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Gut doi:10.1136/gutjnl-2013-305008
  • Nutrition
  • Original article

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

Open Access
  1. Anthony P Goldstone1
  1. 1Metabolic and Molecular Imaging Group, MRC Clinical Sciences Centre, Imperial College London, Hammersmith Hospital, London, UK
  2. 2Section of Investigative Medicine, Division of Diabetes, Endocrinology, and Metabolism, Imperial College London, Hammersmith Hospital, London, UK
  3. 3Robert Steiner MRI Unit, MRC Clinical Sciences Centre, Imperial College London, Hammersmith Hospital, London, UK
  4. 4Department of General Surgery, Imperial Weight Centre, Imperial College Healthcare NHS Trust, London, UK
  5. 5Department of Gastro Surgical Research and Education, University of Gothenburg, Gothenburg, Sweden
  6. 6Department of Clinical Biochemistry, King's College Hospital, London, UK
  7. 7Division of Brain Sciences, Imperial College London, Hammersmith Hospital, London, UK
  8. 8Department of Experimental Pathology, UCD Conway Institute, School of Medicine and Medical Science, University College Dublin, Ireland
  1. Correspondence to Dr Tony Goldstone, Metabolic and Molecular Imaging Group, MRC Clinical Sciences Centre, Imperial College London, Hammersmith Hospital, Du Cane Road, London W12 0NN, UK; tony.goldstone{at}imperial.ac.uk.
  • Received 2 April 2013
  • Revised 14 June 2013
  • Accepted 14 June 2013
  • Published Online First 20 August 2013

Abstract

Objectives Roux-en-Y gastric bypass (RYGB) has greater efficacy for weight loss in obese patients than gastric banding (BAND) surgery. We hypothesise that this may result from different effects on food hedonics via physiological changes secondary to distinct gut anatomy manipulations.

Design We used functional MRI, eating behaviour and hormonal phenotyping to compare body mass index (BMI)-matched unoperated controls and patients after RYGB and BAND surgery for obesity.

Results Obese patients after RYGB had lower brain-hedonic responses to food than patients after BAND surgery. RYGB patients had lower activation than BAND patients in brain reward systems, particularly to high-calorie foods, including the orbitofrontal cortex, amygdala, caudate nucleus, nucleus accumbens and hippocampus. This was associated with lower palatability and appeal of high-calorie foods and healthier eating behaviour, including less fat intake, in RYGB compared with BAND patients and/or BMI-matched unoperated controls. These differences were not explicable by differences in hunger or psychological traits between the surgical groups, but anorexigenic plasma gut hormones (GLP-1 and PYY), plasma bile acids and symptoms of dumping syndrome were increased in RYGB patients.

Conclusions The identification of these differences in food hedonic responses as a result of altered gut anatomy/physiology provides a novel explanation for the more favourable long-term weight loss seen after RYGB than after BAND surgery, highlighting the importance of the gut–brain axis in the control of reward-based eating behaviour.

This is an Open Access article distributed in accordance with the terms of the Creative Commons Attribution (CC BY 3.0) license, which permits others to distribute, remix, adapt and build upon this work, for commercial use, provided the original work is properly cited. See: http://creativecommons.org/licenses/by/3.0/

Open Access


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