Blunting of adaptive thermogenesis as a potential additional mechanism to promote weight loss after gastric bypass

Abstract

BACKGROUND Adaptive thermogenesis (AT) is described as a change in resting metabolic rate (RMR) that is greater than would be predicted from changes in lean body mass (LBM) and fat mass (FM) alone during periods of energy imbalance. Whereas an AT-related downregulation of RMR has been implicated in suboptimal weight loss and weight regain following non-surgical weight loss, defense against AT may underpin the durable weight loss following laparoscopic Roux-en-Y gastric bypass (LRYGB) and other bariatric surgeries. However, methodological differences across the few studies that have evaluated post-operative AT limit interpretation as to the effects of these procedures on RMR. OBJECTIVE To quantify AT six months after LRYGB and laparoscopic adjustable gastric banding (LAGB). SETTING The study was conducted in a large university hospital in the United States. METHODS Changes in body composition and RMR were assessed in thirteen severely obese adults six months after LRYGB (n=8) and LAGB (n=5). AT was calculated as the difference between measured RMR and RMR predicted from LBM, FM, age, and sex before and after surgery. RESULTS RMR significantly decreased after LRYGB (−270±96 kcal/d, p<0.01) but not after LAGB. Despite significantly greater reductions in body weight, FM, and LBM with LRYGB than LAGB, AT responses after LRYGB (15±110 kcal/d, p=0.7) and LAGB (42±97 kcal/d, p=0.4) were similar (p=0.7). CONCLUSION Despite significant body weight and body composition changes, AT was minimal after LRYGB. A blunting of AT may be an additional mechanism that favors sustainable weight loss with LRYGB.

Weight Recidivism After Roux‐en‐Y Gastric Bypass Surgery: An 11‐Year Experience in a Multiethnic Medical Center

“…However, RYGB is associated with “paradoxical” increases in weight‐adjusted resting energy expenditure despite large WL . Blunted adaptive thermogenesis (the difference between measured and expected resting energy expenditure) may also help maintain weight stability after RYGB . Consistent with this, another study showed that subjects who maintained WL had larger diet‐induced thermogenesis than subjects who regained weight after RYGB .…”

Postprandial Uridine Physiology Is Altered by Obesity

“…6 Recent reports further suggest that adaptive thermogenesis and resting metabolic rates are both blunted after gastric bypass. 7 In this context, our contrarian observations of altered uridine postmeal excursions that persist despite weight loss warrant further investigation. We propose that there may potentially be an important mechanistic role for uridine in the persistent impaired thermoregulation observed in subjects with obesity, even after surgically induced weight loss.…”

Does adaptive thermogenesis occur after weight loss in adults? A systematic review

“…AT was only presented for the 20 % fat/15 %PRO and 20 %fat/25 %PRO groups, while the other two groups (40 % fat/15 %PRO and 40 % fat/25 % PRO) did not report AT despite significant WL. Despite the evidence for AT when measured immediately after the WL intervention, some intervention studies reported that this (48) de Jonge et al (29) Karl et al (24) 10-15 % Doucet et al (32) Men Women Byrne et al (20) Redman et al (52) CR and LCD Exercise CR Lecoultre et al (51) CR and LCD Diet and Exercise CR NRT < 5 % Hopkins et al (40) Bosy Westphal et al (31) 5 a 10 % Müller et al (22) Camps et al (27) Goele et al (30) Camps et al (25) 10-20 % Bosy-Westphal et al (28) Weight regainers Thom et al (17) Nymo et al (18) > 20 % Gomez-Arbelaez et al (19) Rosenbaum et al (21) Dulloo et al (33) RT < 10 % McNeil et al (23) Observational < 10 % Ten Haaf et al (47) 10-20 % Pourhassan et al (26) Marlatt et al (50) Martins et al (16) Coupaye et al (39) 20-30 % Wolfe et al (34) Tam et al (37) Browning et al (36) Ravelli et al (53) > 30 % Bettini et al (35) Carrasco et al (38) Johannsen et al (13) Fothergill et al (12) WL, weight loss; WM, weight maintenance; CR, caloric restriction; LCD, low-calorie diet; reported a higher-than-expected decrease for REE/TDEE/SEE (AT), did not report AT. disappeared or was attenuated after a period of weight stabilisation (measured after the follow-up period) (24,27,29) .…”

“…Bariatric surgery. For bariatric surgery, six studies were included in this review (34)(35)(36)(37)(38)(39) , with the study length ranging from 6 to 24 months.…”

“…It has been postulated to be a compensatory response that resists WL and promotes weight regain (12)(13)(14)(15) , but its influence on longer-term weight management has been recently questioned (16) . AT in resting EE (REE) has been previously documented in lifestyle (16)(17)(18)(19)(20)(21)(22)(23)(24)(25)(26)(27)(28)(29)(30)(31)(32)(33) and surgical (34)(35)(36)(37)(38)(39) interventions. However, some studies have reported contrasting findings as they have not observed a significant value for AT (28,32,40) .…”