Abstract: Metabolic and bariatric surgery (MBS) provides durable weight loss and metabolic benefits, but maintaining the lowest postoperative weight should not be the sole criterion for long-term success.The weight-loss plateau may represent either a new healthy homeostatic state or an early warning sign of weight regain, sarcopenia, loss of control over eating, or psychological and sleep disturbances.Based on domestic and international research over the past five years, the consensus on domestic plateau and postoperative follow-up management in 2025, as well as the latest evidence on anti-obesity drugs and body composition from 2024 to 2026, this paper suggests shifting the long-term postoperative follow-up from a single weight threshold to a domain monitoring framework encompassing body weight, waist circumference, metabolic status, body composition, bone health, psychological and behavioral health, and physical function.Then, search for the dominant mechanisms by anatomical type, hungery-metabolic type, sarcopenia-low function type, eating behavior type and psychological-sleep type.Thresholds for recurrent weight gain should therefore serve as triggers for clinical reassessment rather than definitive indicators of treatment failure.The re-evaluation during the plateau period should take into account multiple signals such as weight trend, waist circumference, medication for metabolic diseases, muscle strength, bone density, nutritional intake and follow-up dropout.Nutrition, resistance exercise, micronutrient monitoring and active follow-up form a common foundation.Anti-obesity drugs, cognitive behavioral therapy, endoscopic treatment and corrective surgery should be combined in parallel based on the cause, rather than being remedied step by step after a large amount of recurrence.Potent enterotropin drugs and endoscopic/corrective treatments have provided new tools for relapse management, but they need to simultaneously protect protein intake, lean body mass, bone health and psychological safety, and strictly distinguish between observational evidence, randomized trial evidence and expert opinions.Long-term success should be understood as continuous benefits in fat mass, muscle function, bone health, metabolic health, mental state and quality of life, rather than permanently remaining at the minimum body mass.

Key words: metabolic and bariatric surgery; weight plateau; recurrent weight gain; sarcopenia; anti-obesity medication; psychological behavior; bone health