Some regain is expected and normal. Significant regain almost always has a behavioural cause with a practical fix.
Most patients regain 5–10% of their lowest weight between years two and five. That is physiological adaptation, not failure, and it is why nadir weight is a poor benchmark for success.
Grazing on small amounts continuously, drinking calories, loss of protein priority, and stopping activity. Notice that none of them is 'the surgery stopped working' — the anatomy rarely changes.
Sleeve dilatation and, after bypass, an enlarged gastro-jejunal anastomosis do occur. They are diagnosed by endoscopy, not assumption, and can be revised — but only after behavioural causes have been excluded.
Return to protein-first eating, restart food logging for four weeks, add resistance training, and get bloods checked. Most patients recover the trajectory without further surgery — and our twelve-month programme exists precisely to catch this early.
Sometimes, but outcomes are better when behavioural causes are addressed first. Revision for regain alone has a higher complication rate than the original operation.