Editorial: Nutrition for sustainable weight management post-bariatric surgery

Abstract

This Research Topic, Nutrition for Sustainable Weight Management Post-Bariatric Surgery, was conceived to explore innovative, evidence-based nutritional strategies to bolster longterm weight management for post-MBS patients. Its scope encompasses a multifaceted approach: identifying optimal dietary patterns and the role of micronutrient supplementation, integrating behavioral health interventions to support dietary adherence, and investigating the psychological and social determinants of eating behaviors after surgery. The underlying premise is that long-term success hinges not only on what patients eat but also on their individual relationships with food, their genetic and metabolic profiles, and the quality of multidisciplinary support they receive.By fostering dialogue across disciplines, this collection seeks to generate novel insights and practical evidence that healthcare professionals can use to support their patients throughout the continuum of post-bariatric care. The four contributions assembled here span the spectrum from broad narrative reviews to focused prospective cohort studies, collectively addressing how to optimize nutritional and clinical outcomes after MBS-not merely in the weeks following the procedure, but over the long term. The challenge of recurrent weight gain remains one of the most clinically significant concerns in bariatric medicine, and it is fitting that this collection opens with a comprehensive perspective on the topic. Xiao et al. provide a narrative review addressing the prognostication of post-bariatric surgery outcomes and the management of recurrent weight gain and diabetes recurrence. Their work synthesizes the evidence on predictive factors -including preoperative BMI, dietary habits, physical activity levels, and mental health status -that influence individual trajectories after surgery. Importantly, the authors emphasize that proactive interventions targeting both pre-and postoperative eating behaviors and lifestyle adjustments are more important than investigating preoperative risk factors alone. The review further discusses the growing role of pharmacological agents, particularly GLP-1 receptor agonists such as semaglutide and liraglutide, 10 as well as endoscopic and revisional surgical interventions for patients who experience suboptimal outcomes. By integrating dietary pattern optimization, pharmacotherapy, and procedural revision into a single framework, Xiao et al. make a compelling case that a multimodal, longitudinal approach is essential for managing the complex phenomenon of recurrent weight gain-a message that resonates strongly with the broader aims of this Research Topic.From the broader landscape of weight management, this collection moves to a more focused yet equally critical nutritional concern. Nutritional deficiencies following MBS are well documented, yet certain preoperative risk factors for these deficiencies remain insufficiently addressed in clinical practice. Nie et al. present a multicenter cohort study examining the impact of preoperative anemia on postoperative anemia and related nutritional abnormalities. Among 452 patients followed for one year after bariatric surgery, 11.7% presented with preoperative anemia. Their findings are striking: patients with preoperative anemia were significantly more likely to develop postoperative anemia (OR 3.52, 95% CI 1.83-7.06), ferritin deficiency (OR 3.77, 95% CI 1.74-8.17), and low transferrin saturation levels (OR 4.12, 95% CI 2.16-7.84). These associations persisted after full covariate adjustment, demonstrating a robust and independent relationship. Current clinical guidelines do not routinely recommend the management of anemia prior to bariatric surgery, 7 yet these data make a compelling case for active preoperative screening and correction of iron status. This study highlights a potentially modifiable risk factor that is frequently overlooked in preoperative optimization protocols, and it speaks directly to the Research Topic's emphasis on supplementation strategies and the prevention of nutritional deficiencies.An underappreciated but distressing complication of bariatric surgery is postoperative alopecia, which can significantly impact patient well-being, body image, and overall satisfaction with surgical outcomes. Wang et al. contribute a prospective cohort study examining the correlation between changes in the serum amino acid spectrum and alopecia in patients with obesity undergoing laparoscopic sleeve gastrectomy (LSG). Among 67 patients, the authors demonstrate that LSG significantly alters amino acid profiles, with notable decreases in arginine, alanine, threonine, branched-chain amino acids (valine, isoleucine, leucine), and aromatic amino acids (tyrosine, phenylalanine, tryptophan), while serine and glycine increased. Crucially, serum leucine concentration at three months postoperatively was identified as an independent risk factor for moderate-to-severe alopecia (OR 1.119, 95% CI 1.006-1.245). This work opens a novel window into the metabolic consequences of bariatric surgery at the amino acid level and suggests that targeted nutritional monitoring could help predict and potentially prevent this common yet often neglected complication. The findings contribute to the growing body of evidence that post-MBS nutritional care must extend beyond traditional micronutrient surveillance to encompass the broader metabolic landscape, including protein and amino acid homeostasis.The final contribution broadens the perspective beyond classical nutrition to encompass the genetic and psychosocial dimensions of MBS outcomes. Hanna et al. present a narrative review exploring how precision medicine approaches -incorporating genetic polymorphisms, neurotransmitter signaling pathways (particularly catecholamine and dopaminergic systems), and psychosocial risk profiling -can be leveraged to improve outcome prediction and personalize postoperative care. The authors draw particular attention to the phenomenon of addiction transfer, whereby patients who have undergone bariatric surgery may develop new substance or behavioral addictions during recovery, a concern rooted in shared neurobiological reward pathways and reward deficiency syndrome. This paper underscores a fundamental premise of this Research Topic: that sustainable weight management after bariatric surgery requires not only nutritional optimization but also careful attention to the neuropsychiatric and behavioral architecture of individual patients. By detailing genetic markers and psychosocial screening tools that may predict susceptibility to weight regain and maladaptive behaviors, Hanna et al. lay the groundwork for a truly personalized approach to post-MBS care -one in which treatment plans are tailored to the biological and psychological profile of each patient.Taken together, the four contributions in this Research Topic paint a nuanced and clinically meaningful picture of the post-bariatric landscape. Several overarching themes emerge. First, the preoperative period is not merely a waiting room for surgery but a critical window for optimization -whether that involves correcting anemia (Nie et al.), assessing psychosocial risk and genetic predisposition (Hanna et al.), or establishing baseline dietary and lifestyle patterns (Xiao et al.). Second, the postoperative phase demands sustained, multidimensional surveillance that extends well beyond weight monitoring to include micronutrient status, amino acid metabolism, and behavioral health. Third, the field is moving toward precision and individualization: from one-size-fits-all supplementation protocols toward targeted interventions informed by genetic, metabolic, and psychosocial profiling. These themes collectively reflect the multifaceted vision upon which this Research Topic was founded.These studies also highlight important gaps that warrant further investigation. The amino acid-alopecia relationship identified by Wang et al. warrants validation in larger, multi-ethnic cohorts and exploration of the underlying mechanistic pathways, including potential interactions with iron and zinc metabolism. The preoperative anemia findings of Nie et al. call for prospective interventional trials examining whether systematic correction of anemia before surgery translates into measurably improved postoperative nutritional outcomes. The precision medicine framework proposed by Hanna et al. requires operationalizationdeveloping practical, cost-effective clinical tools that can integrate genetic and psychosocial data into routine preoperative assessment algorithms. And the comprehensive overview by Xiao et al. reinforces the urgent need for standardized long-term follow-up protocols that capture the full spectrum of post-bariatric outcomes, from metabolic and nutritional parameters to psychological well-being and quality of life. Moreover, several topics originally envisioned for this Research Topic -including the role of gut microbiota in post-surgical nutritional absorption, the impact of socioeconomic and cultural factors on dietary adherence, and the synergistic effects of combined dietary and physical activity programsremain fertile ground for future research and warrant dedicated investigation.In conclusion, this Research Topic reaffirms that MBS is not an endpoint but a beginning. The evidence assembled here argues persuasively for a paradigm shift: from a surgicalcentric model to an integrated, patient-centered framework in which nutrition, metabolism, genetics, and psychosocial factors are woven into a continuous thread of care. As MBS rates continue to rise globally, the imperative to develop and implement holistic, evidencebased postoperative management strategies has never been greater. It is our hope that the insights gathered in this collection will stimulate further research, inform clinical practice, and ultimately contribute to more durable and holistic outcomes for patients navigating life after bariatric surgery.