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Weight loss from gastric bypass may be partly due to dietary fat aversion, study suggests

ScienceDaily (July 27, 2011) — Roux-en-Y gastric bypass, the most common type of bariatric surgery in the United States, is currently considered the most effective therapy for morbid obesity. Patients who undergo this procedure, in which the stomach is reduced to a small pouch and connected to the middle of the small intestine, often lose massive amounts of weight. However, the reasons behind this surgery's success have been unclear. Shedding more light on why this procedure prompts such dramatic weight loss, a team of researchers has found, in a study using both humans and rats, that Roux-en-Y appears to lead patients to significantly reduce their intake of dietary fat. This effect, which was present for both solid and liquid dietary fat, lingered for up to 200 days after surgery in the animals. Further experiments suggest that this fat avoidance is triggered through digestive consequences, rather than just altered taste, and may be the result of an excess of hormones previously linked to food avoidance.

The study appears online in the American Journal of Physiology -- Regulatory, Integrative, and Comparative Physiology, published by the American Physiological Society.

Methodology

The researchers used data from a study in obese people comparing gastric bypass to vertical-banded gastroplasty. At 1 and 6 years after surgery, these patients were asked to fill out questionnaires that included a series of questions to determine whether they avoided certain foods.

The researchers also performed either Roux-en-Y gastric bypass or sham operations on rats. At time points ranging from 10 to 200 days after surgery, these animals were subjected to various food preference experiments.

In one experiment, the rats were offered either high- or low-fat chow, with the researchers comparing the animals' intake of both foods before and after surgery. Similarly, the rats were presented with bottles containing either water or various concentrations of a fat emulsions, with the researchers recording intake of each liquid. To determine whether taste could be responsible for preference, the researchers recorded how many licks the animals took at each bottle when it was offered for only a brief amount of time.

To determine whether digestive effects instead might be responsible for aversions, rather than taste, the researchers offered the rats water flavored with saccharine, which they typically prefer to unflavored water. They then placed a feeding tube directly into the stomachs of the animals and infused some with corn oil and others with saline solution. Other animals received an injection that causes unpleasant sensations. Previous studies have shown that animals can be conditioned to avoid foods they associate with illness -- for example, by avoiding saccharine-flavored water after becoming ill from lithium chloride. Consequently, the researchers reasoned that if corn oil caused unpleasant digestive effects, the rats fed this liquid might also avoid the saccharine-flavored water. Additionally, the researchers tested the levels of GLP-1 and PYY, hormones previously linked with food avoidance, in both the Roux-en-Y and sham-operated animals.

Results

Questionnaires from human patients revealed that those who had gastric bypass were significantly more likely to report a reduction in dietary fat intake compared to those who had gastroplasty instead.

The researchers found that rats who underwent Roux-en-Y surgery consumed significantly lower proportions of high-fat chow and higher proportions of low-fat chow compared to the sham-operated animals. Additionally, those animals who underwent the bypass surgery showed a lower preference for high concentrations of the fat emulsions compared to those who received the sham operation. The Roux-en-Y animals had about the same preference for all concentrations of the fat emulsion when exposed to these liquids for only brief amounts of time. However, those that had a small amount of corn oil infused into their stomach were more likely to avoid the saccharine-flavored water than those infused with saline, much like those given the lithium chloride injections. Levels of GLP-1 were significantly higher in the Roux-en-Y rats compared to the non-bypass animals.

Importance of the Findings

The results suggest that people and animals who undergo Roux-en-Y gastric bypass decrease their consumption of both solid and liquid dietary fat, possibly helping people stick to a healthier diet. This avoidance does not appear to be triggered by taste alone, but can be influenced by the effects after ingestion. The hormone GLP-1 might be partly responsible for these effects.

"These findings suggest that changes in fat preference may contribute to long-term maintained weight loss after gastric bypass," the authors wrote. "By elucidating the mechanisms by which obesity surgery reduces the consumption of high fat foods, new surgical and non-surgical therapies could be developed that mimic these mechanisms to offer safe and effective weight loss."

Study Team

The study team was composed of Carel le Roux, Marco Bueter, Torsten Olbers, Hutan Ashrafian, Thanos Athanasious and Stephen Bloom, all of Imperial Weight Centre, Imperial College London, UK; Nadine Theis, Christian Löwenstein, and Thomas A. Lutz, the Institute of Veterinary Physiology Zurich, Switzerland; Malin Werling, Goteborg University, Goteborg, Sweden; Alan Spector, Department of Psychology, Florida State University, Tallahassee.

Story Source:

The above story is reprinted (with editorial adaptations by ScienceDaily staff) from materials provided by American Physiological Society.

Journal Reference:

Carel W. Le Roux, Marco Bueter, Nadine Theis, Malin Werling, Hutan Ashrafian, Christian Löwenstein, Thanos Athanasiou, Stephen R. Bloom, Alan C. Spector, Torsten Olbers, Thomas Alexander Lutz. Gastric bypass reduces fat intake and preference. American Journal of Physiology -- Regulatory, Integrative, and Comparative Physiology, 2011; DOI: 10.1152/ajpregu.00139.2011

Note: If no author is given, the source is cited instead.

Disclaimer: This article is not intended to provide medical advice, diagnosis or treatment. Views expressed here do not necessarily reflect those of ScienceDaily or its staff.



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Gastric bypass surgery changes food preferences so that they eat less high fat food

ScienceDaily (July 27, 2011) — Gastric bypass surgery alters people's food preferences so that they eat less high fat food, according to a new study led by scientists at Imperial College London. The findings, published in the American Journal of Physiology -- Regulatory, Integrative, and Comparative Physiology, suggest a new mechanism by which some types of bariatric surgery lead to long-term weight loss.

A growing number of obese patients are choosing to undergo bariatric surgery in order to lose weight, with over 7,000 such procedures being carried out on the NHS in 2009-10. The most common and the most effective procedure is the 'Roux-en-Y' gastric bypass, which involves stapling the stomach to create a small pouch at the top, which is then connected directly to the small intestine, bypassing most of the stomach and the duodenum (the first part of the small intestine). This means that patients feel full sooner.

The new study involved data from human trials as well as experiments using rats. The researchers used data from 16 participants in a study in which obese people were randomly assigned either gastric bypass surgery or another type of operation, vertical-banded gastroplasty, in which the stomach volume is reduced but no part of the intestine is bypassed. The participants who had had gastric bypass had a significantly smaller proportion of fat in their diet six years after surgery, based on questionnaire responses.

In the rat experiments, rats given gastric bypass surgery were compared with rats that were given a sham operation. Rats that had gastric bypass surgery ate less food in total, but they specifically ate less high fat food and more low fat food. When given a choice between two bottles with different concentrations of fat emulsions, the rats that had gastric bypass surgery showed a lower preference for high fat concentrations compared with rats that had a sham operation.

"It seems that people who've undergone gastric bypass surgery are eating the right food without even trying," said Mr Torsten Olbers from Imperial College London, who performed the operations on patients in the study at Sahlgrenska University Hospital in Göteborg, Sweden.

Dr Carel le Roux, from the Imperial Weight Centre at Imperial College London, who led the research, said: "It appears that after bypass surgery, patients become hungry for good food and avoid junk food not because they have to, but because they just don't like it any more. If we can find out why this happens, we might be able to help people to eat more healthily without much effort."

The rat experiments suggested that the reduced preference for high fat food was partly due to the effects of digesting the food. There was no difference in preferences between gastric bypass rats and sham-operated rats when the rats were only given access to the bottles for a few seconds, suggesting that bypass rats did not dislike the taste of high fat emulsions when they were only allowed small volumes at a time.

Rats can learn to avoid foods that they associate with illness, so the researchers tested whether high fat foods would condition them to avoid certain tastes. They gave the rats saccharine-flavoured water while infusing corn oil into their stomachs. The gastric bypass rats learned to avoid saccharine, but the sham-operated rats did not, suggesting that the effect of digesting corn oil was unpleasant to the rats that had had gastric bypass surgery.

Levels of the satiety-promoting hormones GLP-1 and PYY were higher after feeding in the gastric bypass rats compared with sham-operated rats, suggesting a possible mechanism for the changes in food preferences. The team at Imperial plan to study the role of these hormones further to see if it might be possible to mimic the effects of gastric bypass without using surgery.

Story Source:

The above story is reprinted (with editorial adaptations by ScienceDaily staff) from materials provided by Imperial College London.

Journal Reference:

C. W. Le Roux, M. Bueter, N. Theis, M. Werling, H. Ashrafian, C. Lowenstein, T. Athanasiou, S. R. Bloom, A. C. Spector, T. Olbers, T. A. Lutz. Gastric bypass reduces fat intake and preference. AJP: Regulatory, Integrative and Comparative Physiology, 2011; DOI: 10.1152/ajpregu.00139.2011

Note: If no author is given, the source is cited instead.

Disclaimer: This article is not intended to provide medical advice, diagnosis or treatment. Views expressed here do not necessarily reflect those of ScienceDaily or its staff.



View the original article here

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