Obese patients after gastric bypass surgery have lower brain-hedonic responses to food than after gastric banding

Scholtz, Samantha; Miras, Alexander D.; Chhina, Navpreet; Prechtl, Christina Gabriele; Sleeth, Michelle; Daud, Norlida Mat; Ismail, N A; Durighel, Giuliana; Ahmed, Ahmed R.; Olbers, Torsten; Vincent, Royce P.; Alaghband‐Zadeh, Jamshid; Ghatei, Mohammad A.; Waldman, Adam D.; Frost, Gary; Bell, Jimmy D.; Roux, Carel W. le; Goldstone, Anthony P.

doi:10.1136/gutjnl-2013-305008

Cited by 236 publications

(259 citation statements)

References 42 publications

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“…The anterior insula is part of the primary gustatory cortex (46). Scholtz et al (40) also observed higher activation in the anterior insular cortex with food stimuli after bariatric bypass surgery. In addition, we observed increased activity in the hippocampus, a major memoryrelated area.…”

Section: Discussionmentioning

confidence: 85%

“…Similarly, Bruce et al (39) reported that patients who had undergone gastric banding surgery showed higher inferior frontal activity during the processing of food pictures before than after surgical intervention. In addition, changes in food reward-related brain regions were reported soon after bariatric surgery (24) and after a weight loss of at least 8% (40). The globus pallidus is proposed to directly initiate reward-related signals (41).…”

Section: Discussionmentioning

confidence: 99%

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Neuronal Food Reward Activity in Patients With Type 2 Diabetes With Improved Glycemic Control After Bariatric Surgery

et al. 2016

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OBJECTIVEObesity and type 2 diabetes mellitus (T2DM) are associated with altered foodrelated neuronal functions. Besides weight loss, substantial improvement of glucose metabolism in patients with T2DM can be achieved by bariatric surgery. We aimed to target the neuronal and behavioral correlates of improved glycemic control after bariatric surgery. RESEARCH DESIGN AND METHODSTwo patient groups with T2DM were recruited. The treatment group (n = 12) consisted of patients who had undergone Roux-en-Y gastric bypass (RYGB) surgery, and a control group consisted of patients who did not undergo surgery (n = 12). The groups were matched for age and current BMI. HbA 1c was matched by using the presurgical HbA 1c of the RYGB group and the current HbA 1c of the nonsurgical group. Neuronal activation during a food reward task was measured using functional MRI (fMRI). Behavioral data were assessed through questionnaires. RESULTSRYGB improved HbA 1c from 7.07 6 0.50 to 5.70 6 0.16% (P < 0.05) and BMI from 52.21 6 1.90 to 35.71 6 0.84 kg/m 2 (P < 0.001). Behavioral results showed lower wanting and liking scores as well as lower eating behavior-related pathologies for the patients after RYGB than for similar obese subjects without surgery but with impaired glycemic control. The fMRI analysis showed higher activation for the nonsurgical group in areas associated with inhibition and reward as well as in the precuneus, a major connectivity hub in the brain. By contrast, patients after RYGB showed higher activation in the visual, motor, cognitive control, memory, and gustatory regions. CONCLUSIONSIn obese patients with diabetes, RYGB normalizes glycemic control and leads to food reward-related brain activation patterns that are different from those of obese patients with less-well-controlled T2DM and without bariatric surgery. The differences in food reward processing might be one factor in determining the outcome of bariatric surgery in patients with T2DM.

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Section: Discussionmentioning

confidence: 85%

Section: Discussionmentioning

confidence: 99%

Neuronal Food Reward Activity in Patients With Type 2 Diabetes With Improved Glycemic Control After Bariatric Surgery

et al. 2016

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“…However, in this phase after surgery, patients may still have complaints of the intestinal anastomoses and may have problems with a number of food products, which they can tolerate more than a year after surgery. Others have found reduced CNS responses several years after RYGB (7,40), but further research is needed to determine the role for GLP-1 in these longer-term CNS changes.…”

Section: Discussionmentioning

confidence: 99%

Elevated Postoperative Endogenous GLP-1 Levels Mediate Effects of Roux-en-Y Gastric Bypass on Neural Responsivity to Food Cues

et al. 2017

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OBJECTIVEIt has been suggested that weight reduction and improvements in satiety after Rouxen-Y gastric bypass (RYGB) are partly mediated via postoperative neuroendocrine changes. Glucagon-like peptide-1 (GLP-1) is a gut hormone secreted after food ingestion and is associated with appetite and weight reduction, mediated via effects on the central nervous system (CNS). Secretion of GLP-1 is greatly enhanced after RYGB. We hypothesized that postoperative elevated GLP-1 levels contribute to the improved satiety regulation after RYGB via effects on the CNS. RESEARCH DESIGN AND METHODSEffects of the GLP-1 receptor antagonist exendin 9-39 (Ex9-39) and placebo were assessed in 10 women before and after RYGB. We used functional MRI to investigate CNS activation in response to visual food cues (pictures) and gustatory food cues (consumption of chocolate milk), comparing results with Ex9-39 versus placebo before and after RYGB. RESULTSAfter RYGB, CNS activation was reduced in the rolandic operculum and caudate nucleus in response to viewing food pictures (P = 0.03) and in the insula in response to consumption of palatable food (P = 0.003). GLP-1 levels were significantly elevated postoperatively (P < 0.001). After RYGB, GLP-1 receptor blockade resulted in a larger increase in activation in the caudate nucleus in response to food pictures (P = 0.02) and in the insula in response to palatable food consumption (P = 0.002). CONCLUSIONSWe conclude that the effects of RYGB on CNS activation in response to visual and gustatory food cues may be mediated by central effects of GLP-1. Our findings provide further insights into the mechanisms underlying the weight-lowering effects of RYGB.Bariatric surgery is currently the most effective therapeutic modality for severe obesity in terms of substantial weight loss and long-term efficacy (1). The most commonly performed procedure is Roux-en-Y gastric bypass surgery (RYGB), which comprises the formation of a small gastric pouch, which is connected to the midjejunum, bypassing the duodenum and proximal jejunum. This may lead to reduced ingestive capacity and

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“…22 Furthermore, reduced NAc response to high-calorie food images was associated with reduced palatability and appeal of high-calorie foods and healthier eating behaviors among patients after Roux-en-Y surgery. 72 Taken together, these findings further suggest these regions as promising targets for deep brain stimulation (DBS) to treat obesity, as their dysfunction appears directly associated with food stimuli and response to treatment.…”

Section: Radiological Evidencementioning

confidence: 97%

Deep brain stimulation for obesity: rationale and approach to trial design

Ho¹,

Sussman²,

Pendharkar³

et al. 2015

FOC

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Obesity is one of the most serious public health concerns in the US. While bariatric surgery has been shown to be successful for treatment of morbid obesity for those who have undergone unsuccessful behavioral modification, its associated risks and rates of relapse are not insignificant. There exists a neurological basis for the binge-like feeding behavior observed in morbid obesity that is believed to be due to dysregulation of the reward circuitry. The authors present a review of the evidence of the neuroanatomical basis for obesity, the potential neural targets for deep brain stimulation (DBS), as well as a rationale for DBS and future trial design. Identification of an appropriate patient population that would most likely benefit from this type of therapy is essential. There are also significant cost and ethical considerations for such a neuromodulatory intervention designed to alter maladaptive behavior. Finally, the authors present a consolidated set of inclusion criteria and study end points that should serve as the basis for any trial of DBS for obesity.

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Obese patients after gastric bypass surgery have lower brain-hedonic responses to food than after gastric banding

Cited by 236 publications

References 42 publications

Neuronal Food Reward Activity in Patients With Type 2 Diabetes With Improved Glycemic Control After Bariatric Surgery

Neuronal Food Reward Activity in Patients With Type 2 Diabetes With Improved Glycemic Control After Bariatric Surgery

Elevated Postoperative Endogenous GLP-1 Levels Mediate Effects of Roux-en-Y Gastric Bypass on Neural Responsivity to Food Cues

Deep brain stimulation for obesity: rationale and approach to trial design

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