Importance Bariatric surgery is widely recognized for its health benefits; however, its association with work productivity and employment participation, though frequently reported, has not been systematically synthesized. This evidence is crucial to inform the economic evaluation of bariatric surgery. Objective To systematically analyze the evidence on occupational outcomes of bariatric surgery. Evidence Review A systematic literature search was conducted in 5 online databases to identify empirical studies on bariatric surgery–related employment and productivity outcomes published up to April 2024. Two coauthors independently screened the literature, and all coauthors contributed to data extraction and validation. Differences in occupational outcomes were compared before vs after surgery and between surgery vs nonsurgery groups. Comparisons were categorized into 3 groups: improvement, no difference, and worse. Where possible, summary values of occupational outcomes (eg, the average employment rate) were synthesized for each observational time point. Reported barriers and enablers to employment return or productivity were also identified. Findings A total of 42 studies from 15 countries were included. Studies were published between 1977 and 2023, with most conducted in high-income countries. Roux-en-Y gastric bypass was the most frequently studied procedure. The most commonly evaluated metrics were employment and unemployment rates and absenteeism and sick leave. Bariatric surgery was associated with improvements in presenteeism and work hours and ability and short-term absenteeism and employment rates. However, the long-term employment rate followed a reversed U-shape trajectory, with employment rates initially increasing postsurgery but returning to baseline levels after about 5 years. Key barriers to improved occupational outcomes included insufficient weight loss, female sex, older age, preoperative comorbidities, lower quality of life, and a lack of prior work experience. Conclusions and Relevance Bariatric surgery demonstrates positive short-term impact on productivity and employment, but its long-term occupational benefits remain uncertain. Certain subgroups, such as females and older adults, may require tailored postsurgery support to sustain employment and productivity gains. These findings highlight the critical need for long-term strategies to sustain the occupational benefits postsurgery and to develop targeted interventions for at-risk populations.