Physiological Mechanisms of Bariatric Procedures

Abstract

Bariatric surgery is the most effective intervention for sustained long-term weight loss, and it has been extensively demonstrated to improve and resolve most of the comorbidities associated with severe obesity. Traditionally, the accepted physiological mechanisms of bariatric procedures were based on the concepts of restriction of calorie intake, malabsorption of nutrients, and a combination of the two. As the close interactions between dietary balance and gastrointestinal and neuroendocrine pathways unravel, the physiological mechanisms of these procedures, as well as their classification, have significantly changed. In fact, it has currently become well recognized how the centrally regulated body weight homeostasis and target organ metabolic function are profoundly influenced by hormones secreted in the intestinal tract and adipose tissue. The overall balance of these peripherally secreted hormones, their systemic effects, and their interaction at the level of the hypothalamus would eventually affect food intake and energy expenditure.