Table 1.

ERAS recommendations for preadmission care in bariatric surgery

Element	Recommendation	Level of evidence	Recommendation grade
1. Information, education and counselling	Preoperative information and education, adapted to the individual requirements, should be given to all patients	Low	Strong
2. Indications and contraindications for surgery	Indications for bariatric surgery should follow updated global and national guidelines	Moderate	Strong
3a. Smoking and alcohol cessation	All patients should be screened for alcohol and tobacco use. Tobacco smoking should be stopped at least 4 weeks before surgery. For patients with alcohol abuse, abstinence should be strictly adhered to for 1–2 years. Moreover, the risk for relapse after bariatric surgery should be acknowledged	Smoking: Moderate	Strong
		Alcohol: Low	Strong
3b. Preoperative weight loss	Preoperative weight loss using very low or low-calorie diet prior to bariatric surgery should be recommended	Postoperative complications: Moderate	Strong
	While feasible, patients with diabetes and treatment with glucose-lowering drugs should closely monitor treatment effects, and be aware of the risk for hypoglycaemia. Very low calorie diet improves insulin sensitivity in patients with diabetes	Postoperative weight loss: Low	Strong
		Diabetes: Low	Strong
4. Prehabilitation and exercise	Although prehabilitation may improve general fitness and respiratory capacity, there is insufficient data to recommend prehabilitation before bariatric surgery	Low	Weak