Proposed Definitions and Clinical Recommendations for the Management of Weight Recurrence, Partial Response, and...

Weight recurrence (WR), partial response, and nonresponse following metabolic and bariatric surgery (MBS) remain poorly defined. This lack of standardization hinders timely diagnosis, clinical management, and outcomes research. Moreover, no consensus guidelines currently exist to guide providers in treating these conditions.

To evaluate current practices in managing WR, partial response, and nonresponse after MBS; to propose standardized definitions; and to offer evidence-informed clinical recommendations for their identification and treatment.

A systematic literature review was conducted using terms related to WR, partial response, and nonresponse following primary MBS. The review focused on management strategies, clinical guidelines, and algorithms addressing these conditions.

A total of 119 articles published between 2020 and 2023 were included. Of these, 52% were retrospective, 31% prospective or observational, and 7.6% randomized controlled trials. Nearly half (45%) did not define WR or distinguish partial and nonresponse. Among studies that defined WR, definitions varied widely. Clinical management strategies were heterogeneous, and only 2.5% proposed structured treatment algorithms.

We propose standardized definitions for WR, partial response, and nonresponse after MBS, along with tailored management algorithms. These recommendations aim to support a unified clinical approach and facilitate research in this complex and evolving area of bariatric care.