Bariatric surgery boosts short-term employment, but long-term gains uncertain

An international study led by Queensland University of Technology (QUT) researchers has found that bariatric surgery improves work productivity and employment rates in the short term, but these gains may not last beyond five years without targeted support.

The study’s researchers explained that although bariatric surgery is widely recognised for its health benefits, its association with work productivity and employment participation, though frequently reported, has not been systematically synthesised. This evidence is crucial to inform the economic evaluation of bariatric surgery.

Therefore, they systematically analysed the evidence on occupational outcomes of bariatric surgery, from 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.

Qing Xia

“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,” explained health economist, Dr Qing Xia, from QUT’s Australian Centre for Health Services Innovation (AusHSI), School of Public Health and Social Work. “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.”

Studies were published between 1977 and 2023, with Roux-en-Y gastric bypass the most frequently studied procedure. The most commonly evaluated metrics were employment and unemployment rates, absenteeism and sick leave. Bariatric surgery was associated with improvements in presenteeism and work hours and ability and short-term absenteeism and employment rates.

However, the long-term employment rate followed a reversed U-shape trajectory, with employment rates initially increasing post-surgery but returning to baseline levels after about five years. The researcher said the key barriers to improved occupational outcomes included insufficient weight loss, female sex, older age, preoperative comorbidities, lower quality of life and a lack of prior work experience.

“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,” Xia added. “The pooled results of unemployment rates echoed this trend where the unemployment rates decreased from 38.8 per cent to 34 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 programmes 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 findings were featured in the paper, ‘Bariatric Surgery, Employment, and Productivity Outcomes A Systematic Review’, published in the Journal of the American Medical Association Surgery. To access this paper, please click here (log-in maybe required)