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Background Bariatric surgery in adolescents with obesity and non-alcoholic fatty liver disease (NAFLD) requires sustained postoperative monitoring to support metabolic recovery, physical activity, and behavioral adherence. Advances in wearable health technology and location-based monitoring may provide continuous, real-world assessment beyond conventional clinical follow-up.Methods A prospective observational study was conducted in Gurugram, India, involving 840 obese adolescents diagnosed with NAFLD who underwent bariatric surgery between 2022 and 2024. Participants (male: female = 1:1) were monitored for 30 days using a smart wearable device integrated with geo-fencing functionality. Physiological parameters recorded included heart rate, blood pressure, blood glucose, body weight, step count, energy expenditure, motion duration, sleep metrics, and dietary intake. Geo-fencing alerts were generated when participants exited predefined zones, prompting behavioral feedback. Daily symptom logs and weekly structured interviews evaluated gastrointestinal symptoms, activity patterns, cognitive focus, and quality-of-life measures. Outcomes were compared according to postoperative activity levels.Results Adolescents demonstrating higher physical activity showed significant improvement in heart rate stabilization (p<0.05), increased caloric expenditure, and marked reductions in blood glucose and blood pressure levels (p<0.01). Enhanced metabolic efficiency and longer sleep duration were confirmed through a physiotherapist assessment. Among less active participants, wearable-guided lifestyle modification was associated with improved attention, reduced wandering episodes, and decreased medication requirements during follow-up.Conclusions Integration of wearable monitoring and geo-fencing technology offers a feasible and effective approach for postoperative surveillance in adolescent bariatric patients with NAFLD. Real-time physiological feedback and mobility tracking may enhance engagement, promote healthier behaviors, and support metabolic recovery. These findings highlight the potential role of digital health tools as adjuncts to minimally invasive bariatric surgery pathways in adolescents.