**8. Management of WR**

**Figure 1** illustrates the management strategies of WR. WR after BS is complex and multifactorial [7]. Hence, management requires a holistic strategy addressing patient- and surgery-related factors that might contribute to WR. Dietary patterns, psychological disorders and physical activity levels should all be reviewed, as diet (25.3%), physical activity (21%) and motivational issues (19.7%) were the most common reasons among patients with WR [75]. Patients seeking BS often present with a range of mental health issues including mood, anxiety, addiction and personality disorders [7, 26]. Diagnosis and management of these conditions may improve outcomes following BS. As the patient undergoes psychological, dietary and physical activity counselling, it is critical to address the hormonal causes, and any

anatomic/post-surgical changes that cause WR. Baseline anatomic studies include esophagogastroduodenoscopy or an upper gastrointestinal contrast to evaluate the GI tract [76]. These modalities provide essential data about the gastric remnant size, size of the gastrojejunal anastomosis, presence of gastro-gastric fistula, and location/integrity of the bands. Available treatment options include behavior interventions, WL-approved medications, endoscopic interventions and revision surgery to counter some of the factors that resulted in WR.
