Obesity is a leading risk factor for premature morbidity and mortality, and an increasing public health challenge. This review aimed to systematically identify and appraise national and international clinical guidelines for the management of obesity in adults. We systematically searched MEDLINE, CINAHL, Embase, and PsycINFO from 01/01/2019 to 06/01/2025. We conducted supplementary searches on websites of clinical guideline-producing organizations and other relevant institutional and evidence-based clinical resources. We included national and international guidelines on the management of obesity in adults aged ≥ 18 years that included recommendations on prespecified primary topics of interest, clearly stated the systematic approach and evidence base underpinning recommendations, and included a rating of the quality of evidence. The Appraisal of Guidelines for Research and Evaluation (AGREE) II tool and appraisal using the mEaningful VOice in the design and deLiVery of care (EVOLVE) framework were employed by two reviewers independently. Data were extracted by one reviewer, checked by another, and narratively synthesized. We identified 10 eligible clinical guidelines. The mean overall AGREE II score was 4.9/7 (SD: 1.22). Patients were involved in highlighting preferences, panel membership, reviewing drafts, and consensus meetings in most guidelines, and formulating/prioritizing questions, priority setting, and dissemination in a minority. The 2025 National Institute of Health and Care Excellence guideline on "Overweight and Obesity Management" displayed the most extensive scope and highest overall AGREE II score (7/7). This review will inform adaptation, as part of an ADAPTE process, for a prioritized National Clinical Guideline on the management of obesity in adults in Ireland.
Many survivors of childhood brain tumors face long-term adverse health outcomes like obesity. Uncertainties surround the effect of interventions to manage obesity-related outcomes in survivors of childhood brain tumors. The goal of this updated systematic review and meta-analysis was to provide the best estimate of the treatment efficacy of pharmacotherapy intervention on anthropometric outcomes in this pediatric population. We searched CENTRAL, MEDLINE, EMBASE, CINAHL, PsycINFO, PubMed, ClinicalTrials.gov, and ProQuest for articles published from January 1, 2015, to January 31, 2025. A meta-analysis was performed using the generic inverse-variance method in RevMan 5.4. Heterogeneity was assessed using the Cochrane Q test and the I2 statistic. We used the GRADE approach to determine the certainty of evidence. A total of six studies met the inclusion criteria: four newly identified studies published after January 1, 2015 (125 participants), and two from the previously published review (23 participants). The pooled estimate showed no significant change in body mass index z-score after intervention (mean difference = -0.02; 95% CI: -0.06 to 0.02, I2 = 0%; 4 studies, 94 participants; low certainty of evidence). Similar pooled effects were observed across other outcomes; however, individual studies reported significant changes in some outcomes within the treatment groups after the intervention. Pharmacological agents showed no significant change in anthropometric outcomes for survivors of childhood brain tumors. Further trials are needed to assess the efficacy of pharmacological agents and to identify subgroups most likely to benefit.
As the field of metabolic surgery (MS), also known as bariatric surgery, continues to grow and change, especially in light of emerging anti-obesity medications, the need to identify seminal studies within this domain becomes increasingly crucial. This study aims to provide a comprehensive 10-year update on the most frequently cited articles in MS. Utilizing the SCOPUS database, we identified the top 100 most cited articles in MS as of July 2023. Beyond assessing the most frequently cited works, this study also examines articles with the most citations per year and explores the citation trends. The average number of citations per article increased from 383.5 in 2014 to 889.5. Forty-four papers from the original top 50 list in 2014 were included in the current list. The year 2004 had the most number in the top 100 (n = 10). While Roux-en-Y gastric bypass (RYGB) had the highest representation (48%), sleeve gastrectomy (SG) has rapidly risen in interest. As the landscape of MS expands, the reassessment of top-cited scientific articles becomes imperative for obesity physicians and scientists, metabolic surgeons, fellows, and residents. Many of the articles listed in 2014 persisted in the 10-year update, reflecting the significant growth observed in the MS field during the early 2000s. The increased citation count likely indicates the expanding influence of MS research. Despite RYGB maintaining its status as the most studied procedure, a noticeable uptick in interest in sleeve gastrectomy post-2009 is evident as demonstrated by its increased representation within highly cited publications.
Sarcopenic obesity has been associated with various health conditions and mortality. Our objective was to systematically review and estimate the association between sarcopenic obesity and respiratory function outcomes. We searched EMBASE, MEDLINE, and Google Scholar for observational studies involving adults (≥ 18 years), defined sarcopenic obesity, and assessed respiratory outcomes in those with and without sarcopenic obesity. A random-effects meta-analysis was conducted for the outcomes of forced vital capacity (FVC), forced expiratory volume in 1 s (FEV1), and the ratio of forced expiratory volume in 1 s to forced vital capacity (FEV1/FVC). Seven papers representing 173,677 participants were included. The risk of bias assessment using the JBI Critical Appraisal Checklist revealed that all studies had a low risk of bias. The meta-analysis included data from five studies, revealing a significant association between sarcopenic obesity and lower FVC (in L) (-0.77; 95% CI, -1.27, -0.26) and FEV1 (in L) (-0.84; 95% CI, -1.26, -0.42), both with high heterogeneity (I2 = 94%). Sarcopenic obesity was significantly associated with respiratory function outcome (FEV1) when obesity was assessed using fat mass % (-1.14; 95% CI, -1.21, -1.06), but not when using the body mass index (BMI). In conclusion, sarcopenic obesity was significantly associated with poorer respiratory function outcomes. Assessment of respiratory function may be desirable in those with sarcopenic obesity, especially in high-risk populations such as older adults.
Childhood obesity is a global public health issue with strong familial and intergenerational transmission. However, existing syntheses often overlook the active role of parents and fail to assess outcomes beyond the child. This systematic review and meta-analysis specifically investigate the effects of family-based interventions, which position parents as active co-agents of change, on health outcomes for both children with obesity and their parents. A systematic review and meta-analysis were conducted. Six databases were searched for randomized controlled trials (RCTs) targeting children with obesity and at least one family member. Primary outcomes were children's BMI z-score and parental BMI; secondary outcomes included other adiposity measures and dietary behaviors. Outcomes for both children and parents were synthesized. Subgroup analyses were conducted based on intervention characteristics. Risk of bias was assessed using RoB 2, and evidence certainty was evaluated using GRADE. Twenty RCTs with 1740 participants were included in the meta-analysis. The interventions demonstrated a significant reduction in children's BMI z-score. Additional benefits were observed for long-term BMI z-score and percentage of total body fat. The most effective interventions commonly integrate health education, behavioral strategies, and motivational support. Subgroup analyses indicated that interventions positioning parents as active co-participants, rather than mere supporters, yielded larger effects. However, no significant effects were found on parental BMI. This study demonstrates that family-based interventions can confer significant benefits for children with obesity. Their success hinges on strategically framing parents as active co-agents and integrating motivational strategies.
The corporations that produce and profit from ultra-processed foods (UPFs), and the regulatory conditions under which they operate, have been major contributors to the global rise of obesity and noncommunicable diseases. The aim was to map the drivers and feedback systems of the product design and marketing domains of the UPF system and to consider the implications for potential intervention strategies designed to improve population diets. A systems dynamics methodology, underpinned by a narrative literature review, was used to develop causal loop diagrams of the product design and marketing domains, through an iterative refinement process. Both domains contain multiple key drivers, alongside seven reinforcing feedback loops in the product design diagram and five in the marketing diagram. These loops predominantly focused on generating perceived value for the products, driving sales, and collecting data and information to further optimize product design and marketing strategies, serving the purpose of growing profits for UPF corporations. At many points, elements of human physiology and behavior are embedded in these feedback loops and are being manipulated or exploited by UPF corporations for this purpose. The research highlights multiple areas for intervention that, if implemented concurrently, can alter the dynamics of the current system such that power and control shift towards other types of food producers, communities, and citizens rather than UPF corporations.
Although an attractive approach for treating obesity-related pathologies, the development of peripherally restricted cannabinoid 1 receptor inhibitors has thus far failed to deliver drugs with clinically validated efficacy and safety margins over central nervous system (CNS)-related side effects. Challenges and frequently occurring misleading assumptions with this strategy are discussed. However, the recently reported peripherally restricted hepatotropic cannabinoid 1 receptor inverse agonist TM38837 is noteworthy due to the substantial weight loss efficacy in DIO rodents coupled with minimal CNS exposure, which suggests that such a chemotype may have clinical utility. Furthermore, hepatic cannabinoid 1 receptor upregulation is implicated as a major driver of the obese phenotype in rodents, which opposes current theories based upon experiments with genetically modified mice. Accordingly, a novel hypothesis is proposed, which implicates cannabinoid 1 receptor upregulation as a mediator of cell cycle progression, which drives lipid synthesis during the mitosis phase. The upregulation is initiated by increasing redox state and amplified by a feed-forward effect whereby cannabinoid 1 receptor activation induces cannabinoid 1 receptor upregulation by increasing expression of pro-oxidant enzymes. This mechanism is activated prematurely in the cell cycle by lifestyle factors, which are known to cause oxidative stress in hepatocytes and are associated with the development of obesity. The consequence of such aberrant cannabinoid 1 receptor upregulation is sustained lipogenesis, leading to reduced cellular ATP levels, which drive increased food intake and contribute to other pathologies.
This systematic review and meta-analysis aimed to evaluate the effects of probiotic and symbiotic supplementation on lipid parameters in individuals with overweight and obesity to elucidate the aspects involved in this topic. The PubMed, EMBASE, LILACS, Scopus, Web of Science, Cochrane Library, and Science Direct electronic databases were systematically searched for RCTs up to April 2023. The risk of bias was evaluated using the updated version of the Cochrane tool for assessing bias risk in randomized trials (RoB 2). The certainty of evidence was assessed using the Grading of Recommendations, Assessment, Development, and Evaluation (GRADE) methodology. The review was registered in PROSPERO under the number: CRD42023442133. Of the 1363 articles identified in the search, 28 were included in the systematic review and meta-analysis. Data analysis showed a significant effect of probiotics and symbiotics in reducing total cholesterol (MD = -0.09 mmol/L; 95% CI: -0.16, -0.03), LDL (MD = -0.06 mmol/L; 95% CI: -0.12, -0.01), and triglycerides (MD = -0.05 mmol/L; 95% CI: -0.10, -0.01) levels, but no significant effect on HDL (MD = 0.01 mmol/L; 95% CI: -0.01, 0.03) levels compared to the control group. In subgroup analyses, symbiotics showed a greater reduction in total cholesterol, LDL, and triglycerides. This meta-analysis suggests that probiotic and symbiotic supplementation can reduce total cholesterol, LDL, and triglyceride levels in individuals with overweight or obesity, with a greater effect observed for symbiotic supplementation.
This scoping review aims to identify all outcomes reported in school-based obesity prevention interventions in childhood. It serves as an essential first step towards developing an internationally agreed-upon Core Outcome Set (COS), which defines what should be measured in all school-based childhood obesity prevention studies, thereby reducing research waste and enhancing the comparability and relevance of future research. Four databases (PubMed, Embase, Cochrane Database of Systematic Reviews, and PsycINFO) were searched for published studies on controlled trials of school-based overweight/obesity prevention interventions in 6- to 12-year-olds, from inception until June 2024. Two researchers independently searched for relevant articles, extracted study/intervention characteristics, and reported outcomes. Through multiple meetings and feedback rounds, an international expert panel, including researchers (n = 5), healthcare providers (n = 4; i.e., pediatrician, youth health physician, dietician, psychologist), and a health educator identified unique outcomes underlying all reported outcomes, by reflecting on what was measured irrespective of how outcomes were defined and measured. In total, 262 published studies that evaluated 242 interventions were included in this review. From these studies, we extracted 642 different reported outcomes. BMI (kg/m2) was the most frequently reported outcome (128 studies), then BMI-z (108 studies) and BMI categories (100 studies). Experts identified 69 unique outcomes from all reported outcomes. There is substantial heterogeneity in outcomes reported in studies evaluating school-based overweight/obesity prevention interventions in 6- to 12-year-olds, limiting a synthesis of evidence in meta-analyses. This highlights the need for a consensus-based COS to improve the comparability and relevance of evidence of childhood obesity prevention trials.
Behavioral weight management interventions have been shown to be effective for weight loss. However, a common challenge is difficulty in engaging with the public, participants, or service-users across the research continuum. User-provider relationships are key in weight management and may be integral to continuing engagement. This overview aimed to understand the nature of relationships within behavioral weight management interventions delivered in research studies and healthcare settings, how these may influence retention as well as potential relationship barriers and facilitators. Six databases were searched; 20 reviews (27 reports) were included. Most reviews investigated weight management delivered face-to-face by healthcare professionals across different settings. The Theoretical Domains Framework guided the synthesis of qualitative and quantitative data regarding user-provider relationships. GRADE CER-Qual was used to assess the confidence of findings. Thirty-eight findings were categorized to domains in the framework in addition to two cross-cutting themes. High confidence evidence demonstrated that the domains of knowledge, skills, social/professional role or identity, environmental context and resources, and behavioral regulation provided challenges as well as enabling relationships in weight management. The central domain underpinning the influence of relationships on retention was social influences, with weight stigma a pervasive theme recurring across domains. Application of a theoretical lens to consider cognitive, affective, social, and environmental influences helped better understand user-provider relationships as a potential mechanism through which retention-related behaviors in weight management can be driven or deterred. This overview suggests that improving user-provider relationships should be considered a useful retention strategy in weight management programs.
Excess adiposity is not a recently developed problem but has existed since at least the upper Paleolithic, allowing evolutionary selection pressures to adapt the physiology of the pregnant woman and the feto-placental unit for maternal and fetal protection. Disturbances of the intrauterine environment, in particular metabolic derangements early in pregnancy, such as in women with diabetes and/or obesity, may lead to fetal hyperinsulinaemia. This often results in neonatal adiposity, which may in turn increase the risk for childhood adiposity. In this review, we summarize evidence on possible underlying mechanisms and factors that moderate the association between in utero exposure and childhood adiposity focusing on pregnancies in women with diabetes or obesity. We conclude that in humans causal evidence is missing for fetal programming of adiposity in the deterministic sense as often used and propose a more opportunistic framework. A variety of postnatal exposures and their interaction with the individual's genetic background contribute to the multifactorial problem of excessive adiposity, which may be further compounded by varying sensitivity to environmental perturbations depending on the developmental stage of the individual. We identify research gaps and describe future studies to generate causal evidence necessary.
As poor sleep negatively impacts on adiposity, there is interest in examining whether improving sleep can improve adiposity markers. We reviewed studies aimed at improving sleep using (1) cognitive behavioral therapy for insomnia (CBT-I) and/or sleep hygiene and (2) sleep extension on adiposity markers, dietary intake, and physical activity. Literature searches were performed on MEDLINE, Embase, CINAHL, and Cochrane Library. We included studies featuring adults ≥ 18 years without OSA, a sleep intervention as well as preintervention and postintervention measures. From a total of 27 studies, 25 were used in the meta-analyses. Using CBT-I and/or sleep hygiene in eight studies (n = 1384) led to significant BMI reductions averaging 0.64 kg/m2 (0.28, 1.01, p = 0.0006, I2 = 16%) but the reductions were not significant in five studies (n = 138) of sleep extension, 0.15 kg/m2 (-0.40, 0.11, p = 0.26). In obesity (n = 78, 3 studies) and in type 2 diabetes (n = 1121, 3 studies) BMI reductions averaged 1.53 (0.49, 2.56, p = 0.004, I2 = 0%) and 0.64 kg/m2 (0.37, 0.92, p < 0.00001, I2 = 0%), respectively. For body weight, using sleep interventions led to significant reductions in the obese (n = 72, 3 studies) and overweight ranges (n = 337, 6 studies), averaging 5.55 (4.13, 6.97, p < 0.00001, I2 = 0%) and 0.83 kg (0.32, 1.35, p = 0.002, I2 = 0%), respectively. Using sleep interventions reduced daily energy intake (n = 223, 5 studies) by 147.5 cal/day (5.74, 289.41, p = 0.04, I2 = 53%), but was higher in the obese/overweight range (n = 122, 3 studies) at 238.0 cal/day (138.86, 337.22, p < 0.00001, I2 = 0%); sugar consumption reduced (p = 0.05), and protein consumption increased (p = 0.001). There were no changes in physical activity or sedentary behavior levels. On quality assessment, 12 and 10 studies were of low and some concerns, respectively. Addressing poor sleep health through using sleep interventions has the potential to be integrated into obesity management programs, alongside current lifestyle strategies. CRD42025644060.
Reducing childhood overweight and obesity prevalence is a global public health priority. This systematic review and meta-analysis evaluated the effectiveness of behavioral weight management interventions delivered or referred to by health care providers in primary care settings. Randomized controlled trials (RCTs) of behavioral interventions published up to 05/01/2026, involving participants < 18 years with overweight or obesity, were identified through Cochrane, MEDLINE, PubMed, and PsychINFO. Two reviewers independently screened studies, extracted data, and assessed risk of bias. Meta-analyses calculated pooled mean differences in zBMI and BMI using random effects models. The primary outcome was zBMI change at 12 months; secondary outcomes included zBMI changes at program end, last follow-up, and BMI at 12 months. Fifty-nine RCTs (n = 10,454) were included; 23 trials (n = 3241) contributed to the primary outcome. At 12 months, the pooled mean difference in zBMI was -0.08 (95% CI -0.13 to -0.03, p < 0.01), favoring intervention groups. At program end (n = 30), the mean difference was -0.15 (95% CI -0.22 to -0.08), and at last follow-up (n = 37), -0.08 (95% CI -0.15 to -0.02). BMI at 12 months showed a mean difference of -0.37 (95% CI -0.72 to -0.01). Interventions referred to community settings achieved greater zBMI reductions (-0.14 [95% CI -0.2 to -0.08]) than those delivered within primary care (0.04 [95% CI -0.10 to 0.18]). Behavioral weight management interventions for children delivered or referred to by health care professionals in primary care led to modest reductions in zBMI. Referrals to community-based interventions (e.g., HENRY) may yield greater improvements.
To compare the ratings of quality and risk of bias of systematic reviews/meta-analyses (SRs/MAs) in bariatric research published in 2016 and 2017 using the AMSTAR 2 and ROBIS tools. The methodology is described in detail in our first publication (Obes Rev. 2020; https://doi.org/10.1111/obr.12994). A systematic survey by searching three electronic databases was conducted to identify SRs/MAs assessing any outcome in patients with morbid obesity undergoing or scheduled for bariatric surgery published in 2016 and 2017. Pairs of reviewers independently screened titles and abstracts, assessed full texts, extracted data, and evaluated the quality and risk of bias using the AMSTAR 2 and ROBIS tools. Discrepancies were resolved by a third reviewer. Agreement between reviewers and between the instruments was assessed using Fleiss' kappa and Gwet's statistics. Matching between AMSTAR 2 items (critical and noncritical) and ROBIS signaling questions was also examined. Of the 78 included SRs/MAs, 77 (98.7%) were assessed as critically low methodological quality by AMSTAR 2, while ROBIS classified five reviews (6.4%) as low risk of bias, 61 (78.2%) as high, and 12 (15.4%) as unclear. Both tools demonstrated moderate inter-rater reliability for individual items and overall judgments. The methodological quality of SRs/MAs in bariatric research was predominantly critically low. Calibration exercises are strongly recommended before applying either tool. AMSTAR 2 and ROBIS each address a distinct research question, and tool choice should be guided by the specific study objective. PROSPERO Registration: CRD42017080394.
Meal satisfaction is considered a multidimensional concept that includes sensory enjoyment, cognitive, emotional, and physiological components and relates to contentment with the meal experience as a whole. However, its relevance to eating behavior and body weight remains unclear, especially in children. The present review investigated the potential relationship between meal satisfaction-related constructs and childhood obesity, and whether this relation is shaped by individual factors and the external environment. Seventeen eligible studies from 350 records published between 2008 and 2024 were included. No study directly assessed meal satisfaction; instead, proxy measures were used. Food enjoyment emerged as the proxy most consistently associated with BMI, often clustering with higher food responsiveness, lower satiety responsiveness, and emotional overeating. Parental feeding practices, especially pressure to eat, significantly contributed to variation in children's eating behavior and were associated with lower food enjoyment. Overall, meal satisfaction could be a key aspect to consider in childhood obesity prevention programs. However, to date, the available evidence is heterogeneous and predominantly observational. Future longitudinal and intervention studies are needed, alongside child-appropriate instruments to objectively quantify food satisfaction in children. Research that helps understand the role of contextual eating factors on children's meal satisfaction and eating behavior is also warranted.
Obesity and poor mental well-being in childhood and adolescence are growing public health concerns with potential implications for a broad range of life outcomes. Understanding the longitudinal and potentially bidirectional relationship between weight status and mental well-being is crucial for developing effective interventions to support children and adolescents. This systematic review synthesizes evidence on the bidirectional relationship between weight status and indicators of mental well-being over time. Peer-reviewed studies published up to January 10, 2025 were identified through searches in PubMed, PsycINFO, Scopus, and Web of Science. Eligible studies included longitudinal designs assessing weight status and mental well-being in populations up to age 18 years. The Joanna Briggs Instrument assessed the risk of bias, and the findings were narratively summarized. The review included 33 longitudinal studies conducted between 1994 and 2022. We found that higher childhood weight was associated with subsequent low mental well-being, and an indication that poor mental well-being was associated with subsequent higher weight. However, there was a scarcity of longitudinal studies exploring the influence of mental well-being on subsequent weight status. Large heterogeneity in design and methods was found across the included studies. Findings indicated a bidirectional association between weight status and mental well-being, with stronger evidence supporting the impact of weight status on mental well-being than vice versa. Future research should prioritize longitudinal designs to better understand the influence of mental well-being on later weight development and explore underlying mechanisms.
We conducted a systematic review with network meta-analyses (NMA) summarizing the effects and safety of lifestyle interventions containing nutrition (NUT; e.g., calorie restriction), exercise (EX; e.g., aerobic/resistance exercise) and behavior change interventions (BCI; e.g., behavioral therapy) on physical function, body composition, quality of life, psychosocial outcomes, health and adverse events in community-dwelling older adults with obesity. We used the methodology proposed by Cochrane and searched six databases and one trial registry for eligible randomized controlled trials (RCTs; intervention duration ≥ 12 weeks) up to May 2022 with a full new search in MEDLINE and a re-assessment of previously identified eligible trial registry entries in October 2025. Random-effects NMA ((standardized) mean difference ((S)MD), 95% confidence intervals) were conducted if possible. We included 72 RCTs (n = 6716) for descriptive summaries and 54 RCTs (n = 4249) for NMA. NUT+EX+BCI improved physical function (performance batteries) compared to control (SMD 3.37 [1.76;4.97]; high certainty of evidence). NUT+EX+BCI may reduce body (MD -8.69 [-13.14;-4.25]) and fat mass (MD -6.58 [-10.44;-2.73]) while not negatively affecting fat-free mass (MD -1.38 [-3.52;0.76]) or bone mineral density (MD -0.01 [-0.05;0.02]) (evidence very uncertain). Other interventions (single/combined) may also be effective; however, effects were often imprecise. For psychosocial outcomes, quality of life, and health events, data were insufficient or too heterogeneous to derive clear results. The evidence suggests that NUT+EX+BCI interventions are most suitable for the management of obesity in older adults. Nevertheless, further RCTs-especially in frail populations and on patient-relevant outcomes-are needed.
Maternal obesity represents an urgent public health challenge with serious maternal, neonatal, and health system implications. Characterizing levels of obesity during pregnancy is necessary to guide future research, policy, and practice. This review summarizes existing data on maternal obesity prevalence across Europe. Studies published between 2009 and 2023 that reported the prevalence of obesity during pregnancy were included. The primary outcome was to measure the prevalence of obesity during pregnancy. Secondary outcomes were assessing the method and timing of BMI ascertainment. In total, 99 studies were included. Over three quarters of studies (N = 76, 76.7%) collected data from Swedish, United Kingdom, or Irish populations. Height was objectively assessed in 37 studies (37.4%) and weight in 53 studies (53.5%). The median obesity prevalence was 12.5% (IQR 4.4-20.6). In a subset of studies reporting prevalence by year, obesity ranged from 2.2% (1986) to 28.3% (2007) with a significant positive association of maternal obesity over time (τ = 0.64, p < 0.001). This review highlights consistent increases in obesity during pregnancy among European populations with significant implications for patients and health systems.
This position statement is intended to synthesize and interpret current consensus and salient developments regarding the relationship between obesity and physical activity. It draws from the latest evidence and guidelines to update and share the World Obesity Federation's stance with policymakers, healthcare professionals, public health stakeholders, and civil society organizations. This statement identifies the critical role of physical activity in the prevention and management of obesity, highlights the lived experience of people with obesity, summarizes global recommendations, and considers the emerging connections between obesity, climate change, and physical activity.
Metabolic and bariatric surgery (MBS) effectively manages severe obesity but may lead to psychological complications such as completed suicides and suicide attempts. This review aimed to analyze suicide and self-harm incidence post-MBS. We searched MEDLINE, EMBASE, PsycINFO, and the Cochrane Library databases on August 16, 2022, for longitudinal studies with incidence data on suicide following MBS. We performed a single proportion meta-analysis on the incidence of outcomes and assessed the certainty of evidence using the GRADE approach. The review was registered with PROSPERO (CRD42022352137). Eighty-four studies were included. The meta-analysis showed an incidence of 230.64 suicides per 100,000 participants (95% CI: 167.51 to 317.49) in pooled individual-level data and an incidence of 43.02 suicides per 100,000 person-years (95% CI: 32.49 to 56.97) in pooled person-year data. Evidence was low certainty or very low certainty. The average suicide incidence (231 per 100,000 people) in people with obesity who underwent MBS significantly exceeded the 2019 WHO global estimate for the general population (nine per 100,000 people). These findings underscore the need to incorporate structured psychological screening and follow-up into the perioperative management process of MBS, as patient mental health may play a pivotal role in postoperative adherence and long-term outcomes.