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Background: This study aimed to further explore the application of genetic risk assessments in 24 metabolic bariatric surgery (MBS) patients to predict weight loss outcomes three years after the procedure. Methods: Participants were assessed using the Genetic Addiction Risk Severity (GARS) test, which evaluates neurogenic polymorphisms linked to addiction and reward deficiency. Genetic and psychosocial data collected prior to surgery were analyzed in relation to post-operative weight loss measures, including weight change, body mass index (BMI), percentage of total weight loss (%TWL), and percentage of expected weight loss (%EWL). The analysis examined associations between specific genetic risk alleles, weight-related outcomes at three to four years post-surgery, and psychosocial trait scores. Results: Spearman's correlations revealed that the DRD2 risk allele is negatively correlated with 3-year BMI (r_s = -0.481, p < 0.05, 95% CI: -0.746 to -0.083). One-way ANOVA indicated that there is a significant difference in 3-year BMI (p = 0.018) between 0 and 1 DRD2 risk allele copy. There is also a significant difference in ∆weight (p = 0.022), ∆BMI (p = 0.014), and %EWL (p = 0.032) among the different SNP expression values of the MAOA risk allele. In addition, Spearman's correlation revealed that FCQ scores are negatively correlated with ∆BMI (r_s = -0.470, p < 0.05, 95% CI: -0.767, -0.005), %TWL (r_s = -0.561, p < 0.05, 95% CI: -0.814, -0.129), and %EWL (r_s = -0.533, p < 0.05, 95% CI: -0.800, -0.090) at 3 years post-surgery and positively correlated with 3-year weight (r_s = 0.576, p < 0.05, 95% CI: 0.151, 0.821) and 3-year BMI (r_s = 0.552, p < 0.05, 95% CI: 0.117, 0.810). Lastly, GARS scores are positively correlated with 3-year ∆weight (r_s = 0.422, p < 0.05, 95% CI: 0.010, 0.712).