Published today in JAMA Surgery, the systematic review analysed 42 studies across 15 countries (mostly high-income countries) which included 159,678 patients to assess how weight-loss surgery affected occupational outcomes such as employment status, absenteeism, and work capacity.
Health economist Dr Qing Xia , from QUT's Australian Centre for Health Services Innovation (AusHSI), School of Public Health and Social Work .
"Studies of the cost-effectiveness of bariatric surgery highlight its long-term economic values in managing patients with morbid obesity, especially those with type 2 diabetes, however, these findings were predominantly analysed from a health-care system perspective that did not include the broader effects such as productivity impact," Dr Xia said.
"We compared occupational changes before vs after surgery and found that of the 29 studies with comparisons for employment rates, 14 concluded positive changes, 13 showed no change and two reported negative changes.
"We noted that the earlier studies had shorter follow-up times but four more recent ones indicated that positive effects tapered off over longer follow-ups.
"These studies' findings suggested a substantial improvement in overall short-term employment rates, from 54.4 per cent at baseline to 66.4 per cent in the first year post surgery, remaining stable to the fourth year before a slight decrease in the fifth year.
"The pooled results of unemployment rates echoed this trend where the unemployment rates decreased from 38.8 per cent to 34.0 per cent in the first year and 27.6 in per cent the second year post surgery but returned to baseline level at the fifth year."
Dr Xia said findings showed that bariatric surgery could help people re-enter the workforce and improve their productivity, especially in the first few years after surgery.
"However, the long-term trajectory is concerning. Employment rates tend to peak and then decline, returning to pre-surgery levels after about five years."
"Our study highlights the need for long-term support strategies to sustain employment benefits, particularly for women, older adults, and those with pre-existing health conditions.
"Obesity is a chronic condition, and surgery is just one part of the solution.
"We need to invest in ongoing care—such as nutritional counselling, physical activity programs, and psychosocial support—to help people maintain their health and stay engaged in the workforce."
The study also called for future research to explore the comparative effectiveness of bariatric surgery and emerging pharmacological treatments, such as GLP-1 receptor agonists.
The research team comprised Dr Qing Xia, Dr Thomasina Donovan , and Associate Professor Hannah Carter from AusHSI, QUT; Dr Jiahao Diao from The University of Melbourne; Xiao Yang (MMed) from Shanghai Yangpu District Centre for Disease Control and Prevention; Dr Xingzhong Jin from the University of New South Wales, and Assistant Professor Stella T. Lartey from Clemson University.
The research was funded by QUT's Centre for Healthcare Transformation 2023 Seed Scheme.
The study, Bariatric Surgery, Employment, and Productivity Outcomes A Systematic Review , was published in the Journal of the American Medical Association Surgery.
Women, older adults, and those with comorbidities may need tailored support to sustain workforce participation.
