Bariatric Surgery: It’s More Interesting Than You ThinkTuesday, September 27, 2011
Regular readers of these pages, will by now know that bariatric surgery is by far the most effective and reliable treatment for severe obesity.
However, how exactly bariatric surgery works, continues to be an intense field of medical and experimental research.
Last year, this was the topic of the 13th Bariatric/metabolic International Symposium of the Merck Frosst/CIHR Research Chair in Obesity at Laval University, the proceeding of which have now been published in a supplement to the International Journal of Obesity.
As pointed out by Keith Sharkey, from the University of Calgary, in an accompanying editorial,
“surgeries are remarkably effective in reducing weight over a sustained period of time, and they also have significant beneficial effects on glucose homeostasis. Interestingly, the metabolic benefits of these surgeries frequently occur before significant weight loss.”
Studies in this supplement use animal models to reveal the neurohumoral mechanisms underlying weight loss and improved glucose homeostasis after experimental bariatric surgery.
Not only do these rodent models of bariatric surgery show that food reward is altered and that the proximal gut is important in the control of energy balance and glucose homeostasis, but these studies provide important insights into the molecular and neuronal mechanisms of these effects.
Of course, from my perspective, the hope is that there findings will eventually lead to pharmaceutical approached to treating severe obesity that will eventually put bariatric surgeons out of business.
Till then, we must accept that surgical treatment is far more effective for managing severe obesity in patients, who urgently need treatment, than any conservative ‘Eat-Less-Move-More’ approaches have to offer.
Of course, preventing the obesity in the first place would be even better, but that certainly does not solve the problem of the tens of thousands, who cary 100s of excess pounds and have few, if any, other options to deal with their considerable excess weight and related health problems.
Sharkey KA (2011). Animal models of bariatric/metabolic surgery shed light on the mechanisms of weight control and glucose homeostasis: view from the chair. International journal of obesity (2005), 35 Suppl 3 PMID: 21912385
Tuesday, September 27, 2011
While I agree with you that surgery is the way to go for severe obesity, and maybe moderate obesity with comorbidity as well, I think we need to consider that very few head-to-head RCTs comparing surgery with drugs/lifestyle have been carried out.
Since baseline BMI has a marked effect on future weight loss, regardless of method, some of the outstanding impact of surgery on severe obesity is undoubtedly due to high initial BMI, not surgery alone. So called lifestyle intervention studies tend to recruit participants with markedly lower BMI than surgical intervention studies.
If you use something like VLCD/LCD followed by a 1-2 yr intensive maintenance program, perhaps including Xenical/Alli to keep fat consumption low, the long-term results are not too bad. Just my two cents.
Sincerely & keep up the good work.
Karolinska Institutet, Stockholm
Wednesday, September 28, 2011
If doctors don’t understand how this works, then why do they assume that it’s permanent and that the benefits outweigh the risks of surgery? I haven’t seen any convincing evidence of either.