Physical Exercise in Obesity and Metabolic Bariatric Surgery: The First Latin American Consensus

Physical activity and exercise are key components in obesity management and in the perioperative care of metabolic bariatric surgery (MBS) patients. However, in Latin America, clinical practice remains heterogeneous and lacks regionally adapted, evidence-informed recommendations.

To develop clinical exercise recommendations for adults with obesity and for patients undergoing MBS, based on expert consensus informed by current evidence.

A three-round modified Delphi process was conducted with Latin American experts in exercise science, obesity, and MBS. Recommendations covered assessment, exercise prescription, perioperative management, long-term follow-up, and virtual care. Experts were instructed to prioritize recent evidence published within the previous five years, and recommendations were formulated using the PICO framework as a pragmatic guide. Agreement was assessed on a 5-point Likert scale. Positive consensus required ≥ 70% agreement, ≤ 15% disagreement, standard deviation ≤ 1.0, and interquartile range ≤ 1.0. Response stability was evaluated using the coefficient of variation (≤ 20%).

Thirty-one experts participated. Of 121 proposed recommendations, 106 reached positive consensus: 45 for obesity management and 61 for MBS. These recommendations provide guidance on individualized assessment, exercise prescription, perioperative strategies, long-term physical activity maintenance, and virtual care. No recommendations reached negative consensus.

This consensus provides the first region-specific, clinically oriented exercise recommendations for obesity and MBS in Latin America. It supports multidisciplinary practice, promotes standardization of care, and provides a framework for future updates and implementation studies.