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London 2012: Future of Obesity Treatment

The physiology behind bariatric procedures

Is restriction a side effect of the band?
Carel le Roux

In his presentation Dr Carel le Roux, Imperial College London, asked, ‘What does basic science today predict for future obesity treatments?’ To answer this question he examined the physiology behind bariatric procedures. For example, banding works by restriction so how does that result in patients feeling ‘less hungry’? 

“We know that the vagal fibres that sit at the point where the band presses on, are actually important when it comes to signalling the hypothalamus,” said le Roux. “Therefore, we now believe that it is the pressure on these fibres at the gastro-oesophageal junction that actually allows people to feel less hungry.”

He added that the change in hunger is not universal and estimates that 20 per cent of patients do not have a reduction in hunger, compared to 80 per cent who do have a reduction. “I think restriction is a side effect of the band and not how it works, people should be losing weight because they are eating fewer calories, not by restriction,” said le Roux.

With regards to bypass, he said that one of the most common complaints patients have is constipation, but this does not equate with the malabsorptive aspects of gastric bypass. Le Roux said it was important to look at important role of the alimentary limb, “It appears that operations such as bypass fixes dysfunctional deficiency and increase the gut hormones. This does not appear to be the case with banding.”

Gastric bypass also appears to alter people's food preferences, suggesting a new mechanism of bariatric surgery. “Patients become hungry for fruits and vegetables and no longer crave junk food.” He highlighted a recent study that investigated how bypass affects intake of and preference for high fat food in an experimental (rats) study. “If we can find out why this happens, we might be able to help people to eat more healthily without much effort.” 

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