The mechanisms of weight loss after bariatric surgery

Tadross, John; Roux, Carel W. le

doi:10.1038/ijo.2009.14

Cited by 90 publications

(58 citation statements)

References 56 publications

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“…1 Although the surgery was initially designed to cause weight loss by alimentary restriction and malabsorption, it appears that the surgical manipulations also change the metabolic, gastrointestinal, hormonal and nervous system physiology. 2 The underlying mechanisms of surgically induced weight loss remain incompletely understood, 3 but they seem to induce a decrease in hunger, an increase in satiety, changes in food preferences and energy expenditure. 4 The first mechanisms have been shown to be at least partly physiologically induced by alterations in gastrointestinal and central neuroendocrine signalling.…”

Section: Introductionmentioning

confidence: 99%

Exogenous peptide YY3-36 and Exendin-4 further decrease food intake, whereas octreotide increases food intake in rats after Roux-en-Y gastric bypass

et al. 2011

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Background: Patients show an elevated postprandial satiety gut hormone release after Roux-en-Y Gastric bypass (gastric bypass). The altered gut hormone response appears to have a prominent role in the reduction of appetite and body weight (BW) after gastric bypass. Patients with insufficient BW loss after gastric bypass have an attenuated postprandial gut hormone response in comparison with patients who lost an adequate amount of BW. The effects of additional gut hormone administration after gastric bypass are unknown. Methods: The effects of peripheral administration of peptide YY3-36 (PYY3-36; 300 nmol kg À1 ), glucagon-like peptide-1 (GLP-1) analogue Exendin-4 (20 nmol kg À1 ) and somatostatin analogue octreotide (10 mg kg À1 ) on feeding and BW were evaluated in rats after gastric bypass. Results: Gastric bypass rats weighed (Po0.01) and ate less on postoperative day 5 (Po0.001) and thereafter, whereas postprandial plasma PYY and GLP-1 levels were higher compared with sham-operated controls (Po0.001). Administration of both PYY3-36 and Exendin-4 led to a further decrease in food intake in bypass rats compared with saline treatment (P ¼ 0.02 and Po0.0001, respectively). Similar reduction in food intake was observed in sham rats (P ¼ 0.02 and Po0.001, respectively). Exendin-4 treatment resulted in a significant BW loss in bypass (P ¼ 0.03) and sham rats (P ¼ 0.04). Subsequent treatment with octreotide led to an increase in food intake in bypass (P ¼ 0.007), but not in sham rats (P ¼ 0.87). Conclusion: Peripheral administration of PYY3-36 and Exendin-4 reduces short-term food intake, whereas octreotide increases short-term food intake in rats after gastric bypass. The endogenous gut hormone response after gastric bypass can thus potentially be further enhanced by additional exogenous therapy with pharmacological doses of gut hormones in patients with insufficient weight loss or weight regain after surgery.

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Section: Introductionmentioning

confidence: 99%

Exogenous peptide YY3-36 and Exendin-4 further decrease food intake, whereas octreotide increases food intake in rats after Roux-en-Y gastric bypass

et al. 2011

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“…In addition to its glucose-regulating effects, GLP-1 is associated with reduced appetite, food intake, and body weight (11), which is at least partly mediated via effects in the CNS (12,13). Neuroendocrine changes after RYGB, such as the enhanced GLP-1 secretion, are regarded as possible mechanisms to account for a part of appetite and weight reduction and the sustained efficacy of this procedure (14,15).…”

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confidence: 99%

Elevated Postoperative Endogenous GLP-1 Levels Mediate Effects of Roux-en-Y Gastric Bypass on Neural Responsivity to Food Cues

et al. 2017

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OBJECTIVEIt has been suggested that weight reduction and improvements in satiety after Rouxen-Y gastric bypass (RYGB) are partly mediated via postoperative neuroendocrine changes. Glucagon-like peptide-1 (GLP-1) is a gut hormone secreted after food ingestion and is associated with appetite and weight reduction, mediated via effects on the central nervous system (CNS). Secretion of GLP-1 is greatly enhanced after RYGB. We hypothesized that postoperative elevated GLP-1 levels contribute to the improved satiety regulation after RYGB via effects on the CNS. RESEARCH DESIGN AND METHODSEffects of the GLP-1 receptor antagonist exendin 9-39 (Ex9-39) and placebo were assessed in 10 women before and after RYGB. We used functional MRI to investigate CNS activation in response to visual food cues (pictures) and gustatory food cues (consumption of chocolate milk), comparing results with Ex9-39 versus placebo before and after RYGB. RESULTSAfter RYGB, CNS activation was reduced in the rolandic operculum and caudate nucleus in response to viewing food pictures (P = 0.03) and in the insula in response to consumption of palatable food (P = 0.003). GLP-1 levels were significantly elevated postoperatively (P < 0.001). After RYGB, GLP-1 receptor blockade resulted in a larger increase in activation in the caudate nucleus in response to food pictures (P = 0.02) and in the insula in response to palatable food consumption (P = 0.002). CONCLUSIONSWe conclude that the effects of RYGB on CNS activation in response to visual and gustatory food cues may be mediated by central effects of GLP-1. Our findings provide further insights into the mechanisms underlying the weight-lowering effects of RYGB.Bariatric surgery is currently the most effective therapeutic modality for severe obesity in terms of substantial weight loss and long-term efficacy (1). The most commonly performed procedure is Roux-en-Y gastric bypass surgery (RYGB), which comprises the formation of a small gastric pouch, which is connected to the midjejunum, bypassing the duodenum and proximal jejunum. This may lead to reduced ingestive capacity and

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“…Also described increased levels of PYY and GLP-1 which induces an increased sense of fullness after surgery [23]. These hypotheses are currently under study, as well as other proposed mechanisms, including increased basal energy expenditure at multiple levels or decrease in leptin levels [19].…”

Section: Effects On Weight and Mechanism Inducing Weight Lossmentioning

confidence: 88%

Review: Surgical Treatment of Type 2 Diabetes

Gil¹,

Alarcón²,

Ruiz³

et al. 2014

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In the last decades we have witnessed a significant increase in the incidence of type 2 diabetes mellitus, and obesity in parallel. So 90% of patients with Diabetes Mellitus type 2 (DM2) are obese. Changes in lifestyle (diet and exercise), behavioral therapies or the use of certain anti-obesity drugs have shown a limited effect and are not maintained over time. Currently, bariatric surgery is the most effective anti-obesity treatment, which is durable and resolves associated comorbidities. The surgical treatment of obesity for the modification of the anatomy of the digestive system is to produce gastric capacity constraints alone or associate with varying degrees of intestinal malabsorption and reduce body weight, improve and maintain the comorbidities associated weight loss by reduced food intake alone or in combination with malabsorption of this. The development of these surgical techniques has occurred in stages. With these techniques, setting to bariatric surgery is an effective, safe and proven procedure for the treatment of obesity and its complications especially DM2, as their post surgery referral mechanisms provide us with information for potential therapeutic treatment aimed at optimizing the control DM2 patients metabolic obese. In this review, we expose the evidence in treatment of DM2 with bariatric surgery and the actual hypothesis trying to explain how it is possible.

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The mechanisms of weight loss after bariatric surgery

Cited by 90 publications

References 56 publications

Exogenous peptide YY3-36 and Exendin-4 further decrease food intake, whereas octreotide increases food intake in rats after Roux-en-Y gastric bypass

Exogenous peptide YY3-36 and Exendin-4 further decrease food intake, whereas octreotide increases food intake in rats after Roux-en-Y gastric bypass

Elevated Postoperative Endogenous GLP-1 Levels Mediate Effects of Roux-en-Y Gastric Bypass on Neural Responsivity to Food Cues

Review: Surgical Treatment of Type 2 Diabetes

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