Smoke and Scalpels: Tobacco Cessation Before and After Bariatric Surgery

Picture preparing for bariatric surgery and laying the groundwork for improved health. Then imagine setting it on fire. That’s what smoking and vaping can do.

Smoking and bariatric surgery don’t mix. While the procedure can be life-changing for people with obesity, smoking increases the risks of complications before, during, and after surgery. From slower healing and ulcers to higher rates of infection, smoking sabotages the very benefits bariatric surgery is designed to bring.

Up to 40% of patients heading into surgery are smokers, and if you’ve smoked in the last year, you’re significantly more likely to face severe complications afterward.¹ 

Smoking Magnifies Surgical Risks

Surgery stresses the body, and recovery depends on healthy circulation, oxygen delivery, and tissue repair. Smoking compromises all three.

Nicotine causes blood vessels to constrict, reducing blood flow to tissues that need it most after surgery. Carbon monoxide from cigarette smoke robs red blood cells of their oxygen-carrying power. Meanwhile, thousands of other chemicals in smoke inflame the body and weaken its ability to heal.

That toxic storm sets the stage for complications. In bariatric surgery, the risks can include:

• Wound healing problems, including infections in and around incision areas
• Pulmonary complications such as embolism or respiratory distress
• Ulcer formation at the surgical site
• More extended hospital stays and readmissions
• Higher mortality rates in the short term

Is Smoking a Dealbreaker for Bariatric Surgery?

Some people wonder whether being a smoker means they can’t have bariatric surgery at all, and the answer is nuanced. 

Active smoking isn’t considered an absolute barrier to bariatric surgery, and some patients proceed with surgery while still smoking. However, prior studies have shown a clear connection between smoking and higher complication rates.²  It’s best just to kick the habit, for surgery as well as the long-term health benefits.

By quitting, patients give their bodies the best possible chance to heal, adapt, and thrive after surgery. The benefits of quitting smoking kick in immediately, and continue even decades later³: 

• In the first week, the heart rate begins to normalize, nicotine leaves the bloodstream, and carbon monoxide levels drop, improving oxygen delivery.
• In the first month, breathing becomes easier, coughing and shortness of breath decrease, and circulation and lung function continue to improve.
• In the first year, the risk of heart attack drops significantly and the immune system strengthens, lowering infection risk.
• Beyond the first year coronary heart disease risk is reduced by about half (3-6 years); risk of cancers of the mouth, throat, and voice box drops by roughly 50% and stroke risk declines (5-10 years); lung cancer risk is cut in half and risks for bladder, esophageal, and kidney cancers also decrease (10-15 years); and by 15-20 years after quitting, coronary heart disease risk approaches that of a non-smoker, while risks of pancreatic, cervical, and other cancers continue to fall.

Guidelines vary on how long before surgery you need to quit and are dependent upon the surgeon performing the procedure. Still, most experts recommend quitting at least four to six weeks before bariatric surgery. Many bariatric programs do require patients to quit beforehand, and some even recommend stopping a year or more in advance.⁴  

Realistic Prep Tips to Start Weight Loss and Quit Smoking

If you’re considering bariatric surgery and currently smoke, here are some practical steps:

1. Be honest with your care team. Surgeons aren’t there to judge; they’re there to help. Full disclosure allows them to tailor your care.
2. Set a quit date. Ideally, four to six weeks before surgery, or as instructed by your surgeon.
3. Use evidence-based tools. Nicotine replacement, prescription medications, and behavioral therapy all improve success rates. If you’re using patches or medicine-based approaches, inform your care team. They must be aware of all medications you’re taking.
4. Invite help. Whether it’s a formal program, a quitline, or accountability from friends and family, having backup makes a difference. This can even come from a bariatric support group, bagging two prizes with one move (e.g., weight loss and cessation support).
5. Plan for triggers. Stress, alcohol, or social settings can tempt relapse, so building a strategy ahead of time helps. Learn to walk away and look into mind-body therapies to support stress reduction.

Cessation Doesn’t Cause Weight Gain

There’s a common perception that stopping smoking automatically leads to significant weight gain. For bariatric patients, especially, this dismantling of progress would be devastating. The good news is that research does not support the theory that smoking cessation causes weight accumulation.⁵ 

While some individuals may experience a modest weight gain after stopping, this can often be attributed to changes in habits rather than changes in metabolism. For many people, cigarettes fill a behavioral role, something to do with the hands or mouth, rather than having a direct effect on calorie intake.

To support both smoking cessation and weight management, simple strategies can help redirect those habitual motions:

• Healthy hand replacements: Keep sugar-free gum, mints, or small stress balls handy. Having a substitute action can reduce the urge to reach for a cigarette.
• Mindful snacking: Opt for low-calorie snacks like baby carrots, cucumber slices, or air-popped popcorn when cravings strike. These provide oral satisfaction without sabotaging weight loss.
• Physical activity: Short walks, stretching, or even light household chores can occupy your hands and mind, while also contributing to calorie burn.
• Hydration cues: Sipping water or herbal tea can mimic the hand-to-mouth motion and may help reduce cravings while keeping you hydrated.

If you find cravings are intense or hard to manage on your own, therapists can provide support to strengthen your control over both smoking cessation and weight management. Effective weight management and smoking cessation can coexist, and in fact, addressing both simultaneously may provide broader health benefits.

Managing both smoking and weight can feel like a lot to tackle at once, but you don’t have to do it alone. 

At Higa Bariatrics, our team provides personalized guidance for patients ready to stop smoking, optimize their metabolic health, and safely prepare for surgery. Schedule a consultation today to create a plan that supports both smoking cessation and weight loss, so you can walk into surgery stronger, healthier, and ready for lasting results.

1. Chow, A., Neville, A., & Kolozsvari, N. (2021). Smoking in bariatric surgery: a systematic review. Surgical endoscopy, 35(6), 3047–3066. https://doi.org/10.1007/s00464-020-07669-3. 
2. Janik, M. R., & Aryaie, A. H. (2021). The effect of smoking on bariatric surgical 30-day outcomes: propensity-score-matched analysis of the MBSAQIP. Surgical endoscopy, 35(7), 3905–3914. https://doi.org/10.1007/s00464-020-07838-4. 
3. Centers for Disease Control and Prevention. (2024, May 15). Benefits of Quitting Smoking. CDC Smoking and Tobacco Use. https://www.cdc.gov/tobacco/about/benefits-of-quitting.html. 
4. Inadomi, M., Iyengar, R., Fischer, I., Chen, X., Flagler, E., & Ghaferi, A. A. (2018). Effect of patient-reported smoking status on short-term bariatric surgery outcomes. Surgical endoscopy, 32(2), 720–726. https://doi.org/10.1007/s00464-017-5728-1.
5. Murphy, C. M., Rohsenow, D. J., Johnson, K. C., & Wing, R. R. (2018). Smoking and weight loss among smokers with overweight and obesity in Look AHEAD. Health psychology : official journal of the Division of Health Psychology, American Psychological Association, 37(5), 399–406. https://doi.org/10.1037/hea0000607.