Lifestyle Behaviors and Weight Regain after Bariatric Surgery in Saudi Arabia: Systematic Review of Observational Studies

Sheikh Ahmed¹, Mohammed Elhaj², Asim Ahmed³

Abstract

 Doi : https://doi.org/10.5281/zenodo.19145179

Weight regain following bariatric surgery is a common challenge that can diminish the long-term health benefits of the procedure. This systematic review examined observational evidence on how postoperative lifestyle behaviors such as physical activity, sedentary time, smoking, and dietary habits are associated with weight recurrence. Guided by PRISMA standards, we searched six electronic databases from their inception until December 2025. Sixteen studies met the inclusion criteria, comprising international observational research and studies drawn from Saudi populations. The evidence consisted mainly of cross-sectional studies, supplemented by a smaller set of prospective cohort analyses. Definitions of weight regain varied widely across studies, ranging from absolute weight gained after the lowest postoperative weight to percentages of weight or excess weight regained.

Across the literature, several behaviors were consistently linked to weight regain: insufficient physical activity, high sedentary time, tobacco and waterpipe use, disordered eating patterns (such as grazing, emotional eating, and binge eating), poor diet quality, and inadequate postoperative follow-up. Data from Saudi Arabia offered relevant regional insights, indicating that lifestyle and dietary patterns are closely connected to weight outcomes after surgery, though results were not uniform across different settings.

Overall, the evidence suggests that modifiable lifestyle behaviors may significantly influence the likelihood of postoperative weight regain. However, causal conclusions are limited by considerable variation in how weight regain is defined, a predominance of cross-sectional study designs, and widespread reliance on self-reported measures. Future longitudinal studies within Saudi populations are needed to strengthen the evidence and support the development of tailored postoperative interventions.