Hormones Post Surgery Weight Regain: Hormonal and Metabolic Factors

[Ms skinniness 3,003]

This is so interesting too.......

Post-Surgery Weight Regain: Hormonal and Metabolic Factors

Posted: 13 Sep 2013 06:00 AM PDT

In yesterday’s post, I discussed the importance of dietary factors in weight regain after bariatric surgery.

In this post, I will discuss the role of hormonal and metabolic factors identified in our systematic review of post-surgical weight regain published in Obesity Surgery.

It is now widely assumed that the efficacy of bariatric surgery is not solely dependent on causing a “restriction” or simply “malabsorbtion” of calories.

Rather, there is now growing consensus that the key reason why bariatric surgery works is through its impact on gut hormones and neurological signals from the gut that significantly reduce hunger and/or satiety.

Thus, it is not surprising that in our review we found several studies that noted a significant relationship between post-surgical levels of the “hunger hormone” ghrelin and post-surgical weight regain. Patients who experienced less weight loss or greater weight regain after sleeve gastrectomy and/or roux-en-y bypass surgery demonstrated higher fasting and post-prandial ghrelin levels. Elevated ghrelin levels were also found to correlate with a return of hunger in patients with regain.

Other evidence points to the role of hypoglycaemia in promoting weight regain in some patients. Reactive hypoglycaemia after bariatric surgery may result from the rapid transit of ingested carbohydrates into the small intestine thereby generating an early and significant insulin surge which results in a reactive hypoglycaemia shortly after a meal. This would in turn prompt snacking and increased caloric ingestion resulting in weight regain.

While there is currently no medical treatment to deal with ghrelin elevations, the latter problem can potentially be managed by dietary measures, including the avoidance of high-glycemic index foods.

Given that there are many gut hormones that may be altered by bariatric surgery and their individual roles are still poorly understood, it is clear that we will need further studies to better understand how these factors may explain why some patients failure to lose weight after surgery or show a greater tendency for weight regain.

@DrSharma

Chicago, IL

Karmali S, Brar B, Shi X, Sharma AM, de Gara C, & Birch DW (2013). Weight Recidivism Post-Bariatric Surgery: A Systematic Review. Obesity surgery PMID: 23996349

[gamergirl 4,610]

Thank you for posting this! This confirms what I have read and suspected for a lomg time for me and my husband. Some of us are more carb sensitive than others and much more likely to get hungry after eating carbs.

[Escape_Pod 358]

Dr Sharma's great, he's on my regular blog read list. One of the things I love about him is that he urges his patients to aim for the healthiest lifestyle they can enjoy. As he says, your "best" weight is the weight you can achieve while still enjoying your life and your diet. Sure, you can diet your way down to a lower goal, but if you're not happy doing it, you're not going to maintain it long term!

[CowgirlJane 14,260]

This is a meaningful conclusion. I want to be smaller but my current size /weight reqires diligence and effort but does allow me a little room for " dates nights" and other treats. So I say embrace beong "medium..haha" beats the hell out of 3X and I believe I can maintain this and still "live a little. "

Dr Sharma's great' date=' he's on my regular blog read list. One of the things I love about him is that he urges his patients to aim for the healthiest lifestyle they can enjoy. As he says, your "best" weight is the weight you can achieve while still enjoying your life and your diet. Sure, you can diet your way down to a lower goal, but if you're not happy doing it, you're not going to maintain it long term![/quote']