Weight regain after Roux-en-Y: a significant 20% complication related to PYY.
OBJECTIVE
Roux-en-Y gastric bypass (RYGB) produces rapid and dramatic weight loss in very heavy obese patients. Up to 20% cannot sustain their weight loss beyond 2 to 3 y after surgery.


METHODS
To identify putative etiologic factors producing post-RYGB weight regain, a literature survey of metabolic changes in very obese and a review of our diet-induced obese RYGB rat model data was done.


RESULTS
Weight regain suggests an imbalance in physiologic mechanisms regulating appetite and metabolic rate. Weight regain occurred in 25% of our rats, produced by return to presurgical energy intake levels. The 75% of rats that sustained weight loss secreted a significantly larger amount of peptide YY (PYY) while suppressing leptin secretion; those that failed were unable to develop or sustain a sufficiently large plasma PYY:leptin ratio. Metabolic consequences of this failure included reversal of initial postsurgical increases in peripheral fatty acid oxidation, anorexigenic activity in the hypothalamic arcuate nucleus and paraventricular nucleus, and the expression of uncoupling protein-2 in adipose tissues, and decreases in hepatic lipogenesis, free tri-iodothyronine secretion, expression of orexigenic activity in the arcuate nucleus and paraventricular nucleus, expression of adenosine monophosphate kinase in adipose tissues, skeletal muscle mitochondrial mass, and endocannabinoid content and appetite.


CONCLUSIONS
Weight regain after RYGB occurs in approximately 20% of patients and constitutes a serious complication. Weight regain-promoting consequences are attributed to a failure to sustain elevated plasma PYY concentrations, indicating that combining RYGB with pharmacologic stimulation of PYY secretion in patients after RYGB who exhibit inadequate PYY concentration may increase long-term success of surgical weight reduction in morbidly obese adults.
Meguid
Michael M
MM
Surgical Metabolism and Nutrition Laboratory, Department Surgery, Neuroscience and Physiology Program, SUNY Upstate Medical University, Syracuse, New York, USA. meguidm@upstate.edu
Glade
Michael J
MJ
Middleton
Frank A
FA
D000273:Adipose Tissue / Q000378:metabolism; D000818:Animals; D004734:Energy Metabolism; D005227:Fatty Acids / Q000378:metabolism; D005247:Feeding Behavior; D015390:Gastric Bypass; D006801:Humans; D007031:Hypothalamus / Q000378:metabolism; D020738:Leptin / Q000097:blood; D019894:Peptide YY / Q000097:blood*; D051381:Rats; D012008:Recurrence; D015430:Weight Gain
D005227:Fatty Acids; D020738:Leptin; D019894:Peptide YY