Mechanisms of Weight Loss After Obesity Surgery

Akalestou, Elina; Miras, Alexander D.; Rutter, Guy A.; Roux, Carel W. le

doi:10.1210/endrev/bnab022

Cited by 67 publications

(42 citation statements)

References 152 publications

(146 reference statements)

Supporting

Mentioning

Contrasting

Unclassified

Order By: Relevance

“…In addition, oral administration of GW4064 to WT mice induced hepatic expression of Insig2 , a negative regulator of SREBP activity, whereas Fgf15 deficiency abolished induction [ 141 ]. FGF19 levels can increase following bariatric surgery and this increase is involved in postoperative body weight loss [ 168 ]. Collectively, FGF15/19 positively impacts our health status through these intracellular events.…”

Section: Regulation Production and Biological Function Of Fgf15/19mentioning

confidence: 99%

Molecular Basis of Bile Acid-FXR-FGF15/19 Signaling Axis

Katafuchi,

Makishima

2022

IJMS

View full text Add to dashboard Cite

Bile acids (BAs) are a group of amphiphilic molecules consisting of a rigid steroid core attached to a hydroxyl group with a varying number, position, and orientation, and a hydrophilic side chain. While BAs act as detergents to solubilize lipophilic nutrients in the small intestine during digestion and absorption, they also act as hormones. Farnesoid X receptor (FXR) is a nuclear receptor that forms a heterodimer with retinoid X receptor α (RXRα), is activated by BAs in the enterohepatic circulation reabsorbed via transporters in the ileum and the colon, and plays a critical role in regulating gene expression involved in cholesterol, BA, and lipid metabolism in the liver. The FXR/RXRα heterodimer also exists in the distal ileum and regulates production of fibroblast growth factor (FGF) 15/FGF19, a hormone traveling via the enterohepatic circulation that activates hepatic FGF receptor 4 (FGFR4)-β-klotho receptor complex and regulates gene expression involved in cholesterol, BA, and lipid metabolism, as well as those regulating cell proliferation. Agonists for FXR and analogs for FGF15/19 are currently recognized as a promising therapeutic target for metabolic syndrome and cholestatic diseases.

show abstract

Section: Regulation Production and Biological Function Of Fgf15/19mentioning

confidence: 99%

Molecular Basis of Bile Acid-FXR-FGF15/19 Signaling Axis

Katafuchi,

Makishima

2022

IJMS

View full text Add to dashboard Cite

show abstract

“…In the past two decades, bariatric surgery has universally become an increasingly popular treatment for clinically severe obesity [ 5 , 6 , 7 , 8 , 9 , 10 ]. It has been generally accepted as the most effective treatment, with superior results in weight loss, mortality risk reduction, cardiovascular risk reduction and resolution or improvement of obesity-related comorbidities, contributing to enhanced quality of life and increased life expectancy [ 8 , 11 , 12 , 13 , 14 ]. However, most evaluations of bariatric surgical outcomes have been hampered by inadequate and incomplete long-term follow-up or significantly contrast procedures no longer performed today, such as the nonadjustable gastric band and vertical banded gastroplasty reported in the well-respected Swedish Obese Subjects (SOS) study [ 15 , 16 ].…”

Section: Introductionmentioning

confidence: 99%

Long-Term Trajectories in Weight and Health Outcomes Following Multidisciplinary Publicly Funded Bariatric Surgery in Patients with Clinically Severe Obesity (≥ 3 Associated Comorbidities): A Nine-Year Prospective Cohort Study in Australia

Tan

Jin

Taylor

et al. 2022

JCM

View full text Add to dashboard Cite

Background: Real-world data on long-term (>5 years) weight loss and obesity-related complications after newer bariatric surgical procedures are currently limited. The aim of this longitudinal study was to examine the effectiveness and sustainability of bariatric surgery in a cohort with clinically severe obesity in a multidisciplinary publicly funded service in two teaching hospitals in New South Wales, Australia. Methods: Patients were adults with complex clinically severe obesity with a BMI ≥ 35 kg/m2 and at least three significant obesity-related comorbidities, who underwent bariatric surgeries between 2009 and 2017. Detailed obesity-related health outcomes were reported from annual clinical data and assessments for up to 9 years of follow-up. Data were also linked with the national joint replacement registry. Results: A total of 65 eligible patients were included (mean, 7; range, 3–12 significant obesity-related comorbidities); 53.8% female; age 54.2 ± 11.2 years, with baseline BMI 52.2 ± 12.5 kg/m2 and weight 149.2 ± 45.5 kg. Most underwent laparoscopic sleeve gastrectomy (80.0%), followed by laparoscopic adjustable gastric banding (10.8%) and one anastomosis gastric bypass (9.2%). Substantial weight loss was maintained over 9 years of follow-up (p < 0.001 versus baseline). Significant total weight loss (%TWL ± SE) was observed (13.2 ± 2.3%) following an initial 1-year preoperative intensive lifestyle intervention, and ranged from 26.5 ± 2.3% to 33.0 ± 2.0% between 1 and 8 years following surgery. Type 2 diabetes mellitus (T2DM), osteoarthritis-related joint pain and depression/severe anxiety were the most common metabolic, mechanical and mental health comorbidities, with a baseline prevalence of 81.5%, 75.4% and 55.4%, respectively. Clinically significant composite cumulative rates of remission and improvement occurred in T2DM (50.0%–82.0%) and hypertension (73.7%–82.9%) across 6 years. Dependence on continuous positive airway pressure treatment in patients with sleep-disordered breathing fell significantly from 63.1% to 41.2% in 6 years. Conclusion: Bariatric surgery using an intensive multidisciplinary approach led to significant long-term weight loss and improvement in obesity-related comorbidities among the population with clinically complex obesity. These findings have important implications with respect to clinical care and management of the highest severity of obesity and its medical consequences. Major challenges associated with successful outcomes of bariatric surgery in highly complex patients include improving mental health in the long run and reducing postoperative opioid use. Long-term follow-up with a higher volume of patients is needed in publicly funded bariatric surgery services to better monitor patient outcomes, enhance clinical data comparison between services, and improve multidisciplinary care delivery.

show abstract

“…Other changes, regarding the increased microbial diversity and the energy consumption, with a reduced ability to extract calories, are all features of a leaner phenotype. RYGB appears to be the most increasing diversity intervention [63]. The phylum that mostly increased is Proteobacteria, while changes in oxygen availability seem to reduce the abundance of Bifidobacteria and Blautia [64].…”

Section: Bariatric Surgerymentioning

confidence: 97%

“…On the other hand, in the case of reduced microbiota diversity subsequent to weight loss, the risk of weight-regain increases [63].…”

Section: Bariatric Surgerymentioning

confidence: 99%

Nutritional Management in Bariatric Surgery Patients

Deledda

Pintus²,

Loviselli

et al. 2021

IJERPH

View full text Add to dashboard Cite

The obesity epidemic, mainly due to lifestyle changes in recent decades, leads to serious comorbidities that reduce life expectancy. This situation is affecting the health policies of many nations around the world. Traditional measures such as diet, physical activity, and drugs are often not enough to achieve weight loss goals and to maintain the results over time. Bariatric surgery (BS) includes various techniques, which favor rapid and sustained weight loss. BS is a useful and, in most cases, the best treatment in severe and complicated obesity. In addition, it has a greater benefit/risk ratio than non-surgical traditional therapies. BS can allow the obese patient to lose weight quickly compared with traditional lifestyle changes, and with a greater probability of maintaining the results. Moreover, BS promotes improvements in metabolic parameters, even diabetes remission, and in the quality of life. These changes can lead to an increase of life expectancy by over 6 years on average. The nutrition of people before and after BS must be the subject of indications from a trained staff, and patients must be followed in the subsequent years to reduce the risk of malnutrition and the associated problems. In particular, it is still debated whether it is necessary to lose weight prior to surgery, a procedure that can facilitate the surgeon’s work reducing the surgical risk, but at the same time, lengthens preparation times increasing the risks associated with concomitant pathologies. Furthermore, preventing nutritional deficiencies prior to the intervention can improve the results and reduce short- and long-term mortality.

show abstract

Mechanisms of Weight Loss After Obesity Surgery

Cited by 67 publications

References 152 publications

Molecular Basis of Bile Acid-FXR-FGF15/19 Signaling Axis

Molecular Basis of Bile Acid-FXR-FGF15/19 Signaling Axis

Long-Term Trajectories in Weight and Health Outcomes Following Multidisciplinary Publicly Funded Bariatric Surgery in Patients with Clinically Severe Obesity (≥ 3 Associated Comorbidities): A Nine-Year Prospective Cohort Study in Australia

Nutritional Management in Bariatric Surgery Patients

Contact Info

Product

Resources

About