The Kosi River flows from the eastern Nepal Himalaya into the state of Bihar (India) and has experienced frequent avulsions, causing extensive flood-related damage. Because of this avulsive behavior, the Kosi is called the “Sorrow of Bihar.” The avulsion of 2008 was the most catastrophic avulsion event recorded for the Kosi and has been attributed primarily to hydrological and sedimentological processes that formed a super-elevated river channel and caused avulsion. Detailed topographic analysis of the region near the Kosi exit from the Himalaya, using mean-corrected and resampled 1-arc, Shuttle Radar Topography Mission (SRTM) and Real Time Kinematic Global Positioning System (RTK-GPS) datasets, reveals that the Kosi channel is super-elevated only relative to its eastern floodplain. The western floodplain elevation is similar to or higher than the Kosi channel in the region between the Kosi River exit from the main eastern Nepal Himalaya and the Kosi barrage at the Indo-Nepal border. Structurally, the Kosi exits the Himalaya in the transition zone between the closed Trijuga dun to the west and the Dharan salient to the east. The Trijuga dun is closed by the Main Frontal thrust (MFT)-related frontal topography or the Outer Churia Hills. The eastern slopes of these hills induce west-to-east topographic slope in the channel, such that topographic avulsion indices are highest only in the Outer Churia Hills affected parts of the Kosi Channel and the 2008 avulsion region. Therefore, our preferred model for the primary control on the channel's asymmetric, metastable, super-elevation is the influence of the tectonically controlled MFT-related Outer Churia Hills on the Kosi River channel. Geomorphological processes have operated in the Kosi channel in this backdrop. This study emphasizes that detailed structural and topographic analysis of river exits from mountain belts like the Himalaya can provide better insights into river channel metastability and avulsion worldwide.