Religious Fasting of Muslim Patients After Metabolic and Bariatric Surgery: a Modified Delphi Consensus

Mohammad Kermansaravi, Islam Omar, Kamal Mahawar, Shahab Shahabi, Ahmad Bashir, Ashraf Haddad, Alaa Abbass, Syed Imran Abbas, Mujjahid Abbas, Tarek Abouzeid, Faki Akin, Ebrahim Aghajani, Ali Aminian, Mohanad AlAnsari, Syed Tanseer Asghar, Ahmet Ziya Balta, Waleed Bukhari, Mohamad Hayssam Elfawal, Waleed Gado, Khaled GawdatTikfu Gee, Bijan Ghavami, Ramen Goel, Mohammed AlHadad, Bader AlHadhrami, Mohammad AlHaifi, Ali AlHamdani, Ibrahim Hassan, Selim Jalil Illan, Atif Inam, Aiman Ismaeil, Yasser Kayyal, Khaleel Mohammad, Amir Ulhagh Khan, Mousa khoursheed, Haris Khwaja, K. S. Kular, Laurent Abram Layani, Maazulhassan, Tarek Mahdy, Mumtaz Maher, Ebrahim Mansoor, Salman Mirza, Muhammad S. Niam, Taryel Omarov, Abdolreza Pazouki, Aayed R. Alqahtani, Mohamed Qassem, Masoud Rezvani, Karim Sabry, Safauldeen Salim, Asim Shabbir, Mehdi Skalli, Osama Taha, Mohammad Talebpour, Halit Eren Taskin, Mustafa Taskin, Tahir Yunus, Amir Hossein Davarpanah Jazi, Radwan Kassir, Abdelrahman Nimeri

Research output: Contribution to journalArticlepeer-review

6 Citations (Scopus)


Background: Fasting during Ramadan is one of the five pillars of the Muslim faith. Despite the positive effects of fasting on health, there are no guidelines or clear recommendations regarding fasting after metabolic/bariatric surgery (MBS). The current study reports the result of a modified Delphi consensus among expert metabolic/bariatric surgeons with experience in managing patients who fast after MBS. Methods: A committee of 61 well-known metabolic and bariatric surgeons from 24 countries was created to participate in the Delphi consensus. The committee voted on 45 statements regarding recommendations and controversies around fasting after MBS. An agreement/disagreement ≥ of 70.0% was regarded as consensus. Results: The experts reached a consensus on 40 out of 45 statements after two rounds of voting. One hundred percent of the experts believed that fasting needs special nutritional support in patients who underwent MBS. The decision regarding fasting must be coordinated among the surgeon, the nutritionist and the patient. At any time after MBS, 96.7% advised stopping fasting in the presence of persistent symptoms of intolerance. Seventy percent of the experts recommended delaying fasting after MBS for 6 to 12 months after combined and malabsorptive procedures according to the patient’s situation and surgeon’s experience, and 90.1% felt that proton pump inhibitors should be continued in patients who start fasting less than 6 months after MBS. There was consensus that fasting may help in weight loss, improvement/remission of non-alcoholic fatty liver disease, dyslipidemia, hypertension and type 2 diabetes mellitus among 88.5%, 90.2%, 88.5%, 85.2% and 85.2% of experts, respectively. Conclusion: Experts voted and reached a consensus on 40 statements covering various aspects of fasting after MBS. Graphical abstract: [Figure not available: see fulltext.]

Original languageEnglish
Pages (from-to)5303-5311
Number of pages9
JournalObesity Surgery
Issue number12
Publication statusPublished - Dec 2021
Externally publishedYes


  • Bariatric surgery
  • Calorie restriction
  • Consensus statement
  • Fasting
  • Metabolic surgery
  • Obesity
  • Ramadan

ASJC Scopus subject areas

  • Surgery
  • Endocrinology, Diabetes and Metabolism
  • Nutrition and Dietetics


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