Bariatric Surgery Prehabilitation

This chapter provides an overview of the continuum of care in metabolic and bariatric surgery, from initial consideration through postoperative recovery. It outlines the specialized treatment team involved and discusses the medical necessity of weight loss and bariatric surgery, even for metabolically healthy individuals with obesity. The chapter emphasizes the importance of prehabilitation before bariatric surgery, focusing on exercise, lifestyle modifications, and addressing neuropsychiatric factors like depression and chronic pain. Key components of prehabilitation include exercise interventions such as combining resistance training with high-intensity aerobic exercise for accelerated improvements in body composition and metabolic health when needed, as well as adaptive strategies to permit physical activity despite impairments from body habitus or pain. The chapter also introduces different nutritional strategies that include meal replacements, very low-calorie diets, and targeted supplementation to support weight loss while preserving muscle mass. Other notable features include hormonal optimization like testosterone replacement therapy for men and hormone replacement therapy for postmenopausal women when appropriate, delving into risks and benefits in this population. In related commentary, medication selection based on individual needs and recommendations on typical cessation periods prior to surgery are reviewed. Overall, the chapter reviews the vast components of preoperative metabolic optimization introduced in earlier chapters while adding distinct considerations relevant to major abdominal surgery and subsequent substantial weight loss.