Budny Aleksandra, Janczy Agata, Mika Adriana
Division of Hypertension and Diabetology, Medical University of Gdansk, Gdansk, Poland.
Division of Food Commodity Science, Faculty of Health Sciences With the Institute of Maritime and Tropical Medicine, Medical University of Gdansk, Gdansk, Poland.
Curr Nutr Rep. 2025 Apr 29;14(1):64. doi: 10.1007/s13668-025-00652-1.
Bariatric surgery (BS) has emerged as a crucial and effective treatment for severe obesity (SO), providing significant and sustained weight loss and improving comorbidities. Optimizing perioperative careparticularly through structured prehabilitation is crucial for improving surgical outcomes and long-term weight management. This review examines the role of prehabilitation, nutrition, psychological support, physical activity, and pharmacologic treatment in improving the effectiveness of BS.
Despite the benefits of prehabilitation, there are significant differences in the way it is implemented in different healthcare centers. Protocols vary widely in terms of duration, components and intensity, leading to inconsistencies in patient preparation and postoperative recovery. Many patients still do not receive multidisciplinary support from dietitians, psychologists or physiotherapists prior to surgery, which can affect long-term outcomes. Barriers to effective prehabilitation include a lack of standardized guidelines, insufficient healthcare resources and limited patient adherence due to lack of awareness, low motivation or logistical constraints. Despite its proven benefits, structured prehabilitation lasting at least 3-6 months is not available to all patients, as access remains unequal and suboptimal in many healthcare settings. Prehabilitation is an important but underutilized component of BS preparation. Standardizing protocols and ensuring multidisciplinary, patient-centered support are essential to maximizing surgical benefit. Overcoming barriers such as healthcare system limitations, patient motivation and knowledge gaps is critical to integrating prehabilitation into routine bariatric care. This review emphasizes the need for evidence-based, multimodal prehabilitation strategies to improve perioperative care and long-term outcomes for BS patients.
减重手术已成为治疗重度肥胖的关键且有效方法，能实现显著且持续的体重减轻，并改善合并症。优化围手术期护理，尤其是通过结构化的术前康复训练，对于改善手术效果和长期体重管理至关重要。本综述探讨术前康复训练、营养、心理支持、体育活动及药物治疗在提高减重手术效果方面的作用。
尽管术前康复训练有益，但不同医疗中心的实施方式存在显著差异。方案在持续时间、组成部分和强度方面差异很大，导致患者准备和术后恢复不一致。许多患者在手术前仍未得到营养师、心理学家或物理治疗师的多学科支持，这可能影响长期效果。有效术前康复训练的障碍包括缺乏标准化指南、医疗资源不足以及由于缺乏意识、动力不足或后勤限制导致患者依从性有限。尽管已证实其益处，但并非所有患者都能获得至少持续3至6个月的结构化术前康复训练，因为在许多医疗环境中，获取机会仍然不平等且不理想。术前康复训练是减重手术准备中一个重要但未得到充分利用的组成部分。标准化方案并确保多学科、以患者为中心的支持对于最大化手术益处至关重要。克服医疗系统限制、患者动力和知识差距等障碍对于将术前康复训练纳入常规减重护理至关重要。本综述强调需要基于证据的多模式术前康复训练策略，以改善减重手术患者的围手术期护理和长期效果。
