ReviewEffects of Bariatric Surgery on Energy Homeostasis
Introduction
The prevalence of obesity (body mass index [BMI]≥30 kg/m2) has considerably increased over the last decades. Globally, more than 1 of 10 adults is now obese (http://www.who.int/mediacentre/factsheets/fs311/en/). Even though a slowing of the increase in obesity prevalence has been reported (1), obesity remains a significant health issue. In fact, the prevalence of excess weight remains very high in most industrialized countries, and the prevalence of morbid, or severe, obesity (BMI >40 kg/m2) continues to rise. Obesity, in particular in its severe forms (morbid and visceral), is associated with a plethora of sequelae (https://www.nhlbi.nih.gov/health/health-topics/topics/obe/risks), leading to a major socioeconomic burden.
Complex gene-environment interactions underlie obesity (2); the obesogenic environment in which we live, which facilitates a sedentary lifestyle and overeating through marketing and the availability of energy-dense foodstuffs, proves to be particularly obesity inducing in individuals who are genetically predisposed to a positive energy balance. The heritability of excess fat deposition, which is estimated to be between 40% and 70 % from most biometric studies (e.g. family, adoption and twin studies), is noticeable (3). Predisposition to obesity is admittedly polygenic, and genetic variations that promote obesity are likely to be associated with obesogenic genes. Those genes are involved in modern lifestyle–induced obesity by contributing to overeating, sedentary lifestyle and other obesity-promoting behaviours (4). The modern lifestyle is also responsible for producing epigenetic effects that could contribute to obesity 5, 6, 7. Obesity-related epigenetic effects cannot only be induced or reversed during life but can also be passed through generations (8). The environment in which we live is also likely to alter the gut microbiota, rendering it obesogenic (9).
The high prevalence of obesity, together with the awareness of its detrimental health effects and its socioeconomic burden, has stimulated research on obesity. Part of this research has involved the medical treatment of the condition, in particular, the effects of bariatric surgery, which is recognized as the most efficient treatment for severe obesity (10). Bariatric surgery has also been shown to cure several obesity-related comorbidities, including type 2 diabetes, dyslipidemia, hypertension and sleep apnea, and to improve mental health. Noticeable progress has been made in better understanding of how this surgery cures obesity. There is growing evidence that bariatric surgery influences energy balance regulation in various ways 11, 12, 13, 14. This short article provides an overview of the effects of bariatric surgery on energy homeostasis.
Section snippets
Bariatric Surgery and Obesity
The bariatric surgery procedures that are used to treat severe obesity include gastric banding procedures, mainly laparoscopic adjustable gastric banding, Roux-en-Y gastric bypass (RYGB), sleeve gastrectomy (SG) and biliopancreatic diversion (BPD) (15). Currently, the most commonly performed procedures are RYGB and SG (15), which have been described as restrictive obesity procedures because they limit the amount of food that can be eaten. RYGB restricts the stomach to a small (generally less
Bariatric Surgery and Energy Balance
As stated previously, bariatric surgery constitutes the most efficacious treatment for severe obesity. The BPD-DS has proven to be particularly efficacious, with a loss of 83%±14% of excess body weight observed at 36 months (31). Furthermore, a loss of 40.7%±10.8% of excess body weight has been observed 10 years after laparoscopic BPD-DS in patients with a BMI>50 kg/m2 (32). As mentioned previously, weight loss after bariatric surgery primarily consists of fat mass loss. In high-fat–fed obese
Bariatric Surgery and the Regulation of Energy Balance
In addition to mechanically restricting eating or producing energy malabsorption, bariatric procedures, in particular those that reorganize the small bowel, have been proven to affect energy balance by acting on the regulatory processes governing energy balance 11, 47, 48. Energy balance regulation is achieved through highly coordinated communications between neurobiologic circuits and peripheral homeostatic pathways that control food intake and energy expenditure (49). It involves
Conclusion
Bariatric surgery reduces the size of fat stores and the amount of body fat gain. It represents the most efficient therapy for severe obesity, and it also cures type 2 diabetes. Bariatric surgery procedures reorganize the gastrointestinal tract and thereby alter the gastrointestinal physiology in such a way that effects on energy homeostasis go beyond those caused by mechanical restriction of the stomach or gut malabsorption. Evidence keeps accumulating that the effects of bariatric surgery on
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