Impact of Weight Bias, Stigma and Discrimination on Physical, Mental, and Quality of Life Outcomes of Metabolic and Bariatric Surgery: A Systematic Review

BACKGROUND: Weight-related bias, stigma, and discrimination significantly affect quality of life and health in persons with obesity. Their influence on post-operative outcomes following metabolic surgery and bariatric remains underexplored. OBJECTIVES: This systematic review aimed to evaluate any impact of pre- and post-operative weight bias, stigma, and discrimination on post-metabolic and bariatric surgery outcomes, specifically physical health and mental health, including quality of life. METHODS: This review was conducted in accordance with the PRISMA 2020 guidelines, with the protocol registered on PROSPERO. Comprehensive searches were performed across MEDLINE, PsycINFO, Embase, Web of Science, PEDro, CINAHL, ISRCTN, and CENTRA. Eligible studies included randomized controlled trials, clinical trials, longitudinal studies, cross-sectional studies, and qualitative research involving patients who underwent metabolic and bariatric surgery. Risk of bias was assessed using validated tools tailored to study design. RESULTS: Eleven studies met the inclusion criteria, examining the influence of weight bias, stigma, and discrimination on post-surgical outcomes. Physical health outcomes included weight loss and BMI. Mental health outcomes included depressive symptoms, disordered eating behaviours, and quality of life domains such as social interactions, occupational settings, sexual health, educational experiences, and post-surgical health management. Findings suggest that weight bias negatively influences mental health and quality of life, associating with depressive symptoms, problematic eating, and lower adherence to nutritional instructions and exercise, potentially impeding optimal physical outcomes. CONCLUSIONS: Despite some studies suggesting its negative impact on postoperative outcomes, current evidence on the impact of weight bias, stigma, and discrimination on post-metabolic and bariatric surgery outcomes is limited. Critical gaps remain in understanding how these psychosocial factors affect long-term disease management, self-care, and overall quality of life.