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Shedding pounds after going under the knife: Metabolic insights from cutting the gut

Nature Medicine volume 18, pages 668–669 (2012)Cite this article

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Bariatric surgery is currently the most effective treatment option for obesity, resulting in substantial and durable weight loss with reduction in mortality and obesity-related co-morbidites1. Obesity is the primary risk factor for type 2 diabetes mellitus (T2DM), which is characterized by insufficient insulin secretion and insulin resistance of peripheral tissues2. Proximal gastric bypass surgery (PGBP) is considered the 'gold standard' bariatric procedure, reducing excess body weight by up to 80%. Additionally, the majority of individuals with T2DM that undergo PGBP show immediate improved glycemic control after surgery, before significant weight loss. Although many therapeutic regimens aim to modulate glucose concentrations to prevent end-organ damage, bariatric surgery seems to be the only treatment modality with the potential to induce complete resolution of T2DM.

The mechanisms underlying this process, however, remain elusive. Recently, a technically less complex operation, sleeve gastrectomy, has been shown to result in weight loss and enhanced glycemic control comparable to PGBP3. Understanding how these surgical procedures induce sustained weight loss and resolution of T2DM holds the key to development of more directed, less invasive therapies. In a recent study, Chambers et al.4 investigated bariatric procedures in rodent models of human obesity, highlighting the comparable effectiveness of sleeve gastrectomy with PGBP and the importance of gut-derived hormones in mediating improved glucose homeostasis after surgery.

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Figure 1: Hormonal insights from bariatric surgery.

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  1. Department of Medicine, K. Chandarana and R. L. Batterham are at the Centre for Obesity Research, University College London, Rayne Institute, London, UK.,

    Keval Chandarana & Rachel L Batterham

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  1. Keval Chandarana
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  2. Rachel L Batterham
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Correspondence to Rachel L Batterham.

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Chandarana, K., Batterham, R. Shedding pounds after going under the knife: Metabolic insights from cutting the gut. Nat Med 18, 668–669 (2012). https://doi.org/10.1038/nm.2748

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