Improving Patient Outcomes by Bridging Bariatric and Body Contouring Surgery with Comprehensive Prehabilitation.

BACKGROUND: Rates of obesity and diabetes are increasing in the United States, accompanied by greater use of bariatric surgery and pharmacologic therapies, including glucagon-like peptide-1 receptor agonists and glucose-dependent insulinotropic polypeptide-based agents. Although massive weight loss may improve glycemic control and blood pressure, patients seeking body contouring surgery remain medically complex. Reduced fat-free mass associated with weight-loss pharmacotherapy and the high incidence of wound healing complications after excess skin resection present additional perioperative challenges. METHODS: We reviewed the growing literature on strategies to optimize outcomes after body contouring surgery, with particular attention to exercise preconditioning, nutritional supplementation, psychological support, and modification of established wound healing risk factors. RESULTS: Current evidence suggests that supplementing conventional risk-factor modification with exercise preconditioning, nutritional support, and psychological interventions improve the cardiorespiratory fitness of weight loss patients. Comprehensive prehabilitation initiated before bariatric surgery and continued throughout weight loss and subsequent plastic surgical treatment may also improve weight-loss durability, body composition, and candidacy for body contouring. CONCLUSIONS: Prehabilitation may provide a comprehensive, longitudinal approach to optimizing patients undergoing bariatric and body contouring surgery. Integrating exercise, nutritional supplementation, psychological support, and traditional risk-factor modification has the potential to improve surgical candidacy, perioperative health, and postoperative outcomes. Further research is needed to define standardized protocols and determine their effectiveness in this population.