Weight regain after bariatric surgery: A framework for management

Obesity is a complex, multifactorial disease. Rates of obesity are rising worldwide. Bariatric surgery is the most effective treatment for obesity, as it results in the greatest weight loss as well as significant improvement in or resolution of obesity-related comorbidities. Despite the efficacy of bariatric surgery, postoperative weight gain is a reality for up to 37% of patients. Significant weight regain is associated with recurrence or worsening of comorbidities as well as reduced quality of life. Early identification of those at risk and prompt intervention can minimize the amount of postoperative weight regain. Reinforcing lifestyle modifications, assessing mental health, and scheduling frequent office visits are necessary to minimize weight regain. Phentermine/topiramate, the glucagon-like peptide-1 (GLP-1) receptor agonists liraglutide and semaglutide, and the dual incretin tirzepatide are effective for treating postoperative weight regain. Referral to a bariatric surgeon may be indicated for those needing surgical revision. Further research is necessary to create a formal clinical treatment guideline for identifying and managing weight regain after bariatric surgery.