Weight Recurrence after Metabolic and Bariatric Surgery: Risk Factors and Management Strategies
10.21215/kjfp.2025.15.4.202
- Author:
Jung In CHOI
1
;
Young Hye CHO
;
Sang Yeoup LEE
Author Information
1. Department of Family Medicine and Biomedical Research Institute, Pusan National University Yangsan Hospital, Yangsan, Korea
- Publication Type:Review Article
- From:
Korean Journal of Family Practice
2025;15(4):202-209
- CountryRepublic of Korea
- Language:English
-
Abstract:
Amid the rising prevalence of obesity in Korea, despite advances in pharmacotherapy, metabolic and bariatric surgery remains widely recognized as the most reliable therapy for achieving and maintaining clinically meaningful weight loss and metabolic improvement in moderate-to-severe obesity.Across 5-year cohorts, depending on the definition used, approximately 16%–37% of patients experience clinically meaningful weight regain, which typically begins within the first year after reaching the postoperative nadir. To identify and intervene in weight regain in clinical practice, standardized definitions are necessary, with explicit documentation of baseline weight, nadir weight, rebound (current) weight, and the timing of recurrence. Risk factors include anatomical (sleeve dilation or residual fundus, enlarged pouch, wide gastrojejunostomy), hormonal–metabolic (blunted nutrient-stimulated glucagon‐like peptide‐1/peptide YY responses, late ghrelin rebound, post-bariatric hypoglycemia, metabolic adaptation), dietary–behavioral (snacking, liquid calories/alcohol, grazing and binge/loss-of-control eating, low physical activity, poor adherence), and psychological (depression/anxiety, emotional or night eating, non-planning impulsivity, and low social support) domains. Prevention focuses on intensified surveillance during the first 12 months after the nadir, structured education and self-monitoring, progressive aerobic and resistance activity, and nutrition strategies that prioritize food quality and adherence over fixed macronutrient ratios, with selective adjunct anti-obesity pharmacotherapy when lifestyle measures are insufficient. Notably, liraglutide (3.0 mg) showed an additional 12–24-week weight loss with acceptable tolerability in poor postsurgical responders. Further studies are required to determine the optimal timing, maintenance strategies, and patient selection for adjunct therapies.
