title: Can medical therapy mimic the clinical efficacy or physiological effects of bariatric surgery?
abstract: The number of bariatric surgical procedures performed has increased dramatically. This review discusses the clinical and physiological changes, and in particular, the mechanisms behind weight loss and glycaemic improvements, observed following the gastric bypass, sleeve gastrectomy and gastric banding bariatric procedures. The review then examines how close we are to mimicking the clinical or physiological effects of surgery through less invasive and safer modern interventions that are currently available for clinical use. These include dietary interventions, orlistat, lorcaserin, phentermine/topiramate, glucagon-like peptide-1 receptor agonists, dipeptidyl peptidase-4 inhibitors, pramlintide, dapagliflozin, the duodenal-jejunal bypass liner, gastric pacemakers and gastric balloons. We conclude that, based on the most recent trials, we cannot fully mimic the clinical or physiological effects of surgery; however, we are getting closer. A 'medical bypass' may not be as far in the future as we previously thought, as the physician's armamentarium against obesity and type 2 diabetes has recently got stronger through the use of specific dietary modifications, novel medical devices and pharmacotherapy. Novel therapeutic targets include not only appetite but also taste/food preferences, energy expenditure, gut microbiota, bile acid signalling, inflammation, preservation of β-cell function and hepatic glucose output, among others. Although there are no magic bullets, an integrated multimodal approach may yield success. Non-surgical interventions that mimic the metabolic benefits of bariatric surgery, with a reduced morbidity and mortality burden, remain tenable alternatives for patients and health-care professionals.
authors.affiliation: Molecular and Metabolic Imaging Group, Imperial College London, MRC Institute of Clinical Sciences, London, UK.
authors.forename: A D
authors.initials: AD
authors.lastname: Miras
authors.affiliation: Department of Experimental Pathology, Conway Institute, School of Medicine and Medical Sciences, University College Dublin, Dublin, Ireland.
authors.forename: C W
authors.initials: CW
authors.lastname: le Roux
mesh_terms: D019440:Anti-Obesity Agents / Q000627:therapeutic use*; D050110:Bariatric Surgery / Q000379:methods; D001552:Benzazepines / Q000627:therapeutic use; D001559:Benzhydryl Compounds; D001786:Blood Glucose / Q000378:metabolism*; D003924:Diabetes Mellitus, Type 2 / Q000097:blood / Q000517:prevention & control / Q000628:therapy*; D015444:Exercise; D005247:Feeding Behavior; D005260:Female; D005632:Fructose / Q000031:analogs & derivatives / Q000627:therapeutic use; D000067757:Glucagon-Like Peptide-1 Receptor; D005960:Glucosides / Q000627:therapeutic use; D006442:Glycated Hemoglobin / Q000378:metabolism*; D006706:Homeostasis; D006801:Humans; D058228:Islet Amyloid Polypeptide / Q000627:therapeutic use; D007783:Lactones / Q000627:therapeutic use; D008297:Male; D019060:Minimally Invasive Surgical Procedures / Q000639:trends; D009767:Obesity, Morbid / Q000097:blood / Q000517:prevention & control / Q000628:therapy*; D000077403:Orlistat; D010645:Phentermine / Q000627:therapeutic use; D018027:Receptors, Glucagon / Q000187:drug effects; D000077236:Topiramate; D016896:Treatment Outcome; D015431:Weight Loss
chemical_list: D019440:Anti-Obesity Agents; D001552:Benzazepines; D001559:Benzhydryl Compounds; D001786:Blood Glucose; D005632:Fructose; D000067757:Glucagon-Like Peptide-1 Receptor; D005960:Glucosides; D006442:Glycated Hemoglobin; D058228:Islet Amyloid Polypeptide; D007783:Lactones; D000077403:Orlistat; D010645:Phentermine; D018027:Receptors, Glucagon; D000077236:Topiramate; C000593833:GLP1R protein, human; C517652:hemoglobin A1c protein, human; C529054:dapagliflozin; C506658:lorcaserin; C105254:pramlintide