Barriers to bariatric surgery completion: A narrative review of preoperative attrition and its determinants

Although bariatric surgery is an effective intervention for morbid obesity, a significant proportion of patients referred for surgery fail to proceed to the operation. This narrative review aims to examine the rates, characteristics, and underlying reasons for preoperative attrition among bariatric surgery candidates. The literature demonstrates variability in defining pre-op attrition, with some studies adopting binary classifications and others focusing on attrition at specific stages of the preparation process. Key factors associated with attrition include socio-demographic variables (e.g., gender, age, and income), clinical and logistical issues (e.g., waiting times, insurance barriers), and psychosocial characteristics (e.g., anxiety, substance use, and motivation). Some qualitative studies have reported that patients' thoughts and feelings about the meaning of surgery-particularly their emotional readiness and identity-related concerns-can substantially influence whether they follow through with the procedure. In Türkiye, where no standardized national guidelines are in place and structured interventions are limited, there is a clear need for broader changes in how the pre-op phase is managed. Addressing this issue will likely require support systems that are flexible, multidisciplinary, and responsive to individual circumstances. This review emphasizes that personal experiences and system-level factors jointly influence whether patients complete the surgical process. Recognizing how these layers interact may help create more effective strategies for supporting those at risk of dropping out before surgery.