Is it time to integrate the 24-hour movement paradigm into metabolic and bariatric surgery practice and research? A call to action.

BACKGROUND Individuals who undergo metabolic and bariatric surgery (MBS) are often encouraged to prioritize moderate-to-vigorous physical activity (MVPA) to improve outcomes. However, this approach overlooks other important daily movement behaviors, including light-intensity physical activity, sedentary behaviors, and sleep. The 24-hour paradigm, which recognizes these behaviors as interdependent, guides research and practice in type 2 diabetes and cancer and may offer similar uses and benefits in the context of MBS.

OBJECTIVES (1) Review studies examining movement behaviors, individually or combined, in the context of MBS and clinical outcomes and (2) present rationale and recommendations for integrating the 24-hour movement paradigm into MBS research and practice.

SETTING International collaboration of MBS researchers, clinicians, and stakeholders.

METHODS A narrative review examined how MBS patients engage in movement behaviors beyond MVPA, how these behaviors may be associated with MBS outcomes, and interventions targeting them. This evidence was used to shape the rationale and recommendations for integrating the 24-hour movement paradigm into MBS research and practice.

RESULTS Few studies have examined the 24-hour movement behaviors, and none have explored their interactions. Similarly, few research interventions have targeted behaviors beyond MVPA in MBS patients. There is a clear need to determine how to effectively integrate the 24-hour movement paradigm into MBS practice to improve weight and health outcomes. Several suggestions are offered to help integrate this approach to enhance healthier 24-hour movement patterns.

CONCLUSION Integrating the 24-hour movement paradigm into MBS research and clinical care can yield a more complete view of how daily movement patterns affect clinical outcomes and guide personalized interventions that address all behaviors collectively rather than each one in isolation.