**7. Prevention of weight regain**

**Figure 1** summarizes the prevention strategies of WR. The foundation of prevention of WR after BS is aggressive behavioral interventions, similar to those utilized for medical weight management patients [33]. Behavioral modification components include commitment to regular structured physical activity, dietary control, nutritional optimization with substantive changes in eating practices and lifestyle habits [33, 71]. Other modulators include stress management, realistic goal setting, environmental control strategies, support systems, and cognitive restructuring [33, 71]. Close regular follow-up should start shortly after BS to reinforce nutritional and lifestyle instructions provided at discharge. Monitoring, education, and support should continue on the long term as the effectiveness of behavioral changes diminishes with time [33]. Self-monitoring with regular weight measurement, food records, and exercise diaries are essential tools for avoiding WR. These strategies increase patient's awareness of eating patterns, and allow the bariatric dietitian to identify high-risk areas, such as nutritional inadequacy, food intolerances, poor food choices, or food dislikes that compromise weight loss and nutritional status [72]. In-person dietary counseling by a registered dietitian has an important role in prevention of WR post BS [73]. Structured physical activity is vital for weight prevention. An RCT demonstrated that a 5-month supervised exercise program post LSG resulted in reduction total body weight (TBW) and waist circumference with an increase in EWL% compared with the control group [74]. Conversely, stopping of the exercise program led to weight regain, with increased fat mass and decreased EWL% [74].
