Bridging the Gap: Evaluating Tools for Adherence to Dietary-Related Behavioral Recommendations After Metabolic Bariatric Surgery—A Scoping Review

Background and Aims: Adherence to dietary-related behavioral recommendations following metabolic bariatric surgery (MBS) is important for achieving optimal surgical outcomes, but standardized definitions and tools are lacking. This scoping review aimed to map existing tools for assessing adherence to dietary-related behavioral recommendations after MBS, evaluate their content and psychometric properties, and identify gaps to guide future research and tool development. Methods: The review was registered on the Open Science Framework and followed PRISMA-ScR guidelines. Searches were conducted in PubMed and Embase from inception through April 2024, supplemented by hand-searching the reference lists of included reports. The review included studies of adults who underwent MBS, using tools with at least two items assessing adherence to dietary-related recommendations, with detailed tool descriptions, and, when available, information on validity and reliability. Screening and data extraction were performed independently by two reviewers, with discrepancies resolved by a third reviewer. Results: From 3223 publications, 16 reports from 10 countries were included. Tools assessing dietary adherence post-MBS varied widely in content and behavioral targets, with most robust psychometric properties lacking. Reliability was assessed via Cronbach's alpha and test–retest methods and validity via face, content, construct, and criterion measures. Standardized recall periods and comprehensive scoring systems were notably absent. Conclusions: Existing tools for assessing adherence to dietary-related behavioral recommendations after MBS show significant variability, with most lacking standardized psychometric properties and recall periods, limiting their utility. Future research should focus on standardizing dietary-related “core principles,” facilitating the development of new instruments in research and clinical settings.