The case for stepped care for weight management after bariatric surgery.

Among carefully screened patients, bariatric surgery has proven safe and efficacious in the management of clinically severe obesity and poorly controlled type 2 diabetes. Nonetheless, individual outcomes vary, suggesting the need for interventions to maximize and sustain the health benefits of surgery. In this short review, we synthesize findings from the extant research literature to suggest the potential utility of a stepped care approach to optimize the postsurgery weight trajectory, which requires further research using adaptive designs. Starting with low-intensity, cost-effective interventions, such as self-weighing and self-monitoring, interventions that increase in intensity, such as counseling, meal replacements, or weight loss medications, could be added strategically according to predetermined decision rules based on patient weight change. Interventions could subsequently be withdrawn if no longer indicated, or reinstituted when appropriate, allowing for efficient allocation of resources in a personalized approach to postsurgery weight management over time.