Mechanisms of weight loss and improved metabolism following bariatric surgery

Abstract

Bariatric surgery is increasingly recognized as one of the most effective interventions to help patients achieve significant and sustained weight loss, as well as improved metabolic and overall health. Unfortunately, the cellular and physiological mechanisms by which bariatric surgery achieves weight loss have not been fully elucidated, yet are critical to understanding the central role of the intestinal tract in whole-body metabolism and to developing novel strategies for the treatment of obesity. In this review, we provide an overview of potential mechanisms contributing to weight loss, including effects on regulation of energy balance and both central and peripheral nervous system regulation of appetite and metabolism. Moreover, we highlight the importance of the gastrointestinal tract, including alterations in bile acid physiology, secretion of intestinally derived hormones, and the microbiome, as a potent mediator of improved metabolism in postbariatric patients.

Intensive multidisciplinary weight management in patients with type 1 diabetes and obesity: A one‐year retrospective matched cohort study

“…However, weight‐adjusted insulin requirements were reduced in patients with T1D after bariatric surgery . This difference may be attributed to the greater magnitude of weight loss after bariatric surgery, or may possibly be related to the unique physiological changes that follow these surgeries . Furthermore, the observed changes in glycaemic control and daily insulin dose in this study are similar to those observed in a meta‐analysis of six randomized controlled trials that evaluated the glycaemic effect of aerobic and resistance exercise in patients with T1D .…”

“…magnitude of weight loss after bariatric surgery, 28 or may possibly be related to the unique physiological changes that follow these surgeries. 29 Furthermore, the observed changes in glycaemic control and daily insulin dose in this study are similar to those observed in a metaanalysis of six randomized controlled trials that evaluated the glycaemic effect of aerobic and resistance exercise in patients with T1D. 30 Although change in use of antihypertensive medication compared to baseline use did not reach statistical significance in either cohort, use of antihypertensive medications differed between cohorts at 12 months.…”

Improved metabolism and body composition beyond normal levels following gastric bypass surgery: a longitudinal study

“…In addition, regulation of energy balance, appetite and gastrointestinal factors, as reviewed by Mulla et al . , or improved adipose tissue function may also play a role . Finally, catabolic factors may influence the improvement in metabolism following consumption of a hypocaloric diet.…”

Microbiome, bile acids, and obesity: How microbially modified metabolites shape anti‐tumor immunity

“…Gastric banding has become less common due to physical complications of the band and gastric organ. 46 The various surgical strategies and mechanisms of action have been reviewed in detail elsewhere, 47 but generally include some degree of gastric volume restriction, alteration to endocrine signaling, vagal stimulation, and BA metabolism, with changes in the microbiome.…”