title: What is the Mechanism Behind Weight Loss Maintenance with Gastric Bypass?
abstract: Obesity is an epidemic on the rise. With the failure of non-surgical strategies, bariatric surgery has emerged as the most effective therapeutic option for the treatment of severe obesity. Among various surgical options, Roux-en-Y gastric bypass (RYGB) results in sustained weight loss and profound metabolic improvements. The traditional view that gastric bypass and bariatric surgery in general works primarily through restriction/malabsorption of nutrients has become obsolete. It is now increasingly recognised that its mechanisms of action are primarily physiologic, not mechanic. In fact, clinical and translational studies over the last decade have shown that a number of gastrointestinal mechanisms, including changes in gut hormones, neural signalling, intestinal flora, bile acid and lipid metabolism can play a significant role in the effects of this procedure on energy homeostasis. The clinical efficacy and mechanisms of action of RYGB provide a compelling evidence for the role of the gastrointestinal tract in the regulation of appetite and satiety, body weight and glucose metabolism. This review discusses the physiologic changes that occur after RYGB and that contribute to its mechanisms of action.
authors.affiliation: Bariatric and Metabolic Surgery, Division of Diabetes and Nutritional Sciences, King's College London and King's College Hospital, London, UK.
authors.forename: Saurav
authors.initials: S
authors.lastname: Chakravartty
authors.affiliation: Bariatric and Metabolic Surgery, Division of Diabetes and Nutritional Sciences, King's College London and King's College Hospital, London, UK.
authors.forename: Daniele
authors.initials: D
authors.lastname: Tassinari
authors.affiliation: Bariatric and Metabolic Surgery, Division of Diabetes and Nutritional Sciences, King's College London and King's College Hospital, London, UK.
authors.forename: Angelo
authors.initials: A
authors.lastname: Salerno
authors.affiliation: Bariatric and Metabolic Surgery, Division of Diabetes and Nutritional Sciences, King's College London and King's College Hospital, London, UK.
authors.forename: Emmanouil
authors.initials: E
authors.lastname: Giorgakis
authors.affiliation: Bariatric and Metabolic Surgery, Division of Diabetes and Nutritional Sciences, King's College London and King's College Hospital, London, UK. francesco.rubino@kcl.ac.uk.
authors.forename: Francesco
authors.initials: F
authors.lastname: Rubino
mesh_terms: D001069:Appetite Regulation; D000068959:Body Weight Maintenance / Q000502:physiology*; D004734:Energy Metabolism; D015390:Gastric Bypass; D041981:Gastrointestinal Tract / Q000378:metabolism / Q000382:microbiology / Q000502:physiology*; D006801:Humans; D009767:Obesity, Morbid / Q000378:metabolism / Q000601:surgery*; D015431:Weight Loss / Q000502:physiology*
keywords: Bariatric surgery; Bile acids; Gastric bypass; Glucose metabolism; Gut hormones; Microbiota; Weight loss