality after gastric bypass surgery. N Engl J Med. 2007;357(8):753-761.
  13. 13.Syn NL, Cummings DE, Wang LZ, et al. Association of metabolic-bariatric surgery with long-term survival in adults with and without diabetes: a one-stage meta-analysis of matched cohort and prospective controlled studies with 174 772 participants. Lancet. 2021;397(10287):1830-1841.
  14. 14.Bramante C, Wise E, Chaudhry Z. Care of the patient after metabolic and bariatric surgery. Ann Intern Med. 2022;175(5):ITC65-ITC80.
  15. 15.Robertson AGN, Wiggins T, Robertson FP, et al. Perioperative mortality in bariatric surgery: meta-analysis. Br J Surg. 2021;108(8):892-897.
  16. 16.Coblijn UK, Karres J, de Raaff CAL, et al. Predicting postoperative complications after bariatric surgery: the Bariatric Surgery Index for Complications, BASIC. Surg Endosc. 2017;31(11):4438-4445.
  17. 17.Benotti P, Wood GC, Winegar DA, et al. Risk factors associated with mortality after Roux-en-Y gastric bypass surgery. Ann Surg. 2014;259(1):123-130.
  18. 18.Livingston EH, Huerta S, Arthur D, et al. Male gender is a predictor of morbidity and age a predictor of mortality for patients undergoing gastric bypass surgery. Ann Surg. 2002;236(5):576-582.
  19. 19.Stone G, Samaan JS, Samakar K. Racial disparities in complications and mortality after bariatric surgery: a systematic review. Am J Surg. 2022;223(5):863-878.
  20. 20.Ghusn W, Mosleh KA, Hage K, et al. A comprehensive analysis of health care inequities in randomized clinical trials following bariatric surgeries. Am J Surg. 2024;237:115796.
  21. 21.Ljungqvist O, Scott M, Fearon KC. Enhanced recovery after surgery: a review. JAMA Surg. 2017;152(3):292-298.
  22. 22.Medhati P, Saleh OS, Nimeri A, et al. Outcomes and management of re-establishing bariatric patients. J Am Coll Surg. 2024;238(6):1035-1043.
  23. 23.Banerjee ES, Schroeder R, Harrison TD. Metabolic surgery for adult obesity: common questions and answers. Am Fam Physician. 2022;105(6):593-601.
  24. 24.Moore M, Hopkins J, Wainwright P. Primary care management of patients after weight loss surgery. BMJ. 2016;352:i945.
  25. 25.Skossyrskiy V, Stepochkin D, Zaharova E, et al. A contemporary perspective on long-term complications of bariatric surgery. Obes Surg. 2026;36(2):758-785.
  26. 26.Bretón I, Ballesteros-Pomar MD, Calle-Pascual A, et al. Micronutrients in pregnancy after bariatric surgery: a narrative review. J Clin Med. 2023;12(16):5429.
  27. 27.Cleere EF, Davey MG, Crotty TJ, et al. Hypocalcaemia following thyroidectomy among patients who have previously undergone bariatric surgery: systematic review and meta-analysis. Br J Surg. 2022;109(12):1198-1205.
  28. 28.Committee on Practice Bulletins-Obstetrics. ACOG practice bulletin no. 189: nausea and vomiting of pregnancy. Obstet Gynecol. 2018;131(1):e15-e30.
  29. 29.Scibora LM. Skeletal effects of bariatric surgery: examining bone loss, potential mechanisms and clinical relevance. Diabetes Obes Metab. 2014;16(12):1204-1213.
  30. 30.Vahtera V, Pajarinen J, Kivimäki M, et al. Cohort study on incidence of new-onset type 2 diabetes in patients after bariatric surgery and matched controls. Br J Surg. 2024;111(4):znae105.
  31. 31.Sjöström L, Peltonen M, Jacobson P, et al. Association of bariatric surgery with long-term remission of type 2 diabetes and with microvascular and macrovascular complications. JAMA. 2014;311(22):2297-2304.
  32. 32.Mingrone G, Panunzi S, De Gaetano A, et al. Metabolic surgery versus conventional medical therapy in patients with type 2 diabetes: 10-year follow-up of an open-label, single-centre, randomised controlled trial. Lancet. 2021;397(10271):293-304.
  33. 33.Miras AD, Pérez-Pevida B, Aldhwayan M, et al. Adjunctive liraglutide treatment in patients with persistent or recurrent type 2 diabetes after metabolic surgery (GRAVITAS): a randomised, double-blind, placebo-controlled trial. Lancet Diabetes Endocrinol. 2019;7(7):549-559.
  34. 34.Mok J, Adeleke MO, Brown A, et al. Safety and efficacy of liraglutide, 3.0 mg, once daily vs placebo in patients with poor weight loss following metabolic surgery: the BARI-OPTIMISE randomized clinical trial. JAMA Surg. 2023;158(10):1003-1011.
  35. 35.Gulinac M, Miteva DG, Peshevska-Sekulovska M, et al. Long-term effectiveness, outcomes and complications of bariatric surgery. World J Clin Cases. 2023;11(19):4504-4512.
  36. 36.van Veldhuisen SL, Gorter TM, van Woerden G, et al. Bariatric surgery and cardiovascular disease: a systematic review and meta-analysis. Eur Heart J. 2022;43(20):1955-1969.
  37. 37.Sampalis JS, Sampalis F, Christou N. Impact of bariatric surgery on cardiovascular and musculoskeletal morbidity. Surg Obes Relat Dis. 2006;2(6):587-591.
  38. 38.O’Keefe EL, Sturgess JE, O’Keefe JH, et al. Prevention and treatment of atrial fibrillation via risk factor modification. Am J Cardiol. 2021;160:46-52.
  39. 39.Reynolds K, Barton LJ, Basu A, et al. Comparative effectiveness of gastric bypass and vertical sleeve gastrectomy for hypertension remission and relapse: the ENGAGE CVD study. Hypertension. 2021;78(4):1116-1125.
  40. 40.Lim PW, Stucky CH, Wasif N, et al. Bariatric surgery and longitudinal cancer risk: a review. JAMA Surg. 2024;159(3):331-338.
  41. 41.Hawkins DN, Faler BJ, Choi YU, et al. Time course of blood pressure decrease after bariatric surgery in normotensive and hypertensive patients. Obes Surg. 2018;28(7):1845-1851.
  42. 42.Castaneda D, Popov VB, Wander P, et al. Risk of suicide and self-harm is increased after bariatric surgery—a systematic review and meta-analysis. Obes Surg. 2019;29(1):322-333.
  43. 43.Konttinen H, Sjöholm K, Jacobson P, et al. Prediction of suicide and nonfatal self-harm after bariatric surgery: a risk score based on sociodemographic factors, lifestyle behavior, and mental health: a nonrandomized controlled trial. Ann Surg. 2021;274(2):339-345.
  44. 44.Lagerros YT, Brandt L, Hedberg J, et al. Suicide, self-harm, and depression after gastric bypass surgery: a nationwide cohort study. Ann Surg. 2017;265(2):235-243.
  45. 45.Neovius M, Bruze G, Jacobson P, et al. Risk of suicide and non-fatal self-harm after bariatric surgery: results from two matched cohort studies. Lancet Diabetes Endocrinol. 2018;6(3):197-207.
  46. 46.Dalaei F, de Vries CEE, Poulsen L, et al. Body contouring surgery after bariatric surgery improves long-term health-related quality of life and satisfaction with appearance: an international longitudinal cohort study using the BODY-Q. Ann Surg. 2024;279(6):1008-1017.
  47. 47.Fausta M, Claudio C, Mario M, et al. Psychological and psychiatric standardized procedures for metabolic bariatric surgery: a clinical practice model for mental health providers. Updates Surg. 2025;77(7):1951-1966.
  48. 48.King WC, Chen JY, Courcoulas AP, et al. Alcohol and other substance use after bariatric surgery: prospective evidence from a U.S. multicenter cohort study. Surg Obes Relat Dis. 2017;13(8):1392-1402.
  49. 49.Spadola CE, Wagner EF, Dillon FR, et al. Alcohol and drug use among postoperative bariatric patients: a systematic review of the emerging research and its implications. Alcohol Clin Exp Res. 2015;39(9):1582-1601.
  50. 50.Ivezaj V, Benoit SC, Davis J, et al. Changes in alcohol use after metabolic and bariatric surgery: predictors and mechanisms. Curr Psychiatry Rep. 2019;21(9):85.
  51. 51.Clapp B, Portela R, Sharma I, et al. Risk of non-hormonal cancer after bariatric surgery: meta-analysis of retrospective observational studies. Br J Surg. 2022;110(1):24-33.
  52. 52.Kristensson FM, Andersson-Assarsson JC, Peltonen M, et al. Breast cancer risk after bariatric surgery and influence of insulin levels: a nonrandomized controlled trial. JAMA Surg. 2024;159(8):856-863.
  53. 53.Lovrics O, Butt J, Lee Y, et al. The effect of bariatric surgery on breast cancer incidence and characteristics: a meta-analysis and systematic review. Am J Surg. 2021;222(4):715-722.
  54. 54.Menke MN, King WC, White GE, et al. Contraception and conception after bariatric surgery. Obstet Gynecol. 2017;130(5):979-987.
  55. 55.Samarasinghe SNS, Leca B, Alabdulkader S, et al. Bariatric surgery for spontaneous ovulation in women living with polycystic ovary syndrome: the BAMBINI multicentre, open-label, randomised controlled trial. Lancet. 2024;403(10443):2489-2503.
  56. 56.Boller MJ, Xu F, Lee C, et al. Perinatal outcomes after bariatric surgery compared with a matched control group. Obstet Gynecol. 2023;141(3):583-591.
  57. 57.Ceulemans D, Deleus E, Benhalima K, et al. Pregnancy after metabolic bariatric surgery: risks and rewards for mother and child. BJOG. 2025;132(4):401-413.
  58. 58.Patey O, Bartsota M, Maric T, et al. Impact of maternal bariatric surgery on offspring perinatal cardiac function: a prospective study. BJOG. 2024;131(8):1080-1088.
  59. 59.Kok SN, Kim SJ, Grothe K, et al. The prevalence of postnatal depression in women with a history of bariatric surgery [33R]. Obstet Gynecol. 2018;131(1):203S.
  60. 60.Alalwan AA, Friedman J, Park H, et al. US national trends in bariatric surgery: a decade of study. Surgery. 2021;170(1):13-17.
  61. 61.ACOG practice bulletin no. 105: bariatric surgery and pregnancy. Obstet Gynecol. 2009;113(6):1405-1413.
  62. 62.Demerdash HM. Weight regain after bariatric surgery: promoters and potential predictors. World J Metaanal. 2021;9(5):438-454.
  63. 63.Grover BT, Morell MC, Kothari SN, et al. Defining weight loss after bariatric surgery: a call for standardization. Obes Surg. 2019;29(11):3493-3499.
  64. 64.Shawe J, Ceulemans D, Akhter Z, et al. Pregnancy after bariatric surgery: consensus recommendations for periconception, antenatal and postnatal care. Obes Rev. 2019;20(11):1507-1522.

Copyright © 2026 by the American Academy of Family Physicians.

This content is owned by the AAFP. A person viewing it online may make one printout of the material and may use that printout only for his or her personal, non-commercial reference. This material may not otherwise be downloaded, copied, printed, stored, transmitted or reproduced in any medium, whether now known or later invented, except as authorized in writing by the AAFP. See permissions for copyright questions and/or permission requests.