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Review
. 2022 Jan 12;43(1):19-34.
doi: 10.1210/endrev/bnab022.

Mechanisms of Weight Loss After Obesity Surgery

Elina Akalestou  1 , Alexander D Miras  2 , Guy A Rutter  1   3   4 , Carel W le Roux  5   6
Affiliations
Review

Mechanisms of Weight Loss After Obesity Surgery

Elina Akalestou et al. Endocr Rev. .

Abstract

Obesity surgery remains the most effective treatment for obesity and its complications. Weight loss was initially attributed to decreased energy absorption from the gut but has since been linked to reduced appetitive behavior and potentially increased energy expenditure. Implicated mechanisms associating rearrangement of the gastrointestinal tract with these metabolic outcomes include central appetite control, release of gut peptides, change in microbiota, and bile acids. However, the exact combination and timing of signals remain largely unknown. In this review, we survey recent research investigating these mechanisms, and seek to provide insights on unanswered questions over how weight loss is achieved following bariatric surgery which may eventually lead to safer, nonsurgical weight-loss interventions or combinations of medications with surgery.

Keywords: Obesity surgery; eating behavior; energy expenditure; gut hormones; weight loss.

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Figures

Graphical Abstract
Graphical Abstract
Representation of the main physiological mechanisms underlying weight loss following vertical sleeve gastrectomy (VSG) and Roux-n-Y gastric bypass (RYGB). GLP-1, glucagon like peptide-1; PYY, peptide YY. Figure was created using Servier Medical Art.
Figure 1.
Figure 1.
The “AgRP-POMC” model of gut–brain cross-talk. AgRP, agouti-related peptide; POMC, pro-opiomelanocortin; NPY, neuropeptide Y. Figure was created using Servier Medical Art.
Figure 2.
Figure 2.
Changes in eating behavior following obesity surgery.
Figure 3.
Figure 3.
Bile acid synthesis and receptor activation following obesity surgery. FXR, farnesoid X receptor; TGR5, G protein-coupled bile acid receptor 5; GLP-1, glucagon-like peptide 1; FGF19, fibroblast growth factor 19. Figure was created using Servier Medical Art.
See this image and copyright information in PMC

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