**8. Conclusion**

Obesity can be successfully treated, especially if approached in a comprehensive, multi-disciplinary, long-term fashion, as befits a complex and chronic disease. Important components of successful surgical management include careful patient selection, setting expectations, pre-conditioning, behavioral modification, and longterm postoperative follow-up. This requires screening and management of clinically impactful psychosocial diagnoses, comprehensive education and dietary counseling, access to support groups, and the resources to ensure follow-up postoperatively. Various bariatric surgical procedures, especially those with a hypo-absorptive component, are at risk for several nutrient deficiencies that need to be monitored long-term.

There remains a significant level of uncertainty regarding the best clinical practices for optimizing and maintaining weight loss after bariatric surgery. Standardization of bariatric surgical processes and guidelines by professional organizations such as the American Society for Metabolic and Bariatric surgeons (ASMBS) is an important start. However, more effort is needed to screen and improve psychological care, behavior management, and provide therapeutic patient education **after** surgery.

Understanding post-bariatric surgery outcome failure is important in addressing and helping the significant minority of patients (20–30%) who do not have expected weight loss, and subsequently regain weight previously lost. Screening for the multitude of risk factors related to bariatric surgery outcomes post-operatively can provide clinically relevant and useful information. For example, asking postsurgical patients to rate their level of adherence to dietary recommendations, and the frequency of grazing identifies high risk patients and the need for intervention. Additional measures based on patient's responses might include additional dietary assistance, referral for behavior therapy, and encouraged attendance at bariatric support groups. If return of appetite after surgery is an identified impediment with dietary adherence, evaluation for anti-obesity medications (AOMs) may be useful.

Additional investigation is needed into specific psychosocial, behavioral, and dietary adherence components that affect postsurgical weight loss outcome. Future research should determine how eating disorders such as food addiction affect longterm postoperative outcomes and mood stability, and examine which interventions are successful at improving problematic eating behaviors. It is also important to better understand patient motivational characteristics in relation to treatment compliance such as follow-up, support group participation and other aftercare recommendations. Results of this research will ultimately lead to better understanding of postsurgical outcome success and failure, and lead to better tailored yet standardized interventions accordingly.
